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Background and objectivesCrash injury risk is reduced when a child correctly uses an appropriate restraint; however, incorrect restraint use remains widespread. The aim of this study was to determine whether product information developed using a user-driven approach increases correct child restraint use.MethodsWe conducted a two-arm double-blinded parallel randomised controlled trial in New South Wales, Australia 2019–2021. Participants were current drivers who were either an expectant parent or a parent of at least one child residing in the greater Sydney metropolitan area who were interested in purchasing a new child restraint. The intervention was user-driven product information consisting of instructions printed on an A3 sheet of paper, swing tags with key reminders and a video accessed via Quick Response codes printed on the materials. The control group received a postcard summarising legal child restraint requirements. The primary outcome was the correctness of child restraint use observed during home visit approximately 6 months after restraint purchase. Correct use was defined as no serious error or <2 minor errors. The secondary outcome was a count of observed errors.Results427 participants were recruited. Home visits were conducted for 372 (190 intervention and 182 control). Correct use was more common in the intervention group (37.4%) compared with the control group (24.2%, p=0.006). Participants receiving the intervention were 1.87 times more likely to correctly use their restraint than those in the control group (95% CI 1.19 to 2.93).ConclusionsThe results provide evidence for the effectiveness of user-driven instructions as a countermeasure to restraint misuse.Trial registration numberACTRN12617001252303.

Background Child passenger safety is an important public health problem in China. This study aimed to examine the prevalence of child passenger restraint use while riding in a car in the city of Shantou in China from 2012 to 2017. Methods Three large-scale cross-sectional observational studies were conducted in 2012, 2015 and 2017, respectively. The observation sites included randomly selected hospitals, kindergartens, and primary and secondary schools. The outcome measures included the changes in percentages of seating position (e.g., front vs. rear), whether sitting on lap, and use of child restraint systems (CRS) or seat belts by year and by age group. Descriptive statistics, Chi-square tests and logistic regression were used to address the study aims. Results A total of 9858 commuting children aged 17 and younger were observed in passenger cars in Shantou, China during the study. The proportion of children aged 0–5 sitting on adult’s lap decreased from 26.6% in 2012 to 24.6% in 2017, while the proportion of CRS use among the children sitting in the rear row increased among children aged 0–5 (from 0.7% in 2012 to 14.2% in 2017) and children aged 6–11 (from 0.7% in 2012 to 2.4% in 2017). Comparing children aged 0–11 in 2012, children in the same ages were less likely to sit in the front row in 2015 (OR = 0.42, 95%CI = 0.37, 0.48) and in 2017 (OR = 0.27, 95%CI = 0.23, 0.31). Children aged 0–11 were more likely to sit in the rear row with CRS use in 2015 (OR = 8.50, 95%CI = 5.44, 13.28) and in 2017 (OR = 10.95, 95%CI = 7.02, 17.08) comparing with children in the same ages in 2012. As for children aged 12–17, they were more likely to use seat belt in 2017 (OR = 1.40, 95%CI = 1.06, 1.85) compared with those children in 2012. Conclusions While child passenger safety behaviors improved from 2012 to 2017 in Shantou, China, more efforts are needed to protect child passengers from injuries.

The purpose was to describe characteristics and outcomes of restrained and nonrestrained patients enrolled in a randomized trial of protocolized sedation compared with protocolized sedation plus daily sedation interruption and to identify patient and treatment factors associated with physical restraint. This was a post hoc secondary analysis using Cox proportional hazards modeling adjusted for center- and time-varying covariates to evaluate predictors of restraint use. A total of 328 (76%) of 430 patients were restrained for a median of 4 days. Restrained patients received higher daily doses of benzodiazepines (105 vs 41 mg midazolam equivalent, P < .0001) and opioids (1524 vs 919 μg fentanyl equivalents, P < .0001), more days of infusions (benzodiazepines 6 vs 4, P < .0001; opioids 7 vs 5, P = .02), and more daily benzodiazepine boluses (0.2 vs 0.1, P < .0001). More restrained patients received haloperidol (23% vs 12%, P = .02) and atypical antipsychotics (17% vs 4%, P = .003). More restrained patients experienced unintentional device removal (26% vs 3%, P < .001) and required reintubation (8% vs 1%, P = .01). In the multivariable analysis, alcohol use was associated with decreased risk of restraint (hazard ratio, 0.22; 95% confidence interval, 0.08-0.58). Physical restraint was common in mechanically ventilated adults managed with a sedation protocol. Restrained patients received more opioids and benzodiazepines. Except for alcohol use, patient characteristics and treatment factors did not predict restraint use.

\"Drawing on case studies from the US and the European Union, this Very Short Introduction explores the promise and limitations of competitive market dynamics. In examining the laws and the way they are enforced, Ariel Ezrachi considers the delicate relationship between a free market economy and government intervention, and the fascinating forces of competition that shape modern society.\" --Publisher description.

To explore family perspectives on physical restraint practices and their minimization in an adult intensive care unit. A qualitative descriptive study with one-on-one semi-structured interviews. A deductive content analysis approach was undertaken using the Theoretical Domains Framework. A 20-bed medical, surgical, trauma ICU in Toronto, Canada. Fifteen family members were interviewed. Three themes emerged: (i) barriers and facilitators to restraint minimization. Barriers noted by families included patient agitation posing risks of losing endotracheal tubes, nurse reluctance to remove restraints, lack of family involvement, limited knowledge of alternatives, and a noisy environment. Facilitators included family involvement in decision-making, timely extubation, use of less restrictive alternatives such as mittens, mandating shorter periods of restraints application, and environmental modifications; (ii) unilateral decision-making regarding physical restraint use, where clinicians made decisions with inadequate communication with families nor obtaining consent; and (iii) the emotional impact of physical restraint use, with families experiencing sadness and shock and believing the patient would feel similarly. This qualitative study highlights significant issues surrounding the use of physical restraints, particularly the lack of family involvement in decision-making, the emotional toll on families, and various barriers and facilitators to minimizing restraint use. Effective communication and collaboration between clinicians and families are crucial to addressing these issues. Our findings underscore the critical need to enhance communication between clinicians and families, alongside consent processes. Identifying barriers and facilitators at various levels can inform individualized strategies to reduce restraint use, including integrating alternatives like mittens and involving families in care. Timely introduction of alternatives and family involvement are vital to prevent further emotional distress for families. Prioritizing the reduction of restraint duration is crucial, particularly in settings emphasizing harm minimization.

One of the most followed antitrust cases of recent times--United States v. Apple--reveals a missed truth: what Americans most fear is competition itself. In 2012 the Department of Justice accused Apple and five book publishers of conspiring to fix e-book prices. The evidence overwhelmingly showed an unadorned price-fixing conspiracy that cost consumers hundreds of millions of dollars. Yet before, during, and after the trial millions of Americans sided with the defendants. Pundits on the left and right condemned the government for its decision to sue, decrying Amazon's market share, railing against a new high-tech economy, and rallying to defend beloved authors and publishers. For many, Amazon was the one that should have been put on trial. But why? One fact went unrecognized and unreckoned with: in practice, Americans have long been ambivalent about competition. Chris Sagers, a renowned antitrust expert, meticulously pulls apart the misunderstandings and exaggerations that industries as diverse as mom-and-pop grocers and producers of cast-iron sewer pipes have cited to justify colluding to forestall competition. In each of these cases, antitrust law, a time-honored vehicle to promote competition, is put on the defensive. Herein lies the real insight of United States v. Apple. If we desire competition as a policy, we must make peace with its sometimes rough consequences. As bruising as markets in their ordinary operation often seem, letting market forces play out has almost always benefited the consumer. United States v. Apple shows why supporting cases that protect price competition, even when doing so hurts some of us, is crucial if antitrust law is to protect and maintain markets.-- Provided by publisher

Sudden and unexpected arrest-related deaths are deeply tragic and have generated widespread concern among the public, medical professionals, and law enforcement agencies. One mechanism that has garnered considerable attention is the use of prone restraint, wherein a subject is placed face-down and controlled in this position. The safety and risks of this technique remain subjects of debate within both scientific literature and legal settings. Supporters of prone restraint’s safety frequently cite prospective epidemiologic studies that report no fatalities associated with its use. However, these studies typically involve small cohorts and are conducted over limited timeframes, potentially underestimating rare but serious outcomes. In contrast, retrospective analyses, which assess larger populations over extended periods, have identified multiple cases of fatal outcomes linked to prone restraint. Notably, some of the most comprehensive data on these fatalities come from investigative journalism, which has uncovered patterns and prevalence rates not fully captured in academic or institutional studies. Based on available evidence, we estimate the mortality rate with use of in-custody prone restraint is at approximately 1 per 4.4 million individuals per year, or 0.023 per 100,000 population annually. These findings underscore the need for more rigorous, large-scale, and transparent epidemiological studies to better inform public policy, law enforcement practices, and clinical guidelines. The potential lethality of prone restraint must be recognized, and its use re-evaluated in light of both fatal risk and ethical responsibility. •Prospective studies encompassed an estimated population base of approximately 9.6 million people over a one-year equivalent period and documented 4635 instances of in-custody prone positioning with no deaths reported among individuals restrained in the prone position.•Larger retrospective studies from Ontario, Los Angeles, and the Netherlands, collectively identified 72 prone restraint deaths, yielding an estimated mortality rate of one death per 3.4 million people per year (0.029/100,000/year).•U.S government-based studies and reports have poorly tracked prone restraint deaths.•U.S new agency, the Associated Press performed the most comprehensive investigation in prone restraint deaths finding at least 740 deaths in the United States involving prone positioning with estimated of mortality rate is approximately one death per 4.4 million people per year (0.023/100,000year).•True mortality rate of prone restraint deaths remains unknown. A coordinated effort among medical/forensic communities, law enforcement, public health and policy makers is essential to better study prone restraint deaths.