***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Sixty percent to 70 % of pedestrian injuries in children under the age of 10 years are the result of the child either improperly crossing intersections or dashing out in the street between intersections . The purpose of this injury prevention research study was to evaluate a desktop virtual reality ( VR ) program that was design ed to educate and train children to safely cross intersections . Specifically , the objectives were to determine whether children can learn pedestrian safety skills while working in a virtual environment and whether pedestrian safety learning in VR transfers to real world behavior . Following focus groups with a number of key experts , a virtual city with eight interactive intersections was developed . Ninety-five children participated in a community trial from two schools ( urban and suburban ) . Approximately half were assigned to a control group who received an unrelated VR program , and half received the pedestrian safety VR intervention .  Children were identified by group and grade by colored tags on their backpacks , and actual street crossing behavior of all children was observed 1 week before and 1 week after the interventions . There was a significant change in performance after three trials with the VR intervention . Children learned safe street crossing within the virtual environment . Learning , identified as improved street-crossing behavior , transferred to real world behavior in the suburban school children but not in the urban school . The results are discussed in relation to possibilities for future VR interventions for injury prevention Objective : to evaluate the effectiveness of a school-based injury prevention program . Design : Cluster r and omised controlled trial . Setting : 20 primary schools in Nottingham , UK . Participants : 459 children aged 7 to 10 years . Intervention : The “ Risk Watch ” program delivered by teachers , aim ed at improving bike and pedestrian , falls , poisoning and fire and burns safety . Main outcome measures : Safety knowledge , observed safety skills and self-reported safety behaviour . Results : At follow-up , intervention group children correctly answered more fire and burn prevention knowledge questions than control group children ( difference between means 7.0 % ( 95 % CI 1.5 % to12.6 % ) ) . Children in intervention group schools were more likely to know the correct actions to take if clothes catch fire and the correct way to wear a cycle helmet ( difference between school means 35.3 % ( 95 % CI 22.7 % to 47.9 % ) and 6.3 % ( 95 % CI 1.4 % to 11.1 % ) respectively ) . They were also more likely to know the correct actions to take in a house fire and on finding tablets ( OR 2.80 ( 95 % CI 1.08 to 7.22 ) and OR 3.50 ( 95 % CI 1.18 to 10.38 ) respectively ) and correctly demonstrated more safety skills than control group children ( difference between means 11.9 % ( 95 % CI 1.4 % to 22.5 % ) ) . There was little evidence to suggest the first year of the program impacted on self-reported safety behaviours . Conclusions : The Risk Watch program delivered by teachers in primary schools increased some aspects of children ’s safety knowledge and skills and primary schools should consider delivering this program . Longer term , larger scale evaluations are required to examine retention of knowledge and skills and impact on safety behaviours and child injury rates It was hypothesized that practical training is effective in improving  children 's pedestrian skills  because adult scaffolding and peer discussion during training specifically promote E3 level representation ( linguistically-encoded , experientially-grounded , generalizable knowledge ) , as defined by Karmiloff-Smith 's ( 1992 ) representational redescription ( RR ) model . Two studies were conducted to examine in detail the impact of this social input in the context of simulation-based training in roadside search skills . A group of 5 - 8-year-olds were pre-tested on ability to detect relevant road-crossing features . They then participated in four training sessions design ed to promote attunement to these , under peer discussion versus adult guidance conditions ( Study 1 ) , and adult-child versus adult-group conditions ( Study 2 ) . Performance at post-test was compared with that of controls who underwent no training . Study 1 found that children in the adult guidance condition improved significantly more than those in the peer discussion or control conditions , and this improvement was directly attributable to appropriation of E3 level representations from adult dialogue . Study 2 found that progress was greater still when adult scaffolding was supplemented by peer discussion , with E3 level representation attributable to the children 's exploration of conflicting ideas . The implication s of these findings for the RR model and for practical road safety education are discussed OBJECTIVE Child pedestrian injury is a global public health challenge . This r and omized , controlled trial considered comparative efficacy of individualized streetside training , training in a virtual pedestrian environment , training using videos and Web sites , plus no-training control , to improve children 's street-crossing ability .  METHODS Pedestrian safety was evaluated among 231 7- and 8-year-olds using both streetside ( field ) and laboratory-based ( virtual environment ) trials before intervention group assignment , immediately posttraining , and 6 months posttraining . All training groups received 6 30-min sessions . Four outcomes assessed pedestrian safety : start delay ( temporal lag before initiating crossing ) , hits/close calls ( collisions/near-misses with vehicles in simulated crossings ) , attention to traffic ( looks left and right , controlled for time ) , and missed opportunities ( safe crossing opportunities that were missed ) . RESULTS Results showed training in the virtual pedestrian environment and especially individualized streetside training result ed in safer pedestrian behavior postintervention and at follow-up . As examples , children trained streetside entered safe traffic gaps more quickly posttraining than control group children and children trained streetside or in the virtual environment had somewhat fewer hits/close calls in postintervention VR trials . Children showed minimal change in attention to traffic posttraining . Children trained with videos/websites showed minimal learning . CONCLUSION Both individualized streetside training and training within virtual pedestrian environments may improve 7- and 8-year-olds ' street-crossing  safety . Individualized training has limitations of adult time and labor . Virtual environment training has limitations of accessibility and cost . Given the public health burden of child pedestrian injuries , future research should explore innovative strategies for effective training that can be broadly disseminated Using a simulation game design ed to teach children to obey certain traffic safety rules , an experimental study was conducted with 136 five-year-old children in four Quebec schools . Within each classroom , subjects were r and omly divided into four groups : three intervention groups and one control group . Each of the experimental groups was subjected to a different intervention with outcome measured using three instruments related to attitudes , behavior , and transfer of learning of pedestrian traffic safety . Results suggest that simulation games including role-playing/group dynamics and modeling/training can change attitudes and modify behavior in the area of pedestrian traffic safety in children of this age Pedestrian injuries contribute greatly to child morbidity and mortality . Recent evidence suggests that training within virtual pedestrian environments may improve children ’s street crossing skills , but may not convey knowledge about safety in street environments . We hypothesized that ( a ) children will gain pedestrian safety knowledge via videos/software/internet websites , but not when trained by virtual pedestrian environment or other strategies ; ( b ) pedestrian safety knowledge will be associated with safe pedestrian behavior both before and after training ; and ( c ) increases in knowledge will be associated with increases in safe behavior among children trained individually at streetside locations , but not those trained by means of other strategies . We analyzed data from a r and omized controlled trial evaluating pedestrian safety training . We r and omly assigned 240 children ages 7–8 to one of four training conditions : videos/software/internet , virtual reality ( VR ) , individualized streetside instruction , or a no-contact control . Both virtual and field simulations of street crossing at 2-lane bi-directional mid-block locations assessed pedestrian behavior at baseline , post-training , and 6-month follow-up . Pedestrian knowledge was assessed orally on all three occasions . Children trained by videos/software/internet , and those trained individually , showed increased knowledge following training relative to children in the other groups ( ps < 0.01 ) . Correlations between pedestrian safety knowledge and pedestrian behavior were mostly non-significant . Correlations between change in knowledge and change in behavior from pre- to post-intervention also were non-significant , both for the full sample and within conditions . Children trained using videos/software/internet  gained knowledge but did not change their behavior . Children trained individually gained in both knowledge and safer behavior . Children trained virtually gained in safer behavior but not knowledge . If VR is used for training , tools like videos/internet might effectively supplement training . We discovered few associations between knowledge and behavior , and none between changes in knowledge and behavior . Pedestrian safety knowledge and safe pedestrian behavior may be orthogonal constructs that should be considered independently for research and training purpose BACKGROUND Programmes design ed to teach children about road safety have often failed to assess their effectiveness in terms of either an increase in  children 's knowledge or an improvement in children 's behaviour . AIM The two studies reported here sought to address both issues , by focusing on the abilities of Primary 1 children ( 5 years old ) . SAMPLE A total of 120 Primary 1 children within the age range 4 - 5 years old participated in this study , drawn from three different primary schools within an educational district of Scotl and . METHODS In the first study the effects of three different road safety interventions were tested , all of which employed commercially marketed products : 1 ) a three-dimensional model of the traffic environment ; 2 ) a road safety board game ; and 3 ) illustrated posters and flip-chart material s. In the second study the transfer of knowledge to children 's behaviour in a real-life traffic environment was tested , using a sub sample of 47 children who had taken part in the first study . RESULTS Results from the first study showed , surprisingly , that all three interventions were effective in increasing children 's knowledge about safe and dangerous locations at which to cross the street , and that this knowledge was retained for a period of six months . Study 2 , however , showed that increased knowledge did not result in improved traffic behaviour . Children who had received training performed no better than children in a control group . CONCLUSION These findings highlight the need to distinguish between children 's road safety knowledge and their behaviour , particularly for teachers and parents , who may mistakenly believe that children who know more will be safer on the road Background Pedestrian injuries are among the leading causes of morbidity and mortality in middle childhood . One limitation to existing pedestrian safety interventions is that they do not provide children with repeated practice needed to develop the complex perceptual and cognitive skills required for safe street crossing . Virtual reality offers training through repeated unsupervised practice without risk , automated feedback on success of crossings , adjustment of traffic to match children 's skill and a fun , appealing environment for training . Objective To test the efficacy of virtual reality to train child pedestrians in safe street crossing . Setting Birmingham , Alabama , USA . Methods A r and omised controlled trial is underway with an expected sample of four groups of 60 children aged 7–8 years ( total N=240 ) . One group receives training in an interactive , immersive virtual pedestrian environment . A second receives pedestrian safety training via widely used video and computer strategies . The third group receives what is judged to be the most efficacious treatment currently available , individualised behavioural training at streetside locations . The fourth group serves as a no-contact control group . All participants are exposed to a range of field and laboratory-based measures of pedestrian skill during baseline and post-intervention visits , as well as during a 6-month follow-up assessment . Outcome Measures Primary analyses will be conducted through linear mixed models testing change over time in the four intervention groups . Three pedestrian safety measures will serve as primary outcomes : temporal gap before initiating crossing , temporal gap remaining after crossing and attention to traffic while waiting to cross . Clinical Trial Registration This study is registered at the US government website , www . clinical trials.gov , under the title ‘ Using virtual reality to train children in pedestrian safety ’ , registration number NCT00850759 BACKGROUND Young children in the 5 - 9 age range are particularly vulnerable to road accidents as pedestrians and previous research has identified a range of motivational and cognitive skill factors which may play a part in this . AIMS The present study aim ed to examine the extent to which the development of pedestrian skills in young children was related to individual differences in visual search strategies . SAMPLE A sample of 180 children aged 4/5 , 7/8 and 10/11 years was presented with tasks intended to assess their pedestrian skills . From this analysis a subset of 60 children was selected who had particularly high or low levels of pedestrian skills , together with a r and om sample of 10 adults , for more detailed analysis of their visual search strategies when confronted with the problem of crossing a road safely . METHOD The children 's pedestrian skills were assessed using three tasks based on slide and video presentations of real roadside situations ; these tasks assessed the ability to identify safe places to cross the road , and to decide when it was safe to cross based on the ability to detect dangerous traffic and to co-ordinate information from different directions . Visual search strategies were assessed using a ' spot the difference ' test and by analysing the head and eye movements of children and adults while they were carrying out the video task requiring them to co-ordinate information from different directions . This task was also used to make an assessment of individuals ' processing speeds by measuring the time it took to make decisions that it was safe to cross the road . RESULTS Significant differences emerged in strategic approaches between children in different age groups , and those who had high and low levels of pedestrians skills . A significant strategic shift appeared to be occurring around the age of 7/8 years . CONCLUSIONS The results indicate that the explicit training of visual search strategies might well be beneficial , but that these can not simply be the strategies of the adult pedestrian . Children may need to master simpler strategies which their slower processing speeds allow them to manage before they proceed on to the more sophisticated strategic approaches , typically involving predictions , used by older children and adults OBJECTIVE This r and omized controlled trial examined one aspect of child pedestrian behavior , route selection across intersections , to evaluate whether a combination of widely-available videos and websites effectively train children in safe pedestrian route selection compared to active pedestrian safety control training and a no-contact control group . METHODS A sample of 231 seven- and eight-year-olds were r and omly assigned to one of four groups : training with videos and internet websites , active control groups of individualized streetside training or 
    Output:
    
RESULTS Behavioral interventions generally improve children 's pedestrian safety , both immediately after training and at follow-up several months later .
Available evidence suggested interventions targeting dash-out prevention , crossing at parked cars , and selecting safe routes across intersections were effective .
Individualized/small-group training for children was the most effective training strategy based on available evidence .
Behaviorally based interventions  improve children 's pedestrian safety .