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Alcohol minimum unit pricing is not the only evidence based public health policy that has failed to materialise recently.1 In January 2013, we believed that the UK government would, as promised, publish its green paper on young driver safety in the spring. In the UK, motor vehicle crashes account for a quarter of deaths in 15-19 year olds.2 The …

Individuals with obstructive sleep apnea (OSA) experience sleep fragmentation and poor sleep quality that results in daytime sleepiness, which impairs performance during driving and leads to an increased risk for collisions. Not surprisingly, observational studies have shown that patients with OSA experience a two- to 10-fold higher risk for collision compared with healthy controls. Although treatment would clearly mitigate these risks, there is no current Canadian position on driving and OSA. This article, the first Canadian position statement addressing the issue, provides an overview of provincial regulations and proposes recommendations with regard to driving in patients with OSA.Untreated patients with obstructive sleep apnea (OSA) are at increased risk for motor vehicle collisions; however, it is unclear how this should be translated into fitness-to-drive recommendations. Accordingly, the Canadian Thoracic Society (CTS) Sleep Disordered Breathing Clinical Assembly and the Canadian Sleep Society (CSS) assembled a CTS-CSS working group to propose recommendations with regard to driving in patients with OSA.Recommendations for assessing fitness to drive in noncommercial drivers: 1. Severity of OSA alone is not a reliable predictor of collision risk and, therefore, should not be used in isolation to assess fitness to drive; 2. The severity of sleep apnea should be considered in the context of other factors to assess fitness to drive; 3. The decision to restrict driving is ultimately made by the motor vehicle licensing authority; however, they should take into account the information and recommendations provided by the sleep medicine physician and should follow provincial guidelines; 4. For patients prescribed continuous positive airway pressure (CPAP) therapy, objective CPAP compliance should be documented. Efficacy should also be documented in terms of reversing the symptoms and improvement in sleep apnea based on physiological monitoring; 5. For patients treated with surgery or an oral appliance, verification of adequate sleep apnea treatment should be obtained; and 6. A driver diagnosed with OSA may be recertified as fit to drive based on assessment of symptoms and demonstrating compliance with treatment. The assessment should be aligned with the provincial driver’s license renewal period.Commercial vehicles: Assessment of fitness to drive should be more stringent for patients operating commercial vehicles. In general, the CTS-CSS working group was in agreement with the Medical Expert Panel recommendations to the Federal Motor Carrier Safety Administration in the United States; these recommendations were adapted for Canadian practitioners.

Taxi and for-hire vehicle (FHV) drivers are a predominantly immigrant population facing a range of occupational stressors, including lack of workplace benefits and increasing financial strain from tumultuous industry changes and now COVID-19’s devastating impact. Bilingual research staff surveyed 422 New York City taxi/FHV drivers using a stratified sampling approach in driver-frequented locations to examine drivers’ health and financial planning behaviors for the first time. Drivers lacked health insurance at double the NYC rate (20% vs. 10%). Life insurance and retirement savings rates were lower than U.S. averages (20% vs. 60%, 25% vs. 58%, respectively). Vehicle ownership was a significant predictor of health insurance, life insurance, and retirement savings. Compared to South Asian drivers, Sub-Saharan African drivers were significantly less likely to have health insurance and North African, and Middle Eastern drivers were significantly less likely to have retirement savings. Although most drivers indicated the importance of insurance and benefits

Background Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. Methods In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. Results In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. Conclusions In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers.

BackgroundWith the rapid growth of the older adult population worldwide, car accidents involving this population group have become an increasingly serious problem. Cognitive impairment, which is assessed using neuropsychological tests, has been reported as a risk factor for being involved in car accidents; however, it remains unclear whether this risk can be predicted using daily behavior data.ObjectiveThe objective of this study was to investigate whether speech data that can be collected in everyday life can be used to predict the risk of an older driver being involved in a car accident.MethodsAt baseline, we collected (1) speech data during interactions with a voice assistant and (2) cognitive assessment data—neuropsychological tests (Mini-Mental State Examination, revised Wechsler immediate and delayed logical memory, Frontal Assessment Battery, trail making test-parts A and B, and Clock Drawing Test), Geriatric Depression Scale, magnetic resonance imaging, and demographics (age, sex, education)—from older adults. Approximately one-and-a-half years later, we followed up to collect information about their driving experiences (with respect to car accidents) using a questionnaire. We investigated the association between speech data and future accident risk using statistical analysis and machine learning models.ResultsWe found that older drivers (n=60) with accident or near-accident experiences had statistically discernible differences in speech features that suggest cognitive impairment such as reduced speech rate (P=.048) and increased response time (P=.040). Moreover, the model that used speech features could predict future accident or near-accident experiences with 81.7% accuracy, which was 6.7% higher than that using cognitive assessment data, and could achieve up to 88.3% accuracy when the model used both types of data.ConclusionsOur study provides the first empirical results that suggest analysis of speech data recorded during interactions with voice assistants could help predict future accident risk for older drivers by capturing subtle impairments in cognitive function.

Chromosome gains and losses are a frequent feature of human cancers. However, how these aberrations can outweigh the detrimental effects of aneuploidy remains unclear. An initial comparison of existing chromosomal instability (CIN) mouse models suggests that aneuploidy accumulates to low levels in these animals. We therefore developed a novel mouse model that enables unprecedented levels of chromosome missegregation in the adult animal. At the earliest stages of T-cell development, cells with random chromosome gains and/or losses are selected against, but CIN eventually results in the expansion of progenitors with clonal chromosomal imbalances. Clonal selection leads to the development of T-cell lymphomas with stereotypic karyotypes in which chromosome 15, containing the Myc oncogene, is gained with high prevalence. Expressing human MYC from chromosome 6 (MYC(Chr6)) is sufficient to change the karyotype of these lymphomas to include universal chromosome 6 gains. Interestingly, while chromosome 15 is still gained in MYC(Chr6) tumors after genetic ablation of the endogenous Myc locus, this chromosome is not efficiently gained after deletion of one copy of Rad21, suggesting a synergistic effect of both MYC and RAD21 in driving chromosome 15 gains. Our results show that the initial detrimental effects of random missegregation are outbalanced by clonal selection, which is dictated by the chromosomal location and nature of certain genes and is sufficient to drive cancer with high prevalence.

Tyrosine kinase 2 (TYK2) is a widely expressed receptor-associated kinase that is involved in signaling by a variety of cytokines with important immune regulatory activities. Absence of TYK2 in mice results in impaired NK cell maturation and antitumor activity, although underlying mechanisms are largely unknown. Using conditional ablation of TYK2 in NK cells we show that TYK2 is required for IFN-γ production by NK cells in response to IL-12 and for an efficient immune defense against Listeria monocytogenes. Deletion of TYK2 in NK cells did not impact NK cell maturation and IFN-γ production upon NK cell activating receptor (actR) stimulation. Similarly, NK cell–mediated tumor surveillance was unimpaired upon deletion of TYK2 in NK cells only. In line with the previously reported maturation-associated Ifng promoter demethylation, the less mature phenotype of Tyk2−/− NK cells correlated with an increased CpG methylation at the Ifng locus. Treatment with the DNA hypomethylating agent 5-aza-2-deoxycytidine restored the ability of Tyk2−/− NK cells to produce IFN-γ upon actR but not upon IL-12 stimulation. NK cell maturation was dependent on the presence of TYK2 in dendritic cells and could be rescued in Tyk2-deficient mice by treatment with exogenous IL-15/IL-15Rα complexes. IL-15 treatment also rescued the in vitro cytotoxicity defect and the impaired actR-induced IFN-γ production of Tyk2−/− NK cells. Collectively, our findings provide the first evidence, to our knowledge, for a key role of TYK2 in the host environment in promoting NK cell maturation and antitumor activity.

Objectives/background To assess brake reaction time (BRT; key factor in driving ability) in patients receiving transfemoral coronary angiography (CAG). We assumed that patients would have a significantly impaired BRT after the procedure. Methods A prospective, observational study design was applied. Consecutive patients undergoing right-sided transfemoral CAG as part of the clinical routine were included. An experimental driving simulator was used to determine BRT after receiving a visual stimulus. The subjects applied the brake with their right foot as quickly as possible when a red-light signal appeared. The time interval between stimulus and brake application was taken as BRT. In addition to the total BRT, also its components were determined: neurologic reaction time, foot transfer time and brake travel time. BRT was determined before and 1 day after CAG (pre-post comparison). Results 71 patients were included in the analysis (58 male, age 61 ± 9 years). Total BRT was 594 ± 188 and 591 ± 198 ms before and after the CAG procedure, respectively (p = 0.270). Similarly, also the BRT components ‘foot transfer time’ and ‘brake travel time’ did not show significant differences between the two test occasions. However, neurologic reaction time decreased from 269 ± 67 to 255 ± 64 ms (p = 0.036). Conclusions We found no impairment of BRT on the first day after puncture of the right-sided femoral artery in patients undergoing CAG. Therefore, with regard to BRT, it is regarded safe to resume driving from day 1 after CAG. Other factors of driving safety beyond BRT must also be considered.

Background: Age-related cognitive and physical decline can impair safe driving performance. Tai Chi exercise benefits cognitive and physical function and may influence safe driving performance in older adults. The primary aim of this observational study was to compare cognitive processes and physical function related to safe driving performance among older adult Tai Chi practitioners to normative reference values. Secondary aims were to examine relationships between Tai Chi exercise habits, cognitive processes, and physical function related to safe driving performance and to explore potential predictors of safe driving performance. Methods: The DrivingHealth Inventory, the Driving Scenes Test, other driving-related cognitive and physical measures, and self-reported measures including the Mindful Attention Awareness Scale (MAAS) and the Vitality Plus Scale (VPS) were collected from current Tai Chi practitioners (n = 58; age 72.9 ± 5.9 years, mean ± SD) with median >3 years Tai Chi practice. Results: Compared to normative reference values, participants performed better on numerous cognitive measures including the Driving Scenes Test (p

Background A construction method has emerged in which a camera is installed around a construction machine, and the operator remotely controls the machine while synchronizing the vibration of the machine with the images seen from the operator's seat using virtual reality (VR) technology. Indices related to changes in heart rate (HR) and physical vibration, such as heart rate variability (HRV) and multiscale entropy (MSE), can then be measured among the operators. As these indices are quantitative measures of autonomic regulation in the cardiovascular system, they can provide a useful means of assessing operational stress. Objective In this study, we aimed to evaluate changes in HR and body vibration of machine operators and investigate appropriate methods of machine operation while considering the psychological load. Methods We enrolled 9 remote operators (18-50 years old) in the experiment, which involved 42 measurements. A construction machine was driven on a test course simulating a construction site, and three patterns of operation—riding operation, remote operation using monitor images, and VR operation combining monitor images and machine vibration—were compared. The heartbeat, body vibration, and driving time of the participants were measured using sensing wear made of a woven film-like conductive material and a three-axis acceleration measurement device (WHS-2). We used HRV analysis in the time and frequency domains, MSE analysis as a measure of the complexity of heart rate changes, and the ISO (International Standards Organization) 2631 vibration index. Multiple regression analysis was conducted to model the relationship among the low frequency (LF)/high frequency (HF) HRV, MSE, vibration index, and driving time of construction equipment. Efficiency in driving time was investigated with a focus on stress reduction. Results Multiple comparisons conducted via the Bonferroni test and Kruskal-Wallis test showed statistically significant differences (P=.05) in HRV-LF/HF, the vibration index, weighted acceleration, motion sickness dose value (MSDVz), and the driving time among the three operation patterns. The riding operation was found to reduce the driving time of the machine, but the operation stress was the highest in this case; operation based on the monitor image was found to have the lowest operation stress but the longest operation time. Multiple regression analysis showed that the explanatory variables (LH/HF), RR interval, and vibration index (MSDVz by vertical oscillation at 0.5-5 Hz) had a negative effect on the driving time (adjusted coefficient of determination R2=0.449). Conclusions A new method was developed to calculate the appropriate operating time by considering operational stress and suppressing the physical vibration within an acceptable range. By focusing on the relationship between psychological load and physical vibration, which has not been explored in previous studies, the relationship of these variables with the driving time of construction machines was clarified.

This study aimed to investigate the impact of driving cessation on social isolation in older adults. Data came from the National Health and Aging Trends Study round 1 through round 6 surveys. Study sample consisted 6,916 Medicare beneficiaries aged 65+ who were eligible drivers at baseline. Social isolation measure was based on social domains concerning marriage, family and friends, church participation, and club participation. The impact of driving cessation on social isolation was assessed using mixed-effects ordered logistic regression and piece-wise regression. In multivariable mixed-effects ordered logistic regression, past-year non-drivers had a two-fold increase in the odds of being in a higher social isolation category (OR=2.1, p

Background A large Midwestern state commissioned a virtual driving test (VDT) to assess driving skills preparedness before the on-road examination (ORE). Since July 2017, a pilot deployment of the VDT in state licensing centers (VDT pilot) has collected both VDT and ORE data from new license applicants with the aim of creating a scoring algorithm that could predict those who were underprepared. Objective Leveraging data collected from the VDT pilot, this study aimed to develop and conduct an initial evaluation of a novel machine learning (ML)–based classifier using limited domain knowledge and minimal feature engineering to reliably predict applicant pass/fail on the ORE. Such methods, if proven useful, could be applicable to the classification of other time series data collected within medical and other settings. Methods We analyzed an initial dataset that comprised 4308 drivers who completed both the VDT and the ORE, in which 1096 (25.4%) drivers went on to fail the ORE. We studied 2 different approaches to constructing feature sets to use as input to ML algorithms: the standard method of reducing the time series data to a set of manually defined variables that summarize driving behavior and a novel approach using time series clustering. We then fed these representations into different ML algorithms to compare their ability to predict a driver’s ORE outcome (pass/fail). Results The new method using time series clustering performed similarly compared with the standard method in terms of overall accuracy for predicting pass or fail outcome (76.1% vs 76.2%) and area under the curve (0.656 vs 0.682). However, the time series clustering slightly outperformed the standard method in differentially predicting failure on the ORE. The novel clustering method yielded a risk ratio for failure of 3.07 (95% CI 2.75-3.43), whereas the standard variables method yielded a risk ratio for failure of 2.68 (95% CI 2.41-2.99). In addition, the time series clustering method with logistic regression produced the lowest ratio of false alarms (those who were predicted to fail but went on to pass the ORE; 27.2%). Conclusions Our results provide initial evidence that the clustering method is useful for feature construction in classification tasks involving time series data when resources are limited to create multiple, domain-relevant variables.

Journal of medical internet research : JMIR 19(12), e372 (2017). doi:10.2196/jmir.6983 special issue: "Special Issue Computing and Mental Health 2016/17 / Guest Editors: Calvo, Dinakar,Torous, Picard, Christensen", Published by Healthcare World, Richmond, Va.

To understand the impact of drinking and driving laws on drinking and driving fatality rates, this study explored the different effects these laws have on areas with varying severity rates for drinking and driving. Unlike previous studies, this study employed quantile regression analysis. Empirical results showed that policies based on local conditions must be used to effectively reduce drinking and driving fatality rates; that is, different measures should be adopted to target the specific conditions in various regions. For areas with low fatality rates (low quantiles), people’s habits and attitudes toward alcohol should be emphasized instead of transportation safety laws because “preemptive regulations” are more effective. For areas with high fatality rates (or high quantiles), “ex-post regulations” are more effective, and impact these areas approximately 0.01% to 0.05% more than they do areas with low fatality rates.

Introduction As people with a range of disabilities strive to increase their community mobility, occupational therapy driver assessors are increasingly required to make complex recommendations regarding fitness-to-drive. However, very little is known about how therapists use information to make decisions. The aim of this study was to model how experienced occupational therapy driver assessors weight and combine information when making fitness-to-drive recommendations and establish their level of decision agreement. Method Using Social Judgment Theory method, this study examined how 45 experienced occupational therapy driver assessors from the UK, Australia and New Zealand made fitness-to-drive recommendations for a series of 64 case scenarios. Participants completed the task on a dedicated website, and data were analysed using discriminant function analysis and an intraclass correlation coefficient. Results Accounting for 87% of the variance, the cues central to the fitness-to-drive recommendations made by assessors are the client’s physical skills, cognitive and perceptual skills, road law craft skills, vehicle handling skills and the number of driving instructor interventions. Agreement (consensus) between fitness-to-drive recommendations was very high: intraclass correlation coefficient = .97, 95% confidence interval .96–.98). Conclusion Findings can be used by both experienced and novice driver assessors to reflect on and strengthen the fitness-to-drive recommendations made to clients.

After right total knee arthroplasty (TKA), patients are usually eager to return to driving. Previous studies suggest 6 weeks postsurgery is a safe time. However, recent advances in surgical technique, pain management, and rehabilitation have theoretically improved recovery after TKA.We therefore determined if (1) the timeframe for return to driving, as determined by attainment of preoperative braking levels, would be shorter after contemporary right TKA than that reported previously for a traditional TKA; and (2) gender or age influence recovery of baseline response time.Brake response times for all 29 patients undergoing right-sided TKA between January 17, 2008, and January 29, 2009, were scheduled to be measured by a trained occupational therapist before surgery and at 4, 6, and 8 weeks after surgery. For each patient, testing was discontinued once the preoperative level was achieved.All patients returned to baseline braking levels by 4 weeks after surgery. Gender and age did not influence recovery times.If other requirements for driving are met, surgeons may consider allowing patients treated with contemporary right TKAs to drive 4 weeks after surgery.

Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective: The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods: The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results: A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P

Background : Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. Aim: To systematically evaluate the quality of selected national guidelines about driving with medical illness. Design: A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. Methods: Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Results: Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57–0.79). Conclusions: This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.

To explore the driving problems associated with Parkinson's disease (PD) and to ascertain whether any clinical features or tests predict driver safety.The driving ability of 154 individuals with PD referred to a driving assessment centre was determined by a combination of clinical tests, reaction times on a test rig and an in-car driving test.The majority of cases (104, 66%) were able to continue driving although 46 individuals required an automatic transmission and 10 others needed car modifications. Ability to drive was predicted by the severity of physical disease, age, presence of other associated medical conditions, particularly dementia, duration of disease, brake reaction, time on a test rig and score on a driving test (all p0.001). The level of drug treatment and the length of driving history were not correlated. Discriminant analysis revealed that the most important features in distinguishing safety to drive were severe physical disease (Hoehn and Yahr stage 3), reaction time, moderate disease associated with another medical condition and high score on car testing.Most individuals with PD are safe to drive, although many benefit from car modifications or from using an automatic transmission. A combination of clinical tests and in-car driving assessment will establish safety to drive, and a number of clinical correlates can be shown to predict the likely outcome and may assist in the decision process. This is the largest series of consecutive patients seen at a driving assessment centre reported to date, and the first to devise a scoring system for on-road driving assessment.

Objective: To assess visual search and recognition of roadside targets and safety errors during a landmark and traffic sign identification task in drivers with Alzheimer's disease. Methods: 33 drivers with probable Alzheimer's disease of mild severity and 137 neurologically normal older adults underwent a battery of visual and cognitive tests and were asked to report detection of specific landmarks and traffic signs along a segment of an experimental drive. Results: The drivers with mild Alzheimer's disease identified significantly fewer landmarks and traffic signs and made more at-fault safety errors during the task than control subjects. Roadside target identification performance and safety errors were predicted by scores on standardised tests of visual and cognitive function. Conclusions: Drivers with Alzheimer's disease are impaired in a task of visual search and recognition of roadside targets; the demands of these targets on visual perception, attention, executive functions, and memory probably increase the cognitive load, worsening driving safety.

OBJECTIVES: To evaluate the efficiency of different automotive cabin air filters to prevent penetration of components of diesel exhaust and thereby reduce biomedical effects in human subjects. Filtered air and unfiltered diluted diesel exhaust (DDE) were used as negative and positive controls, respectively, and were compared with exposure to DDE filtered with four different filter systems. METHODS: 32 Healthy non- smoking subjects (age 21-53) participated in the study. Each subject was exposed six times for 1 hour in a specially designed exposure chamber: once to air, once to unfiltered DDE, and once to DDE filtered with the four different cabin air filters. Particle concentrations during exposure to unfiltered DDE were kept at 300 micrograms/m3. Two of the filters were particle filters. The other two were particle filters combined with active charcoal filters that might reduce certain gaseous components. Subjective symptoms were recorded and nasal airway lavage (NAL), acoustic rhinometry, and lung function measurements were performed. RESULTS: The two particle filters decreased the concentrations of diesel exhaust particles by about half, but did not reduce the intensity of symptoms induced by exhaust. The combination of active charcoal filters and a particle filter significantly reduced the symptoms and discomfort caused by the diesel exhaust. The most noticable differences in efficacy between the filters were found in the reduction of detection of an unpleasant smell from the diesel exhaust. In this respect even the two charcoal filter combinations differed significantly. The efficacy to reduce symptoms may depend on the abilities of the filters investigated to reduce certain hydrocarbons. No acute effects on NAL, rhinometry, and lung function variables were found. CONCLUSIONS: This study has shown that the use of active charcoal filters, and a particle filter, clearly reduced the intensity of symptoms induced by diesel exhaust. Complementary studies on vehicle cabin air filters may result in further diminishing the biomedical effects of diesel exhaust in subjects exposed in traffic and workplaces.

Automated guided vehicle technology has become a hot area of scientific research due to its increasing use in manufacturing and logistics. Its main features are programming and control, remote computer eye tracking, command receiving and execution, autonomous route planning, and autonomous driving execution of tasks, with the advantages of high intelligence and flexibility. In this work, a simple vehicle model is used to study the route planning and tracking control of automatic guided vehicles. This paper uses wireless communication to find the optimal route planning problem. Using geometric methods, we develop a model of the working environment of the mobile automatic guided vehicle and develop a route finding algorithm. Based on the kinematic model, an advanced routing controller is designed to conduct experimental simulation of two trajectories and verify the effectiveness of the trajectory tracking controller. When the time is after 2 s, the position error is almost completely zero. In the path planning, when the number of iterations is greater than 10, the path length remains constant, verifying the effectiveness of the method in this paper.

Approximately 5% of all households in Sri Lanka operate a three-wheeler as their primary source of income. However, very little is known about the occupational health risks associated with driving these vehicles.The aim of this study was to assess occupational risk factors, including the number of hours worked associated with the 4-week prevalence of low back pain (LBP) among drivers of three-wheelers.Questionnaires were administered to 200 full-time drivers of three-wheelers from the Galle District in Sri Lanka. Occupational, psychological, socio-demographic, lifestyle, and anthropometric variables were collected. Univariate and multivariate analysis were used to investigate the correlation between occupational risk factors of the prevalence of LBP.15·5% of respondents reported experiencing LBP in the previous 4 months. Univariate analysis revealed that the number of hours worked per week, feeling pressure to compete with other drivers, and perceived stress scale scores were significantly associated with the 4-week prevalence of LBP. Multivariate analysis found that the number of hours worked per week and engine type were significantly associated with LBP.LBP is common among drivers of three-wheelers in Sri Lanka. Long work hours and two-stroke engines were significantly associated with LBP. Results from this study point towards a role for educational, behavioral health, and policy interventions to help prevent and reduce LBP among these drivers.

OBJECTIVES—To facilitate decisions about interventions and to establish baseline values for future evaluation of preventive efforts, the aim of the present study was to elucidate the disease pattern among male professional drivers in Denmark. The study differentiated between drivers of goods vehicles and drivers of passenger transport. METHODS—Cohorts of all 20-59 year old Danish male professional drivers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardised hospital admission ratios (SHRs) and time trends (1981-97) for many diagnostic aggregations. RESULTS—SHRs for diseases in practically all systems and organs of the body were higher among professional drivers than they were in the male working population at large. Also drivers of passenger transport, compared with drivers of goods vehicles, had significantly high SHRs due to infectious and parasitic diseases, diseases of the circulatory system, and diseases of the respiratory system, and significantly lower rates of injury. For both driver groups, the SHRs for acute myocardial infarction increased with time whereas the SHR for acute gastritis decreased, and for drivers of passenger transport an increasing SHR for chronic obstructive pulmonary disease, was found over time. CONCLUSION—Drivers of passenger transport and drivers of goods vehicles differ in their disease patterns. The results support the hypothesis that preventive efforts are needed in both groups, but underline that different strategies are required for different categories of drivers. Keywords: professional drivers; hospital admissions; surveillance system

Background: Driving a car is a complex instrumental activity of daily living and driving performance is very sensitive to cognitive impairment. The assessment of driving-relevant cognition in older drivers is challenging and requires reliable and valid tests with good sensitivity and specificity to predict safe driving. Driving simulators can be used to test fitness to drive. Several studies have found strong correlation between driving simulator performance and on-the-road driving. However, access to driving simulators is restricted to specialists and simulators are too expensive, large, and complex to allow easy access to older drivers or physicians advising them. An easily accessible, Web-based, cognitive screening test could offer a solution to this problem. The World Wide Web allows easy dissemination of the test software and implementation of the scoring algorithm on a central server, allowing generation of a dynamically growing database with normative values and ensures that all users have access to the same up-to-date normative values. Objective: In this pilot study, we present the novel Web-based Bern Cognitive Screening Test (wBCST) and investigate whether it can predict poor simulated driving performance in healthy and cognitive-impaired participants. Methods: The wBCST performance and simulated driving performance have been analyzed in 26 healthy younger and 44 healthy older participants as well as in 10 older participants with cognitive impairment. Correlations between the two tests were calculated. Also, simulated driving performance was used to group the participants into good performers (n=70) and poor performers (n=10). A receiver-operating characteristic analysis was calculated to determine sensitivity and specificity of the wBCST in predicting simulated driving performance. Results: The mean wBCST score of the participants with poor simulated driving performance was reduced by 52%, compared to participants with good simulated driving performance ( P

OBJECTIVES—To study the exposure of Parisian taxi drivers to automobile air pollutants during their professional activity. METHODS—A cross sectional study was carried out from 27 January to 27 March 1997, with measurements performed in the vehicles of 29 randomly selected drivers. Carbon monoxide (CO) content was measured over an 8 hour period by a CO portable monitor. The fine suspended particles were measured according to the black smoke index (BS), with a flow controlled portable pump provided with a cellulose filter. The nitrogen oxides, NO and NO2 were measured with a passive sampler. RESULTS—These drivers are exposed during their professional activity to relatively high concentrations of pollutants (mean, median (SD) 3.8, 2 (1.7) ppm for CO, 168, 164 (53) µg/m3 for BS, 625, 598 (224) µg/m3 for NO, and 139, 131 (43) µg/m3 for NO2.) For CO the concentrations were clearly lower than the threshold values recommended by the World Health Organisation. The situation is less satisfactory for the other pollutants, especially for the BS index. All concentrations of pollutants recorded were noticeably higher than concentrations in air recorded by the ambient Parisian air monitoring network and were close to, or slightly exceeded, the concentrations measured at the fixed stations close to automobile traffic. Pollutant concentrations were also influenced greatly by weather conditions. CONCLUSION—This first French study conducted in taxi drivers shows that they are highly exposed to automobile pollutants. The results would justify a medical follow up of this occupational group. Keywords: taxi drivers; exposure assessment

Falling asleep while driving accounts for a considerable proportion of vehicle accidents under monotonous driving conditions. Many of these accidents are related to work--for example, drivers of lorries, goods vehicles, and company cars. Time of day (circadian) effects are profound, with sleepiness being particularly evident during night shift work, and driving home afterwards. Circadian factors are as important in determining driver sleepiness as is the duration of the drive, but only duration of the drive is built into legislation protecting professional drivers. Older drivers are also vulnerable to sleepiness in the mid-afternoon. Possible pathological causes of driver sleepiness are discussed, but there is little evidence that this factor contributes greatly to the accident statistics. Sleep does not occur spontaneously without warning. Drivers falling asleep are unlikely to recollect having done so, but will be aware of the precursory state of increasing sleepiness; probably reaching a state of fighting off sleep before an accident. Self awareness of sleepiness is a better method for alerting the driver than automatic sleepiness detectors in the vehicle. None of these have been proved to be reliable and most have shortcomings. Putative counter measures to sleepiness, adopted during continued driving (cold air, use of car radio) are only effective for a short time. The only safe counter measure to driver sleepiness, particularly when the driver reaches the stage of fighting sleep, is to stop driving, and--for example, take a 30 minute break encompassing a short (< 15 minute) nap or coffee (about 150 mg caffeine), which are very effective particularly if taken together. Exercise is of little use. CONCLUSIONS: More education of employers and employees is needed about planning journeys, the dangers of driving while sleepy, and driving at vulnerable times of the day.

Advising patients when to drive after surgery is a common practice which gynaecologists need to do on a regular basis as a part of their duty to patients. We carried out a literature search regarding advice given on driving after gynaecological surgical procedures, and found no study or research on this area. We then carried out a questionnaire survey of 99 gynaecologists in Northern Ireland. We have identified wide variation in clinical practice, and advocate a United Kingdom wide survey and further studies to find out optimum time to drive after different gynaecological surgeries. There is a need for national guidelines on driving after surgery, which would be of great benefit to gynaecologists, patients, motor insurers, police and all other interested parties.

OBJECTIVES: To compare two programmes for reducing the levels of risk indicators of heart diseases among professional drivers. The programmes were focused on changes of lifestyle. The aim of the programmes was to initiate and motivate a process of change within the driver, which in the long term should lead to permanent and sound health habits. One programme was based on health profile assessment and the other was a health examination. METHODS: Altogether, 102 subjects were investigated (51 allocated to an intervention group and 51 to a reference group). The programme in the intervention group (health profile assessment) was based on revelatory communication, adjusted to the driver and contained individual and group activities. The reference group went through a health examination. In both groups blood pressure, serum lipid concentrations, body mass index, and estimated maximal oxygen uptake were measured and the lifestyle habits were surveyed by questionnaires at the start and at follow ups of 6 and 18 months. RESULTS: The results showed that in the intervention group the maximal oxygen uptake increased, as did exercise habits and the intention to practice good dietary habits. Variable working hours was the most common obstacle to change a health habit. In the reference group the maximal oxygen uptake increased and the concentration of serum total cholesterol and the number of people who perceived stress and loneliness decreased. CONCLUSIONS: Both the health profile assessment and the health examination had an effect on the levels of some risk indicators of heart diseases. Both programmes turned out to be useful because of high participation during the entire period and a generally positive attitude among the subjects.

OBJECTIVES: To study risk of lung cancer among groups of professional drivers probably exposed to different levels of traffic exhaust fumes. METHODS: A nationwide case-control study (1970-89) based on employees comprising 28,744 men with primary lung cancer and incidence density sampled matched controls (1:1). Employment histories were reconstructed back to 1964 for each study subject from the records of a nationwide pension scheme with compulsory membership. Socioeconomic status was derived from the individual job title taken from the national population registry. Information on tobacco smoking habits was available from historical surveys. Relative risks were estimated by odds ratios (ORs) based on conditional logistic regression analyses. RESULTS: In total 2251 of the male lung cancer cases had been employed as bus, lorry, taxi, or unspecified drivers. No significant difference in tobacco smoking habits was found among professional male Danish drivers and the total employed population. The OR for lung cancer adjusted for socioeconomic status was 1.6 (95% confidence interval (95% CI) 1.2 to 2.2) among taxi drivers, who were considered to be exposed to the highest concentrations of vehicle exhaust fumes, and 1.3 (1.2 to 1.5) for bus and lorry drivers. The OR was 1.4 (1.3 to 1.5) for unspecified drivers. The adjusted risk of lung cancer increased significantly with increasing duration of employment as a driver, and the risk was highest for long term taxi drivers with 10 years of lag time (OR 3.0; 1.2 to 6.8). CONCLUSION: Occupational factors, probably exposure to vehicle exhaust, seems to play an important part in the development of lung cancer among drivers.

OBJECTIVES: To evaluate coach drivers' work stress during work and in the course of recovery from work by measurement of urinary catecholamines and cortisol. METHODS: The urinary excretion rate of adrenaline, noradrenaline, and cortisol of 10 coach drivers was studied during a long distance trip of three days and two consecutive days off. Each driver was asked to provide seven urine samples on the working days and six urine samples on the days off. The second day off was considered as the baseline. RESULTS: An occupationally induced disturbance of the circadian rhythmicity was found for adrenaline and noradrenaline but not for cortisol. The mean excretion rates of adrenaline on the first working day and most samples on all working days were higher than the baseline. For both adrenaline and noradrenaline the mean excretion rates on the first day off were lower than the baseline. For cortisol, the mean excretion rate on all working days was higher than the baseline. A trend towards accumulation of cortisol excretion from the first working day to the third working day was found. A backward shift in peak concentrations was found for adrenaline and noradrenaline on the second working day, as was a forward shift in peak concentration of cortisol on both days off. CONCLUSIONS: Long distance coach drivers showed occupationally induced reactivity in rates of urinary excretion of adrenaline, noradrenaline, and cortisol. After the outward journey the rates of excretion of catecholamines did not return to baseline values. The course of recovery in adrenaline excretion after the journey showed a new phenomenon, which has been called "fatigue debt". It is recommended that longer resting times in shuttle bus trips and fixed days off after these kind of trips should be planned. Extensive future research should be focused on the additional relations between fatigue debt and health complaints.

In this paper, we proposed a new theory of solving the multitarget control problem by introducing a machine learning framework in automatic driving and implementing the acquisition of excellent drivers’ knowledge. Nowadays, there still exist some core problems that have not been fully realized by the researchers in automatic driving, such as the optimal way to control the multitarget objective functions of energy saving, safe driving, headway distance control, and comfort driving. It is also challenging to resolve the networks that automatic driving is relied on and to improve the performance of GPU chips on complex driving environments. According to these problems, we developed a new theory to map multitarget objective functions in different spaces into the same one and thus introduced a machine learning framework of SDL (super deep learning) for optimal multitarget control based on knowledge acquisition. We will present in this paper the optimal multitarget control by combining the fuzzy relationship of each multitarget objective function and the implementation of excellent drivers’ knowledge acquired by machine learning. Theoretically, the impact of this method will exceed that of the fuzzy control method used in the automatic train.

Made available in DSpace on 2014-12-03T13:08:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-01-01Bitstream added on 2014-12-03T13:23:39Z : No. of bitstreams: 1 WOS000327463200010.pdf: 494828 bytes, checksum: fc776ee347a9365c0b31ff54cbf59c1f (MD5) Universidade Federal de Sao Paulo Associacao Fundo de Incentivo a Pesquisa Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Centro Multidisciplinar em Sonolencia e Acidentes (CEMSA)/Fundo de Incentivo a Pesquisa (AFIP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Centro de Estudo em Psicobiologia e Exercicio (CEPE) Objective: The objective of this study was to analyze the effect of individual circadian preferences of drivers with fixed night work schedules on sleep patterns. Subjects and Methods: A total of 123 professional drivers, 32 indifferent preference drivers and 91 morning preference drivers of an intermunicipality and interstate bus transportation company were evaluated. All drivers underwent polysomnographic recordings after their shifts. Furthermore, they filled out a questionnaire that contained sociodemographic and health questions. The Home and Ostberg questionnaire was used to assess the subjects' morningness-eveningness preference. Results: The mean age was 42.54 +/- 6.98 years and 82 (66.66%) of the drivers had worked for = 15 years. A significant effect on rapid eye movement (REM) was observed in the morning preference drivers. They showed an increased sleep latency and an REM sleep percentage of 5% of the total REM time. This reveals a significant effect on sleep architecture associated with work time. Conclusion: The drivers reported that morning preference had a significant effect on their sleep pattern indicating less REM sleep and longer REM sleep latency in the morning preference group. Thus, it is important to evaluate interactions between individual aspects of health and other parameters, such as sleep quality and work organizational factors, to promote night shift workers' health and well-being. (C) 2013 S. Karger AG, Basel Associacao Fundo Incent Pesquisa, Ctr Multidisciplinar Sonolencia & Acidentes, Sao Paulo, Brazil Univ Fed Sao Paulo, Sao Paulo, Brazil UNESP, Univ Estadual Paulista Julio de Mesquita Fillho, Assis, Brazil Univ Estadual Campinas, Fac Ciencias Aplicadas, Limeira, Brazil UNESP, Univ Estadual Paulista Julio de Mesquita Fillho, Assis, Brazil

Background Sponsorship of Formula One (F1) motor racing, which has been used as an indirect medium of tobacco advertising for several decades, was prohibited by the 2005 European Union Tobacco Advertising Directive. Most F1 tobacco sponsorship of motor racing in the EU has since ceased, with the exception of the Scuderia Ferrari team, which continues to be funded by Philip Morris. In 2007, the Marlboro logo on Ferrari cars and other race regalia was replaced by an evolving ‘barcode’ design, which Ferrari later claimed was part of the livery of the car, and not a Marlboro advertisement. \ud \ud Objective: To determine whether the ‘barcode’ graphics used by Ferrari represent ‘alibi’ Marlboro advertising. \ud \ud Methods Academic and grey literature, and online tobacco industry document archives, were searched using terms relevant to tobacco marketing and motorsport. \ud \ud Results Tobacco sponsorship of F1 motor racing began in 1968, and Philip Morris has sponsored F1 teams since 1972. Phillip Morris first used a ‘barcode’ design, comprising red vertical parallel lines below the word Marlboro on the British Racing Motors F1 car in 1972. Vertical or horizontal ‘barcode’ designs have been used in this way, latterly without the word Marlboro, ever since. The modern ‘barcode’ logos occupied the same position on cars and drivers' clothing as conventional Marlboro logos in the past. The shared use of red colour by Marlboro and Ferrari is also recognised by Philip Morris as a means of promoting brand association between Marlboro and Ferrari. \ud \ud Conclusion The Ferrari ‘barcode’ designs are alibi Marlboro logos and hence constitute advertising prohibited by the 2005 EU Tobacco Advertising Directive.

Autonomous vehicles for the intention of human behavior of the estimated traffic participants and their interaction is the main problem in automatic driving system. Classical cognitive theory assumes that the behavior of human traffic participants is completely reasonable when studying estimation of intention and interaction. However, according to the quantum cognition and decision theory as well as practical traffic cases, human behavior including traffic behavior is often unreasonable, which violates classical cognition and decision theory. Based on the quantum cognitive theory, this paper studies the cognitive problem of pedestrian crossing. Through the case analysis, it is proved that the Quantum-like Bayesian (QLB) model can consider the reasonability of pedestrians when crossing the street compared with the classical probability model, being more consistent with the actual situation. The experiment of trajectory prediction proves that the QLB model can cover the edge events in interactive scenes compared with the data-driven Social-LSTM model, being more consistent with the real trajectory. This paper provides a new reference for the research on the cognitive problem of intention on bounded rational behavior of human traffic participants in autonomous driving.

Pedestrian detection is an important research domain due to its relevance for autonomous and assisted driving, as well as its applications in security and industrial automation. Often, more than one type of sensor is used to cover a broader range of operating conditions than a single-sensor system would allow. However, it remains difficult to make pedestrian detection systems perform well in highly dynamic environments, often requiring extensive retraining of the algorithms for specific conditions to reach satisfactory accuracy, which, in turn, requires large, annotated datasets captured in these conditions. In this paper, we propose a probabilistic decision-level sensor fusion method based on naive Bayes to improve the efficiency of the system by combining the output of available pedestrian detectors for colour and thermal images without retraining. The results in this paper, obtained through long-term experiments, demonstrate the efficacy of our technique, its ability to work with non-registered images, and its adaptability to cope with situations when one of the sensors fails. The results also show that our proposed technique improves the overall accuracy of the system and could be very useful in several applications.

Objective: The purpose of this study was to investigate the factors which predict neck pain initially and at 1 year following a rear end collision. Methods: All people who reported a rear end collision to the Devon and Cornwall Constabulary were identified and formed the basis of the cohort. People were excluded if they were under 18 years of age or had suffered a head injury. The main outcome measures were neck pain lasting for more than a week after the accident and neck pain at least 1 day a week at 1 year. Logistic regression was used to investigate associations between demographic and accident related variables and outcomes. Results: A total of 1147 people reported rear end collisions to the police during the study period and 503 (44%) agreed to take part in the study. Of the respondents, 78% had neck pain lasting for more than a week and 52% still had pain at 1 year. Age (odds ratio, 95% confidence interval: 0.957, 0.942–0.972) and prior history of neck pain (8.32, 2.89–23.89) were the most important predictors of early neck pain. The most important predictors of pain at 1 year were the initial neck visual analogue scale (VAS) score (1.03, 1.01–1.05) and the presence of a compensation claim (4.09, 1.62–10.32). There was only weak evidence that measures of the severity of the impact were associated with outcomes. Conclusion: Demographic variables and the presence of a compensation suit show the strongest correlation with acute and chronic neck pain following rear end collisions.

To explore the effect of drivers' use of mobile (cell) phones on road safety.A case-crossover study.Perth, Western Australia.456 drivers agedor = 17 years who owned or used mobile phones and had been involved in road crashes necessitating hospital attendance between April 2002 and July 2004.Driver's use of mobile phone at estimated time of crash and on trips at the same time of day in the week before the crash. Interviews with drivers in hospital and phone company's records of phone use.Driver's use of a mobile phone up to 10 minutes before a crash was associated with a fourfold increased likelihood of crashing (odds ratio 4.1, 95% confidence interval 2.2 to 7.7, P0.001). Risk was raised irrespective of whether or not a hands-free device was used (hands-free: 3.8, 1.8 to 8.0, P0.001; hand held: 4.9, 1.6 to 15.5, P = 0.003). Increased risk was similar in men and women and in drivers agedor = 30 and30 years. A third (n = 21) of calls before crashes and on trips during the previous week were reportedly on hand held phones.When drivers use a mobile phone there is an increased likelihood of a crash resulting in injury. Using a hands-free phone is not any safer.

OBJECTIVES: The primary aim of this study was to determine how Parkinson's disease (PD) affects driving performance. It also examined whether changes in driver safety were related to specific clinical disease markers or an individual's self rating of driving ability. METHODS: The driving performance of 25 patients with idiopathic PD and 21 age matched controls was assessed on a standardised open road route by an occupational therapist and driving instructor, to provide overall safety ratings and specific driving error scores. RESULTS: The drivers with PD were rated as significantly less safe (p

Objectives: To test: (1) whether citation under the Minors in Possession (MIP) law, vicarious citation (knowing someone who was cited), and threat of driving licence suspension are associated with decreased intentions to smoke next year; and (2) whether the policy is differentially enforced. Subjects: 28 249 white, Hispanic, and African American students in grades 6-12 (11-18 years old) participated in the study. Method: The 86 item anonymous Texas Youth Tobacco Survey was completed by students attending 37 schools in 14 east and central Texas communities. Results: Hierarchical linear modelling showed that MIP citation was unrelated to the future smoking intentions of most youth. However, there was a negative association between citation and smoking intentions for ever daily smoking youth at four schools. Threat of licence suspension was associated with a lower likelihood of future smoking intentions among ever daily smoking youth and vicarious citation did not deter youth from future smoking. African American and Hispanic youth had a higher probability of being cited than their peers. Conclusions: Threat of driving licence suspension has the intended effect upon youth who are/were committed smokers and MIP citation has the intended effect upon committed smokers at only four schools. However, differential enforcement of the law based on ethnicity may be occurring. Before drawing firm conclusions, current findings must be replicated with longitudinal data to determine the consequences of citation on subsequent tobacco use.

Objectives: To assess what interventions are effective in promoting a population shift from using cars towards walking and cycling, and to assess the health and distributional effects of such interventions. \ud Data sources: Published and unpublished reports in any language identified from electronic databases, bibliographies, websites and reference lists.\ud Review methods: Systematic search and appraisal to identify experimental or observational studies with a prospective or controlled retrospective design that evaluated any intervention applied to an urban population or area by measuring outcomes in members of the local population. \ud Results: 22 studies met the inclusion criteria. We found some evidence that targeted behaviour change programmes can change the behaviour of motivated subgroups, resulting (in the largest study) in a modal shift of around 5% of all trips at a population level. Single studies of commuter subsidies and a new railwy station have also shown modest effects. The balance of best available evidence about publicity campaigns, engineering measures and other interventions suggests that they have not been effective. Participants in trials of active commuting experienced short-term improvements in certain health and fitness measures, but we found no good evidence about the health effects of any effective population-level intervention.\ud Conclusions: The best available evidence of effectiveness is for targeted behaviour change programmes, but the social distribution of their effects is unclear and some other types of intervention remain to be rigorously evaluated. We need a stronger evidence base for the health impacts of transport policies, preferably based on properly conducted prospective studies.

Syncope is a common clinical condition,1 which for obvious reasons constitutes a very drastic form of driving impairment. The legislative and expert panels in most countries have therefore issued laws or guidelines regarding driving and syncope.2–4 So far, however, little is known about the impact of driving recommendations on the behaviour of patients or the incidence of traffic crashes. All patients referred to us for investigation of syncope who hold a driving licence are routinely given verbal advice on driving by the physician doing the diagnostic work up. From February 1998 until June 2000 we conducted an anonymous survey among these patients. The survey was based on self reporting and consisted of two short structured interviews about history of syncope, driving, and crashes. We did the first interview on the day of head-up tilt table testing, and …

Introduction Freeway accidents are a leading cause of death in China, which also triggers substantial economic loss and an emotional burden to society. However, the internal mechanism of how microscopic kinetic parameters of vehicles influenced by road characteristics determine the occurrence of different types of accidents has not been explicitly studied. This research aimed to explore the “link role” of tire microscopic kinetic parameters in road characteristic variables and traffic accidents to aid in facilitating the traffic design and management, and thus to prevent traffic accident. Method: A mountain freeway in Zhejiang Province, China was used as the research object and the data used in this paper were obtained through a real-time vehicle experiment. Multiple estimation models, including the standard ordered logit (SOL) model, fixed parameters logit (FPL) model, and random parameters logit (RPL) model were established. Results: The findings show that road characteristics will affect the longitudinal kinetic characteristics of the vehicle and, consequently, map the level of risk of rear-end accidents. Driving compensation effects were also identified in this paper (i.e., the drivers tend to be more cautious in complicated driving circumstances). Another finding relating to the mountain freeway is that different tunnel characteristics (e.g., tunnel entrance and tunnel exit) have different effects on different types of traffic accidents. Practical Applications: The framework proposed in this article can provide new insight for researchers to enlarge the research subjects of both explanatory and outcome variables in accident analysis. Future research could be implemented to consider more driving conditions.

This paper proposes a deep learning based object detection method to locate a distant region in an image in real-time. It concentrates on distant objects from a vehicular front camcorder perspective, trying to solve one of the common problems in Advanced Driver Assistance Systems (ADAS) applications, which is, to detect the smaller and faraway objects with the same confidence as those with the bigger and closer objects. This paper presents an efficient multi-scale object detection network, termed as ConcentrateNet to detect a vanishing point and concentrate on the near-distant region. Initially, the object detection model inferencing will produce a larger scale of receptive field detection results and predict a potentially vanishing point location, that is, the farthest location in the frame. Then, the image is cropped near the vanishing point location and processed with the object detection model for second inferencing to obtain distant object detection results. Finally, the two-inferencing results are merged with a specific Non-Maximum Suppression (NMS) method. The proposed network architecture can be employed in most of the object detection models as the proposed model is implemented in some of the state-of-the-art object detection models to check feasibility. Compared with original models using higher resolution input size, ConcentrateNet architecture models use lower resolution input size, with less model complexity, achieving significant precision and recall improvements. Moreover, the proposed ConcentrateNet architecture model is successfully ported onto a low-powered embedded system, NVIDIA Jetson AGX Xavier, suiting the real-time autonomous machines.

The ability to predict a driver's reaction time to road events could be used in driver safety assistance systems, allowing for autonomous control when a driver may be about to react with sup-optimal performance. In this paper, we evaluate a number of machine learning and feature engineering strategies that we use to predict the reaction time(s) of 24 drivers to road events using EEG (Electroencephalography) captured in an immersive driving simulator. Subject-independent models are trained and evaluated using EEG features extracted from time periods that precede the road events that we predict the reaction times for. Our paper has two contributions: 1) we predict the reaction times corresponding to individual road events using EEG spectral features from a time period before the onset of the road event, i.e. we take EEG data from 2 seconds before the event, and 2) we predict whether a subject will be a slow or fast responder compared to other drivers.

The rapid development of the economy has promoted the growth of freight transportation. The truck service areas on expressways, as the main places for truck drivers to rest, play an important role in ensuring the driving safety of trucks. If these service areas are constructed densely or provide a plentiful supply of parking areas, they are costly to construct. However, if the distance between two adjacent truck service areas is very large or the number of truck parking spaces in service areas is small, the supply will fail to meet the parking needs of truck drivers. In this situation, the continuous working time of truck drivers will be longer, and this is likely to cause driver fatigue and even traffic accidents. To address these issues, this paper established a non-linear optimization model for truck service area planning of expressways to optimize truck driving safety. An improved genetic algorithm is proposed to solve the model. A case study of a 215.5-kilometers-length section of the Guang-Kun expressway in China was used to demonstrate the effectiveness of the model and algorithm. As validated by this specific case, the proposed model and solution algorithm can provide an optimal plan for the layout of truck service areas that meet the parking needs of truck drivers while minimizing the service loss rate. The research results of this paper can contribute to the construction of truck service areas and the parking management of trucks on expressways.

Objectives—To determine whether patients who return to driving after head injury can be considered safe to do so and to compare the patient characteristics of those who return to driving with those who do not. Methods—In a multicentre qualitative study 10 rehabilitation units collectively registered 563 adults with traumatic brain injury during a 2.5 year period. Recruitment to the study varied from immediately after hospital admission to several years after injury. Patients and their families were interviewed around 3 to 6 months after recruitment. A total of 383 (67.5%) subjects were interviewed within 1 year of injury, of whom 270 (47.6%) were interviewed within 6 months of injury. Main outcome measures were the presence or absence of driving related problems reported by drivers and ex-drivers, and scores on driving related items of the functional independence/functional assessment measure (FIM+FAM). Results—Of the 563 patients 381 were drivers before the injury and 139 had returned to driving at interview. Many current drivers reported problems with behaviour (anger, aggression, irritability; 67 (48.2%)), memory ( 89 (64%)), concentration and attention (39 (28.1%)), and vision (39 (28.1%)). Drivers reported most driving related problems as often as ex-drivers, main exceptions were epilepsy and community mobility. Current drivers scored significantly higher on the FIM+FAM (were more independent),than ex-drivers. The driving group had sustained less severe head injuries than ex-drivers; nevertheless, 78 (56.2%) current drivers had received a severe head injury. Few (61 (16%)) previous drivers reported receiving formal advice about driving after injury. Conclusions—The existence of problems which could significantly aVect driving does not prevent patients returning to driving after traumatic brain injury. Patients should be assessed for both mental and physical status before returning to driving after a head injury,and systems put in place to enable clear and consistent advice to be given to patients about driving. (J Neurol Neurosurg Psychiatry 2001;70:761‐766)

BACKGROUND Driving is a complex form of activity involving especially cognitive and psychomotor functions. These functions may be impaired by Parkinson’s disease. The relation between Parkinson’s disease and driving ability is still obscure and clinicians have to make decisions concerning the driving ability of their patients based on insufficent information. Until now no studies have compared different methods for evaluating the driving ability of patients with Parkinson’s disease. METHODS The driving ability of 20 patients with idiopathic Parkinson’s disease and 20 age and sex matched healthy control subjects was evaluated by a neurologist, psychologist, vocational rehabilitation counsellor, and driving instructor using a standard 10 point scale. The patients and controls also evaluated their own driving ability. Cognitive and psychomotor laboratory tests and a structured on road driving test were used for evaluating the subjects’ driving ability. RESULTS The patients with Parkinson’s disease performed worse than the controls both in the laboratory tests and in the driving test. There was a high correlation between the laboratory tests and driving test both in the patient group and in the control group. Disease indices were not associated with the driving test. The neurologist overestimated the ability of patients with Parkinson’s disease to drive compared with the driving ability evaluated by the structured on road driving test and with the driving related laboratory tests. Patients themselves were not capable of evaluating their own ability reliably. CONCLUSION Driving ability is greatly decreased in patients with even mild to moderate Parkinson’s disease. The evaluation of patients’ driving ability is very difficult to carry out without psychological and psychomotor tests and/or a driving test.