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Cannabis and its major constituents, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are being widely used to treat sleep disturbances. However, THC can cause acute cognitive and psychomotor impairment and there are concerns that driving and workplace safety might be compromised the day after evening use. Here, we examined possible 'next day' impairment following evening administration of a typical medicinal cannabis oil in adults with insomnia disorder, compared to matched placebo. This paper describes the secondary outcomes of a larger study investigating the effects of THC/CBD on insomnia disorder. Twenty adults [16 female; mean (SD) age, 46.1 (8.6) y] with physician-diagnosed insomnia who infrequently use cannabis completed two 24 h in-laboratory visits involving acute oral administration of combined 10 mg THC and 200 mg CBD ('THC/CBD') or placebo in a randomised, double-blind, crossover trial design. Outcome measures included 'next day' (≥9 h post-treatment) performance on cognitive and psychomotor function tasks, simulated driving performance, subjective drug effects, and mood. We found no differences in 'next day' performance on 27 out of 28 tests of cognitive and psychomotor function and simulated driving performance relative to placebo. THC/CBD produced a small decrease (-1.4%, p=.016, d=-0.6) in accuracy on the Stroop-Colour Task (easy/congruent) but not the Stroop-Word Task (hard/incongruent). THC/CBD also produced a small increase (+8.6, p=.042, d=0.3) in self-ratings of Sedated at 10 h post-treatment, but with no accompanying changes in subjective ratings of Alert or Sleepy (p's>0.05). In conclusion, we found a lack of notable 'next day' impairment to cognitive and psychomotor function and simulated driving performance following evening use of 10 mg oral THC, in combination with 200 mg CBD, in an insomnia population who infrequently use cannabis. [ABSTRACT FROM AUTHOR]

Background: Mild traumatic brain injury (mTBI) and traffic-related injuries are two major public health problems disproportionately affecting young people. Young drivers, whose driving skills are still developing, are particularly vulnerable to impaired driving due to brain injuries. Despite this, there is a paucity of research on how mTBI impacts driving and when it is safe to return to drive after an mTBI. This paper describes the protocol of the study, R2DRV, Longitudinal Assessment of Driving After Mild TBI in Young Drivers, which examines the trajectory of simulated driving performance and self-reported driving behaviors from acutely post-injury to symptom resolution among young drivers with mTBI compared to matched healthy drivers. Additionally, this study investigates the associations of acute post-injury neurocognitive function and cognitive load with driving among young drivers with and without mTBI. Methods: A total of 200 young drivers (ages 16 to 24) are enrolled from two study sites, including 100 (50 per site) with a physician-confirmed isolated mTBI, along with 100 (50 per site) healthy drivers without a history of TBI matched 1:1 for age, sex, driving experience, and athlete status. The study assesses primary driving outcomes using two approaches: (1) high-fidelity driving simulators to evaluate driving performance across four experimental study conditions at multiple time points (within 96 h of injury and weekly until symptom resolution or 8 weeks post-injury); (2) daily self-report surveys on real-world driving behaviors completed by all participants. Discussion: This study will fill critical knowledge gaps by longitudinally assessing driving performance and behaviors in young drivers with mTBI, as compared to matched healthy drivers, from acutely post-injury to symptom resolution. The research strategy enables evaluating how increased cognitive load may exacerbate the effects of mTBI on driving, and how post-mTBI neurocognitive deficits may impact the driving ability of young drivers. Findings will be shared through scientific conferences, peer-reviewed journals, and media outreach to care providers and the public. [ABSTRACT FROM AUTHOR]

Driving after drug use like heroin increases the risk of traffic crashes and such drug driving accidents have appeared more frequently over the past ten years. The current study compared the driving performance of drivers with heroin addiction and healthy controls. The participants were required to attend the Lane Change Task (LCT) and the adapted Change/No Change task to measure driving performance. In addition, the Attention Bias Task was used to quantify the drug addiction severity. Results showed that heroin misusers performed poorer driving performance than the healthy controls in the LCT task and in the Change/ No Change task. The correlation between attention bias to drug and driving performance indicated that addiction severity was associated with poorer driving performance. The results of this study suggest that the mechanisms of how drug use changes attention bias, which thereby further impairs driving performance. This study can inform how to persuade drivers of drug use and provide suggestions on how to give up drugs and thus improve driving safety. [ABSTRACT FROM AUTHOR]

Extra-long tunnels have adverse effects on driving performance since drivers will be affected by the enclosed, dimly lit, and monotonous environment for a longer time. In the context of the increasing number of extra-long tunnels, this study aims to investigate the effects of extra-long freeway tunnels with a length of 20 km on driving performance using driving simulation tests. Factors including the tunnel environment, driving time, traffic flow, and gender were considered as influencing factors. Performance indicators including the brake reaction time, standard deviation of driving speed, and standard deviation of lateral position were collected. A total of 60 drivers were recruited for the driving simulation study, and the relationships between the driving performance indicators and influencing factors were analyzed by establishing linear mixed models with random intercept. The results demonstrate that driving performance significantly degraded after 5 – 6 min of driving in the extra-long tunnel although drivers were more cautious and presented a better performance when just entering the tunnel. Moderately higher traffic flow could improve driving performance in the extra-long tunnel but not on the open road. Meanwhile, female drivers had better lateral and longitudinal stability in the extra-long tunnel, while no significant difference was witnessed in reaction ability and driving performance on the open road. [ABSTRACT FROM AUTHOR]

Purpose: We sought to determine the effect of acute severe hypoxia, with and without concurrent manipulation of carbon dioxide (CO2), on complex real-world psychomotor task performance. Methods: Twenty-one participants completed a 10-min simulated driving task while breathing room air (normoxia) or hypoxic air (PETO2 = 45 mmHg) under poikilocapnic, isocapnic, and hypercapnic conditions (PETCO2 = not manipulated, clamped at baseline, and clamped at baseline + 10 mmHg, respectively). Driving performance was assessed using a fixed-base motor vehicle simulator. Oxygenation in the frontal cortex was measured using functional near-infrared spectroscopy. Results: Speed limit exceedances were greater during the poikilocapnic than normoxic, hypercapnic, and isocapnic conditions (mean exceedances: 8, 4, 5, and 7, respectively; all p ≤ 0.05 vs poikilocapnic hypoxia). Vehicle speed was greater in the poikilocapnic than normoxic and hypercapnic conditions (mean difference: 0.35 km h−1 and 0.67 km h−1, respectively). All hypoxic conditions similarly decreased cerebral oxyhaemoglobin and increased deoxyhaemoglobin, compared to normoxic baseline, while total hemoglobin remained unchanged. Conclusions: These findings demonstrate that supplemental CO2 can confer a neuroprotective effect by offsetting impairments in complex psychomotor task performance evoked by severe poikilocapnic hypoxia; however, differences in performance are unlikely to be linked to measurable differences in cerebral oxygenation. [ABSTRACT FROM AUTHOR]

Rationale: Alcohol-induced driving impairment can occur with any departure from a zero-blood alcohol concentration (BAC). Because intoxication is characterised by impaired judgement, drivers under the influence of alcohol may overestimate their capacity to safely operate a vehicle. Objectives: This study examined the effects of alcohol on driving performance, four-choice reaction time (FCRT), and self-rated confidence in driving ability. It specifically focused on alcohol doses equal to commonly enforced legal BAC limits (i.e. 0.05% and 0.08%). Methods: A randomized, double-blind, placebo-controlled design was utilised. Seventeen participants were tested in three conditions: placebo and two alcohol conditions aiming for BACs of 0.05% and 0.08%. Participants underwent a baseline FCRT task and a 1-h simulated highway driving task before completing another FCRT task and rated their confidence in their driving ability. Results: The high and low alcohol dose conditions resulted in a mean BAC of 0.07%, and 0.04%, respectively (n = 17). The high BAC treatment significantly increased standard deviation of lateral position (SDLP) by 4.06 ± 5.21 cm and standard deviation of speed (SDS) by 0.69 ± 0.17 km/h relative to placebo, while confidence in driving ability remained unchanged across treatments. FCRT performance was impaired by the high BAC treatment (all < 0.01), but there we no significant differences between placebo and low BAC conditions. Conclusions: The findings of this study show that driving performance and associated psychomotor functioning become significantly impaired below legally permissible driving limits in some jurisdictions. We identified a dissociation between driving performance and subjective awareness of impairment. Despite a significantly diminished driving ability at 0.07% BAC, drivers were unaware of their impairment. [ABSTRACT FROM AUTHOR]

This study explores the influence of cooperative vehicle infrastructure system (CVIS) on the driver's visual and driving performance. Taking the work zone as an example, a driving simulation experiment involving 37 drivers has been conducted to collect driver's eye movement and vehicle running data in the same scenario with and without CVIS information respectively. Next, the nonparametric test and grey relational analysis (GRA) have been used to compare the specific performance and to analyze the correlations among the multi-stage of driver's information process. The results present that CVIS information has the potential to alleviate the driver's tension and the difficulty of information perception. Meanwhile, the driver tends to search visual information more actively and complete the lane changing behavior earlier. Further analysis indicates that CVIS information can reduce the influence of mental workload on lane-changing decisions, and enhance the correlation between visual information processing and lane-changing decisions, as well as the effect of decision-making timing on the running state. Therefore, drivers' speed control ability was improved and the traffic flow was smoother. The findings give an insight into the influence mechanism of the cooperative information on driving performance and provide a direction for a comprehensive assessment of CVIS based on human factors. [ABSTRACT FROM AUTHOR]

Rationale: The effects of hypnotics on automobile driving have been attracting increasing attention. However, few driving simulators (DSs) have been confirmed to have acceptable reliability and validity for assessing the next-day residual effects of zopiclone as a positive control on driving performance. Objective: To investigate whether a new DS could permit detection of the next-day residual effects of zopiclone on driving performance. Methods: In this double-blind, randomized, placebo-controlled crossover trial, 28 healthy males received zopiclone 7.5 mg at bedtime on days 1 and 8 and placebo on the other days over a period of 16 days. The participants took part in three driving tasks—road-tracking, car-following, and harsh-braking—using a DS on days 2 and 9 at 9-h post-dosing. Scores on the Karolinska Sleepiness Scale and Profile of Mood States-Second Edition were then assessed, as was the serum concentration of zopiclone. Results: The estimated differences in the standard deviation of lateral position (cm) in the road-tracking task between the zopiclone and placebo groups on days 2 and 9 were 3.75 cm (90% confidence interval (CI): 1.71–5.79) and 4.07 cm (90% CI: 2.02–6.11), respectively. The estimated differences in the distance coefficient of variation in the car-following task and in the brake reaction time in the harsh-braking task between the zopiclone and placebo groups on day 2 were 4.31 (90% CI: 1.94–6.69) and 24.6 ms (90% CI: 12.7–36.4), respectively. Conclusions: The DS used in this study has sufficient sensitivity to detect the next-day residual effects of zopiclone on driving performance. [ABSTRACT FROM AUTHOR]

Rationale: Although driving simulators (DS) are receiving increasing attention due to concern over traffic accidents under the influences of drugs, few DS are recognized for their reliability and validity. Therefore, the development of an evaluation system using DS for driving performance is urgently needed. Objectives: To investigate whether the standard deviation of lateral position (SDLP) increases with blood alcohol concentration (BAC) using a DS with reliability and calculate the SDLP threshold from the difference between BAC levels of 0 and 0.05%. Methods: Twenty healthy Japanese men performed the DS tasks up to 60 min in Study 1 and DS tasks twice at 1-week intervals in Study 2. Twenty-six healthy men conducted the same DS tasks under BAC level (0, 0.025, 0.05, and 0.09%) in double-blind, randomized, crossover trial in Study 3. The primary outcome was SDLP in a road-tracking test. The test–retest reliability of DS data was assessed, and the estimated difference in SDLP between BAC levels of 0 and 0.05% was calculated using a linear regression model. Results: The cumulative SDLP values at 5-min intervals were stable, and the intraclass correlation coefficient for its values was 0.93. SDLP increased with BAC in a concentration-dependent manner. The predicted ΔSDLP value for the difference between BAC levels of 0 and 0.05% was 9.23 cm. No participants dropped out because of simulator sickness. Conclusions: The new DS used in these studies has reliability, validity, and tolerability and is considered suitable for evaluating the influence of drugs on driving performance. [ABSTRACT FROM AUTHOR]

Adults with dyslexia may find difficulties in reading the messages on variable message signs (VMS) while driving. These signs are an essential part of the traffic communication systems, aimed at informing road users of special circumstances, such as congestion, traffic diversion, or unexpected events. A driving simulation experiment was conducted to test if complementary audio versions of the VMS would be helpful for drivers with dyslexia. Twenty adults with dyslexia and 20 matched controls participated. They were asked to classify the messages displayed on VMS posted along a simulated route, which was completed twice: one with text VMS (visual condition), and another one with text VMS plus complementary audio messages (audio + visual condition). The results showed that in the ordinary, visual condition, the participants with dyslexia needed to be closer to the VMS than controls to correctly classify the message, but, crucially, these group differences vanished when the driver received an audio version of the message (audio + visual condition). Moreover, the availability of audio versions had positive effects for all participants, as shown by higher accuracy in the message classification task, as well as better driving performance. Therefore, technologies aimed at providing audio versions of VMS can help drivers with dyslexia. A mobile application, READit VMS, which is able to provide real-time complementary audio versions of VMS, is presented as an example. [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine whether an elderly subject without diabetes experiences hypoglycemia during his daily life or after an oral glucose tolerance test (OGTT), and investigate whether hypoglycemic episodes affect cognitive function. The 85-year-old healthy subject, who is a sports enthusiast, showed lower than normal (< 80 mg/dl) blood glucose levels on two occasions over 6 days in the early morning. The subject also experienced hypoglycemic episodes and blood glucose levels of 65 and 74 mg/dl, respectively, during the 6-h OGTT given after a 13-h fast. Cognitive function, as assessed using a numeracy test and a driving simulator test, deteriorated during the hypoglycemic episodes but recovered 0.5 h after ingestion of a confectionary product (two pieces of Dorayaki containing 247 kcal and 51.5 g of carbohydrate each). Cognitive dysfunction caused by mild hypoglycemia can be involved in a part of traffic accidents in elderly drivers. [ABSTRACT FROM AUTHOR]

Currently, lane change decision aid systems primarily address foveal vision and thus compete for drivers' attention with interfaces of other assistant systems. Also, alternative modalities such as acoustic perception (Mahapatra et al., in: 2008 International conference on advanced computer theory and engineering, pp 992–995. https://doi.org/10.1109/ICACTE.2008.165, 2008), tactile perception (Löcken et al., in: Adjunct proceedings of the 7th international conference on automotive user interfaces and interactive vehicular applications, AutomotiveUI '15, pp 32–37. ACM, New York, NY, USA. https://doi.org/10.1145/2809730.2809758, 2015), or peripheral vision (Löcken et al., in: Proceedings of the 7th international conference on automotive user interfaces and interactive vehicular applications, AutomotiveUI '15, pp 204–211. ACM, New York, NY, USA. https://doi.org/10.1145/2799250.2799259, 2015), have been introduced for lane change support. We are especially interested in ambient light displays (ALD) addressing peripheral vision since they can adapt to the driver's attention using changing saliency levels (Matthews et al., in: Proceedings of the 17th Annual ACM symposium on user interface software and technology, UIST '04, pp 247–256, ACM. https://doi.org/10.1145/1029632.1029676, 2004). The primary objective of this research is to compare the effect of ambient light and focal icons on driving performance and gaze behavior. We conducted two driving simulator experiments. The first experiment evaluated an ambient light cue in a free driving scenario. The second one focused on the difference in gaze behavior between ALD and focal icons, called "abstract faces with emotional expressions" (FEE). The results show that drivers decide more often for safe gaps in rightward maneuvers with ambient light cues. Similarly, drivers decide to overtake more often when the gaps are big enough with both displays in the second experiment. Regarding gaze behavior, drivers looked longer towards the forward area, and less often and shorter into the side mirrors when using ALD. This effect supports the assumption that drivers perceive the ALD with peripheral vision. In contrast, FEE did not significantly affect the gaze behavior when compared to driving without assistance. These results help us to understand the effect of different modalities on performance and gaze behavior, and to explore appropriate modalities for lane change support. [ABSTRACT FROM AUTHOR]

Driving on the curved road is a common task that many drivers routinely performed, but there is an underlying impact on driver behavior and vehicle maneuverability. Previous studies have shown that driving performance (speed and acceleration) and visual performance (gaze and Useful Field of View (UFOV)), can be critical components of curve analysis. However, with the change of road conditions, there are increasing safety concerns for the driving environment required to determine vehicle safety maneuverability. In this study, we examined how different curved roads influence concurrent-driver driving behavior and vehicle maneuvering performance along a simulated continuously curved road. Twenty-eight participants of different ages and occupations were invited to participate. A structural equation model was established to represent how the road geometry influences driving performance and vehicle maneuverability. The results showed that there are clear differences in driving behavior and vehicle maneuvering performance between the curved road groups. Driver will suffer a more complex driving environment, and must observe more objects, which will result in increasing lane position errors, gazing, and workload, while decreasing speed, acceleration and UFOV. [ABSTRACT FROM AUTHOR]

An electric motor coupled with a gear train generates driving torque to move step band and handrail band together with passenger load for operation. Therefore, understanding of electric motor dynamics and its influence on escalator system in transient and steady state is very important for both product development and service operation in compliance with safety code requirement. A multidisciplinary escalator simulation model in complete system-level is introduced based on multibody dynamics technology including 3-phase induction motor, gear train inside of machine gearbox, step band, handrail band and all other drive chain bands. Torque from 3-phase induction motor is considered in the system model by the flux linkages equations derived from d-q axis equivalent circuit. The verified simulation model compared with Thévenin's equivalent circuit model is used to investigate driving performance of an escalator system in different passenger load condition. [ABSTRACT FROM AUTHOR]

Various studies show that drowsiness reduces driver alertness and can significantly affect driver performance. In this paper, we investigate the effect of drowsiness on the interaction with the in-vehicle infotainment system (IVIS) while driving. The motivation was to investigate whether a specific type of user interface can provide better performance and lower distraction when the driver is drowsy. The users were asked to navigate a vehicle in a driving simulator and simultaneously perform a set of tasks of varying complexity first when they were rested and alert and then when they were drowsy, after 7 h without sleep. A hierarchical, list-based menu was presented using a stereoscopic head-up display (HUD) and a head-down display (HDD). Based on the results, no general and statistically significant connection was found between drowsiness and driving performance. Surprisingly, the secondary task performance was even better when participants were drowsy, which was evident from the faster task completion times. This could be attributed to extra efforts invested in executing tasks as a result of the participants being aware of their drowsiness. However, when comparing the participants’ performance using HUD and HDD displays, the results showed that using HUD introduces less mental fatigue than using HDD but only in rested and alert condition. No significant difference between the displays was found in the drowsy state. [ABSTRACT FROM AUTHOR]

This paper suggests a real-time method for detecting a driver’s cognitive and visual distraction using lateral driving performance measures. The algorithm adopts radial basis probabilistic neural networks (RBPNNs) to construct classification models. In this study, combinations of two driving performance data measures, including the standard deviation of lane position (SDLP) and steering wheel reversal rate (SRR), were considered as measures of distraction. Data for training and testing the RBPNN models were collected under simulated conditions in which fifteen participants drove on a highway. While driving, they were asked to complete auditory recall tasks or arrow search tasks to create cognitively or visually distracted driving periods. As a result, the best performing model could detect distraction with an average accuracy of 78.0 %, which is a relatively high accuracy in the human factors domain. The results demonstrated that the RBPNN model using SDLP and SRR could be an effective distraction detector with easy-to-obtain and inexpensive inputs. [ABSTRACT FROM AUTHOR]

Recently, haptic guidance technologies have been proposed to enhance driving safety. This study concentrates on the influence of haptic guidance on driving behaviours estimated using mechanical arm admittance, while facing critical driving situation. We constructed an adaptable haptic guidance model, which can assist a driver to follow an ideal trajectory, with real-time steering feedback based on the monitoring of the lateral position and the yaw angle of the vehicle. In a driving simulator experiment, fourteen participants experienced seven designs of the haptic guidance model under three different amplitudes of steering perturbations. For high steering perturbation amplitudes, haptic guidance was effective in increasing arm stiffness leading to an improvement of the steering stability. For low steering perturbation amplitudes, arm stiffness was decreased by haptic guidance but the trajectory stability was enhanced. [ABSTRACT FROM AUTHOR]

Glare from oncoming headlights is a problem for nighttime drivers because it can decrease visual acuity and cause discomfort. This diminished visual ability and discomfort due can increase drivers' risk for traffic accidents. Older drivers experience more severe detrimental effects from nighttime glare, and these effects may pose a growing roadway hazard as the number of older drivers increases. The increased brightness of popular high-intensity-discharge (HID) headlights may further exacerbate these visibility problems. In a sample of younger (under 40 years of age) and older (40 years of age and older) drivers, we examined the impact of headlight glare from HID and traditional halogen lights on driving performance in a simulator, as well as the effectiveness of novel polarized glare-reducing eyeglasses for mitigating glare-induced performance deficits. The glare-reducing glasses increased visual awareness in the face of oncoming HID headlights compared to halogen headlights in both age groups. Older drivers performed significantly worse than did younger drivers on several measures of driving and visual detection performance. The glare-reducing glasses mitigated performance deficits, with older drivers performing similarly to younger drivers when exposed to HID headlights while wearing the polarized glasses. Due to the introduction of brighter LED-based headlights to the consumer automotive market and an expanding population of older drivers, automotive manufactures should consider glare-mitigation strategies when designing future headlight systems. [ABSTRACT FROM AUTHOR]

The present study was designed to examine driving skills according to regulations of the German guidelines for road and traffic safety in unmedicated schizophrenic inpatients. A total of 13 first-episode (FES) and 13 recurrent-episode (RES) schizophrenic inpatients were included in the analysis and compared with a group of 20 healthy controls (HC). Data were collected with the computerised Wiener Testsystem measuring visual perception, reactivity and stress tolerance, concentration and vigilance. Analysis of data indicates that a great proportion (58 %) of schizophrenic patients were impaired in psychomotor functions related to driving skills. FES and RES significantly differed with respect to driving ability with a greater proportion in the FES (38 %) showing severe impairments when compared with RES (25 %). Differences with respect to HC performance were most pronounced in concentration and for the FES additionally in visual perception. Analysis of our data indicates that a great proportion of schizophrenic patients are impaired in psychomotor functions related to driving skills that cannot be attributed to adverse side effects of psychopharmacological treatment. Besides, we cannot confirm a chronical decline of psychomotor functions related to driving skills at least in the early course of schizophrenic illness. [ABSTRACT FROM AUTHOR]

To examine the effects of alcohol regarding the fitness required to ride a bicycle, practical cycling tests, accompanied by medical examinations, were carried out at different blood alcohol concentrations. Seventy-eight persons were included in the trials (41 males, 37 females). Eighty-three evaluable trials were obtained. Men committed less coordinative driving faults with comparable blood alcohol concentrations. Single highly alcoholized men were able to safely ride their bicycle; however, each of the female test persons had at least one severe driving fault at blood alcohol levels above 1.43 g/kg. Women tended to exhibit signs of alcoholization in the medical examination reports earlier than men. [ABSTRACT FROM AUTHOR]

Rationale: The driving simulator provides a safe and controlled environment for testing driving behaviour efficiently. The question is whether it is sensitive to detect drug-induced effects. Objective: The primary aim of the current study was to investigate the sensitivity of the driving simulator for detecting drug effects. As a case in point, we investigated the dose-related effects of oral ∆-tetrahydrocannabinol (THC), i.e. dronabinol, on simulator and on-the-road driving performance in equally demanding driving tasks. Method: Twenty-four experienced driver participants were treated with dronabinol (Marinol®; 10 and 20 mg) and placebo. Dose-related effects of the drug on the ability to keep a vehicle in lane (weaving) and to follow the speed changes of a lead car (car following) were compared within subjects for on-the-road versus in-simulator driving. Additionally, the outcomes of equivalence testing to alcohol-induced effects were investigated. Results: Treatment effects found on weaving when driving in the simulator were comparable to treatment effects found when driving on the road. The effect after 10 mg dronabinol was however less strong in the simulator than on the road and inter-individual variance seemed higher in the simulator. There was, however, a differential treatment effect of dronabinol on reactions to speed changes of a lead car (car following) when driving on the road versus when driving in the simulator. Conclusion: The driving simulator was proven to be sensitive for demonstrating dronabinol-induced effects particularly at higher doses. Treatment effects of dronabinol on weaving were comparable with driving on the road but inter-individual variability seemed higher in the simulator than on the road which may have potential effects on the clinical inferences made from simulator driving. Car following on the road and in the simulator were, however, not comparable. [ABSTRACT FROM AUTHOR]

Rationale: Hypnotics are widely used to treat insomnia but adverse effects of different hypnotics, especially benzodiazepine receptor agonists, are getting more attention lately. The effects of novel hypnotics have not been fully examined. Objective: This study aims to assess the effects of two hypnotics, ramelteon and triazolam, on driving performance, cognitive function, and equilibrium function. Methods: In this double-blinded, three-way crossover trial, 17 healthy males received acute doses of 8 mg ramelteon, 0.125 mg triazolam, and placebo. The subjects were administered three driving tasks-road-tracking, car-following, and harsh-braking-using a driving simulator and three cognitive tasks-Continuous Performance Test, N-back Test, and Trail-Making Test-at baseline and at 1 and 4 h post-dosing. The Stanford Sleepiness Scale scores and computerized posturography were also assessed. Results: In the driving simulations, ramelteon and triazolam increased the number of subjects who slid off the road. Triazolam increased the standard deviation of lateral position compared to ramelteon and placebo at 1 h post-dosing. Ramelteon and triazolam significantly increased the time to complete of Trail-Making Test part A and the environmental area in posturography compared to placebo at 1 and 4 h post-dosing. Ramelteon and triazolam significantly increased subjective sleepiness compared to placebo at 1 h post-dosing. Conclusions: Ramelteon may affect road-tracking performance, visual attention and/or psychomotor speed measured by Trail-Making Test part A, and body balance in acute dosing. Lower dose of triazolam also impaired performance worse than ramelteon. Physicians should consider risks and benefits when prescribing both drugs, especially in the initial period of administration. [ABSTRACT FROM AUTHOR]

To determine the threshold for the absolute inability to ride a bicycle, practical cycling tests and medical examinations at different blood alcohol concentrations were performed. Special attention was given to additional medical examinations, reaction tests and alcohol consumption under real-life conditions. Seventy-eight test subjects were included in the trials (37 females, 41 males). Five test subjects participated twice; thus, there were a total of 83 evaluable trials. Alcohol-related deficits were already identifiable at very low BACs. A significant increase in gross motoric disturbances compared to the soberness state did not regularly occur until a BAC of at least 0.8 g/kg was reached. At the BAC of 1.4 g/kg and above, no test subjects were able to achieve or surpass their sober driving results. Isolated highly alcoholised test subjects rode the bike in a manner that was not conspicuously different than the other sober test persons. Contrary to the assumptions of current German legal practise, it cannot be stated that all people are 'absolutely impaired' to the point of being incapable of riding bicycle at BACs of at least 1.6 g/kg. [ABSTRACT FROM AUTHOR]

Rationale: Some recent pharmacoepidemiological studies revealed an elevated risk of driving accidents after opioid analgesics uses. Among analgesics, codeine is often associated with paracetamol in numerous pharmaceutical specialties. Objectives: The objective of this study was to evaluate the dose-effect relationship of three usual therapeutic doses of codeine/paracetamol on driving ability, psychomotor performance, subjective alertness, in link with blood concentrations in healthy young volunteers. Methods: Driving performance, responses to psychomotor vigilance tests, and scales reflecting alertness were evaluated during the morning after drug intake in a double-blind, randomized, placebo-controlled study. Sixteen healthy volunteers (23.4 ± 2.7 years old, 8 men and 8 women) participated in this balanced, cross-over study. Three doses of codeine/paracetamol (20/400, 40/800, 60/1200 mg) were evaluated against placebo. Two blood samples were collected, 1 and 4 h after drug intake. In serum, codeine and morphine concentrations were determined in serum using high-performance liquid chromatography electrospray ionization-tandem mass spectrometry, and paracetamol concentrations using fluorescence polarization immunoassay. Results: Driving and psychomotor performance were not affected by any of the three codeine/paracetamol doses. However, significant, though modest, correlations were observed between the driving parameters and both morphine and codeine blood concentrations. Conclusions: This study did not reveal any significant impairment in performance due to the three therapeutic doses used in healthy young volunteers. However, the relationships between drug blood concentration and behavioral measures suggest that an inter-subject variability in blood concentration may influence the power of the observed drug effect. [ABSTRACT FROM AUTHOR]

Distraction effects of three alternative touch screen scrolling methods for searching music tracks on a mobile device were studied in a driving simulation experiment with 24 participants. Page-by-page scrolling methods with Buttons or Swipe that better facilitate resumption of visual search following interruptions were expected to lead to more consistent in-vehicle glance durations and thus on less severe distraction effects than Kinetic scrolling. As predicted, Kinetic scrolling induced decreased visual sampling efficiency and increased visual load compared with Swipe, increased experienced workload compared with both Buttons and Swipe, as well as decreased lane-keeping accuracy compared with baseline. However, Buttons did not significantly excel Kinetic with any metric but on subjective ratings. Based on the results, we do not recommend the use of kinetic scrolling with in-vehicle touch screen displays in the manner used in the experiment. Instead, page-by-page swiping seems to suit significantly better for in-vehicle displays due to its systematic nature and low levels of pointing accuracy required for scrolling the pages. [ABSTRACT FROM AUTHOR]

Korea is currently experiencing a rapidly increasing distribution rate of in-vehicle display devices, such as navigation or DMB displays, owing to remarkable advances in IT. At the same time, the number of traffic accidents and traffic violations is increasing due to the distraction of drivers' attention by such devices. In particular, in-vehicle display devices such as navigation systems temporarily distract drivers' visual or cognitive attention when they perform a unit task. Accordingly, it is necessary to prepare adequate standards to regulate in-vehicle display devices, especially in Korea. There are few empirical studies that have employed experiments to support such regulation. In this study, an experiment was conducted using a driving simulator to establish the proper standards regarding the maximum distraction time per unit task that can be allowed without causing any disturbance in safe driving. A total of 25 participants participated in the experiment. The distraction time was controlled by asking participants to perform the two tasks at once: while participants were driving as a primary task, they performed secondary task that count the number of intersections between the start point and the arrival point displayed on the screen. The results showed that the 2.0 second condition differed from the controlled condition in the deviation in the distance from the preceding vehicle, speed, and steering wheel movement, whereas there were no differences between the controlled condition and the 1.0 or 1.5 second condition. Finally, the limitations of the study and the implications of the findings with regard to future studies and application of the Korean version of guidelines for in-vehicle display devices are discussed. [ABSTRACT FROM AUTHOR]

Driving a car is vital for the functional autonomy of patients to take part in activities of daily living. Both psychopathologic symptoms and psychopharmacologic treatment may impair driving ability. This article provides a systematic review of published studies (1980-2011) on commonly prescribed newer antidepressants and driving performance. A total of 21 studies could be included in the review, indicating that there is a lack of controlled patient studies. Investigations on newer antidepressants were frequently undertaken in healthy subjects focusing on acute or subchronic effects of application, predominately in young male participants, with dosages usually given in an ambulatory setting. No data, according to selection criteria, were found with respect to agomelatine, duloxetine, bupropion and viloxazine. There is evidence that the SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline, paroxetine) and the SNRI venlafaxine have no deleterious effects on driving ability. Acute use of mirtazapine does produce impairments that diminish to some degree when given as a nocturnal dose and cannot be seen after repeated dosing in healthy controls. Patients obviously benefit from treatment with newer antidepressants; however, at least a subgroup does not reach performance level of healthy subjects. More patient studies are needed that elaborate specific relationships between clinical subtypes of the illness and response to different antidepressants, considering course and duration of illness, co-morbidities and not least neuropsychological and neurobiological characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Obstructive sleep apnoea (OSA) patients effectively treated by and compliant with continuous positive air pressure (CPAP) occasionally miss a night's treatment. The purpose of this study was to use a real car interactive driving simulator to assess the effects of such an occurrence on the next day's driving, including the extent to which these drivers are aware of increased sleepiness. Methods: Eleven long-term compliant CPAP-treated 50-75-year-old male OSA participants completed a 2-h afternoon, simulated, realistic monotonous drive in an instrumented car, twice, following one night: (1) normal sleep with CPAP and (2) nil CPAP. Drifting out of road lane ('incidents'), subjective sleepiness every 200 s and continuous electroencephalogram (EEG) activities indicative of sleepiness and compensatory effort were monitored. Results: Withdrawal of CPAP markedly increased sleep disturbance and led to significantly more incidents, a shorter 'safe' driving duration, increased alpha and theta EEG power and greater subjective sleepiness. However, increased EEG beta activity indicated that more compensatory effort was being applied. Importantly, under both conditions, there was a highly significant correlation between subjective and EEG measures of sleepiness, to the extent that participants were well aware of the effects of nil CPAP. Conclusions: Patients should be aware that compliance with treatment every night is crucial for safe driving. [ABSTRACT FROM AUTHOR]

Rationale: Stimulant drugs are commonly abused and also used to promote wakefulness, yet their effects on driving performance during sleep deprivation have not been thoroughly researched in experimental studies. Objectives: The aims were to assess the effects on fundamental driving parameters during simulated driving of two doses of d-amphetamine and further to assess the interaction between d-amphetamine and sleep deprivation. Methods: A double-blind, placebo-controlled experiment including 18 healthy male volunteers was conducted. Results: The participants felt more alert when taking a dose of d-amphetamine than when taking placebo, and the effect was stronger for the higher dose. However, the data did not show any evidence that taking d-amphetamine prevented the subjects from becoming successively sleepier during the night. A significant main effect of the dose was found for three out of the five primary indicators where the lower dose led to improved driving. These indicators were crossing-car reaction time, and coherence and delay from a car-following event. Regarding sleep deprivation, a main effect was found for four of the primary indicators and three of the secondary indicators. The results showed overall impaired driving with respect to standard deviation of lateral position and delay in reaction time when the sleep-deprived conditions were compared to the alert condition. We found no interactions between dose and sleep deprivation for any of the performance indicators. Conclusions: Our results suggest that administration of d-amphetamine does not compensate for impairment of driving due to fatigue. The positive effects of 10 mg were not further improved or even sustained when increasing the dose to 40 mg. [ABSTRACT FROM AUTHOR]

Rationale: In party circuits dexamphetamine is frequently used in combination with alcohol. It is hypothesized that co-administration of dexamphetamine to alcohol might reduce the sedative effects of alcohol, but may potentiate risk-taking behaviour. Objectives: The study was aimed at assessing the effects of alcohol, dexamphetamine and the combination of both on simulated driving and cognitive performance. Method: Eighteen subjects participated in a randomized, crossover, placebo-controlled study employing four conditions: 10 mg dexamphetamine, 0.8 g/kg alcohol, 10 mg dexamphetamine + 0.8 g/kg alcohol, and placebo. Fundamental driving skills and risk-taking behaviour were assessed in a driving simulator. Subjects also completed vigilance and divided attention tasks, and subjective ratings. Results: Mean BAC levels during simulated driving were between 0.91‰ and 0.64‰. Subjects using alcohol showed a significantly larger mean standard deviation of lateral position and shorter accepted gap time and distance. Use of alcohol or dexamphetamine + alcohol was associated with a higher frequency of red light running and collisions than the dexamphetamine or placebo conditions. Performance of vigilance and divided attention tasks was significantly impaired in the alcohol condition and, to a lesser degree, in the dexamphetamine + alcohol condition. Conclusion: Single doses of 0.8 g/kg alcohol increased risk-taking behaviours and impaired tracking, attention and reaction time during a 3-h period after drinking when BACs declined from 0.9 to 0.2 mg/ml. The stimulatory effects of co-administration of dexamphetamine 10 mg were not sufficient to overcome the impairing effects of alcohol on skills related to driving. [ABSTRACT FROM AUTHOR]

Rational: An increasing number of fatal road-accidents have been reported in which ecstasy was found in the blood of drivers. Although, ecstasy is frequently found to have been used in combination with alcohol, studies on the acute effects of ecstasy co-administered with alcohol on driving performance are relatively rare. Objective: The present study was designed to establish the extent of driver impairment as a consequence of ecstasy or combined ecstasy and alcohol use as compared to driving under the influence of 0.3‰, 0.5‰ and 0.8‰ alcohol. Furthermore, subjective performance was also assessed. Results: Alcohol and ecstasy mainly influenced automated driving performance such as lateral and speed control. However, small to no effects of the substances were found on more complex driving behaviour. Overall, variance within the different driving measures was high especially when participants were treated with 3.4-methylenedioxy-methamphetamine (MDMA) and alcohol. Furthermore, equivalence testing showed that combined use may lead to impaired driving for some, but not all, drivers. Participants rated their own performance to be slightly worse than normal in both studies. Since driving was actually seriously deteriorated, this was a falsely positive assessment of their condition. Conclusions: The dissociation between subjective perceptions and objective performance decrements are important notions for traffic safety since this may affect a driver's judgement of whether or not it is safe to drive. For example, an intoxicated individual might decide to drive because the feelings of alertness caused by MDMA cloud the impairing effects of other drugs such as alcohol, thereby creating a potentially serious risk for traffic safety. [ABSTRACT FROM AUTHOR]

Rationale: Although hypnotics are primarily used by older people, the residual effects the morning after a single nighttime intake of the two most commonly prescribed hypnotics, zolpidem (Zp) and zopiclone (Zc), on older middle-aged drivers have not been evaluated and compared. Methods: Sixteen healthy subjects, 55 to 65 years of age, participated in this double-blind, balanced, cross-over study. Zc (7.5 mg), Zp (10 mg) and flunitrazepam (Fln) (1 mg) or a placebo was administered at each subject's home at 11.00 pm. The next morning, at 9.00 am, the subjects had to drive in a simulated monotonous driving environment for 1 h. During each morning session, two blood samples were collected, and subjective feelings of alertness were completed three times. Results: In comparison to placebo, Zp and Zc equivalently and significantly impaired the standard deviation of lateral position, the standard deviation of speed and the number of road exits. Detectable blood concentrations were found with Zp in 11 subjects at 8.30 am and at 1.30 pm. The subjective alertness factor was significantly impaired with Zp. Conclusions: This is the first study revealing residual effects of Zp on driving performance in ageing drivers which are similar to that of Zc. Studying the effects of medication in different age ranges appears useful to complete the studies on behavioural-pharmacological effects of medication. To reduce the incidence of driving accidents due to prescription drugs, patients should be warned at the time of treatment initiation that they should avoid driving. [ABSTRACT FROM AUTHOR]

the use of in-vehicle technologies became more popular, there is concern about a concomitant increase in driver distraction arising from their use. While the introduction of voice recognition systems is intended to reduce the distraction due to manual operation of these units, a significant proportion of the distraction associated with their use may arise not from the manual manipulation but rather the cognitive consequences. It is also known that the risk of inattentive driving varies with age. In this study, the impact of cognitive workload and traffic environments on older drivers' behavior was investigated in a driving simulator. To assess the impact of advancing age on driving performance degradation under a dual task condition, the performance of 63 drivers, divided into younger (20-29) and older (60-69) age groups, was evaluated. The authors also considered driving behavioral differences in the context of urban and highway driving, appropriately counterbalanced. At a specified location in the two scenarios, subjects were asked to complete a series of auditory tasks of increasing complexity. Comparisons of younger and older drivers' driving performance, including forward velocity, speed control, standard deviation of lane position and steering wheel reversal rate, were conducted. Results indicated that age and traffic environment impact both driving performance and compensatory behavior during dual task conditions. [ABSTRACT FROM AUTHOR]

Background: As the number of older drivers increases, concern has been raised about the potential safety implications. Flexibility, coordination, and speed of movement have been associated with older drivers' on road performance.Objective: To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility, coordination, and speed of movement could improve driving performance among older drivers.Design: Randomized controlled trial with blinded assignment and end point assessment. Participants randomized to intervention underwent graduated exercises; controls received home, environment safety modules.Participants: Drivers, 178, age > or = 70 years with physical, but without substantial visual (acuity 20/40 or better) or cognitive (Mini Mental State Examination score > or =24) impairments were recruited from clinics and community sources.Measurements: On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban, residential, and highway traffic. Performance rated three ways: (1) 36-item scale evaluating driving maneuvers and traffic situations; (2) evaluator's overall rating; and (3) critical errors committed. Driving performance reassessed at 3 months by evaluator blinded to treatment group.Results: Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants (P = .03). Intervention drivers committed 37% fewer critical errors (P = .08); there were no significant differences in evaluator's overall ratings (P = .29). No injuries were reported, and complaints of pain were rare.Conclusions: This safe, well-tolerated intervention maintained driving performance, while controls declined during the study period. Having interventions that can maintain or enhance driving performance may allow clinician-patient discussions about driving to adopt a more positive tone, rather than focusing on driving limitation or cessation. [ABSTRACT FROM AUTHOR]

Depression is a common mental disorder with cognitive deficits, but little information is available on the effects of antidepressant treatment on driving performance in depressed patients. Assessing actual driving performance and cognition of depressed patients receiving long-term antidepressant treatment. Performance was assessed in depressed patients receiving selective serotonin reuptake inhibitor (SSRI) or serotonin and noradrenalin reuptake inhibitor (SNRI) treatment for 6–52 weeks and in matched healthy controls by means of two standardised on-the-road driving tests and laboratory tests of cognition. Data showed poorer driving performance as indicated by a higher standard deviation of lateral position or ‘weaving motion’ in medicated patients relative to controls. Time to speed adaptation and critical flicker fusion threshold were also impaired in medicated patients. The Hamilton Depression Rating Scale scores in medicated patients were significantly higher as compared to that of controls. No other significant results between the two groups were demonstrated on the variables of the driving tests and laboratory tests of cognition. The depressed patients receiving long-term treatment with SSRI- and SNRI-type antidepressants show impaired driving performance. This impairment in driving performance can probably be attributed to residual depressive symptoms instead of the antidepressant treatment. [ABSTRACT FROM AUTHOR]

Rationale: The number of road fatalities related to the presence of amphetamines in drivers has been relatively constant over the past 10 years. However, there remains uncertainty as to the extent that these drugs induce driving impairment, and whether any such impairments translate to an increase in road fatalities. Objectives: To examine the acute effects of 0.42 mg/kg dexamphetamine on simulated driving performance, and to establish which, if any, simulated driving abilities become impaired following dexamphetamine administration. Methods: A repeated-measures, counter-balanced, double-blind, placebo-controlled design was employed. Twenty healthy volunteers completed two treatment conditions--0.42 mg/kg dexamphetamine and placebo. Performance was assessed using a driving simulator task. Blood and saliva samples were obtained prior to the driving tasks and immediately after task completion (120 min and 170 min post-drug administration, respectively). Results: Mean dexamphetamine blood concentrations were 83 ng/ml and 98 ng/ml at 120 min and 170 min, respectively. Results indicated a decrease in overall simulated driving ability following dexamphetamine administration during the day-time but not the nighttime scenario tasks. Contributing to this performance reduction, "incorrect signalling", "failing to stop at a red traffic light" and "slow reaction times" were the behaviours most strongly affected bydexamphetamine. Conclusions: Thedecrease in simulated driving ability observed during the daytime driving tasks are consistent with the perceptual narrowing or tunnel vision that is associated with dexamphetamine consumption. [ABSTRACT FROM AUTHOR]

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Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine whether mefloquine, a quinoline antimalarial drug, affects psychomotor and actual driving performance when given in a prophylactic regimen, alone or in combination with alcohol. Methods: Forty male and female volunteers were randomly assigned in equal numbers to two groups, and were treated double-blind for one month with mefloquine and placebo. The medication was taken in a 250 mg dose on the evenings of Days 1, 2, 3, 8, 15, 22 and 29. Testing was done on Days 4, 23 and 30, the latter after repeated doses of alcohol sufficient to sustain a blood concentration of about 0.35 mg ⋅ml. Two real driving tests were used to measure prolonged (1 h) road tracking and car following performance. Critical Flicker/Fusion Frequency (CFF), critical instability tracking and body sway were also measured in the laboratory. Results: Mefloquine caused no significant impairment in any test at any time relative to placebo. It significantly improved road tracking performance on Day 4. A significant interaction between prior treatment and alcohol was found in the body sway test, as the alcohol-induced change was less after mefloquine than placebo. The sensitivity of the driving test and the CFF test were shown by the significant overall effect of alcohol which did not discriminate between the two prior treatments. Conclusion: Mefloquine did not impair driving performance but rather improved it in the longer test, suggesting that the drug may possess psychostimulating properties. [ABSTRACT FROM AUTHOR]

The study was conducted according to a nineway, observer- and subject-blind, cross-over design. Its purpose was to compare the single-dose effects of the following drugs on driving performance: acrivastine (8, 16 and 24 mg); the combination of acrivastine (8 mg) with pseudoephedrine (60 mg); terfenadine (60, 120 and 180 mg); diphenhydramine-HCL (50 mg); and placebo. The subjects were 18 healthy female volunteers. Drug effects were assessed in two repetitions of two driving tests (highway driving and car-following) after each treatment. Acrivastine's impairing effects in both driving tests were similarly dose-related. The 8-mg dose had a small, but significant, effect on highway driving in the first trial. The 16-mg and 24-mg doses significantly impaired driving in both tests during the first trial and the 24-mg dose did so again during the second trial. Neither the combination of acrivastine with pseudoephedrine nor terfenadine caused any significant impairment of performance. Diphenhydramine significantly impaired driving in both tests during every trial. In conclusion, the normal therapeutic dose of acrivastine (8 mg) had little effect on driving performance, and virtually none when that dose was given in combination with pseudoephedrine (60 mg). Higher doses of acrivastine severely impaired driving performance. Terfenadine had no significant effect on driving performance after any dose while diphenhydramine strongly impaired every important driving parameter. [ABSTRACT FROM AUTHOR]

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The acute and sub-chronic effects of moclobemide and mianserin on driving and psychometric performance were compared to those of placebo in a double-blind, cross-over study involving 17 healthy volunteers. Mianserin, moclobemide and placebo were administered for 8 days. Subjects' performance was measured on days 1 and 8 of each treatment series; subjective sleep parameters, mood, and possible side-effects were recorded each treatment day on questionnaires or visual analog scales. Mianserin affected most of the performance measures, while moclobemide affected none; mianserin also impaired driving and tracking performance and decreased CFF. Whilst receiving mianserin, subjects reported depressed levels of alertness, calmness, and contentment; the quality of their sleep was unaffected, but its duration increased, together with feelings of drowsiness and fatigue during the day. No statistical interactions between the factors Drugs and (Treatment) Days were found, indicating that little pharmacological tolerance developed over time during mianserin treatment. Mianserin's sedative properties are held responsible for all performance and subjective effects of the drug. It is concluded that moclobemide 200 mg b.i.d. has no important sedative properties. [ABSTRACT FROM AUTHOR]