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Adolescent females’ disengagement from physical education, physical activity, and sport has been well documented. Participating in a quality intramural program could help to increase rates of adolescent females’ engagement in physical activity at school. This study was conducted with female students in four high schools in south-central Canada. A school-specific organizing committee consisting of an outside expert, teacher-lead, and several female student-facilitators designed and implemented a new optional intramural program rooted in best practices to 483 female students. Semistructured focus group interviews were held with 25 student-facilitators before and after the intramural intervention. There was a noticeable reduction in the females’ perceived barriers to being engaged in physical activity at school after the program intervention. Accommodating the intrapersonal, inter­personal, and environmental needs of adolescent females may help intramurals to counter the allure of more sedentary options at school.

This research examines the interacting role of processes of state transformation – namely, devolution and Europeanisation – in the development of Scottish nationalism. It draws on the concept of ‘member statehood’, examining how relationships within nation states have been transformed by the European dynamic. Superficially, Scotland seems to contradict central aspects of this theory: the main citizen mobilising response to Brexit has been in Scotland and aimed precisely at restoring a notional Scottish popular sovereignty by re- joining the EU. However, an analysis of Scottish political development reveals a more complex picture putting state transformation theories in a more sympathetic light. Scottish independence emerges as a complex, contradictory response to post-neoliberalism and the crisis of member-statehood. While Europeanism has proved a useful tool for competing forces in Scotland, it has been refracted through problems of a ‘democratic deficit’ and claims for the ‘restoration’ of sovereignty appealing to disenchanted voters.

ObjectiveTo quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland.MethodsInitial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020–26 March 2020 and Ireland: 25 March 2020–2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being.Results5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role.ConclusionsFindings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term.Trial registration numberISRCTN10666798.

Cycling as a means of transport or recreational activity is increasing in popularity in Ireland. However, increasing numbers of cyclists may lead to an increased number of bicycle collisions and fatalities. The Road Safety Authority is the statutory body for road safety in Ireland but uses police data alone to collate cycling collision statistics. This may lead to an underestimation of cycling injuries in Ireland. Using hospital statistics may provide a greater understanding of cycling trauma in Ireland.The present study examines cycling related trauma in Ireland using the Major Trauma Audit (MTA) data collected via the Trauma and Research Network (TARN) from hospitals in Ireland for the period 2014 to 2016. The database was interrogated for demographics, mechanism of injury, injury characteristics and patient outcomes.There were 410 cycling collisions recorded in the TARN database which represented 4.4% of trauma captured by TARN for the study period. Of this cohort 79% were male compared with 58% in the overall (TARN) trauma cohort (p 0.001) and the median (IQR) age was 43.8 years (31.0, 55.7) which is younger than the median (IQR) of 58.9 (36.2, 76.0) years for the overall trauma cohort (p 0.001). Cycling collisions had a median (IQR) injury severity score (ISS) of 10 (9, 20) which was higher than the overall trauma cohort ISS of 9 (9, 17). Of the mechanisms observed for cycling trauma, 31.7% (n = 130) had a collision with a motor vehicle. Of those who did not wear a helmet, 52.2% (n = 47) sustained a head injury compared with 27.5% (n = 44) in the group who were wearing a helmet (p 0.001).The TARN data presented in this paper builds a more complete overview of the burden of cycling collisions in Ireland. Particular points of focus are that serious cycling injuries occur in a predominantly male population, and that only around 30% of cases are recorded as involving a motor vehicle, with the majority having an unknown mechanism of injury. There was an association between helmets and head injuries in this study, but there are likely other contributing factors such as mechanism of injury, velocity or cycling infrastructure. Using hospital data such as the MTA provides valuable information on the injuries sustained by cyclists, but more prospective studies to capture injury mechanism and contributing factors are needed.

Received 12th May 2021. Accepted 17th May 2021. Published online 28th May 2021. Issue published 1st August 2021.

The project of European integration has undergone a succession of shocks, beginning with the Eurozone crisis, followed by reactions to the sudden growth of irregular migration, and, most recently, the coronavirus pandemic. These shocks have politicised questions related to the governance of borders and markets that for decades had been beyond the realm of contestation. For some time, these questions have been spilling over into domestic and European electoral politics, with the rise of “populist” and Eurosceptic parties. Increasingly, however, the crises have begun to reshape the liberal narratives that have been central to the European project. This book charts the rise of contestation over the meaning of “Europe”, particularly in light of the coronavirus crisis and Brexit. Drawing together cutting edge, interdisciplinary scholarship from across the continent, it questions not merely the traditional conflict between European and nationalist politics, but the impact of contestation on the assumed “cosmopolitan” values of Europe.

This chapter addresses three cases where governments have adopted explicitly Euro-critical or anti-EU stances linked to migration. The primary aim was to understand how nations that reject the established European narrative of international protection have framed their obligations to alleviate the suffering of war and conflicts. This has been broken into three conceptual areas for comparative purposes: humanitarianism, solidarity, and sovereignty. While observing areas of distinction between these states and the EU, the analysis suggests the difficulties involved in hardened contrasts between a cosmopolitan-humanitarian EU and national-sovereigntist states. Instead, the chapter presents a more nuanced picture of how states have developed distinct accounts of humanitarianism and international order. Moreover, there is considerable evidence that narratives of Europeanness developing on the liminal periphery have been reshaping core notions of “European” identity embodied in the official pronouncements of the Commission.

Peripheral disease affects both arteries and veins and encompasses pathophysiologic conditions that affect arterial, venous, and lymphatic circulations. This article discusses disorders of peripheral vascular disease (PVD) that affect the lower extremity. PVD is an obstruction in the arteries known as arteriosclerosis obliterans, a condition that manifests from insufficient tissue perfusion that results in hardening of the arteries. Peripheral artery disease leads to an inflammatory condition called atherosclerosis. People at greatest risk include smokers, diabetics, those with high blood pressure, and those with elevated cholesterol levels.

Rapid detection and identification of novel viruses, such as SARS-CoV-2, is critical to treat, isolate, or hospitalize those infected, ultimately, to curb the spread of the virus. Diagnostic assays, such as enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), are considered the gold standard for testing, but are labor-intensive and/or involve creating probe molecules specific to the virus. We propose Raman spectroscopy as an alternative method of detection because it can be label-free and can offer identifying information on many analytes within a sample. Specifically, we are developing a vacuum ultraviolet (VUV) Raman spectrometer using an incoherent excitation source that emits the hydrogen Lyman-α line radiation at 121.57 nm. The main benefit of using a VUV source is that the Raman scattering cross-section is inversely proportional to the fourth power of wavelength, which means that VUV photons would yield several orders of magnitude higher scattering cross-sections than excitation in the visible or near-infrared. In addition, the 121.57 nm wavelength transmits up to 2 cm in dry air, so the analyte can be oriented in standard testing formats. We have been successful in producing strong and consistent HLA emission using both a dielectric-barrier discharge (DBD) plasma source and a commercial source. In the near future, we expect to produce consistent Raman signatures in solid and liquid media. HLAS will transform diagnostic medicine and several other industries through its powerful capabilities of detecting real-time infections and important health markers. © 2021 SPIE.

Rupture of the axillary artery after blunt trauma is an unusual injury, typically occurring in association with anterior dislocation of the shoulder or fracture-dislocation of the surgical head of the humerus. An associated blunt brachial plexus injury will typically accompany such an injury due to its intimate anatomical juxtaposition. We present the case of an elderly female, who presented after a fall from height, onto the outstretched arm, sustaining a combined axillary artery and brachial plexus blunt injury. The patient in this case recovered well post-operatively. The challenge in cases such as this is timely diagnosis and management of the vascular injury. The mechanism of injury combined with the presence or absence of hard signs of vascular injury should alert the clinician with rapid transition to investigation and management where appropriate, to minimise the warm ischaemic time to the upper limb and / or control of haemorrhage. Blunt injuries to the brachial plexus often require a prolonged period of time before accurate recovery can be prognosticated for.

Promoting human-wildlife coexistence is one of the most complex and pressing global conservation challenges faced today, particularly for large carnivore species. Effective conservation of large carnivores rests on interventions fostering coexistence in human-dominated landscapes, across the large ranges on which they depend. However, there is a paucity of research evaluating such interventions, and impact on the social determinants of behavioural outcomes. To bridge this evidence gap, we evaluate the impact of Warrior Watch, a grassroots intervention established in 2010 that draws on the traditional social structures and roles of Samburu pastoralists in northern Kenya to mitigate human-lion conflict peacefully. Using a novel approach blending elements of theory-based methods and traditional impact evaluations, and tailored to local resources and capacities, we evaluate the impact of Warrior Watch on a) attitudes towards lions and b) killing intentions as a proxy for tolerance. We show that warriors in the intervention site reported significantly more positive attitudes towards lions and were significantly less likely to indicate intentions to kill lions than their counterparts in the comparison conservancy. Furthermore, respondents in the intervention site were significantly more likely to report positive changes in their attitudes and tolerance towards lions since the inception of Warrior Watch, and to attribute these changes to the intervention. Our study demonstrates how evaluations tailored to local capacities and resource-limited situations can produce robust insights to support the adaptive management of interventions and increase the evidence-base to guide conservation practice.

Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

BACKGROUND CONTEXT Despite the known influence of hormones on bone metabolism and osteogenic differentiation, the few clinical studies evaluating outcomes after spine surgery have come to contradictory conclusions as to a sex-based differential response. This study aimed to quantify and compare the bone regenerative response to rhBMP-2 in males vs females in a preclinical setting of spine fusion. PURPOSE The purpose of this study was to determine whether sex influences fusion success, bone regenerative capacity, and bone quality after rhBMP-2-mediated spine fusion. STUDY DESIGN/SETTING Preclinical animal study. PATIENT SAMPLE Male and female Sprague-Dawley rats, ages 12-16 weeks. OUTCOME MEASURES Radiography, fusion scoring, microCT imaging, biomechanics testing. METHODS Twenty-four male and 24 female Sprague Dawley rats underwent L4-L5 posterolateral spine fusion with bilateral placement of an absorbable collagen sponge loaded with 5 μg of rhBMP-2 each (Infuse™; 10 μg/animal). Fusion was evaluated at 8 weeks postoperatively via blinded manual palpation on 14 rats/treatment group using an established scoring system wherein 0=no fusion, 1=unilateral fusion, 2=bilateral fusion, 3=bilateral fusion adjacent to a unilateral fusion, and 4=two adjacent bilateral fusion. A fusion score of 1 or greater (unilateral, single level fusion) was considered successfully fused. Specimens then underwent microCT imaging to evaluate and quantify new bone formation. Biomechanical testing was performed on the remaining 10 rats/group to quantify segmental flexion-extension range of motion and stiffness. RESULTS Both male and female rats achieved 100% fusion rates (with 1-level unilateral bridging considered fused), as assessed by blinded manual palpation. However, fusion scores were greater in male rats when compared with females (female: 2.4 vs males 3.1; p CONCLUSIONS Although a smaller amount of new bone was formed in females treated with Infuse™ relative to their male counterparts, that new bone was denser, with twice the number of trabeculae. Interestingly, female spines exhibited on average a greater segmental flexion-extension range-of-motion, suggesting that biomechanical stabilization may be more dependent upon fusion mass volume than density of the newly formed bone. These results are strongly suggestive of sex-dependent differences in the bone regenerative response to rhBMP-2, and they underscore the need for further study of this phenomenon and the underlying mechanisms involved. FDA DEVICE/DRUG STATUS rhBMP-2: Investigational.

We describe progress toward detection of pathogens through Raman spectroscopy in the vacuum ultraviolet using the hydrogen Lyman alpha line at 121.6 nm.

Data from a naturalistic driving study was used to examine foot placement during routine foot pedal movements and possible pedal misapplications. The study included four weeks of observations from 30 drivers, where pedal responses were recorded and categorized. The foot movements associated with pedal misapplications and errors were the focus of the analyses. A random forest algorithm was used to predict the pedal application types based the video observations, foot placements, drivers’ characteristics, drivers’ cognitive function levels and anthropometric measurements. A repeated multinomial logit model was then used to estimate the likelihood of the foot placement given various driver characteristics and driving scenarios. The findings showed that prior foot location, the drivers’ seat position, and the drive sequence were all associated with incorrect foot placement during an event. The study showed that there is a potential to develop a driver assistance system that can reduce the likelihood of a pedal error.

BACKGROUND CONTEXT Historically, autogenous iliac crest bone graft (ICBG) has been considered the gold standard material for spinal fusion. However, the high burden of donor-site morbidity associated with graft harvesting has led clinicians to favor other materials. Notably, INFUSETM – recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered via an absorbable collagen sponge (ACS) – has been shown to yield excellent fusion rates as individual therapy, although its use is associated with significant postoperative inflammation and adverse events. In contrast, most other bone graft substitutes provide insufficient bone regeneration when utilized alone for spinal fusion. Hence, there is a need for novel bone graft substitutes capable of providing adequate osteogenesis with a favorable safety profile. PURPOSE To compare the efficacy and safety profile of previously described 3D-printed HA-DBM composite scaffolds relative to INFUSETM in a rodent L4-L5 posterolateral fusion (PLF) model. STUDY DESIGN/SETTING Preclinical animal model (rat L4-L5 posterolateral spinal fusion model) PATIENT SAMPLE Female Sprague-Dawley rats (age 12-16 weeks) OUTCOME MEASURES Radiographs, fusion scoring, biomechanical testing, MRI quantification of local edema METHODS Fifty Sprague-Dawley rats underwent bilateral L4-L5 posterolateral fusion (PLF), receiving either INFUSETM (10 µg rhBMP-2 on ACS) or HA-DBM composite scaffold. Spines were harvested at 8 weeks postoperation. Fusion was assessed via manual palpation of the samples by three blinded observers. For each sample, a fusion score was determined, wherein 0 = no bridging bone, 1 = unilateral bridging bone, and 2 = bilateral bridging bone. Samples with an average fusion score ≥1 were considered successfully fused. A subpopulation of twenty specimens, 10 INFUSETM and 10 HA-DBM, underwent biomechanical testing to quantify segmental range-of-motion and overall stiffness relative to 8 nonoperated control specimens. An additional 60 animals underwent L4-L5 PLF receiving either ACS only, INFUSETM, or HA-DBM, and were harvested at increasing postoperative time points to undergo lumbar MRI for quantification of soft tissue edema. An additional 90 animals underwent L4-L5 PLF, and various gene and protein expression analyses were used to investigate the pro-osteogenic mechanism of action of the different implant materials. RESULTS Fusion rates were similar between the INFUSETM (100%) and HA-DBM (93%) scaffold groups, although the average fusion score was greater for INFUSETM (2.0± 0.0) relative to HA-DBM (1.5±0.5). Both INFUSETM and HA-DBM treatment resulted in significantly greater stiffness and reduced segmental range-of-motion relative to the nonoperative controls, although these effects were significantly more profound in INFUSETM relative to HA-DBM groups. Both INFUSETM and HA-DBM groups demonstrated significant increases in expression of various pro-osteogenic markers (eg, Alp, Osx, and Runx2). Notably, the INFUSETM group yielded significant edema at both 2- and 5-days postoperation, which was not seen with HA-DBM treatment. CONCLUSIONS The HA-DBM scaffold yielded comparable fusion rates with slightly lower fusion scores and reduced osteoinductivity relative to INFUSETM. However, the exaggerated host inflammatory response seen with INFUSETM was absent in HA-DBM-treated animals. Therefore, the HA-DBM scaffold shows promise as a bone graft substitute with a favorable safety profile. FDA DEVICE/DRUG STATUS rhBMP-2 (INFUSE) [non-human use] (Investigational/Not approved)

Bilateral patellar tendon rupture is an extremely rare occurrence, especially in otherwise healthy individuals without systemic disease. The authors report the case of a man who presented with simultaneous, spontaneous bilateral rupture of his patellar tendons. He had a history of unilateral patellar tendinopathy but no other predisposing risk factors such as steroid or fluoroquinolone use. He underwent surgical repair and following intensive rehabilitation, he returned to baseline physical activity 6 months post injury.

The HSE strategy highlights the need for seamless connections between various agencies working with clients. Many agencies work in silos due to pressure and focus of workload. From An acute medical social work perspective there was an awareness that sensitive information about clients was being managed through referral forms and bureaucratic processes. It was felt that clients interests would be best serviced by a sharing of information, resources and ideas in a less formal more personal manner. A structured series of meetings and seminars on topics of shared interests was carried out between acute hospitals and social workers in primary and secondary health services. A clarification of agency roles and services emerged. We produced a resource directory and a contact list of social workers in HSE CHO area 9. We held seminars and workshops on a variety of topics including: interagency working with chronically challenging clients; managing homelessness; and promoting excellence in practice. We conducted a survey of participants highlighting the benefits of getting to know each other personally and developing closer links between services to develop integrated care pathways for service users.

In our rapidly diversifying society the needs of sometimes vastly different populations must be considered. The current population is made up of a greater number of older adults, “Baby Boomers” and younger adults “Millenials” than the current middle aged-adult population. These two generations have consistently forced change on many fronts, and will continue to do so, particularly in the area of transportation. This panel is intended to address transportation research and design needs in our ever-diversifying society, from driver-interface (DVI) design to public transportation needs, from increased safety systems to the integration of technology for our navigation of various forms of transportation. Specifically, needs that might require researchers to consider the design of systems to address the sometimes conflicting abilities, desires, cultural and demographic factors, and personal goals related to age groups separated by anywhere from 20 to 60 years in age. Panelists included have a broad range of expertise working with technology, transportation, and both older and younger adult population groups.

Network meta-analysis of responses to DPP-4 and SGLT 2 inhibitors: What next after metformin with a baseline HbA1c u22648%?W.D. Strain1, M.C. Thomas2, J.E. Foley 3, P.M. Paldu00e1nius41University of Exeter Medical School, Exeter, UK2Baker IDI Heart and Diabetes Institute, Melbourne, Australia3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA4Novartis Pharma AG, Basel, SwitzerlandBackground: Treatment decisions for timely delivery of care for optimised management of type 2 diabetes mellitus (T2DM) should be supported by evidence-based data and guidelines, which are tailored to individual patient preferences, projected long-term plans and presence or anticipated future risk of comorbidities. Guidelines indicate early and more aggressive intensification of failing metformin monotherapy for prevention of hyperglycaemia-driven complications of T2DM especially in younger patients with shorter duration of T2DM. Dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) lower glucose levels in patients with T2DM proportional to the baseline HbA1c albeit with different mechanisms of action. This relationship, in those with normal renal function at least, appears to be steeper with SGLT2i, with greater glycosuria and efficacy in patients with sustained high HbA1c levels, but attenuating efficacy closer to target levels for glycaemic control. Aim: To explore the relative benefits of DPP4i and SGLT2i in people inadequately controlled with monotherapy at the level of HbA1c indicated for therapy escalation by most guidelines.Methods: A network meta-analyses based on a systematic literature review was undertaken to identify all studies that provide information on the comparative efficacy of DPP4i and SGLT2i in patients with T2DM, as add-on to metformin or to metformin and sulphonylurea, exploring the HbA1c reduction from a baseline u22648.0%. A base-case analysis of 12u201326 weeks and a sensitivity analysis of 12u201352 weeks inclusive were performed with a fixed and random effects model. The mean difference in change from baseline (u0394HbA1c) between intervention and control were used as model inputs.Results: Outcome data on patients with baseline u22648% HbA1c was found in 19 phase III/IV randomised controlled trials, 13 of which reported data on patients receiving only metformin as background therapy. The only DPP4i with information reviewed was vildagliptin. For the background metformin monotherapy network, the fixed effect model indicated that vildagliptin (daily dose of 100 mg) and SGLT2i were more effective than placebo and (additional) metformin. For the background metformin and sulphonylurea network, the fixed effect model indicates that vildagliptin 100 mg is more effective than placebo (u0394HbA1c=u22120.90; 95% CI u22121.25, u22120.55), dapagliflozin 10 mg (u0394HbA1c=u22120.54; u22120.96, u22120.12), canagliflozin 100 mg (u0394HbA1c=u22120.45; u22120.88, u22120.03) and comparable to canagliflozin 300mg (u0394HbA1c=u22120.26; u22120.69, +0.16). There were no reports using empagliflozin (10 or 25 mg), nor of weight change within the population of interest. Discussion: The limited literature supports the hypothesis that in patients with a HbA1c u22648%, SGLT2i may be less effective for lowering glucose than other treatment strategies such as DPP4i. For delivery of individualised care, decisions must therefore be made balancing the optimisation of glucose control versus the potential benefits of SGLT2i in those with pre-existing cardiovascular disease.

The baseline characteristics of the drug nau00efve patients with HbA1c 7.5%). 66 patients who could not tolerate a metformin dose of 1000 mg/day were classified as run-in failures. Overall, 2001 patients from Europe (52.4%), Latin America (26.8%), Asia (17.15%), South Africa (3.1%) and Australia (0.5%) were included. Patients were newly diagnosed with a mean T2DM duration of 6.5u00b17.7 months and 47% of patients were men. The mean age of patients was 54.3u00b19.4 years and more than 25% were under the age of 50; age was about 5 years lower in India than other regions. Mean weight was 85.5u00b117.5 kg and baseline BMI averaged 31.1u00b14.7 kg/m2; mean weight and BMI were lower in Asians than other groups. About 14% of the overall patient population reported a history of smoking, ~18% in the European region as compared to ~10% in other regions. The average daily dose of metformin was approximately 1600 mg. The mean baseline glomerular filtration rate was 87.4u00b118.5 mL/min/1.73m2, the mean baseline HbA1c was 6.9u00b10.3% and the mean baseline FPG was 7.5u00b11.5 mmol/L; patients from Europe had relatively higher mean FPG level of ~7.9 mmol/L while those in other regions had relatively lower mean FPG levels of 7.1 mmol/L. Fasting insulin was 117u00b197 pmol/L, HOMA-B was 117u00b197 and HOMA-IR was 6.6u00b16.3. Mean sitting systolic blood pressure was 132.3u00b114.4 mmHg and sitting diastolic was 80.6u00b18.61 mmHg. Low density lipoprotein cholesterol, very low density lipoprotein cholesterol and triglyceride levels were 2.89u00b10.94 mg/dL, 0.54u00b10.34 mg/dL and 1.92u00b10.96 mg/dL respectively. Microvascular complications were reported in only ~8% of patients. In the subset of patients (n=462) who undertook meal tests the 2 hour plasma glucose values were 9.3u00b12.8 mmol/L, the ISR/G was 27.8u00b112.3 pmol/min/m2/mmol/L and the OGIS was 353u00b157 ml/min/m2. Discussion: VERIFY study population is representative of the major racial populations of the world and essentially evenly divided on the basis of sex, is truly newly diagnosed and has an age range that represents the vast majority of the patients observed to have diagnosed T2DM. The patients have normal renal function and on average are obese; the blood pressure and fasting lipid profiles, the high fasting insulin levels, and degrees of both fasting and meal associated insulin resistance are associated with such obesity. The insulin response to this increased insulin resistance is robust, but clearly not enough to prevent elevations in 2 hour glucose values during meals, in FPG values and in HbA1c values in the mildly hyperglycemic range of T2DM in VERIFY study population. Thus these T2DM subjects display the classic profile of inadequate insulin secretion in the face of the increased demand for insulin associated with obesity.

The effectiveness of an idealized lane departure warning (LDW) was evaluated in an interactive fixed base driving simulator. Thirty-eight older (mean age = 77 years) and 40 younger drivers (mean age = 35 years) took four different drives/routes similar in road culture composition and hazards encountered with and without LDW. The four drives were administered over visits separated approximately by two weeks to examine changes in long-term effectiveness of LDW. Performance metrics were number of LDW activations and average correction time to each LDW. LDW reduced correction time to re-center the vehicle by 1.34 seconds on average (95% CI = 1.12–1.57 seconds) but did not reduce the number of times the drivers drifted enough in their lanes to activate the system (LDW activations). The magnitude of reductions in average correction RT was similar for older and younger drivers and did not change with repeated exposures across visits. The contribution of individual differences in basic visual and motor function, as well as cognitive function to safety gains from LDW was also examined. Cognitive speed of processing predicted lane keeping performance for older and younger drivers. Differences in memory, visuospatial construction, and executive function tended to predict performance differences among older but not younger drivers. Cognitive functioning did not predict changes in the magnitude of safety benefits from LDW over time. Implications are discussed with respect to real-world safety systems.

The Toyota Technical Center wanted to implement a companywide safety campaign to discourage the use of cell phones while walking. However, the traditional posters and directives from management did not seem to be working and a new approach was needed. The goal was to create an obstacle course that would be interesting enough to assess situational awareness and be fun for the participant. Thus the “Walking Dojo” was created to demonstrate that cell phones and walking don’t mix. A known measure of workload, the n-back task, was used to provide a consistent surrogate task for texting. The Dojo effectively demonstrates that walking while cognitively loaded significantly increases the time to negotiate the Dojo and increases response time to the n-back task. The lessons of the Dojo can contribute to safe walking whether it is crossing a street or on a factory floor.