Older driver retraining: An updated systematic review of evidence of effectiveness

Problem and Objective

The number of older drivers who might benefit from driver retraining is growing. A previous review on the effectiveness of older driver retraining included intervention studies up to 2004. The objective was to perform an updated systematic review of the effectiveness of older driver retraining for improving driving-related skills and reducing crash rates.

Method

Articles published from 2004-2008 were grouped according to the intervention provided and outcome studied. Randomized clinical trials (RCTs) were appraised using the Physiotherapy Evidence Database (PEDro) Scale and scored for quality according to their internal validity. Each intervention's effectiveness was then rated and assigned a level of evidence by combining pre- and post- 2004 findings.

Results

Three RCTs and one matched-pairs cohort design met the inclusion criteria. There is strong evidence (Level 1a) that education combined with on-road training improves driving performance and moderate evidence (Level 1b) that it improves knowledge. There is moderate evidence (Level 1b) that physical retraining improves driving performance. There is moderate evidence (Level 1b) that an educational intervention curriculum alone is not effective in reducing crashes.

Summary

The updated evidence on the effectiveness of retraining aimed at older drivers is sufficiently encouraging to merit assertive health promotion actions regarding intervention and program planning.

Impact on Industry

These positive findings warrant a comprehensive plan that has both behavioral and monetary incentives encouraging older driver participation in programs aimed at driver safety.     

Integrated model of simulated occupant injury risk and real medical costs

Introduction

The purpose of this study was to develop an integrated methodology that links occupant injury risk functions, estimated in the laboratory, with real world medical treatment costs by using the abbreviated injury score (AIS). Using our model, the expected medical treatment costs for crash injuries to various body regions and of different severities can be investigated.

Methods

First, the simulation results are compared with NHTSA crash data. We used a modified kinematics simulation model that incorporates an F = E^b function as a supplement to the previous Steffan's model to obtain a more accurate acceleration history a(t). Second, head injury criteria HIC₃₆ can be calculated from a(t), and we use the injury probability P as a function of HIC_36, as proposed by Kuppa, to obtain the injury risk function for various AIS values. Third, medical treatment cost models for various AIS values can be calculated by using a regression cost model with real world data. Finally, the injury risk function and medical treatment cost models are linked through AIS values. We establish an integrated methodology and predict medical costs and car safety data using real world police reports, medical treatment costs, and laboratory simulation results.

Results

Using head injuries in frontal crashes as an example, we focus on simulation parameters for different vehicle models, with and without airbags. We specifically examine impact closing speed, Delta-V, and impact directions.

Conclusion

Simulation results can be used to supplement insufficient real crash data, in particular ΔV, and injury risk results from police crash reports.

Impact on industry

The proposed integrated methodology may provide the vehicle industry with a new safety assessment method. Real crash data coupling provides consumers with more realistic and applicable information.     

Global trend according to estimated number of occupational accidents and fatal work-related diseases at region and country level

Background

Although occupational accidents and work-related diseases have been of interest for a long time, due to lack of proper recording and notification systems the official numbers of occupational accidents and work-related diseases are missing for many countries. Presently, the demand for effectiveness and an interest in the economic aspects of accidents have increased prevention activities at company and country levels.

Methods

Occupational accident data of selected countries and of World Health Organization regional divisions together with the global burden of disease were used in estimating global occupational accidents and fatal work-related diseases. The trend of global occupational accidents and work-related diseases is presented at region and country levels. The years 1998, 2001, and 2003 are compared in the case of occupational accidents and the years 2000 and 2002 in the case of work-related diseases.

Results

The total number of occupational accidents and fatal work-related diseases has increased, but the fatality rates per 100,000 workers have decreased. There were almost 360,000 fatal occupational accidents in 2003 and almost 2 million fatal work-related diseases in 2002. Every day more than 960,000 workers get hurt because of accidents. Each day 5,330 people die because of work-related diseases.

Conclusions

Information on occupational accidents and work-related diseases is needed so that countries may understand better the importance of occupational health and safety at country and company level. Especially companies in developing countries are not familiar with occupational safety and health. Statistical data is essential for accident prevention; it is a starting point for the safety work.     

A note on the effectiveness of the house-arrest alternative for motivating DWI offenders to install ignition interlocks

Introduction

The effectiveness of ignition interlocks at reducing drunk driving has been limited by the ability of driving-while-intoxicated (DWI) offenders to avoid court orders to install the devices.

Methods

In a pilot program in New Mexico, four Santa Fe County judges imposed home confinement (via electronic monitoring bracelets) on offenders who claimed to have no car or no intention to drive. Interlock installation rates for Santa Fe County were compared with all other counties in New Mexico over a 2-year program and 2-year post-program period.

Results

During the two program years, 70% of the drivers convicted of DWI in Santa Fe County installed interlocks, compared to only 17% in the other counties, but when the program was terminated, the Santa Fe installation rate fell by 18.8 percentage points.

Summary

Mandating the alternative sanction of house arrest led to the highest reported interlock installation rate for DWI offenders.

Impact on Industry

Impaired driving is a substantial expense to employers, particularly when it bars driving that interferes with employment. Interlocks provide a method of protecting the public while permitting the offender to drive sober. This study was directed at increasing interlock use by DWI offenders.     

A Strategic Project Appraisal framework for ecologically sustainable urban infrastructure

Actors in the built environment are progressively considering environmental and social issues alongside functional and economic aspects of development projects. Infrastructure projects represent major investment and construction initiatives with attendant environmental, economic and societal impacts across multiple scales. To date, while sustainability strategies and frameworks have focused on wider national aspirations and strategic objectives, they are noticeably weak in addressing micro-level integrated decision making in the built environment, particularly for infrastructure projects. The proposed approach of this paper is based on the principal that early intervention is the most cost-effective and efficient means of mitigating the environmental effects of development projects, particularly macro infrastructure developments. A strategic overview of the various project alternatives, taking account for stakeholder and expert input, could effectively reduce project impacts/risks at low cost to the project developers but provide significant benefit to wider communities, including communities of future stakeholders. This paper is the first exploratory step in developing a more systematic framework for evaluating strategic alternatives for major metropolitan infrastructure projects, based on key sustainability principles. The developed Strategic Project Appraisal (SPA) framework, grounded in the theory of Strategic Environmental Assessment (SEA), provides a means of practically appraising project impacts and alternatives in terms of quantified ecological limits; addresses the neglected topic of metropolitan infrastructure as a means of delivering sustainability outcomes in the urban context and more broadly, seeks to open a debate on the potential for SEA methodology to be more extensively applied to address sustainability challenges in the built environment. Practically applied and timed appropriately, the SPA framework can enable better decision-making and more efficient resource allocation ensuring low impact infrastructure development.     

Estimating the variance in before-after studies

Problem

To simplify the computation of the variance in before-after studies, it is generally assumed that the observed crash data for each entity (or observation) are Poisson distributed. Given the characteristics of this distribution, the observed value (x_i) for each entity is implicitly made equal to its variance. However, the variance should be estimated using the conditional properties of this observed value (defined as a random variable), that is, f(x_i|μ_i), since the mean of the observed value is in fact unknown.

Method

Parametric and non-parametric bootstrap methods were investigated to evaluate the conditional assumption using simulated and observed data.

Results

The results of this study show that observed data should not be used as a substitute for the variance, even if the entities are assumed to be Poisson distributed. Consequently, the estimated variance for the parameters under study in traditional before-after studies is likely to be underestimated.

Conclusions

The proposed methods offer more accurate approaches for estimating the variance in before-after studies.     

Biodegradation potential of MTBE in a fractured chalk aquifer under aerobic conditions in long-term uncontaminated and contaminated aquifer microcosms

The potential for aerobic biodegradation of MTBE in a fractured chalk aquifer is assessed in microcosm experiments over 450 days, under in situ conditions for a groundwater temperature of 10 °C, MTBE concentration between 0.1 and 1.0 mg/L and dissolved O₂ concentration between 2 and 10 mg/L. Following a lag period of up to 120 days, MTBE was biodegraded in uncontaminated aquifer microcosms at concentrations up to 1.2 mg/L, demonstrating that the aquifer has an intrinsic potential to biodegrade MTBE aerobically. The MTBE biodegradation rate increased three-fold from a mean of 6.6 ± 1.6 μg/L/day in uncontaminated aquifer microcosms for subsequent additions of MTBE, suggesting an increasing biodegradation capability, due to microbial cell growth and increased biomass after repeated exposure to MTBE. In contaminated aquifer microcosms which also contained TAME, MTBE biodegradation occurred after a shorter lag of 15 or 33 days and MTBE biodegradation rates were higher (max. 27.5 μg/L/day), probably resulting from an acclimated microbial population due to previous exposure to MTBE in situ. The initial MTBE concentration did not affect the lag period but the biodegradation rate increased with the initial MTBE concentration, indicating that there was no inhibition of MTBE biodegradation related to MTBE concentration up to 1.2 mg/L. No minimum substrate concentration for MTBE biodegradation was observed, indicating that in the presence of dissolved O₂ (and absence of inhibitory factors) MTBE biodegradation would occur in the aquifer at MTBE concentrations (ca. 0.1 mg/L) found at the front of the ether oxygenate plume. MTBE biodegradation occurred with concomitant O₂ consumption but no other electron acceptor utilisation, indicating biodegradation by aerobic processes only. However, O₂ consumption was less than the stoichiometric requirement for complete MTBE mineralization, suggesting that only partial biodegradation of MTBE to intermediate organic metabolites occurred. The availability of dissolved O₂ did not affect MTBE biodegradation significantly, with similar MTBE biodegradation behaviour and rates down to ca. 0.7 mg/L dissolved O₂ concentration. The results indicate that aerobic MTBE biodegradation could be significant in the plume fringe, during mixing of the contaminant plume and uncontaminated groundwater and that, relative to the plume migration, aerobic biodegradation is important for MTBE attenuation. Moreover, should the groundwater dissolved O₂ concentration fall to zero such that MTBE biodegradation was inhibited, an engineered approach to enhance in situ bioremediation could supply O₂ at relatively low levels (e.g. 2–3 mg/L) to effectively stimulate MTBE biodegradation, which has significant practical advantages. The study shows that aerobic MTBE biodegradation can occur at environmentally significant rates in this aquifer, and that long-term microcosm experiments (100s days) may be necessary to correctly interpret contaminant biodegradation potential in aquifers to support site management decisions.     

Committing driving violations: An observational study comparing city, town and village

Introduction

This article compares observed driving behavior in a city, a town, and a village.

Method

Unobtrusive observations were made at intersections in each residential type. Five violation types were observed: (a) not wearing a seat belt (seat belt violation); (b) not using a safety seat for a child (safety seat violation for children); (c) not using a speaker while speaking on the phone (on-phone violation); (d) failing to comply with a ‘give way’ sign (‘give way’ sign violation); and (e) stopping in an undesignated area (undesignated stop violation). It was expected that in accordance with the anonymity hypothesis that the bigger residential areas' rate of traffic violations would be higher. The effects of the residential type, drivers' gender, and age were assessed using the multiple regression model. The stepwise method of evaluation was employed. The model converged on step 3 (Adjusted R square = 0.039). Residential type and gender contributed significantly to the model. Results: Consistent with prior research, male drivers committed more violations than female drivers. Chi-square analyses were used to test the distribution of violations by the settlement types. Overall, more drivers committed violations in the two small residential areas than in the city, with 30% of city drivers, 43% of town drivers, and 51% of village drivers committing at least one violation (χ2 (2) = 37.65, p < 0.001). Moreover, in the town and the village, a combination of one or more violations was committed more often than in the city (χ2 (1) = 34.645, p < 0.001). Accordingly, more drivers committed violations in the two small settlements (48.4%) than in the city (30.6%). Possible explanations for the observed results were provided in the Discussion section.

Impact on Industry

The conclusions of this paper are that drivers in small villages tend to disobey traffic laws. Therefore, efforts have to be made in companies to take this issue in consideration while running fleets in companies located in small places far from the center.     

Preferred modes of travel among older adults: What factors affect the choice to walk instead of drive?

Introduction

There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics.

Methods

This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving.

Results

Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR = 1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR = 1.53; 95% CI = 1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem.

Discussion

Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. Impact on Industry: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.     

Laboratory stabilization/solidification of tank sludges: GAAT, OHF, and combined tank sets

Highly radioactive, mixed-waste sludges that have been collected at Oak Ridge over several decades are being combined for treatment and disposal. Stabilization of the sludges in the different tank sets was tested prior to the proposed combination and treatment. This paper, which follows a previous article on the Melton Valley Storage Tank/Bethel Valley Evaporator Storage Tank set, documents the testing of the Gunite and Associated Tank and Old Hydrofracture Facility tank sets, as well as the combined sludges of all the Oak Ridge National Laboratory tank sets; the third paper on this subject will discuss efforts to maximize the sludge loading. The grout formulations were tested in the laboratory with surrogates. A wet-sludge loading of 60wt% resulted in strong wasteforms with no free water and gave a volume increase of about 30-40vol%. The Resource Conservation and Recovery Act metals included in the surrogate testing were silver, cadmium, chromium, lead, selenium, thallium, zinc, and mercury. The grout formulations stabilized these metals within the Universal Treatment Standards limits. In addition, a grout leachability index of about 10.0-12.0 was measured for both (85)Sr and (137)Cs, meeting the recommended requirement of >6.0.