Road safe seniors: Screening for age-related driving disorders in inpatient and outpatient settings

Introduction

Older drivers are increasing in number and they often have health conditions that place them at high risk for motor-vehicle crashes (MVC). Screening is underutilized, and is rarely done in hospital settings.

Methods

A convenience sample of 755 older adults completed age related driving disorders screening at University of California, San Diego inpatient and outpatient health centers. Screening included three strength/frailty tests, two vision tests (acuity and fields), and two cognitive tests, based on AMA recommendations. The average age of participants was 72.5; 55.5% were male and 94% English-speaking; 17.8% of older adults failed at least one aspect of screening.

Results

In multivariate analysis, significant associations of failed status were age, male sex, selfrestrictions of driving, and inpatient screening locations. The screening identified one in six adults to be 'high-risk' for age related driving disorders. Screening was effective and feasible in both inpatient and outpatient settings.

Impact on industry

As the driving population ages, industry, government and health car providers need to plan for the management of driving impairments in older adults.     

A review of fetal and neonatal consequences of maternal systemic lupus erythematosus

Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. Multidisciplinary counseling before and during pregnancy from rheumatology, maternal fetal medicine, obstetrics, and pediatric cardiology is critical. Transplacental passage of autoantibodies, present in about 40% of women with SLE, can result in neonatal lupus (NL). NL can consist of usually permanent cardiac manifestations, including conduction system and myocardial disease, as well as transient cutaneous, hematologic, and hepatic manifestations. Additionally, women with SLE are more likely to develop adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, and preterm birth, perhaps due to an underlying effect on placentation. This review describes the impact of SLE on maternal and fetal health by trimester, beginning with prepregnancy optimization of maternal health. This is followed by a discussion of NL and the current understanding of the epidemiology and pathophysiology of anti-Ro/La mediated cardiac disease, as well as screening, treatment, and methods for prevention. Finally discussed is the known increase in preeclampsia and fetal growth issues in women with SLE that can lead to iatrogenic preterm delivery.     

Applying Integrated Resource and Environmental Management to Transmission Right-of-way Maintenance

The concept of a substantive integrator is introduced as a method for integrated resource and environmental management as a means to assimilate different resource values at the operational or field level. A substantive integrator is a strategic management tool for integrating multiple uses into corporate management regimes that traditionally manage for single values. Wildlife habitat management is presented as a substantive integrator for managing vegetation on electric utility power line corridors. A case study from northern British Columbia provides an example of wildlife habitat management as a means to integrate other resource values such as aesthetics, access and subsistence along British Columbia Hydro and Power Authority's transmission rights-of-way.     

Contaminants of Emerging Concern in Fish from Western U.S. and Alaskan National Parks — Spatial Distribution and Health Thresholds

Remote national parks of the western U.S. and Alaska are not immune to contaminants of emerging concern. Semivolatile organic compounds (SOCs) such as pesticides and PCBs can selectively deposit from the atmosphere at higher rates in cold, high‐elevation and high‐latitude sites, potentially increasing risk to these ecosystems. In the environment, SOCs magnify up food chains and are known to increase health risks such as cancer and reproductive impairment. One hundred twenty‐eight fish in 8 national parks in Alaska and the western U.S. were analyzed for contaminant concentrations, assessed by region, and compared to human and wildlife health thresholds. SOC concentrations from an additional 133 fish from a previous study were also included, for a total of 31 water bodies sampled. PCBs, endosulfan sulfate, and p,p′‐DDE were among the most frequently detected contaminants. Concentrations of historic‐use pesticides dieldrin, p,p′‐DDE, and/or chlordanes in fish exceeded USEPA guidelines for human subsistence fish consumers and wildlife (kingfisher) health thresholds at 13 of 14 parks. Average concentrations in fish ranged from 0.6‐280 ng/g lipid (0.02‐7.3 μg/g ww). Contaminant loading was highest in fish from Alaskan and Sierra Nevada parks. Historic compounds were highest in Alaskan parks, while current‐use pesticides were higher in the Rockies and Sierra Nevada. This study provides a rigorous analysis of CECs in fish from national parks and identifies regions at potential risk.     

An experimental test of alternative population augmentation scenarios

Human land use is fragmenting habitats worldwide and inhibiting dispersal among previously connected populations of organisms, often leading to inbreeding depression and reduced evolutionary potential in the face of rapid environmental change. To combat this augmentation of isolated populations with immigrants is sometimes used to facilitate demographic and genetic rescue. Augmentation with immigrants that are genetically and adaptively similar to the target population effectively increases population fitness, but if immigrants are very genetically or adaptively divergent, augmentation can lead to outbreeding depression. Despite well‐cited guidelines for the best practice selection of immigrant sources, often only highly divergent populations remain, and experimental tests of these riskier augmentation scenarios are essentially nonexistent. We conducted a mesocosm experiment with Trinidadian guppies (Poecilia reticulata) to test the multigenerational demographic and genetic effects of augmenting 2 target populations with 3 types of divergent immigrants. We found no evidence of demographic rescue, but we did observe genetic rescue in one population. Divergent immigrant treatments tended to maintain greater genetic diversity, abundance, and hybrid fitness than controls that received immigrants from the source used to seed the mesocosms. In the second population, divergent immigrants had a slightly negative effect in one treatment, and the benefits of augmentation were less apparent overall, likely because this population started with higher genetic diversity and a lower reproductive rate that limited genetic admixture. Our results add to a growing consensus that gene flow can increase population fitness even when immigrants are more highly divergent and may help reduce uncertainty about the use of augmentation in conservation.     

Urbanized landscapes favored by fig-eating birds increase invasive but not native juvenile strangler fig abundance

Propagule pressure can determine the success or failure of invasive plant range expansion. Range expansion takes place at large spatial scales, often encompassing many types of land cover, yet the effect of landscape context on propagule pressure remains largely unknown. Many studies have reported a positive correlation between invasive plant abundance and human land use; increased propagule pressure in these landscapes may be responsible for this correlation. We tested the hypothesis that increased rates of seed dispersal by fig-eating birds, which are more common in urban habitats, result in an increase in invasive strangler fig abundance in landscapes dominated by human land use. We quantified abundance of an invasive species (Ficus microcarpa) and a native species (F. aurea) of strangler fig in plots spanning the entire range of human land use in South Florida, USA, from urban parking lots to native forest. We then compared models that predicted juvenile fig abundance based on distance to adult fig seed sources and fig-eating bird habitat quality with models that lacked one or both of these terms. The best model for juvenile invasive fig abundance included both distance to adult and fig-eating bird habitat terms, suggesting that landscape effects on invasive fig abundance are mediated by seed-dispersing birds. In contrast, the best model for juvenile native fig abundance included only presence/absence of adults, suggesting that distance from individual adult trees may have less effect on seed limitation for a native species compared to an invasive species undergoing range expansion. However, models for both species included significant effects of adult seed sources, implying that juvenile abundance is limited by seed arrival. This result was corroborated by a seed addition experiment that indicated that both native and invasive strangler figs were strongly seed limited. Understanding how landscape context affects the mechanisms of plant invasion may lead to better management techniques. Our results suggest that prioritizing removal of adult trees in sites with high fig-eating bird habitat may be the most effective method to control F. microcarpa abundance.     

SPATIAL DELINEATION OF BIOTIC AND ABIOTIC GRADIENTS IN A RURAL NEW YORK RESERVOIR1

ABSTRACT: The spatial changes in abiotic and biotic variables from riverine to lacustrine areas characterized by the river-lake concept of reservoir function was applied to the Tomhannock Reservoir, Rensselaer County, New York. To identify these longitudinal gradients, a two-year investigation (May 1991 to October 1992) was conducted to measure primary productivity, nutrient concentrations, chlorophyll α and phytoplankton biomass at three locations in the 705-ha water supply reservoir. Emphasis was placed on the measurement of primary production using the carbon-14 artificial incubator (photosynthetron) technique. The average annual production in 1992 was 247.3 gm^?2 245 d^?1, ranging from 52 to 2677 mg C m^?2. Mean alpha^B (assimilation efficiency), P^Bm (assimilation number), and I_k (saturation irradiance) were 4.40 mg C mgChl^?1 E^?1 m^?2, 3.82 mg C mgChl^?1 h^?1, and 236.5 μE m^?2 s^?1, respectively. Neither seasonal nor spatial variability of these photosynethetic parameters were observed. Except for Secchi depth, distinct longitudinal zones from river inflow to darn were not statistically demonstrated in the Tomhannock Reservoir. Mean extinction coefficient, chlorophyll α and total phosphorus concentrations decreased; Secchi transparency and phytoplankton biomass increased; while primary productivity and dissolved inorganic nitrogen concentration remained the same from headwater to darn. These baseline data will be used to assess the future effectiveness of best management practices (BMPs) recently instituted on selected watershed farmland in an attempt to reduce the detrimental impact of agricultural activities on drinking water quality.