Effectiveness of the CDC HEADS UP online training on healthcare providers’ mTBI knowledge and self-efficacy

Background: Many healthcare providers do not consistently implement recommendations contained in clinical guidelines on mild traumatic brain injury (mTBI). As such, the Centers for Disease Control and Prevention (CDC) created the HEADS UP to Healthcare Providers online training to promote uptake of five key recommendations in the CDC Pediatric mTBI Guideline. Methods: Using data from modules in the CDC HEADS UP to Healthcare Providers online training, healthcare providers’ self-reported knowledge and self-efficacy prior to and immediately following completion of the training was analyzed. Results: Improvements for 8 out of the 10 knowledge questions had a high level of practical significance. The knowledge question with the highest level of practical significance pre- to post-test improvement was for the key guideline recommendation on neuroimaging (pre-test correct: 70.2%; post-test correct: 87.8%; (p < 0.0001, Cohen’s g = 0.39). Four out of the six questions had a self-efficacy level increase of a high level of practical significance (r > 0.50) between the pre- and post-tests. The self-efficacy question with pre- to post-test improvement with the highest level of practical significance was “I am confident in my ability to manage the return to sports progression for my patients” (p < 0.001; r = 0.54). Conclusions: The HEADS UP to Healthcare Providers online training led to significant improvements in knowledge and self-efficacy related to mTBI diagnosis and management. Expanded use of this training among healthcare providers who commonly provide care for pediatric patients with mTBI may be beneficial. Practical Applications: This study highlights several factors guideline developers may take into consideration when creating an implementation tool, such as using health behavior theories, working with partners and key stakeholders, and focusing on digital-based tools.     

污水处理厂与城市公园建设

从环境效益、经济效益和社会效益三个方面分析和探讨了污水处理厂与城市公园建设的优越性。把污水处理厂、城市公园和环保教育综合为一体是可行的。     

关于高校环境类专业本科教学的思考

论述了从培养目标、课程设置、教学方法与实践等方面培养高素质复合型的环境类专业的本科生，以满足社会需求，并为环境类专业本科教学改革提供参考。     

Driver education and graduated licensing in North America: past, present, and future

PROBLEM: A stated objective of driver education in North America is to produce safer drivers, typically defined as drivers less likely to crash. This paper examines the extent to which driver education has achieved this objective independently as well as the extent to which such programs can support the success of graduated licensing in reducing young driver crashes. In so doing, it discusses past experiences, recent developments, and the future direction of driver education and training in relation to graduated driver licensing. METHOD: Literature review and synthesis. RESULTS: Driver education programs have yet to demonstrate consistent attainment of their safety objectives. Moreover, they have not been found to enhance the safety effectiveness of graduated licensing programs--indeed, some practices, for example, "time discounts" for driver education have actually had a detrimental effect on teen safety. DISCUSSION: Despite its disappointing safety record to date, it is important not to abandon driver education. In particular, there are opportunities to improve driver education so that it achieves its safety objectives, and ensure that programs in the future complement graduated driver licensing and contribute to its overall safety benefits. Current and future efforts to improve driver education and better integrate it with graduated licensing programs, however, need to be rigorously evaluated to determine what does and does not work to reduce young driver crashes, and as importantly, to understand why this is the case. IMPACT ON INDUSTRY: Improved driver education integrated with graduated driver licensing has potential safety benefits.     

Post-license education for novice drivers: evaluation of a training programme implemented in Spain

INTRODUCTION: This study evaluated the implementation of a second phase training program for novice drivers in Spain, which puts the primary focus of the training on the higher hierarchical levels of driver behavior. METHOD: Two hundred and sixty-three participants took part throughout the study, which was implemented as an experimental design with the test and control groups assessed before and after the one day safety training. Measurement of the impact of the training program focused on the participants' self-evaluation and self-reporting of some driving behavior indicators related to accident risk. RESULTS: Data analysis showed a change in the expected direction in the scale related to the skills for careful driving, but not for the other four scales considered. A feedback survey about the training course offered some important input for evaluating the organization, contents, tuition, and results of the three parts of the training program (discussion group, on-road and track training) as reported by the participants in the test group. CONCLUSIONS AND SUGGESTIONS: The results of the experiment show that using a one day driver safety course, it is possible to change some of the drivers' evaluations connected to safe driving style into safe direction. The follow-up period was exceptionally long (9 months) and the design (randomly divided experimental and control groups with before and after measurements) was reliable. More effort should be devoted to improving the on-road part of the training, which was often perceived as a typical driving lesson rather than a feedback drive. IMPACT ON INDUSTRY: The findings suggest consideration of a mandatory 2nd phase driver training programme as a means to raise awareness of the full range of risks encountered by novice drivers, and as already introduced in 5 EU countries: Austria, Estonia, Finland, Luxembourg and Switzerland.     

Secondary analysis of time of day on simulated driving performance

PROBLEM: Age and gender are frequently controlled for in studies of driving performance, but the effects of time of day or circadian cycles on performance are often not considered. Previous research on time of day effects of simulated driving is contradictory and provides little guidance for understanding the impact of these variables on results. METHODS: Using driving simulator data from 79 subjects ages 18 to 65, this paper focuses on the impact of age, gender, and time of day on the simulated driving performance of subjects who self-selected the time of participation. RESULTS: Time of day effects were consistently evident for drivers' speed overall and across different simulated environments. Drivers in the late afternoon period consistently drove significantly slower than drivers in other time periods. Age and gender affected speed such that women and those participants 50 and older tended to drive more slowly. Time of day also had an effect on reaction time and on speed variability measures. Gender did not have significant effects on reaction time or variability measures, but age effects were present. SUMMARY: Taken together, the results suggest that time of day effects should be considered as part of simulated driving performance, and that interactions between time of day and other variables, notably age, should be controlled for as part of future research. IMPACT ON INDUSTRY: Implications of these findings on current efforts for older driver testing are discussed.     

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.     

将劳动安全卫生教育推向社会

从阐述我国劳动安全卫生教育面临的一个重要方面的问题入手,提出劳动安全卫生教育必须由企业推向社会。还探讨了劳动安全卫生教育推向社会的意义、作用以及具体方法。     

The learner's permit

PROBLEM: This paper considers the role and value of an extended learner's period in a graduated licensing system. METHOD: Review and synthesis of the literature. RESULTS: The learner's permit allows beginners to practice under supervision before attempting the road test for a driver's license. A learner's permit stage was an integral part of the "provisional" (graduated) licensing model initially formulated by NHTSA in the mid-1970s. Almost all Canadian provinces and U.S. states now have graduated licensing (GDL) programs that typically include an extended period of supervised driving. Most parents and teens favor the learner stage, and consistent with the intent of GDL, most learners are practicing and gaining driving experience under low-risk conditions. Research shows that very few learners crash while under supervision and that an extended learner stage has safety benefits. IMPACT ON RESEARCH, PRACTICE AND POLICY: Further research is needed on the safety benefits of an extended learner stage and on its optimal features.     

Graduated driver licensing and safer driving

Graduated Driver Licensing (GDL) inserts between the leaner permit and full licensure an intermediate or "provisional" license that allows novices to drive unsupervised but subject to provisions intended to reduce the risks that accompany entry into highway traffic. Introduction of GDL has been followed by lowered accident rates, resulting from both limiting exposure of novices to unsafe situations and by helping them to deal with them more safely. Sources of safer driving include extended learning, early intervention, contingent advancement, and multistage instruction. To extend the learning process, most GDL systems lengthen the duration of the learner phase and require a specified level of adult-supervised driving. Results indicate that extended learning can reduce accidents substantially if well structured and highly controlled. Early intervention with novice traffic violators have shown both a general deterrent effect upon novice violators facing suspension and a specific effect upon those who have experienced it. Making advancement to full licensure contingent upon a violation-free record when driving on the provisional license has also evidenced a reduction in accidents and violations during that phase of licensure. Multistage instruction attempts development of advanced skills only after novices have had a chance to master more basic skills. Although this element of GDL has yet to be evaluated, research indicates crash reduction is possible in situations where it does not increase exposure to risk. While the various elements of GDL have demonstrated potential benefit in enhancing the safety of novice drivers, considerable improvement in the nature and enforcement of GDL requirements is needed to realize that potential.