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.     

Human bioaccessibility of Cr, Cu, Ni, Pb and Zn in urban soils from the city of Torino, Italy

Several physiologically based extraction procedures have been proposed to estimate the fraction of the potentially toxic element content that would be bioaccessible in the human gastro-intestinal tract following accidental ingestion of soil. Many of these procedures are complex, they have been applied to a very limited range of soils, and most work has focussed on arsenic and lead. In the present study, a simplified, two-stage extraction, simulating the human stomach and intestine, was developed and applied to urban soil samples from ten public-access areas in the City of Torino, Italy. The human oral bioaccessibility of chromium, copper, nickel, lead and zinc was estimated. Lead and zinc bioaccessibilities were found to be higher in the stomach, but chromium was more bioaccessible in the intestine. Analyte concentrations were higher in roadside soils than in soils from parks. A higher proportion of the soil metal content was found in bioaccessible forms at roadsides than in parks. Comparison of the current findings with results of earlier work involving sequential extraction of the same soils indicated that the sequential procedure gave a relative, but not an absolute, indication of bioaccessibility. Calculations based on the bioaccessible analyte concentrations suggest that ingestion of only 2–3 g of some of the roadside soil samples from Torino could deliver the tolerable daily oral intake of chromium, nickel and lead to a 20-kg child. The developed procedure is useful for preliminary screening of soils and prediction of whether their bioaccessible metal contents are likely to pose a risk to human health.     

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.     

Growing an environmental leadership strategy at duke power company

This article presents information on Duke Power Company's environmental leadership strategic measures, targets, and results. Information is presented on how each measure is defined, how progress is measured and reported, what behavior changes have been observed, the results achieved, and what challenges are foreseen in the future.     

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.