Cognitive skills underlying driving in patients discharged following self-poisoning with central nervous system depressant drugs

Background: Central nervous system-depressant (CNS-Ds) drugs can impair cognitive functions and driving. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. In Australia most of these patients are discharged within 48?h, while they still have possible subclinical drug effects. We aimed to determine whether patients treated for self-poisoning with CNS-Ds are impaired in the Trail-Making Test (TMT, parts A and B), a neuropsychological test that is known to correlate with driving performance. Methods: This study was a conducted from November 2008 to April 2011 in a referral center for poisonings in New South Wales, Australia. One hundred seven patients discharged from the clinical toxicology unit following treatment for self-poisoning of CNS-Ds (benzodiazepines, atypical antipsychotics, or opioids) and a control group of 68 discharged following self-poisoning of non-CNS-depressant drugs (acetaminophen or nonsedating antidepressants) were tested with the TMT (parts A and B). Due to the known association of impaired TMT with driving impairment and increased risk of traffic accidents, performance less than the 10th percentile for age was defined as significant impairment in each part of the TMT. The odds ratio (OR) for impairment in each part was calculated in multivariate logistic regression (MLR) models adjusted for gender, education, IQ, and the presence of a major psychiatric illness. A secondary MLR analysis was conducted only for those patients (78 CNS-D and 54 control group participants) who were directly discharged home, after excluding those who were transferred for further psychiatric care. Results: The odds of impairment in the CNS-D group was 2.8?times that of the control group on the TMT-A (38 [35.5%] vs. 11 [16.2%]: adjusted OR = 2.76, 95% confidence interval [CI]: 1.28-5.97), and 4.6?times on the TMT-B (67 [62.6%] vs. 22 [32.4%]: adjusted OR = 4.63, 95% CI: 2.06-10.42). The results were similar in the subgroup of patients discharged home, and the odds of impairment in the CNS-D group was 3.3?times that of the control group on the TMT-A (25 [32.1%] vs. 7 [13.0%]: adjusted OR = 3.30, 95% CI: 1.28-8.52), and 3.6?times on the TMT-B (46 [59.0%] vs. 17 [31.5%]: adjusted OR = 3.64, 95% CI: 1.44-9.20). TMT-B impairment in the CNS-D group remained significant even after adjusting for TMT-A performance. Conclusions: Patients with CNS-D overdose may have significant impairment in cognitive skills underlying driving at the time of discharge from hospitals. Clinicians should warn these patients that their driving skills might still be impaired, even if they are considered clinically recovered and advise them not to drive during the first 1 to 2?days following discharge.     

Reflections on 40 years of Disasters, 1977–2017

This reflection, based on a keynote address to celebrate the fortieth anniversary of Disasters on 14 September 2017, begins by considering some of the prevailing assumptions that existed at the time of the journal's creation. Next is a summary of significant milestones during the past 40 years, covering major global trends, changing disaster impacts, and key developments in disaster risk management. Contrasting approaches in the first and fourth decade of the journal's history are then followed by examples of changes in terminology in the disaster field as an indication of shifting values. The paper goes on to explore the context of 2017, with observations of problem areas such as the loss of knowledge, failures to tackle the root causes of disasters, shortfalls in international assistance, and some negative attitudes. It closes by evaluating some current positive occurrences, including a reduction in casualties, sharing of experience, technological advances, and dramatic improvements in disaster warning.     

Flooding and schools: experiences in Hull in 2007

Hull, a city in the East Riding of Yorkshire, United Kingdom, suffered severe flooding in June 2007, affecting some 8,600 households and most schools. Despite the potential for damage in such disasters, no studies of the effects of floods on teachers and schools in the UK appear to have been published previously. This study analysed the impacts of the floods on teachers in Hull in two stages: first through correspondence with Hull City Council and a mailed questionnaire to 91 head teachers of primary, secondary, and special schools; and second, through in‐depth interviews with head teachers from six flooded schools, representing different degrees of flood experience, and a questionnaire completed by eight teachers from the same schools. The findings reveal the importance and the complexity of the role of the school in the wider community in a time of crisis. The study highlights issues concerning preparedness for floods, support for schools, and flood protection for schools.     

The reclamation of worked-out sand and gravel quarries utilising domestic waste — the issue of groundwater pollution

Landfill is the cheapest method of domestic waste disposal but the amount disposed of in this way has declined in recent years. This decline in landfill is due principally to the unavailability of acceptable tipping sites. Up to 30% of land taken for sand and gravel extraction may not be restored to a productive use in the absence of fill material. Domestic waste is often available to reclaim derelict sand and gravel quarries, but unsubstantiated fears of tip leachate polluting groundwaters has prevented its use for this purpose.     

Biorheological properties of intertidal organic fluff on mud flats and its modification of gill ventilation in buried sole <Emphasis Type="Italic">Solea solea</Emphasis>

Intertidal mudflats are important nursery grounds for juveniles of many fish species. However, they are being used increasingly to farm bivalve molluscs, which produce large amounts of organic “fluff”, overlying the mud. Fish such as sole, Solea solea, hide in this fluff from potential predators, but the energy consumed by respiring the fluff may be high due to its biorheological properties. We developed an ichthyoviscometer. It incorporates a freshly killed fish as a viscometer, and we developed it to measure the rheological properties of fluids and suspensions, including fluff, at scales encompassing those in gill ventilation. We have shown that the rheological behaviour of fluff is close to that of a gel with a yield stress strongly dependent on particulate organic matter concentration ([POM]). This has allowed us to model fluff flow through the gill channels in living sole as a function of fish size and [POM], showing that in a 26-g sole, fluff would halve flow at a [POM] value of 3.2 g l⁻¹, and stop it at 3.4.     

Wave Enhancement of Diffusivities within Surficial Sediments

The enhancement of solute diffusivities within coastal surficial sediments as a result of wave action is examined. Fluctuating pressure gradients associated with passing waves cause interstitial water motions leading to enhanced diffusivities through the mechanism of shear dispersion. Wave amplification of diffusivities is likely to be greatest for waves of period 10 s, in shallow water, over a bottom of coarse grain. Diffusivity enhancement of hundreds of times molecular diffusivity is achievable. The mechanism is distinct from, but complements, the mechanism of rotational dispersion which has been previously described. Other mechanisms that enhance solute transport within surficial sediments rely on the interaction between wave-driven or steady flow over bottom obstructions such as biogenic structures or sand ripples. It is suggested that while the resulting advective flows may dominate solute transport within the top few 10 s of centimeters of the sediment column, shear dispersion may be more important deeper within the sediment. In any event, in contrast to these other mechanisms, shear dispersion is operative even when the seabed is flat. Application of the theory to sediments of the South Atlantic Bight would suggest that shear dispersion is capable of explaining a major part of the interstitial transport inferred from measurements.