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.     

工伤保险与安全管理

从我国安全管理实际出发,分析了借助于工伤保险的经济杠杆作用实现国家对企业安全管理制约机制的必要性,并对建立制约机制有关的指标体系及综合评估模型,以及该机制实现等问题进行了深入探讨.     

Protégé selection by mentors: what makes the difference?

This study examined protégé characteristics that mentors reported were most influential when choosing a protégé. Based on existing research, two variables were identified related to protégé selection: perceptions regarding the protégé's potential/ability and perceptions regarding the protégé's need for help. The relationships of these two factors with perceived barriers to mentoring others, mentor advancement aspirations, and mentor gender were investigated. Data from 282 mentors revealed that mentors were more likely to choose a protégé based on perceptions regarding the protégé's ability/potential than based on perceptions regarding the protégé's need for help. Additionally, women were more likely to choose a protégé based on the protégé's perceived ability than were men. Copyright © 2000 John Wiley & Sons, Ltd.     

Post-explosion observations of experimental mine and laboratory coal dust explosions

The Pittsburgh Research Laboratory (PRL) of the National Institute for Occupational Safety and Health (NIOSH) and the Mine Safety and Health Administration (MSHA) conducted joint research on dust explosions by studying post-explosion dust samples. The samples were collected after full-scale explosions at the PRL Lake Lynn Experimental Mine (LLEM), and after laboratory explosions in the PRL 20-L chamber and the Fike 1 m³ chamber. The dusts studied included both high- and low-volatile bituminous coals. Low temperature ashing for 24 h at 515 °C was used to measure the incombustible content of the dust before and after the explosions. The data showed that the post-explosion incombustible content was always as high as, or higher than the initial incombustible content. The MSHA alcohol coking test was used to determine the amount of coked dust in the post-explosion samples. The results showed that almost all coal dust that was suspended within the explosion flame produced significant amounts of coke. Measurements of floor dust concentrations after LLEM explosions were compared with the initial dust loadings to determine the transport distance of dust during an explosion. All these data will be useful in future forensic investigations of accidental dust explosions in coal mines, or elsewhere.     

Small-scale physical explosions in shock tubes in comparison with condensed high explosive detonations

A series of small-scale experiments involving physical explosions in a 1.6 l pressure vessel was carried out. Explosions were initiated by spontaneous rupture of an aluminium membrane on one side of the vessel at a pressure in the range 1–1.2 MPa. The pressure waves released were measured at different distances along two separate shock tubes, one 10 m long and 200 mm in diameter (closed at one end by the high pressure vessel) and the other 15 m long and 100 mm in diameter.TNT equivalency was used for predicting the blast wave characteristics after vessel rupture. TNT equivalency was used because equations for prediction of peak pressure and impulse of the blast wave in 1-D geometry after detonations of condensed explosives are known. Some experiments with an equivalent amount of real explosive were carried out for comparison with the theoretical and experimental data obtained. The applicability of the TNT equivalency method presented for calculations of maximum pressure and shock wave impulse generated after rupture of the pressure vessel in 1-D geometry is discussed.     

Healthcare utilization and costs among older adult female drivers and former drivers

PurposeThis study compared the healthcare utilization and costs for specific types of medical services among older adult women who currently drive and those who no longer drive.MethodsThis study included 347 women aged 65 or older who were either former (had stopped driving) or current drivers, randomly sampled from a large U.S. health plan to participate in a telephone survey, and who had automated health records with healthcare utilization and cost data. Bivariate analyses and generalized linear modeling were used to examine associations between driving status and healthcare utilization and costs.ResultsAdjusting for age, income, and marital status, former drivers were more likely than current drivers to use mental health care services (RR = 3.37; 95% CI: 1.03, 10.98). Former drivers also tended to use more inpatient (RR = 1.85; 95% CI: 0.88, 3.87) and emergency services (RR = 1.89; 95% CI: 0.96, 3.70), but results did not reach statistical significance. Total annual healthcare costs in 2005 were almost twice as high for former drivers compared with current drivers ($13,046 vs. $7,054; mean difference = $5,992; 95% CI: -$360, $12,344), although this relationship was not statistically significant (CR = 1.61; 95% CI: 0.88, 2.96).Impact on IndustryFormer drivers were more than three times as likely as current drivers to use mental health services, and tended to use more emergency and inpatient services. Further research on factors that potentially mediate the relationship between driving status and health service use is warranted.     

细水雾阻隔火焰热辐射的模拟研究

从热辐射传递方程出发,根据Mie散射理论,考虑雾滴对热辐射的散射和吸收特性,建立细水雾阻隔火焰热辐射的两通量模型,并给出简化算法;同时建立小尺度模拟实验系统,对理论模型进行验证.结果表明,两通量模型较为合理地预测了细水雾对火焰热辐射的衰减作用.在此基础上,应用上述理论模型进一步探讨火焰温度、细水雾特性参数、雾场厚度对阻隔热辐射效率的影响,为细水雾系统的实际工程应用提供了理论和依据.