Objectives: There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI).
Methods: Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses.
Results: Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample.
Conclusions: The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive. 相似文献
Introduction: This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator. Method: Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders. Results: The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47–0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35–0.78, p < 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48–0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive. 相似文献
Pine–oak forests are of high ecological importance worldwide, but many are threatened by uncharacteristically severe wildfire.
Forest restoration treatments, including the reintroduction of a surface fire regime, are intended to decrease fire hazard
and emulate historic ecosystem structure and function. Restoration has recently received much management attention and short-term
study, but little is known about longer-term ecosystem responses. We remeasured a replicated experimental restoration site
in the southwestern United States 5 years after treatments. Basal area, tree density, and canopy cover decreased in the treated
units at a faster rate than in controls. Delayed mortality, not evident right after treatment, decreased density modestly
(13% in treated units and 10% in controls) but disproportionately affected large trees (“large” ponderosa pines were those
with diameter at breast height [dbh] ≥37.5 cm; other species dbh ≥20 cm). In treated units, 10.9 large trees ha–1 died, whereas 6.2 trees ha–1 died in control units. Compared with reference conditions, the experimental blocks remained higher in pine density and, in
three of the four blocks, in basal area. Pine trees grew significantly faster in treated units than in controls, enough to
reach the reference level of basal area in 6 years. Although mortality of large trees is a concern, the treated units have
vigorous growth and low density, indicating that they will be relatively resistant to future drought and fire events. Similar
treatments may be beneficial in many areas of the United States and in related pine-oak ecosystems elsewhere. 相似文献
ABSTRACT: Physically-based models are extensively used to simulate the infiltration process under varied field conditions. Most models are based on the deterministic nature of input parameters related to the flow process (such as hydraulic conductivity). These models yield poor predictions of infiltration rates because they do not include the field-scale variations of flow parameters. The paper presents an approach for integrating the field-scale variability of hydraulic conductivity with an infiltration model to simulate infiltration under the rainfall conditions. A model describing the spatial structure of hydraulic conductivity has been developed using stochastic techniques. The stochastic structure of hydraulic conductivity was then incorporated in the Green-Ampt and Mein-Larson infiltration model. The model outputs on the instantaneous infiltration rates and cumulative infiltration were evaluated using the field infiltration data measured under simulated rainfall conditions. The results show that the combined model is capable of rep. resenting the instantaneous infiltration rates and cumulative infiltration of the study soils. The model may, therefore, be used to simulate the rainfall infiltration process for spatially-variable soils under the field conditions. 相似文献