PubMed · 11219377
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R B Voas. 2000. DUI risk screening instruments.. https://pubmed.ncbi.nlm.nih.gov/11219377/
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In-vehicle information systems will soon confront drivers with an increasing number of warnings and alerts for situations ranging from imminent collisions to the arrival of e-mail messages. Coordinating these alerts can ensure that they enhance rather than degrade driving safety. Two experiments examined how temporal conflict and sound parameters affect driver performance and acceptance. The temporal conflict of an e-mail alert occurring 300 ms before a collision warning interfered with the response to the collision warning, but an e-mail alert occurring 1000 ms before the collision warning had the opposite effect and enhanced the response to the collision warning. These results emphasize the need to consider how in-vehicle devices influence drivers' strategic anticipation of high-demand situations. Regarding sound parameters, results showed that highly urgent sounds tended to speed drivers' accelerator release, but the annoyance associated with highly urgent sounds increased workload. In fact, there was a strong positive association between ratings of annoyance and subjective workload. Consistent with the urgency mapping principle, there was a slight negative association between the differences in the rated urgency of collision warnings and e-mail alerts and subjective workload. The results suggest that warning and alert design should consider an annoyance trade-off in addition to urgency mapping.
HISTORY AND ADMISSION FINDINGS: A 35-year-old patient presented with a non-penetrating chest trauma due to an automobile accident. Examinations showed a trauma of the left shoulder (reversed Hill-Sachs lesion). After diagnostic procedures, he underwent surgery four weeks later. During the hospital stay, the patient developed angina pectoris, dizziness and syncopes. INVESTIGATIONS AND DIAGNOSIS: When the patient was transferred to our institution a 12-leads electrocardiogram and blood analysis were unremarkable. Cardiac catheterization revealed a relaxation disorder of the left ventricular anterior wall with normal coronaries. The Holter-ECG detected with occasional attacks of dizziness and recurrent syncopes concurrent with intermittent episodes of high-degree atrioventricular block and supraventricular tachycardias. This led to the diagnosis of myocardial contusion with long term symptomatic arrhythmias. TREATMENT AND COURSE: Since syncopes and arrhythmias persisted over several weeks following myocardial contusion a combined therapy with a dual chamber pacemaker and beta-blocker was initiated. CONCLUSION: ECG monitoring after blunt chest trauma in the early period and after several days is mandatory to screen and prevent potentially life threatening posttraumatic arrhythmias.
CONTEXT: Little is known about how state-level driver licensure laws, such as in-person renewal, vision tests, road tests, and the frequency of license renewal relate to the older driver traffic fatality rate. OBJECTIVE: To determine whether state driver's license renewal policies are associated with the fatality rate among elderly drivers. DESIGN, SETTING, AND POPULATION: Retrospective, longitudinal study conducted January 1990 through December 2000 of all fatal crashes in the contiguous United States identified in the Fatality Analysis Reporting System, which involved either an older (ages 65-74 years, 75-84 years, and > or =85 years) or middle-aged (ages 25-64 years) driver. Two regression approaches were used to study the effect of state laws mandating in-person renewal, vision tests, road tests, and frequency of license renewal on driver fatalities, controlling for state-level factors including the number of licensed elderly drivers, primary and secondary seatbelt laws, maximum speed limit laws, blood alcohol level of 0.08, and administrative license revocation drinking and driving laws, per capita income, and unemployment rate. The first regression approach examined only elderly driver fatalities and the second approach examined daytime elderly driver fatalities and used daytime fatalities among middle-aged drivers as a general control for unobserved variation across states and over time. MAIN OUTCOME MEASURES: Older driver fatalities and older and middle-aged daytime driver fatalities. RESULTS: Among individuals aged 85 years or older, there were a total of 4605 driver fatalities and 4179 daytime driver fatalities during the study period. For this age cohort, after controlling for middle-aged daytime driver deaths, states with in-person license renewal were associated with a lower driver fatality rate (incident rate ratio [RR], 0.83; 95% confidence interval [CI], 0.72-0.96). This was the only policy related to older drivers that was significantly associated with a lower fatality risk across both regression models. Thus, state-mandated vision tests, road tests, more frequent license renewal, and in-person renewal (for individuals aged 65-74 years and 75-84 years) were not found to be independently associated with the fatality rate among older drivers in the 2 models. CONCLUSIONS: In-person license renewal was related to a significantly lower fatality rate among the oldest old drivers. More stringent state licensure policies such as vision tests, road tests, and more frequent license renewal cycles were not independently associated with additional benefits.