A systematic review of prescribing criteria to evaluate appropriateness of medications in frail older people

This study systematically reviews the published literature regarding inappropriate prescribing in frail individuals aged at least 65 years. Twenty-five of 466 identified studies met the inclusion criteria. All papers measured some surrogate indicators of frailty, such as performance-based tests, cognitive function and functional dependency. Beers criteria were used in 20 studies (74%) to evaluate inappropriate medication use and 36% (9/25) studies used more than one criterion. The prevalence of inappropriate medications ranged widely from 11 to 92%. Only a few studies reported the relationship between potentially inappropriate medication use and surrogate measures of frailty. These diverse findings indicate the need for a standardized measure for assessing appropriateness of medication in frail older individuals. Prescribing tools should address both medication and patient-related factors such as life expectancy and functional status to minimize inappropriate prescribing in frail individuals.

Reliability in the Parameterization of the Functional Reach Test in Elderly Stroke Patients: A Pilot Study

BACKGROUND: Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. OBJECTIVES: To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. DESIGN: Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). PARTICIPANTS: Five subjects over 65 who suffer from a stroke. MEASUREMENTS: FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. RESULTS: FRT measure is  12.75±2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject, respectively. CONCLUSION: The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.

A novel ambiguity acceptance test threshold determination method with controllable failure rate

Ambiguity validation as an important procedure of integer ambiguity resolution is to test the correctness of the fixed integer ambiguity of phase measurements before being used for positioning computation. Most existing investigations on ambiguity validation focus on test statistic. How to determine the threshold more reasonably is less understood, although it is one of the most important topics in ambiguity validation. Currently, there are two threshold determination methods in the ambiguity validation procedure: the empirical approach and the fixed failure rate (FF-) approach. The empirical approach is simple but lacks of theoretical basis. The fixed failure rate approach has a rigorous probability theory basis, but it employs a more complicated procedure. This paper focuses on how to determine the threshold easily and reasonably. Both FF-ratio test and FF-difference test are investigated in this research and the extensive simulation results show that the FF-difference test can achieve comparable or even better performance than the well-known FF-ratio test. Another benefit of adopting the FF-difference test is that its threshold can be expressed as a function of integer least-squares (ILS) success rate with specified failure rate tolerance. Thus, a new threshold determination method named threshold function for the FF-difference test is proposed. The threshold function method preserves the fixed failure rate characteristic and is also easy-to-apply. The performance of the threshold function is validated with simulated data. The validation results show that with the threshold function method, the impact of the modelling error on the failure rate is less than 0.08%. Overall, the threshold function for the FF-difference test is a very promising threshold validation method and it makes the FF-approach applicable for the real-time GNSS positioning applications.

Effect of mobile phone use and aggression on speed selection by young drivers : a driving simulator study

Aggressive driving has been associated with engagement in other risky driving behaviours, such as speeding; while drivers using their mobile phones have an increased crash risk, despite the tendency to reduce their speed. Research has amassed separately for mobile phone use and aggressive driving among younger drivers, however little is known about the extent to which these behaviours may function independently and in combination to influence speed selection behaviour. The main aim of the current study was to investigate the effect of driver aggression (measured by the Driving Anger Expression Inventory) and mobile phone use on speed selection by young drivers. The CARRS-Q advanced driving simulator was used to test the speed selection of drivers aged 18 to 26 years (N = 32) in a suburban (60kph zone) driving context. A 2 (level of driving anger expression: low, high) X 3 (mobile phone use condition: baseline, hands-free, hand-held) mixed factorial ANOVA was conducted with speed selection as the dependent variable. Results revealed a significant main effect for mobile phone use condition such that speed selection was lowest for the hand-held condition and highest for the baseline condition. Speed selection, however, was not significantly different across the levels of driving anger expression; nor was there a significant interaction effect between the mobile phone use and driving anger expression. As young drivers are over-represented in road crash statistics, future research should further investigate the combined impact of driver aggression and mobile phone use on speed selection.

Male and female, cyclist and driver perceptions of crash risk in critical road situations

Male and Female, Cyclist and Driver Perceptions of Crash Risk in Critical Road Situations. Governments are promoting cycling but many Australians, particularly women, do not ride because they perceive it to be too risky. This research compared the risks perceived by female and male, cyclists and drivers in specific on-road situations, accounting for factors such as travel patterns and experience, perceived skill, and risk taking behaviours. Compared to their male counterparts, female cyclists and drivers gave similarly elevated perceptions of risk. These differences are not completely accounted for by cycling patterns or perceptions of skill. Thus, these gender differences are not specific to cycling, but may reflect wider differences in risk perception.

Investigating how designers collaborate and respond to sustainable design criteria

This research provides a critical link to ensure designers remain at the forefront of developing safe, sustainable and innovative products and services in the future. The four key findings of this research contribute to the advancement of knowledge and provide an understanding of the relationships between designers' co-evolution approach and their use of analogy. The behavioural relationships between sketching and gesture were investigated. The outcome of this research is a Design Activity Framework. This framework demonstrates a novel understanding how designers design by concentrating on co-evolution, problem-framing and solution seeking.

Male and female cyclist and driver perceptions of crash risk

Many drivers and non-cyclists perceive cycling as an extremely risky activity with women in particular being concerned about the risk of injury. The low rates of cycling participation by women pose a threat to the achievement of government targets for cycling participation and restrict the potential transport, health and environmental benefits that increased levels of cycling could provide. This study seeks to extend earlier research in gender and cycling by comparing the risks perceived by female and male cyclists and drivers in specific on-road situations while accounting for other potentially gender-related factors such as travel patterns and experience, perceived skill, and risk taking behaviors. In an online survey, 444 regular cyclists and 151 (non-cyclist) car drivers rated the level of risk in six situations: Failing to yield; Going through a red light; Not signaling when turning; Swerving; Tailgating; and Not checking traffic. The study found that the higher levels of risk perceived by women are not completely accounted for by differences in cycling patterns or perceptions of skill. Compared to their male counterparts, female cyclists and car drivers had similarly elevated perceptions of risk suggesting that these gender differences are not specific to cycling, but reflect wider differences in risk perception. Not all of the gender differences were consistent across cyclists and drivers. Higher levels of perceived skill were evident for male cyclists but not for male car drivers. Further research is needed to explore the robustness and interpretation of this finding.

Using augmented video to test in-car user experiences of context analog HUDs

Automotive interactive technologies represent an exemplar challenge for user experience (UX) designers, as the concerns for aesthetics, functionality and usability add up to the compelling issues of safety and cognitive demand. This extended abstract presents a methodology for the user-centred creation and evaluation of novel in-car applications, involving real users in realistic use settings. As a case study, we present the methodologies of an ideation workshop in a simulated environment and the evaluation of six design idea prototypes for in-vehicle head up display (HUD) applications using a semi-naturalistic drive. Both methods rely on video recordings of real traffic situations that the users are familiar with and/or experienced themselves. The extended abstract presents experiences and results from the evaluation and reflection on our methods.

Impact of real-time traffic characteristics on freeway crash occurrence: Systematic review and meta-analysis

The development of methods for real-time crash prediction as a function of current or recent traffic and roadway conditions is gaining increasing attention in the literature. Numerous studies have modeled the relationships between traffic characteristics and crash occurrence, and significant progress has been made. Given the accumulated evidence on this topic and the lack of an articulate summary of research status, challenges, and opportunities, there is an urgent need to scientifically review these studies and to synthesize the existing state-of-the-art knowledge. This paper addresses this need by undertaking a systematic literature review to identify current knowledge, challenges, and opportunities, and then conducts a meta-analysis of existing studies to provide a summary impact of traffic characteristics on crash occurrence. Sensitivity analyses were conducted to assess quality, publication bias, and outlier bias of the various studies; and the time intervals used to measure traffic characteristics were also considered. As a result of this comprehensive and systematic review, issues in study designs, traffic and crash data, and model development and validation are discussed. Outcomes of this study are intended to provide researchers focused on real-time crash prediction with greater insight into the modeling of this important but extremely challenging safety issue.

Analysis of young driver crash data. Report to the Research Council of Oman, Muscat

Road traffic crashes are an alarming public health issue in Oman, despite ongoing improvements in traffic law enforcement practices and technology. One of the main target groups for road safety in Oman are young drivers aged 17-25 years. This report provides an overview of the characteristics of crashes in Oman involving young drivers (17-25 years) between 1st January 2009 and 31st December 2011. Although, young drivers aged 17-25 years comprise around 17% of all licence holders in Oman, they represented more than one third of all drivers involved in road traffic crashes in the country. A total of 11,101 young drivers (17-25 years) were involved in registered crashes during the study period. From this, 7,727 young drivers (69.6%) were found to be the cause of the crashes...

Crash involvement patterns of unlicensed drivers and riders in Queensland. Report to Queensland Department of Transport and Main Roads

Unlicensed driving remains a serious problem for road safety, despite ongoing improvements in traffic law enforcement practices and technology. While it does not play a direct causative role in road crashes, unlicensed driving undermines the integrity of the driver licensing system and is associated with a range of high-risk behaviours. This report examines official road crash data from Queensland for the years 2003-08 to compare the crash involvement patterns of unlicensed drivers with those of licensed drivers and explore the scope and nature of unlicensed driving. This study replicates and extends upon two previous studies examining the involvement of unlicensed drivers in crashes in Queensland (Watson, 2004a; 2004b; Watson & Steinhardt, 2006).