Vision, functional and cognitive determinants of motor vehicle incidents in older drivers

Background: The proportion of older individuals in the driving population is predicted to increase in the next 50 years. This has important implications for driving safety as abilities which are important for safe driving, such as vision (which accounts for the majority of the sensory input required for driving), processing ability and cognition have been shown to decline with age. The current methods employed for screening older drivers upon re-licensure are also vision based. This study, which investigated social, behavioural and professional aspects involved with older drivers, aimed to determine: (i) if the current visual standards in place for testing upon re-licensure are effective in reducing the older driver fatality rate in Australia; (ii) if the recommended visual standards are actually implemented as part of the testing procedures by Australian optometrists; and (iii) if there are other non-standardised tests which may be better at predicting the on-road incident-risk (including near misses and minor incidents) in older drivers than those tests recommended in the standards. Methods: For the first phase of the study, state-based age- and gender-stratified numbers of older driver fatalities for 2000-2003 were obtained from the Australian Transportation Safety Bureau database. Poisson regression analyses of fatality rates were considered by renewal frequency and jurisdiction (as separate models), adjusting for possible confounding variables of age, gender and year. For the second phase, all practising optometrists in Australia were surveyed on the vision tests they conduct in consultations relating to driving and their knowledge of vision requirements for older drivers. Finally, for the third phase of the study to investigate determinants of on-road incident risk, a stratified random sample of 600 Brisbane residents aged 60 years and were selected and invited to participate using an introductory letter explaining the project requirements. In order to capture the number and type of road incidents which occurred for each participant over 12 months (including near misses and minor incidents), an important component of the prospective research study was the development and validation of a driving diary. The diary was a tool in which incidents that occurred could be logged at that time (or very close in time to which they occurred) and thus, in comparison with relying on participant memory over time, recall bias of incident occurrence was minimised. Association between all visual tests, cognition and scores obtained for non-standard functional tests with retrospective and prospective incident occurrence was investigated. Results: In the first phase,rivers aged 60-69 years had a 33% lower fatality risk (Rate Ratio [RR] = 0.75, 95% CI 0.32-1.77) in states with vision testing upon re-licensure compared with states with no vision testing upon re-licensure, however, because the CIs are wide, crossing 1.00, this result should be regarded with caution. However, overall fatality rates and fatality rates for those aged 70 years and older (RR=1.17, CI 0.64-2.13) did not differ between states with and without license renewal procedures, indicating no apparent benefit in vision testing legislation. For the second phase of the study, nearly all optometrists measured visual acuity (VA) as part of a vision assessment for re-licensing, however, 20% of optometrists did not perform any visual field (VF) testing and only 20% routinely performed automated VF on older drivers, despite the standards for licensing advocating automated VF as part of the vision standard. This demonstrates the need for more effective communication between the policy makers and those responsible for carrying out the standards. It may also indicate that the overall higher driver fatality rate in jurisdictions with vision testing requirements is resultant as the tests recommended by the standards are only partially being conducted by optometrists. Hence a standardised protocol for the screening of older drivers for re-licensure across the nation must be established. The opinions of Australian optometrists with regard to the responsibility of reporting older drivers who fail to meet the licensing standards highlighted the conflict between maintaining patient confidentiality or upholding public safety. Mandatory reporting requirements of those drivers who fail to reach the standards necessary for driving would minimise potential conflict between the patient and their practitioner, and help maintain patient trust and goodwill. The final phase of the PhD program investigated the efficacy of vision, functional and cognitive tests to discriminate between at-risk and safe older drivers. Nearly 80% of the participants experienced an incident of some form over the prospective 12 months, with the total incident rate being 4.65/10 000 km. Sixty-three percent reported having a near miss and 28% had a minor incident. The results from the prospective diary study indicate that the current vision screening tests (VA and VF) used for re-licensure do not accurately predict older drivers who are at increased odds of having an on-road incident. However, the variation in visual measurements of the cohort was narrow, also affecting the results seen with the visual functon questionnaires. Hence a larger cohort with greater variability should be considered for a future study. A slightly lower cognitive level (as measured with the Mini-Mental State Examination [MMSE]) did show an association with incident involvement as did slower reaction time (RT), however the Useful-Field-of-View (UFOV) provided the most compelling results of the study. Cut-off values of UFOV processing (>23.3ms), divided attention (>113ms), selective attention (>258ms) and overall score (moderate/ high/ very high risk) were effective in determining older drivers at increased odds of having any on-road incident and the occurrence of minor incidents. Discussion: The results have shown that for the 60-69 year age-group, there is a potential benefit in testing vision upon licence renewal. However, overall fatality rates and fatality rates for those aged 70 years and older indicated no benefit in vision testing legislation and suggests a need for inclusion of screening tests which better predict on-road incidents. Although VA is routinely performed by Australian optometrists on older drivers renewing their licence, VF is not. Therefore there is a need for a protocol to be developed and administered which would result in standardised methods conducted throughout the nation for the screening of older drivers upon re-licensure. Communication between the community, policy makers and those conducting the protocol should be maximised. By implementing a standardised screening protocol which incorporates a level of mandatory reporting by the practitioner, the ethical dilemma of breaching patient confidentiality would also be resolved. The tests which should be included in this screening protocol, however, cannot solely be ones which have been implemented in the past. In this investigation, RT, MMSE and UFOV were shown to be better determinants of on-road incidents in older drivers than VA and VF, however, as previously mentioned, there was a lack of variability in visual status within the cohort. Nevertheless, it is the recommendation from this investigation, that subject to appropriate sensitivity and specificity being demonstrated in the future using a cohort with wider variation in vision, functional performance and cognition, these tests of cognition and information processing should be added to the current protocol for the screening of older drivers which may be conducted at licensing centres across the nation.

Does lymphedema following breast cancer warrant clinical attention?

Secondary lymphedema (swelling) after breast cancer treatment usually develops on the hand, arm, shoulder, and/or breast on the treated side. It is commonly associated with the presence of other upper-body symptoms, such as pain and aching1; it impacts physical and psychosocial functioning and adversely influences quality of life.2 Moreover, it is considered incurable, progressive, and difficult to treat. Arguably, lymphedema is the most problematic and dreaded treatment-related complication of breast cancer.3

Enhancing Student Learning in Large Undergraduate Clasees by Using Audio-visual Case Studies

Critical skills such as identifying and appreciating issues that confront firms engaging in international business, and the ability to undertake creative decision-making, are considered fundamental to the study of International Business. It has been argued that using audio-visual case studies can help develop such skills. However, this is difficult due to a lack of Australian case studies. This paper reviews the literature outlining the advantages believed to result from the use of audio-visual case studies, describes a project implemented in a large cohort of students studying International Business, reports on a pilot evaluation of the project, and outlines the findings and conclusions of the survey.

Structural health monitoring of bridges using acoustic emission technology and signal processing techniques

Structural health monitoring (SHM) is the term applied to the procedure of monitoring a structure’s performance, assessing its condition and carrying out appropriate retrofitting so that it performs reliably, safely and efficiently. Bridges form an important part of a nation’s infrastructure. They deteriorate due to age and changing load patterns and hence early detection of damage helps in prolonging the lives and preventing catastrophic failures. Monitoring of bridges has been traditionally done by means of visual inspection. With recent developments in sensor technology and availability of advanced computing resources, newer techniques have emerged for SHM. Acoustic emission (AE) is one such technology that is attracting attention of engineers and researchers all around the world. This paper discusses the use of AE technology in health monitoring of bridge structures, with a special focus on analysis of recorded data. AE waves are stress waves generated by mechanical deformation of material and can be recorded by means of sensors attached to the surface of the structure. Analysis of the AE signals provides vital information regarding the nature of the source of emission. Signal processing of the AE waveform data can be carried out in several ways and is predominantly based on time and frequency domains. Short time Fourier transform and wavelet analysis have proved to be superior alternatives to traditional frequency based analysis in extracting information from recorded waveform. Some of the preliminary results of the application of these analysis tools in signal processing of recorded AE data will be presented in this paper.

Eye-movements and visual imagery : a working memory approach to the treatment of post-traumatic stress disorder

It has been claimed that the symptoms of post-traumatic stress disorder (PTSD) can be ameliorated by eye-movement desensitization-reprocessing therapy (EMD-R), a procedure that involves the individual making saccadic eye-movements while imagining the traumatic event. We hypothesized that these eye-movements reduce the vividness of distressing images by disrupting the function of the visuospatial sketchpad (VSSP) of working memory, and that by doing so they reduce the intensity of the emotion associated with the image. This hypothesis was tested by asking non-PTSD participants to form images of neutral and negative pictures under dual task conditions. Their images were less vivid with concurrent eye-movements and with a concurrent spatial tapping task that did not involve eye-movements. In the first three experiments, these secondary tasks did not consistently affect participants' emotional responses to the images. However, Expt 4 used personal recollections as stimuli for the imagery task, and demonstrated a significant reduction in emotional response under the same dual task conditions. These results suggest that, if EMD-R works, it does so by reducing the vividness and emotiveness of traumatic images via the VSSP of working memory. Other visuospatial tasks may also be of therapeutic value.

Maternal anxiety and attention problems in children at 5 and 14 years

Objective: This study examines the association between maternal anxiety from pregnancy to 5 years and child attention problems at 5 and 14 years. Method: Birth cohort of 3,982 individuals born in Brisbane between 1981 and 1983 are assessed. Self-reported measures of maternal anxiety are assessed at four time points. Maternal reports of child attention problems using Achenbach’s Child Behavior Checklist are assessed at 5 and 14 years. Results: Children of mothers experiencing anxiety during or after pregnancy are at greater risk of experiencing attention problems at 5 and 14 years. After adjusting for maternal age and child’s gender, antenatal anxiety is strongly associated with persistent attention problems (OR = 3.65, 95% CI = 2.19, 6.07). Children with chronically anxious mothers are 5.67 (95% CI = 3.56, 9.03) times more likely to have persistent attention problems. These associations remain consistent after adjusting for potential confounders. Conclusions: Maternal anxiety appears to increase the rate of child attention problems and identifies a need for treatment programs to have a dual focus—the mother and her child. (J. of Att. Dis. 2009; XX(X) 1-XX)

Decentred optical axes and aberrations along principal visual field meridians

Suggestions that peripheral imagery may affect the development of refractive error have led to interest in the variation in refraction and aberration across the visual field. It is shown that, if the optical system of the eye is rotationally symmetric about an optical axis which does not coincide with the visual axis, measurements of refraction and aberration made along the horizontal and vertical meridians of the visual field will show asymmetry about the visual axis. The departures from symmetry are modelled for second-order aberrations, refractive components and third-order coma. These theoretical results are compared with practical measurements from the literature. The experimental data support the concept that departures from symmetry about the visual axis in the measurements of crossed-cylinder astigmatism J45 and J180 are largely explicable in terms of a decentred optical axis. Measurements of the mean sphere M suggest, however, that the retinal curvature must differ in the horizontal and vertical meridians.

Interaction between visual status, driver age and distracters on daytime driving performance

This study investigated the effects of visual status, driver age and the presence of secondary distracter tasks on driving performance. Twenty young (M = 26.8 years) and 19 old (M = 70.2 years) participants drove around a closed-road circuit under three visual (normal, simulated cataracts, blur) and three distracter conditions (none, visual, auditory). Simulated visual impairment, increased driver age and the presence of a distracter task detrimentally affected all measures of driving performance except gap judgments and lane keeping. Significant interaction effects were evident between visual status, age and distracters; simulated cataracts had the most negative impact on performance in the presence of visual distracters and a more negative impact for older drivers. The implications of these findings for driving behaviour and acquisition of driving-related information for people with common visual impairments are discussed

Growing up

‘Growing Up’ is the key concept as well as the ideology for modernism. For modernism, ‘Growing Up’ has been regarded as ‘good’, ‘advance’, ‘power’ and ‘positive’; while, postmodernists pay attention to its negatives that it brings about abuse of natural resources, war, suppression of human rights, environmental pollution, and institutionalisation. The artwork, Growing Up illustrates the positive and negative aspects of ‘Growing Up’ by using three images of a flower, a bee and a devil. The flower represents flourish of modernism, the bee does prosperity (spread) of modernism, and a devil image generated from the flower (modernism) is negative aspects of modernism. The message of the artwork is that modernism itself determines its own destiny from ‘Growing Up’ that may jeopardise the bee.

Measuring Visual Consistency in 3D Rendering Systems

One of the major challenges facing a present day game development company is the removal of bugs from such complex virtual environments. This work presents an approach for measuring the correctness of synthetic scenes generated by a rendering system of a 3D application, such as a computer game. Our approach builds a database of labelled point clouds representing the spatiotemporal colour distribution for the objects present in a sequence of bug-free frames. This is done by converting the position that the pixels take over time into the 3D equivalent points with associated colours. Once the space of labelled points is built, each new image produced from the same game by any rendering system can be analysed by measuring its visual inconsistency in terms of distance from the database. Objects within the scene can be relocated (manually or by the application engine); yet the algorithm is able to perform the image analysis in terms of the 3D structure and colour distribution of samples on the surface of the object. We applied our framework to the publicly available game RacingGame developed for Microsoft(R) Xna(R). Preliminary results show how this approach can be used to detect a variety of visual artifacts generated by the rendering system in a professional quality game engine.

Patterning fashion : drafting a visual framework

Christine Schmidt uses swimwear to illustrate that the methodological practice of the assemblage of pattern pieces is inherent to the intellectual construction that underpins fashion's cultural and historical discourses. She argues that these common threads are woven together to shape the finished 'global' garment.

Seeing pedestrians at night : visual clutter does not mask biological motion

Although placing reflective markers on pedestrians’ major joints can make pedestrians more conspicuous to drivers at night, it has been suggested that this “biological motion” effect may be reduced when visual clutter is present. We tested whether extraneous points of light affected the ability of 12 younger and 12 older drivers to see pedestrians as they drove on a closed road at night. Pedestrians wore black clothing alone or with retroreflective markings in four different configurations. One pedestrian walked in place and was surrounded by clutter on half of the trials. Another was always surrounded by visual clutter but either walked in place or stood still. Clothing configuration, pedestrian motion, and driver age influenced conspicuity but clutter did not. The results confirm that even in the presence of visual clutter pedestrians wearing biological motion configurations are recognized more often and at greater distances than when they wear a reflective vest.

Impact of simulated visual impairment on the cognitive test performance of young adults

Aims: This study investigated the effect of simulated visual impairment on the speed and accuracy of performance on a series of commonly used cognitive tests. ----- Methods: Cognitive performance was assessed for 30 young, visually normal subjects (M=22.0yrs ± 3.1 yrs) using the Digit Symbol Substitution Test (DSST), Trail Making Test (TMT) A and B and the Stroop Colour Word Test under three visual conditions: normal vision and two levels of visually degrading filters (VistechTM) administered in a random order. Distance visual acuity and contrast sensitivity were also assessed for each filter condition. ----- Results: The visual filters, which degraded contrast sensitivity to a greater extent than visual acuity, significantly increased the time to complete (p<0.05), but not the number of errors made, on the DSST and the TMT A and B and affected only some components of the Stroop test.----- Conclusions: Reduced contrast sensitivity had a marked effect on the speed but not the accuracy of performance on commonly used cognitive tests, even in young individuals; the implications of these findings are discussed.

Accounts of the visual art classroom : catering for artistically talented students

Inclusive education practices call for the diverse and individual needs of all students to be met satisfactorily. The needs and experiences of artistically talented students in Australian visual art classrooms are currently unknown. This study addresses this gap in research through an inquiry into the experiences of artistically talented students and their teachers in visual art classrooms, by examining the accounts of a group of students and teachers at one high school in South East Queensland. This study is significant as it provides teachers, parents and others involved in the education of artistically talented students with additional means to plan and cater for the educational needs of artistically talented students. Teacher and student accounts of the visual art classroom in this study indicated that identification processes for artistically talented students are unclear and contradictory. Furthermore, teacher and student accounts of their experiences presented a wide variety of conceptions of the visual art classroom and point towards an individualised approach to learning for artistically talented students. This study also discovered a mismatch between assessment practices in the subject visual art and assessment of art in the ‘real world’. Specifically, this study proposes a renewal of programs for artistically talented students, and recommends a revision of current procedures for the identification of artistically talented students in visual art classrooms.