Mobility changes in older age: neuropsychological, neurophysiological and cognitive predictors of successful adaptation in a real world scenario

The aims of this thesis were to investigate the neuropsychological, neurophysiological, and cognitive contributors to mobility changes with increasing age. In a series of studies with adults aged 45-88 years, unsafe pedestrian behaviour and falls were investigated in relation to i) cognitive functions (including response time variability, executive function, and visual attention tests), ii) mobility assessments (including gait and balance and using motion capture cameras), iii) motor initiation and pedestrian road crossing behavior (using a simulated pedestrian road scene), iv) neuronal and functional brain changes (using a computer based crossing task with magnetoencephalography), and v) quality of life questionnaires (including fear of falling and restricted range of travel). Older adults are more likely to be fatally injured at the far-side of the road compared to the near-side of the road, however, the underlying mobility and cognitive processes related to lane-specific (i.e. near-side or far-side) pedestrian crossing errors in older adults is currently unknown. The first study explored cognitive, motor initiation, and mobility predictors of unsafe pedestrian crossing behaviours. The purpose of the first study (Chapter 2) was to determine whether collisions at the near-side and far-side would be differentially predicted by mobility indices (such as walking speed and postural sway), motor initiation, and cognitive function (including spatial planning, visual attention, and within participant variability) with increasing age. The results suggest that near-side unsafe pedestrian crossing errors are related to processing speed, whereas far-side errors are related to spatial planning difficulties. Both near-side and far-side crossing errors were related to walking speed and motor initiation measures (specifically motor initiation variability). The salient mobility predictors of unsafe pedestrian crossings determined in the above study were examined in Chapter 3 in conjunction with the presence of a history of falls. The purpose of this study was to determine the extent to which walking speed (indicated as a salient predictor of unsafe crossings and start-up delay in Chapter 2), and previous falls can be predicted and explained by age-related changes in mobility and cognitive function changes (specifically within participant variability and spatial ability). 53.2% of walking speed variance was found to be predicted by self-rated mobility score, sit-to-stand time, motor initiation, and within participant variability. Although a significant model was not found to predict fall history variance, postural sway and attentional set shifting ability was found to be strongly related to the occurrence of falls within the last year. Next in Chapter 4, unsafe pedestrian crossing behaviour and pedestrian predictors (both mobility and cognitive measures) from Chapter 2 were explored in terms of increasing hemispheric laterality of attentional functions and inter-hemispheric oscillatory beta power changes associated with increasing age. Elevated beta (15-35 Hz) power in the motor cortex prior to movement, and reduced beta power post-movement has been linked to age-related changes in mobility. In addition, increasing recruitment of both hemispheres has been shown to occur and be beneficial to perform similarly to younger adults in cognitive tasks (Cabeza, Anderson, Locantore, & McIntosh, 2002). It has been hypothesised that changes in hemispheric neural beta power may explain the presence of more pedestrian errors at the farside of the road in older adults. The purpose of the study was to determine whether changes in age-related cortical oscillatory beta power and hemispheric laterality are linked to unsafe pedestrian behaviour in older adults. Results indicated that pedestrian errors at the near-side are linked to hemispheric bilateralisation, and neural overcompensation post-movement, 4 whereas far-side unsafe errors are linked to not employing neural compensation methods (hemispheric bilateralisation). Finally, in Chapter 5, fear of falling, life space mobility, and quality of life in old age were examined to determine their relationships with cognition, mobility (including fall history and pedestrian behaviour), and motor initiation. In addition to death and injury, mobility decline (such as pedestrian errors in Chapter 2, and falls in Chapter 3) and cognition can negatively affect quality of life and result in activity avoidance. Further, number of falls in Chapter 3 was not significantly linked to mobility and cognition alone, and may be further explained by a fear of falling. The objective of the above study (Study 2, Chapter 3) was to determine the role of mobility and cognition on fear of falling and life space mobility, and the impact on quality of life measures. Results indicated that missing safe pedestrian crossing gaps (potentially indicating crossing anxiety) and mobility decline were consistent predictors of fear of falling, reduced life space mobility, and quality of life variance. Social community (total number of close family and friends) was also linked to life space mobility and quality of life. Lower cognitive functions (particularly processing speed and reaction time) were found to predict variance in fear of falling and quality of life in old age. Overall, the findings indicated that mobility decline (particularly walking speed or walking difficulty), processing speed, and intra-individual variability in attention (including motor initiation variability) are salient predictors of participant safety (mainly pedestrian crossing errors) and wellbeing with increasing age. More research is required to produce a significant model to explain the number of falls.

Children's attentional skills and road behavior

Switching attention and concentration, 2 skills expected to be used by skillful pedestrians, were studied. A sample of 160 children (aged 4 years 3 months-10 years) played a computer game involving attention switching. To examine concentration, a subset of the children was distracted with a cartoon video while they attempted a difficult task that required matching familiar figures. The same subset was also observed crossing roads. Older children switched faster and were less distracted. Children who were better at switching were more likely to show awareness of traffic when about to cross a road. Children who maintained concentration when challenged by a distracting event crossed the road in a less reckless manner. Parents and educators designing safety programs should take into account the development of these skills.

Investigation of dyslexia and SLI risk variants in reading- and language-impaired subjects

Dyslexia (or reading disability) and specific language impairment (or SLI) are common childhood disorders that show considerable co-morbidity and diagnostic overlaps and have been suggested to share some genetic aetiology. Recently, genetic risk variants have been identified for SLI and dyslexia enabling the direct evaluation of possible shared genetic influences between these disorders. In this study we investigate the role of variants in these genes (namely MRPL19/C20RF3, ROBO1, DCDC2, KIAA0319, DYX1C1, CNTNAP2, ATP2C2 and CMIP) in the aetiology of SLI and dyslexia. We perform case–control and quantitative association analyses using measures of oral and written language skills in samples of SLI and dyslexic families and cases. We replicate association between KIAA0319 and DCDC2 and dyslexia and provide evidence to support a role for KIAA0319 in oral language ability. In addition, we find association between reading-related measures and variants in CNTNAP2 and CMIP in the SLI families.

Understanding the role of self-identity in habitual risky behaviours: pedestrian road-crossing decisions across the lifespan

Self-identity as a careful pedestrian has not been fully considered in previous work on predicting intention to cross the road, or actual crossing behaviour, in non-optimal situations. Evidence suggests that self-identity may be a better predictor than attitudes in situations where decision-making styles have become habitual ways to respond. This study compared contributions of self-identity and attitudes to the prediction of intentions in two situations differing in level of habitual crossing expectation, and to crossing behaviour. Three hundred and sixty-two adults (17–92 years) completed a questionnaire measuring self-identity, attitudes, intentions, experience, social identity variables (e.g. age, gender) and personal limitations (mobility). Two hundred and five participants also completed a road-crossing simulation. Self-identity and attitude were both shown as significant independent predictors of intention in both situations. However, self-identity was less effective as a predictor in the higher risk scenario, where intention to perform the behaviour was lower, and for participants aged >75 years who had lower intention across scenarios. Self-identity strongly predicted intention to cross, which in turn predicted behaviour, but self-identity did not directly predict behaviour. Self-identity was strongly predicted by age. Implications for theories of compensation in older age and for design and targeting of pedestrian safety education are discussed.

The effect of age, gender and driver status on pedestrians' intentions to cross the road in risky situations

The theory of planned behaviour (TPB) has been used successfully in the past to account for pedestrians' intentions to cross the road in risky situations. However, accident statistics show age and gender differences in the likelihood of adult pedestrian accidents. This study extends earlier work by examining the relative importance of the model components as predictors of intention to cross for four different adult age groups, men, women, drivers and nondrivers. The groups did not differ in the extent to which they differentiated between two situations of varying perceived risk. The model fit was good, but accounted for less of the variance in intention for the youngest group (17-24) than for other age groups. Differences between the age groups in intention to cross seemed to be due to differences in perceived value of crossing rather than differences in perceived risk. Women were less likely to intend to cross than men and perceived more risk, and there were important age, gender and driver status differences in the importance of the TPB variables as predictors of intention. A key implication of these findings is that road safety interventions need to be designed differently for different groups. © 2006 Elsevier Ltd. All rights reserved.

Risk homeostasis theory in simulated environments

This thesis has two aims. First, it sets out to develop an alternative methodology for the investigation of risk homeostasis theory (RHT). It is argued that the current methodologies of the pseudo-experimental design and post hoc analysis of road-traffic accident data both have their limitations, and that the newer 'game' type simulation exercises are also, but for different reasons, incapable of testing RHT predictions. The alternative methodology described here is based on the simulation of physical risk with intrinsic reward rather than a 'points pay-off'. The second aim of the thesis is to examine a number of predictions made by RHT through the use of this alternative methodology. Since the pseudo-experimental design and post hoc analysis of road-traffic data are both ill-suited to the investigation of that part of RHT which deals with the role of utility in determining risk-taking behaviour in response to a change in environmental risk, and since the concept of utility is critical to RHT, the methodology reported here is applied to the specific investigation of utility. Attention too is given to the question of which behavioural pathways carry the homeostasis effect, and whether those pathways are 'local' to the nature of the change in environmental risk. It is suggested that investigating RHT through this new methodology holds a number of advantages and should be developed further in an attempt to answer the RHT question. It is suggested too that the methodology allows RHT to be seen in a psychological context, rather than the statistical context that has so far characterised its investigation. The experimental findings reported here are in support of hypotheses derived from RHT and would therefore seem to argue for the importance of the individual and collective target level of risk, as opposed to the level of environmental risk, as the major determinant of accident loss.

Rural road accident investigation and prevention in Iran

The objectives are to examine rural road accident data in order to develop a method by which high accident rate locations and accident causes can be identified, and also to develop proposals for improvements at such locations and to identify measures which will improve road safety throughout the country. The problem of road safety in Iran is an important issue, because of the tragic and unnecessary loss of life, and the enormous cost of accidents in the country. The resources available to deal with the problems are limited and must be allocated on priority basis. This study represents an initial effort to identify the extent of the problem in order to take remedial measures. A study was made of all the available road accident data collected by agencies related to road safety in Iran, and the major organisations responsible for road safety development were visited. The Vice Minister of Roads and Transportation selected for this study a 280 Km rural road in South West Iran. Mainly because of the lack of suitable maps and plans of the roads, it was not possible to accurately identify the location of accidents. Accident scene data was subsequently collected by the highway police and personally by the author. The data for the study road was then analysed to identify 'high accident rate' locations, and also to determine, as far as was possible, the reasons for the accidents. The study suggests specific improvements for each of the high accident rate locations examined (eg. the building of dual carriageways with central guard rails to reduce the risk of collision with oncoming vehicles, pedestrian facilities to allow pedestrians to cross dangerous roadsl]. In addition recommendations are made to guide and assist the major organisations responsible for road safety in Iran. These recommendations are: (al for improving accident data collection and storage (bl for subsequent analysis for taking remedial measures with a view to accident prevention

Enclosing the behavior of a hybrid system up to and beyond a Zeno point

Even simple hybrid systems like the classic bouncing ball can exhibit Zeno behaviors. The existence of this type of behavior has so far forced simulators to either ignore some events or risk looping indefinitely. This in turn forces modelers to either insert ad hoc restrictions to circumvent Zeno behavior or to abandon hybrid modeling. To address this problem, we take a fresh look at event detection and localization. A key insight that emerges from this investigation is that an enclosure for a given time interval can be valid independently of the occurrence of a given event. Such an event can then even occur an unbounded number of times, thus making it possible to handle certain types of Zeno behavior.

Information and communication technology adoption in the Italian road freight haulage industry

Despite the importance of information and communication technology (ICT) in the management of transport and logistics systems, there is a shortage of studies in the road freight haulage sector. This paper is aimed at filling this void through an exploratory survey on ICT adoption and the influencing factors carried out in the Italian road transport market. The paper provides a review of the previous research on this topic that allows the identification of research gaps that have been addressed through a questionnaire survey. The findings provide evidence of a passive stance on ICT usage characterised by the adoption of isolated applications. The financial risk associated with technology investment and human resources are the main barriers to ICT adoption, while the improvement of service level and the reliability of transport operations emerge as stimulating factors. The results suggest that the potential benefits of technology have not been fully exploited and a risk-sensitive stance on ICT is evident preventing the full incorporation of ICT into business processes.

Progmosis:evaluating risky individual behavior during epidemics using mobile network data

The possibility to analyze, quantify and forecast epidemic outbreaks is fundamental when devising effective disease containment strategies. Policy makers are faced with the intricate task of drafting realistically implementable policies that strike a balance between risk management and cost. Two major techniques policy makers have at their disposal are: epidemic modeling and contact tracing. Models are used to forecast the evolution of the epidemic both globally and regionally, while contact tracing is used to reconstruct the chain of people who have been potentially infected, so that they can be tested, isolated and treated immediately. However, both techniques might provide limited information, especially during an already advanced crisis when the need for action is urgent. In this paper we propose an alternative approach that goes beyond epidemic modeling and contact tracing, and leverages behavioral data generated by mobile carrier networks to evaluate contagion risk on a per-user basis. The individual risk represents the loss incurred by not isolating or treating a specific person, both in terms of how likely it is for this person to spread the disease as well as how many secondary infections it will cause. To this aim, we develop a model, named Progmosis, which quantifies this risk based on movement and regional aggregated statistics about infection rates. We develop and release an open-source tool that calculates this risk based on cellular network events. We simulate a realistic epidemic scenarios, based on an Ebola virus outbreak; we find that gradually restricting the mobility of a subset of individuals reduces the number of infected people after 30 days by 24%.

Enclosing the behavior of a hybrid automaton up to and beyond a Zeno point

Even simple hybrid automata like the classic bouncing ball can exhibit Zeno behavior. The existence of this type of behavior has so far forced a large class of simulators to either ignore some events or risk looping indefinitely. This in turn forces modelers to either insert ad-hoc restrictions to circumvent Zeno behavior or to abandon hybrid automata. To address this problem, we take a fresh look at event detection and localization. A key insight that emerges from this investigation is that an enclosure for a given time interval can be valid independent of the occurrence of a given event. Such an event can then even occur an unbounded number of times. This insight makes it possible to handle some types of Zeno behavior. If the post-Zeno state is defined explicitly in the given model of the hybrid automaton, the computed enclosure covers the corresponding trajectory that starts from the Zeno point through a restarted evolution.

Self-affirmation before exposure to health communications promotes intentions and health behavior change by increasing anticipated regret

Health-risk information can elicit negative emotions like anticipated regret that may positively affect health persuasion. The beneficial impact of such emotions is undermined when target audiences respond defensively to the threatening information. We tested whether self-affirming (reflecting on cherished attributes) before message exposure can be used as strategy to enhance the experience of anticipated regret. Women were self-affirmed or not before exposure to a message promoting fruit and vegetable consumption. Self-affirmation increased anticipated regret and intentions reported following message exposure and consumption in the week after the intervention; regret mediated the affirmation effect on intentions. Moreover, results suggest that anticipated regret and intentions are serial mediators linking self-affirmation and behavior. By demonstrating the mediating role of anticipated regret, we provide insights into how self-affirmation may promote healthy intentions and behavior following health message exposure. Self-affirmation techniques could thus potentially be used to increase the effectiveness of health communication efforts.