Senior Drivers' Workbook, April 21, 2009

This booklet is part of the Iowa Department of Transportation’s “Choices Not Chances - The Road to Driving Safer and Longer” series. These booklets and video were developed to help Iowa drivers remain safe and mobile as they age. For more information, contact the Department of Transportation’s Office of Driver Services.

Older Drivers and Risk, August 2, 2007

The value of driving We as Americans - and especially as Iowans - value the independence of getting around in our own vehicles and staying connected with our families and communities. The majority of older Iowans enjoy a more active, healthy and longer life than previous generations. Freedom of mobility shapes our quality of life. With aging, driving becomes an increasing concern for older Iowans and their families. How we deal with changes in our driving ability and, eventually, choose when and how to retire from driving, will affect our safety and our quality of life.

Iowa Driver’s License Renewal, August 3, 2007

One-on-one communication with driver’s license customers is the most valuable tool Driver Services employees use to help drivers stay independent and safe. Driver Services employees understand that a sense of remaining independent, in everything from running errands to shopping to visits with friends, family and doctors, depends on a driver’s license. There are times when Driver Services personnel, or even the drivers themselves, determine it’s time to stop driving. In those cases, people are given a free identification card. There are also times when the DOT must suspend a person’s driving privilege. This can be caused by vision problems, a medical condition or unsafe driving. If the driver cannot be relicensed, DOT personnel make the commitment to work with the individual by providing information about available transportation alternatives. We are providing this information to make the renewal process understandable and less stressful. We hope that by explaining why the DOT screens vision, requires medical information and requests drive tests, and describing how these all relate to highway safety, drivers will know what to expect. Personnel are available to answer questions or discuss concerns at any of the Iowa Department of Transportation or County Treasurer driver’s license sites. Please contact one of the driver’s license stations listed in this booklet.

Information on Iowa’s Graduated Driver Licensing system for drivers under the age of 18, February 3, 2012

Information in this Q and A brochure was provided and produced by the Iowa Department of Transportation.

Curb it-Click it New Safety Laws For Teen Drivers, July 13, 2010

This brochure explains Iowa's laws that directly effect teenage drivers, their consequences and issues.

Hepatitis B virus infection is associated with impaired immunological recovery during antiretroviral therapy in the Swiss HIV cohort study.

Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients worldwide. It is unclear whether HIV-related outcomes are affected by HBV coinfection. We compared virological suppression and immunological recovery during antiretroviral therapy (ART) of patients of different HBV serological status in the Swiss HIV Cohort Study. CD4 cell recovery during ART was significantly impaired in hepatitis B surface antigen-positive patients and in those with anti-hepatitis B core antigen alone compared with HBV-uninfected patients, despite similar virological efficacy of ART. CD4 increase in patients with resolved HBV infection was similar to that in HBV-uninfected individuals.

Report on a review of selected application controls over the Iowa Department of Transportation’s Driver’s License System for the period May 2, 2011 through May 27, 2011

Report on a review of selected application controls over the Iowa Department of Transportation’s Driver’s License System for the period May 2, 2011 through May 27, 2011

Ecological and historical drivers of diversification in the fly genus Chiastocheta Pokorny.

Coevolution is among the main forces shaping the biodiversity on Earth. In Eurasia, one of the best-known plant-insect interactions showing highly coevolved features involves the fly genus Chiastocheta and its host-plant Trollius. Although this system has been widely studied from an ecological point of view, the phylogenetic relationships and biogeographic history of the flies have remained little investigated. In this integrative study, we aim to test the monophyly of the five Chiastocheta eco-morphological groups, defined by Pellmyr in 1992, by inferring a mitochondrial phylogeny. We further apply a new approach to assess the effect of (i) different molecular substitution rates and (ii) phylogenetic uncertainty on the inference of the spatio-temporal evolution of the group. From a taxonomic point of view, we demonstrate that only two of Pellmyr's groups (rotundiventris and dentifera) are phylogenetically supported, the other species appearing para- or polyphyletic. We also identify the position of C. lophota, which was not included in previous surveys. From a spatio-temporal perspective, we show that the genus arose during the Pliocene in Europe. Our results also indicate that at least four large-scale dispersal events are required to explain the current distribution of Chiastocheta. Moreover, each dispersal to or from Asia is associated with a host-shift and seems to correspond to an increase in speciation rates. Finally, we highlight the correlation between diversification and climatic fluctuations, which indicate that the cycles of global cooling over the last million years had an influence on the radiation of the group.

Ethanol among randomly controlled drivers

Objectives: Ethanol is well-known to impair driving ability. The major aim of this study was to evaluate the number of drivers driving under the influence of ethanol in a population of randomly controlled drivers. Methods: 1016 drivers were randomly controlled at 27 different locations in Western Switzerland from October 2006 to April 2008. Drivers were controlled for alcohol consumption with a breathalyzer according to the Swiss Road traffic law. If the result was equal or higher than an equivalent of a blood alcohol concentration of 0.8 g/kg, a blood sample was taken; otherwise, a saliva sample was obtained. Blood and saliva were analysed for ethanol by Head-space gas chromatography coupled with a FID detector. Results: Among the controlled drivers, men (69%) predominated over female (31%). The mean age was 41 (range: 16 90). For 968 drivers (95.3%) ethanol was not detected in blood or saliva. These drivers were not under the influence of ethanol. Ethanol was detected in saliva or blood of 48 drivers (4.7%). Among these drivers, blood alcohol concentration (BAC) was above the legal limit of 0.8 g/kg (serious offence) in 14 cases (1.4% of the total population). BAC were in the range of 0.91 to 2.43 g/kg (mean: 1.32 g/kg, median: 1.11 g/kg). Among these 14 cases, men (13 cases, 93%) were over represented. No ethanol was found in the population of truck drivers (17 cases). 986 drivers were car drivers and 46 of them have drunk ethanol (5%). 13 bikers were controlled and 2 of them have drunk ethanol (15%). Conclusion: Driving under the influence of ethanol concerned about 5% of a population of randomly controlled drivers, and 1,4% of the drivers had a blood alcohol concentration higer than 0.8 g/kg (legale limit for a serious offence).

Specific fibroblastic niches in secondary lymphoid organs orchestrate distinct Notch-regulated immune responses.

Fibroblast-like cells of secondary lymphoid organs (SLO) are important for tissue architecture. In addition, they regulate lymphocyte compartmentalization through the secretion of chemokines, and participate in the orchestration of appropriate cell-cell interactions required for adaptive immunity. Here, we provide data demonstrating the functional importance of SLO fibroblasts during Notch-mediated lineage specification and immune response. Genetic ablation of the Notch ligand Delta-like (DL)1 identified splenic fibroblasts rather than hematopoietic or endothelial cells as niche cells, allowing Notch 2-driven differentiation of marginal zone B cells and of Esam(+) dendritic cells. Moreover, conditional inactivation of DL4 in lymph node fibroblasts resulted in impaired follicular helper T cell differentiation and, consequently, in reduced numbers of germinal center B cells and absence of high-affinity antibodies. Our data demonstrate previously unknown roles for DL ligand-expressing fibroblasts in SLO niches as drivers of multiple Notch-mediated immune differentiation processes.

Impaired uptake of glutathione by hepatic mitochondria from chronic ethanol-fed rats. Tracer kinetic studies in vitro and in vivo and susceptibility to oxidant stress.

Isolated hepatocytes incubated with [35S]-methionine were examined for the time-dependent accumulation of [35S]-glutathione (GSH) in cytosol and mitochondria, the latter confirmed by density gradient purification. In GSH-depleted and -repleted hepatocytes, the increase of specific activity of mitochondrial GSH lagged behind cytosol, reaching nearly the same specific activity by 1-2 h. However, in hepatocytes from ethanol-fed rats, the rate of increase of total GSH specific radioactivity in mitochondria was markedly suppressed. In in vivo steady-state experiments, the mass transport of GSH from cytosol to mitochondria and vice versa was 18 nmol/min per g liver, indicating that the half-life of mitochondrial GSH was approximately 18 min in controls. The fractional transport rate of GSH from cytosol to mitochondria, but not mitochondria to cytosol, was significantly reduced in the livers of ethanol-fed rats. Thus, ethanol-fed rats exhibit a decreased mitochondrial GSH pool size due to an impaired entry of cytosol GSH into mitochondria. Hepatocytes from ethanol-fed rats exhibited a greater susceptibility to the oxidant stress-induced cell death from tert-butylhydroperoxide. Incubation with glutathione monoethyl ester normalized the mitochondrial GSH and protected against the increased susceptibility to t-butylhydroperoxide, which was directly related to the lowered mitochondrial GSH pool size in ethanol-fed cells.

Diagnostic Tools for Identifying Sleepy Drivers in the Field, RB21-012, 2013

The overarching goal of this project was to identify and evaluate cognitive and behavioral indices that are sensitive to sleep deprivation and may help identify commercial motor vehicle drivers (CMV) who are at-risk for driving in a sleep deprived state and may prove useful in field tests administered by officers. To that end, we evaluated indices of driver physiognomy (e.g., yawning, droopy eyelids, etc.) and driver behavioral/cognitive state (e.g. distracted driving) and the sensitivity of these indices to objective measures of sleep deprivation. The measures of sleep deprivation were sampled on repeated occasions over a period of 3.5-months in each of 44 drivers diagnosed with Obstructive Sleep Apnea (OSA) and 22 controls (matched for gender, age within 5 years, education within 2 years, and county of residence for rural vs. urban driving). Comprehensive analyses showed that specific dimensions of driver physiognomy associated with sleepiness in previous research and face-valid composite scores of sleepiness did not: 1) distinguish participants with OSA from matched controls; 2) distinguish participants before and after PAP treatment including those who were compliant with their treatment; 3) predict levels of sleep deprivation acquired objectively from actigraphy watches, not even among those chronically sleep deprived. Those findings are consistent with large individual differences in driver physiognomy. In other words, when individuals were sleep deprived as confirmed by actigraphy watch output they did not show consistently reliable behavioral markers of being sleep deprived. This finding held whether each driver was compared to him/herself with adequate and inadequate sleep, and even among chronically sleep deprived drivers. The scientific evidence from this research study does not support the use of driver physiognomy as a valid measure of sleep deprivation or as a basis to judge whether a CMV driver is too fatigued to drive, as on the current Fatigued Driving Evaluation Checklist.. Fair and accurate determinations of CMV driver sleepiness in the field will likely require further research on alternative strategies that make use of a combination of information sources besides driver physiognomy, including work logs, actigraphy, in vehicle data recordings, GPS data on vehicle use, and performance tests.

Age vs. Experience: Evaluation of a Video Feedback Intervention for Newly Licensed Teen Drivers, TPF-5(207), 2013

This project examines the effects of age, experience, and video-based feedback on the rate and type of safety-relevant events captured on video event recorders in the vehicles of three groups of newly licensed young drivers: 1. 14.5- to 15.5-year-old drivers who hold a minor school license (see Appendix A for the provisions of the Iowa code governing minor school licenses); 2. 16-year-old drivers with an intermediate license who are driving unsupervised for the first time; 3. 16-year-old drivers with an intermediate license who previously drove unsupervised for at least four months with a school license. METHODS: The young drivers’ vehicles were equipped with an event-triggered video recording device for 24 weeks. Half of the participants received feedback regarding their driving, and the other half received no feedback at all and served as a control group. The number of safety-relevant events per 1,000 miles (i.e., “event rate”) was analyzed for 90 participants who completed the study. RESULTS: On average, the young drivers who received the video-based intervention had significantly lower event rates than those in the control group. This finding was true for all three groups. An effect of experience was seen for drivers in the control group; the 16-year-olds with driving experience had significantly lower event rates than the 16-year-olds without experience. When the intervention concluded, an increase in event rate was seen for the school license holders, but not for either group of 16-year-old drivers. There is strong evidence that giving young drivers video-based feedback, regardless of their age or level of driving experience, is effective in reducing the rate of safety-relevant events relative to a control group who do not receive feedback. Specific comparisons with regard to age and experience indicated that the age of the driver did not have an effect on the rate of safety-events, while experience did. Young drivers with six months or more of additional experience behind the wheel had nearly half as many safety-relevant events as those without that experience.

Efavirenz Dose Adjustment in HIV Patients with Impaired CYP2B6 Function

Efavirenz dosage adjustment in several patients with high EFV levels and presenting CNS toxicity have been successfully achieved in Switerland over the past seven years but many others have not beneficiated from dosage reduction owing to the lack of prospective studies evaluating the safety and clinical benefit of reduced dosage regimens.

Soluble major histocompatibility complex-peptide octamers with impaired CD8 binding selectively induce Fas-dependent apoptosis.

Fluorescence-labeled soluble major histocompatibility complex class I-peptide "tetramers" constitute a powerful tool to detect and isolate antigen-specific CD8(+) T cells by flow cytometry. Conventional "tetramers" are prepared by refolding of heavy and light chains with a specific peptide, enzymatic biotinylation at an added C-terminal biotinylation sequence, and "tetramerization" by reaction with phycoerythrin- or allophycocyanin-labeled avidin derivatives. We show here that such preparations are heterogeneous and describe a new procedure that allows the preparation of homogeneous tetra- or octameric major histocompatibility complex-peptide complexes. These compounds were tested on T1 cytotoxic T lymphocytes (CTLs), which recognize the Plasmodium berghei circumsporzoite peptide 252-260 (SYIPSAEKI) containing photoreactive 4-azidobenzoic acid on Lys(259) in the context of H-2K(d). We report that mutation of the CD8 binding site of K(d) greatly impairs the binding of tetrameric but not octameric or multimeric K(d)-PbCS(ABA) complexes to CTLs. This mutation abolishes the ability of the octamer to elicit significant phosphorylation of CD3, intracellular calcium mobilization, and CTL degranulation. Remarkably, however, this octamer efficiently activates CTLs for Fas (CD95)-dependent apoptosis.