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.

Investigating relationships between relationship quality, customer loyalty and cooperation : an empirical study of convenience stores' franchise chain systems in Taiwan

Franchising has been widely accepted as an effective way to conduct and expand businesses. However, a franchise system is not a guarantee of success in the market. A successful franchise system should rely on a close and strong franchising relationship. Franchising is an important relationship management business. Franchising arrangements normally last for a number of years, so the franchisor and franchisee in the arrangement relationship are usually motivated to cooperate with each other. In addition, highly loyal franchisees may be obtained through a successful long-term franchising relationship. Over the last few decades, there has been a tremendous wave of interest in franchising relationships. However, little research has been conducted to determine the reasons for long-term franchising relationships. As a result, this study focuses on the important elements that might lead to a successful long-term franchising relationship. This study attempts to examine empirically three essential constructs (relationship quality, cooperation and customer loyalty), which might lead to successful long-term franchising relationships between franchisees and franchisors among the convenience stores in Taiwan. Mailed questionnaires were utilised to collect the research data. A total of 500 surveys were mailed randomly to the manager/supervisor of convenience stores’ franchisees among the four main franchisors (7-ELEVEN, Family, Hi-Life and OK) in Taiwan. The final sample size is 120, yielding a response rate of 24 per cent. The results show that relationship quality positively influences the cooperative relationships between franchisors and franchisees. Relationship quality is also positively correlated with franchisees’ loyalty. Additionally, the results indicate that the cooperative relationships between franchisors and franchisees are significantly associated with franchisees’ loyalty.

Departing from the virtual community : a discussion of the ways and means to uncover localised order in online games

This paper is part one of a three part study into the collective regulation processes of players in massive multiplayer online games (MMOG). Traditionally game playing has not been classed as problematic, however with introduction of new media technologies and new ways to play games, certain contexts have become obscure, namely the localised order of ‘playing online’ or how players manage and maintain order between each other as opposed to ‘following the rules’. Principally this paper will examine concepts of ‘virtual community’. These will be illustrated as particularly unhelpful when considering how people conduct themselves in these spaces. Thus, ‘virtual community’ will be seen as critical in implicating various online behaviours as superior to other online behaviours causing obscurity and blurring actions. This obscurity is grounded by strong associations in the virtual community as logic of practise in and of itself; behaviours that fall outside this category become common sense and as such are made invisible for investigation. This paper will draw upon the theories of Basil Bernstein and Pierre Bourdieu to produce a distinction between online behaviours and ultimately make them visible for further investigation. In doing so this paper seeks to form a basis for future research where interaction in these spaces can be identified as belonging to a certain framework to inform the design of online games and applications more effectively.

Friends looking out for friends as an intervention strategy for young adults' risky driving

Young adults are at the greatest risk of experiences road trauma disproportionately to those in other age groups. While the influence of peers is commonly associated with motor vehicle crashes and injury few studies examine whether their influence can be positive. In particular friends may be able to actively intervene to reduce the likelihood of risky driving (e.g. speeding, drink driving or drug driving) and alcohol use. The aim of this paper is to conduct a systematic review on intervening in risky driving behaviour including the situations in which it is likely or unlikely to occur, factors associated with individuals who might or report having intervened and any evaluated programs that make use of such strategies. In addition a study was conducted with 247 first year university students (32% males) to examine whether young adults report engaging in protective behaviour with their peers in South-east Queensland. In particular, if they intervene if their friends are about to drive after drinking, drive after taking illicit drugs or when speeding. It examines any differences in reported likelihood of discouraging such illegal and dangerous behaviour (in the past 12 months prior to the survey). Findings showed that young adults (17-25 years) did indeed report protective behaviour in relation to friends’ drink driving, drug driving, speeding and binge drinking. Conclusions will be drawn regarding important considerations in developing positive strategies and advertising campaigns that encourage positive behaviours (e.g. ‘don’t let mates drink and drive’).

Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders : a qualitative systematic review of randomised controlled trials

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders.

A brief philosophical examination of ADHD

Concerns have been raised over ADHD from within a range of different disciplines, concerns which are not only voiced from within the hard sciences themselves, but also from within the social sciences. This paper will add the discipline of philosophy to that number, arguing that an analysis of two traditionally philosophical topics - namely "truth" and "free-will" - allows us a new and unsettling perspective on conduct disorders like ADHD. More specifically, it will be argued that ADHD not only fails to meet its own ontological and epistemological standards as an 'objective' pathology, but it also constitutes one more element in what has already become a significant undermining of a crucial component of social life: moral responsibility.

Free will, moral responsibility and ADHD

One of the oldest problems in philosophy concerns the relationship between free will and moral responsibility. If we adopt the position that we lack free will, in the absolute sense—as have most philosophers who have addressed this issue—how can we truly be held accountable for what we do? This paper will contend that the most significant and interesting challenge to the long-standing status-quo on the matter comes not from philosophy, jurisprudence, or even physics, but rather from psychology. By examining this debate through the lens of contemporary behaviour disorders, such as ADHD, it will be argued that notions of free will, along with its correlate, moral responsibility, are being eroded through the logic of psychology which is steadily reconfiguring large swathes of familiar human conduct as pathology. The intention of the paper is not only to raise some concerns over the exponential growth of behaviour disorders, but also, and more significantly, to flag the ongoing relevance of philosophy for prying open contemporary educational problems in new and interesting ways.

Why ask new questions?

It can probably be said those people who work in the world of the natural sciences— chemistry, biology, mathematics, and so on—regard themselves as inhabiting a fairly straight-forward epistemological world. They have a body of knowledge to draw upon from within any given area, much like a set of bricks in a wall, and when they conduct their experiments, they add another brick to that wall … and the wall gets taller, and they know more than they did before. Such scientists would contend that the questions they ask as part of their research flow naturally from the very nature of the world itself. But even then, they could also argue that the specifics of the question ultimately don‟t really matter that much, because if enough people work on any given brick, the truth will eventually emerge anyway.

New routes for the field trip

As with the broader field of education research, most writing on the subject of school excursions and field trips has centred around progressive/humanist concerns for building pupil’s self-esteem and for the development of the ‘whole child’. Such research has also stressed the importance of a broad, grounded, and experiential curriculum - as exemplified by subjects containing these extra-school activities - as well as the possibility of strengthening the relationship between student and teacher. Arguing that this approach to the field trip is both exhausted of ideas and conceptually flawed, this paper proposes some alternate routes into the area for the prospective researcher. First, it is argued that by historicising the subject matter, it can be seen that school excursions are not simply the product of the contemporary humanist desire for diverse and fulfilling educational experiences, rather they can, in part, be traced to eighteenth century beliefs among the English gentry that travel formed a crucial component of a good education, to the advent of an affordable public rail system, and to school tours associated with the Temperance movement. Second, field trips can be understood from within the associated framework of concerns over the governance of tourism and the organisation of disciplinary apparatuses for the production of an educated and regulated citizenry. Far from being a simple learning experience, museums and art galleries form part of a complex of disciplinary and power relations designed to produce a populace with very specific capacities, aspirations and styles of public conduct. Finally, rather than allowing children ‘freedom’ from the constraints of the classroom, on the contrary, through the medium of the field-trip, children can become accustomed to having their activities governed in the broader domain of the generalised community . School excursions thereby constitute an effective tactic through which young people have their conduct managed, and their social and scholastic identities shaped and administered.

Youth, Sex, and Government

For nearly twenty-five years, the field of youth studies has employed the same conceptual tools to explain the conduct of young people, tools that inexorably lead to the same recurrent conclusions-youth equals resistance, youth equals alienation, youth equals problem. This book offers a way out of this theoretical Groundhog Day. Starting with the familiar notion of youth subcultures, but also addressing topics such as young women's magazines, 'at risk' youth, anorexia nervosa, and HIV/AIDS programs, this book examines the way in which youth is produced as both a governmental object and a set of practices of the self. Employing the ideas of Foucault, Rose and Mauss, this new approach attempts to reinvigorate what is an important-yet slumbering-area of research.

Converse Bergmann cline in a eucalyptus herbivore, paropsis atomaria olivier (coleoptera: chrysomelidae) : phenotypic plasticity or local adaptation?

Aim To measure latitude-related body size variation in field-collected Paropsis atomaria Olivier (Coleoptera: Chrysomelidae) individuals and to conduct common-garden experiments to determine whether such variation is due to phenotypic plasticity or local adaptation. Location Four collection sites from the east coast of Australia were selected for our present field collections: Canberra (latitude 35°19' S), Bangalow (latitude 28°43' S), Beerburrum (latitude 26°58' S) and Lowmead (latitude 24°29' S). Museum specimens collected over the past 100 years and covering the same geographical area as the present field collections came from one state, one national and one private collection. Methods Body size (pronotum width) was measured for 118 field-collected beetles and 302 specimens from collections. We then reared larvae from the latitudinal extremes (Canberra and Lowmead) to determine whether the size cline was the result of phenotypic plasticity or evolved differences (= local adaptation) between sites. Results Beetles decreased in size with increasing latitude, representing a converse Bergmann cline. A decrease in developmental temperature produced larger adults for both Lowmead (low latitude) and Canberra (high latitude) individuals, and those from Lowmead were larger than those from Canberra when reared under identical conditions. Main conclusions The converse Bergmann cline in P. atomaria is likely to be the result of local adaptation to season length.

Youth, personhood and 'practices of the self'

In contrast to most previous research in the field, this paper argues that the concept of 'youth' is best understood as an example of the governmental formation of a specific type of person. It is constructed at the intersection of a variety of diverse problematisations, being produced by the processes of individuation/ normalisation and the regulation of relations of time. Within programs such as those pertinent to the management of sex, an array of technologies structure the practices by which individuals pattern their own conduct - thereby fashioning a kind of habitus. This forms part of a general strategy of enrolling the objects of these programs in their own self-reformation. Consequently, `youth' can be understood as `the doing of specific types of work on the self'. By utilising this framework, the paper not only seeks to identify and better understand some of the sexual subjectivities associated with the construction of youth, it also seeks to offer some new directions for research in the area.

Free will, moral responsibility and ADHD

One of the oldest problems in philosophy concerns the relationship between free will and moral responsibility. If we adopt the position that we lack free will, in the absolute sense—as have most philosophers who have addressed this issue—how can we truly be held accountable for what we do? This paper will contend that the most significant and interesting challenge to the long-standing status-quo on the matter comes not from philosophy, jurisprudence, or even physics, but rather from psychology. By examining this debate through the lens of contemporary behaviour disorders, such as ADHD, it will be argued that notions of free will, along with its correlate, moral responsibility, are being eroded through the logic of psychology which is steadily reconfiguring large swathes of familiar human conduct as pathology. The intention of the paper is not only to raise some concerns over the exponential growth of behaviour disorders, but also, and more significantly, to flag the ongoing relevance of philosophy for prying open contemporary educational problems in new and interesting ways.

Pathologising difference, governing personality

Recent research has stressed the integral part played by teachers in both preliminary diagnosis and ongoing treatment of a range of conduct and personality disorders. Teachers are not only required to be aware of a variety of new categories of difference (Attention Deficit Disorder, Selective Mutism, Borderline Personality Disorder, Antisocial Personality Disorder, to name but a few), but are also now lauded for extending the role of education into new areas of social management. This paper will take issue with this understanding on two counts: first, teachers have always sought to mould the personalities of students, and the pathologisation of specific forms of conduct is simply a new tactic within a very old and familiar strategy. Second, schools do not simply discover disorders such as ADD as objective facts of nature. Rather, they are part of the process through which such differences are created, and by which individuals can be more effectively governed.

A disordered approach

It seems a new behaviour disorder is identified every week. Forms of conduct once simply regarded as part of the human condition, are rapidly being reinterpreted as types of mental illness. Individuals are no longer simply quiet or shy, they are reclassified as suffering from Generalised Social Phobia, or Selective Mutism, or Avoidant Personality Disorder. Others are no longer simply unpopular or obnoxious, they are reclassified as Borderline Personality Disorder, or Antisocial Personality Disorder. Still more are no longer lively or boisterous, they have Attention Deficit Hyperactivity Disorder, or Conduct Disorder, or Oppositional Defiance Disorder.