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At least 991 records · Page 55Linked to original sources
PubMed1995

A profile of the demographics, training and driving history of telescopic drivers in the state of Michigan.

BACKGROUND: Five-hundred twenty-eight licensed, telescopic drivers in the state of Michigan, were sent a questionnaire consisting of 50 questions to evaluate the demographics, formal training procedures experienced by these drivers, and their driving habits. METHODS: One-hundred forty-nine responses were tabulated to determine the characteristics of the telescopic driver in the state of Michigan. RESULTS: The findings show an increased necessity for dynamic assessment, training and follow-up of the telescopic wearer and for referral to a specific driving program to establish safe driving skills. CONCLUSION: As the field of low vision expands in its delivery of care, and with improvement in technology, the desire for telescopic driver's licenses will increase. The need for dynamic training procedures delivered by the multidisciplinary rehabilitative team becomes even more vital to ensure safe driving skills and to protect the privilege to drive. Extensive training, followup and communication must be an integral part of this process.

Adolescent↗
PubMed1994

Recurrent cardiac events in survivors of ventricular fibrillation or tachycardia. Implications for driving restrictions.

OBJECTIVE: To determine when survivors of ventricular tachycardia (VT) or ventricular fibrillation (VF) might most safely return to driving. DESIGN: Consecutive case series of 501 VT and VF survivors discharged alive between August 1978 and October 1989 and followed from 0 to 117 months (mean, 26 months). SETTING: Cardiac arrhythmia service of a university hospital. PATIENTS: The study group comprised 290 consecutive patients with sustained VT and 211 patients with VF who underwent electrophysiological studies and were discharged alive (78% male; mean age, 59 years). The mean ejection fraction (available in 338 patients) was 0.42. INTERVENTIONS: Antiarrhythmic drug testing for all patients was guided by serial electrophysiological testing. Overall, 227 patients (45%) were discharged on conventional antiarrhythmic agents, 115 (23%) on amiodarone, 39 (8%) received an implantable defibrillator, and 120 (24%) received no specific antiarrhythmic therapy. MAIN OUTCOME MEASURES: Main outcomes included any event that could hamper a patient's ability to operate a motor vehicle. Specifically, these events included recurrent VF, poorly tolerated, hemodynamically unstable VT, syncope, sudden cardiac death, and implantable defibrillator discharge. RESULTS: Event risks were assessed during the first year after hospital discharge because that is when most patients decide whether to begin driving again. The 1-year outcome event rate for all 501 patients was 17%. Three distinct periods of risk were identified. The monthly hazard rate was highest in the first month after hospital discharge (4.22% per month), intermediate in months 2 through 7 (1.81% per month), and lowest in months 8 through 12 (0.63% per month). The 191 patients for whom no successful conventional antiarrhythmic drug could be found during electrophysiological testing experienced a persistently high monthly event risk (1.6%) during months 8 through 12. CONCLUSIONS: All survivors of VT or VF should refrain from driving during the first month after hospital discharge when the hazard for events that could impair their ability to drive is greatest. Our data would support restricting driving for most patients until the eighth month after hospital discharge, when risk becomes lowest. Restriction might be lengthened in patients for whom electrophysiological testing finds no satisfactory conventional antiarrhythmic agent because their risk remains higher than average even after 7 months. Individualized recommendations should be allowed because the accident rate for patients who actually suffer sudden death is low.

Accidents, Traffic↗
PubMed1993

Effects of cardiovascular disease on driving tasks.

Heart disease, even in the elderly individual, need not preclude driving; however, safety for the patient and the public is dependent on close cooperation between the patient and the physician. The patient with ischemic heart disease must be in a stable condition wherein the risk of sudden incapacitation is acceptably low. The physician must take into consideration not only the symptom history, but also the potential impact of concomitant illnesses, devices (e.g., pacemakers), and medications. The patient with congestive heart failure must be assessed for functional ability. Where there is doubt about a subjective report, a practical road test may be advisable. Consideration also should be given to limited driving under preset conditions, such as daytime only, or local roads (excluding highways). Many elderly drivers already limit their driving in such a fashion. Finally, it should be realized that a driving permit is a means to independent mobility. Where heart disease precludes driving and personal transportation is not available, physicians should advise and support their patients to obtain paratransport services where communities offer such services for otherwise immobile citizens.

Aged↗
PubMed1997

Impact of vestibular disorders on fitness to drive: a census of the American Neurotology Society.

BACKGROUND: Legislation for reporting unfit-to-drive patients by physicians varies dramatically among U.S. states and Canadian provinces. The impact of vestibular disease on driving safety is not well described in the literature. OBJECTIVES: (1) to learn more about the critical issues and current practices of neurotologists regarding reporting of vestibular patients and (2) to make recommendations for reporting patients with vestibular disorders. STUDY DESIGN: A mailed census of members of the American Neurotology Society using a questionnaire based on a modified Dillman Total Design Survey Method. RESULTS: Most respondents are aware of the potential safety risks of patients who drive with vestibular diseases, most notably those with Tumarkins' attacks. Although many have counselled patients (94%) and considered reporting vestibular patients (75%), few actually have (14%). There was no consensus of opinion on a method of reporting unfit-to-drive patients. Only 18.9% of respondents supported mandatory physician reporting. Respondents who live in states where reporting is not mandatory and who are aware of this fact are (a) more satisfied with their state's legislation (chi 2 = 60.1, p = 0.001) and (b) less likely to report patients who they consider unfit-to-drive (chi 2 = 10.6, p = 0.03). CONCLUSIONS: In that there is no general consensus amongst respondents and the relative safety risks seem low in comparison to other disorders, at present we do not advocate mandatory reporting of patients with vestibular disorders.

Accidents, Traffic↗
PubMed1997

[Drinking and driving].

A worrisome connection between driving and drinking was found in 166 people randomly surveyed in public places in Beer Sheba. 80% of the study population stated that they drink alcoholic beverages. Of these, 45% reported drinking at least once a week, and 21% drank 3 glasses/cans at each drinking bout. We noted a trend among those who drank frequently to drink greater amounts. Of the sample, 110 interviewees stated that they had a driver's license and that they drank alcoholic drinks. 39% reported driving after a number of alcoholic drinks, and 23% of them did so invariably or frequently. 5% drank while driving. The drinkers exhibited a high-risk behavioral pattern, remaining in the car with friends (53%) or relatives (16%) also under the influence of alcohol. Those who are aware of the influence of alcohol on their driving skills and the danger of being involved in car accidents, moderate their consumption of alcohol. The results of the study confirm our hypothesis that there is an upswing in the phenomenon of high-risk driving connected with drinking alcoholic beverages.

Alcohol Drinking↗
PubMed1997

The effect of drinking and driving interventions on alcohol-involved traffic crashes within a comprehensive community trial.

The Drinking and Driving Component, one of five elements of the Community Trials Project, involved the implementation of a special drink driving countermeasure in the three experimental communities, one in Northern California, one in Southern California and another in South Carolina. This intensified enforcement of driving under the influence (DUI) was designed to deter potential drinking drivers by increasing their perception of the risk of being arrested leading to a reduction in the consumption of alcohol before driving. See component detailed description in Voas (1997, this issue). The evaluation found that media advocacy training and technical assistance resulted in increased DUI news coverage and that additional police officer hours for DUI enforcement, greater use of breathalyzer equipment, increased officer training and more checkpoints produced increased DUI enforcement. The combined effects of increased DUI news coverage and DUI enforcement yielded increased public perceived risk of arrest and subsequently less drinking and driving. Overall the evaluation found that alcohol-involved traffic crashes were reduced as a result of this component in the experimental communities as contrasted with the matched comparison communities.

Accidents, Traffic↗
PubMed1997

Night driving restrictions for youthful drivers: a literature review and commentary.

The research literature on night driving curfews is reviewed. Driving at night involves high risk, particularly for young beginners. Although only about 15 percent of the total miles of 16-17-year-old drivers occur between 9 p.m. and 6 a.m., about 40 percent of their fatal crashes take place during these hours. Curfews that limit recreational driving at night without an adult have been found to substantially reduce nighttime crashes. Parents of teenagers strongly endorse curfews and favor earlier starting times than prevail in most jurisdictions with curfews. A night driving curfew is an essential component of graduated licensing, a system that phases in young beginners to full-privilege licensure, limiting initial driving to lower-risk situations.

Accidents, Traffic↗
PubMed1998

Autism as the defusion of drives.

The author's metapsychological view of the dismantling and adhesive identification typical of infantile autism is that these phenomena result from the fate of the death drive and the libido in a situation of thoroughgoing defusion of the drives. He notes that Freud's original idea of the defused death drive was taken up by Ferenczi and then by Klein, who applied it to the situation at the very beginning of life. A clinical illustration is given and the author observes that this view has therapeutic consequences that are also relevant to the work of an institution and to the therapists' countertransference, in terms of the value of sadism and masochism in helping to fuse the drives. Fusion of the drives is presented as an important element of Bion's alpha or container function. This conception also tends to modify the therapist's attitude to the parents of autistic children. In the author's view, the fate of the libidinal component in autism has tended to be disregarded, but accounts for the phenomena of adhesiveness and auto-sensuality; the latter should in his opinion rather be called dismantled erotism, to emphasise the absence of the unifying function of forms of auto-erotism in integration of the self. The author stresses the lack of projection in autistic pathology and discusses its possible reasons.

Attitude to Death↗
PubMed1998

Ethical dilemmas in people with epilepsy who drive.

Concern about driving safety in people with epilepsy has been present since the automobile became a widely used source of transportation (Siegel, 1988). Unfortunately, we still do not have adequate means to determine who can and cannot drive. Clinicians must use their best medical judgment to make these determinations. They then must consider the aspects of their state's driving laws and legal consequences of their judgments. In the 44 states that do not require clinician reporting of seizures, they must deliberate about breaching or maintaining the confidentiality of patients with uncontrolled seizures who continue to drive. In making this deliberation they should consider both the probability and magnitude of harm posed by continued driving of an individual patient. Judgments to breach confidentiality should include assessment of risks and benefits to the patient and to society by taking such action. Ultimately, each patient must be judged individually.

Automobile Driving↗
PubMed1996

Homosynaptic and heterosynaptic changes in driving of dentate gyrus interneurons after brief tetanic stimulation in vivo.

This study addressed changes in interneuron driving in the dentate gyrus (DG) of urethane-anaesthetized rats in response to tetanic stimulation of the perforant path (PP) or the converging dentate commissural pathway (CP). Using an extracellular tungsten electrode, we recorded from putative interneurons in the DG that fired to stimulation of both the PP and the CP. Conditioning trains (400 Hz, 17.5 ms) were delivered to each pathway individually and to the two pathways together. The primary measure of synaptic drive was the latency of interneuron discharge. High-intensity PP tetany, CP tetany, and paired tetany consistently reduced firing latency to CP driving (P < .05 for all three), indicating an LTP-like increase in synaptic activation through the CP. High-intensity PP tetany decreased latency to PP driving in only two of seven cases. Heterosynaptic changes occurred frequently in individual experiments. Activity-mediated adjustments in synaptic driving of inhibitory interneurons could play a role in normal physiological function.

Animals↗
PubMed1998

Can a difference in chest wall mechanics explain the lower respiratory drive during propofol versus halothane anesthesia in children?

This article extends previous work which suggested that respiratory drive was lower during propofol compared with halothane anesthesia. The aim of this study was to assess simultaneously chest wall motion, measured with respiratory inductive plethysmography (RIP), and respiratory drive measured by P0.1 the pressure generated during the initial 100 msec of an occluded inspiratory effort. Ten healthy children age 3 to 6 years who presented for a dental restorative procedure that required in excess of 2.5 hours were recruited. Patients were anesthetized with propofol (2.5 mg x kg(-1); 15 mg x kg(-1) x hr) or halothane (1.25%), in a randomized crossover study design. Following induction of anesthesia, RIP bands were placed at the level of the nipples and the umbilicus for the measurement of rib cage and abdomen excursion, respectively. Flow and airway pressure were measured. A manually operated pneumatic balloon was used for brief airway occlusion. Following a 60-minute washin/out of the anesthetic, the children were removed from mechanical ventilation and spontaneous ventilation was reinstated. The RIP signals were calibrated by the method of simultaneous solution of equations. The phase lag was calculated. During airway occlusion the maximal excursion of the calibrated rib cage trace (RMAX) was measured; a negative value indicated retraction of the rib cage. Respiratory drive was assessed both at a fixed interval (100 msec) (P0.1) and fixed proportion (10%) (P10%) of the occluded inspiratory effort. Significance of differences were assessed with a paired t-test (P-value < 0.05). Thoracoabdominal asynchrony was greater during halothane than propofol anesthesia, as was the amount of rib cage retraction, evidenced by lower values of RMAX; respiratory drive was higher during halothane than propofol anesthesia, as evidenced by higher values of both P0.1, and P10%. We conclude that during halothane anesthesia altered chest wall mechanics may result in a greater respiratory drive than during propofol anesthesia.

Anesthesia, General↗
PubMed2000

Marijuana, alcohol and actual driving performance.

The objective of the current study was to assess the separate and combined effects of marijuana and alcohol on actual driving performance. Eighteen subjects were treated with drugs and placebo according to a balanced, 6-way, crossover design. On separate evenings they were given weight calibrated Delta(9)-tetrahydrocannabinol (THC) doses of 0, 100 and 200 &mgr;g/kg with and without an alcohol dose sufficient for achieving blood alcohol concentrations (BAC) of 0.04 g/dl while performing a Road Tracking and Car Following Test in normal traffic. Main outcome measures were standard deviation of lateral position (SDLP), time driven out of lane (TOL), reaction time (RT) and standard deviation of headway (SDH). Both THC doses alone, and alcohol alone, significantly impaired the subjects performances in both driving tests. Performance deficits were minor after alcohol and moderate after both THC doses. Combining THC with alcohol dramatically impaired driving performance. Alcohol combined with THC 100 and 200 &mgr;g/kg produced a rise in SDLP the equivalent of that associated with BAC=0.09 and 0.14 g/dl, respectively. Mean TOL rose exponentially with SDLP. Relative to placebo mean RT lengthened by 1.6 s under the combined influence of alcohol and THC 200 &mgr;g/kg. Changes in SDH ranged between 0.9 and 3.8 m. Low doses of THC moderately impair driving performance when given alone but severely impair driving performance in combination with a low dose of alcohol. Copyright 2000 John Wiley & Sons, Ltd.

Journal Article↗
PubMed2006

Predictors of driving assessment outcome in Parkinson's disease.

This study evaluated selected clinical and functional tests as predictors of driving safety outcomes in Parkinson's disease (PD) patients. A total of 25 PD patients and 21 age-matched controls, all regular drivers, underwent neurological evaluation and assessment of cognitive, visual, and motor function and a standardized, on-road driving assessment. The capacity of the tests to predict pass/fail driving outcomes was determined by selecting a subset with the highest predictive value from each domain and then subjecting these subsets to discriminant function analysis. Accuracy, sensitivity, specificity, and positive and negative predictive values were determined. Three relatively simple tests from the larger battery predicted passes with relatively high sensitivity (PD, 72.7%; controls, 93.8%; both combined, 85.2%); and moderate specificity (PD, 64.3%; controls, 60.0%; both combined. 63.2%). These tests assessed motor performance (Purdue Pegboard test), contrast sensitivity (Pelli-Robson test), and cognitive function (verbal version of Symbol Digit Modalities test). Adding time since diagnosis for the PD group increased sensitivity to 90.9% and specificity to 71.4%. These simple tests confer more objectivity and predictive power to clinical recommendations for driving, they reflect distinct functions that are necessary for safe driving, and they may be especially useful when on-road assessments are not feasible.

Activities of Daily Living↗
PubMed1978

Photic EEG-driving responses in thalamotomized and medicated cases of Parkinson's disease.

EEG-driving responses to visual stimulation were studied using EEG Interval Spectrum Analysis (EISA) before and after stereotaxic thalamotomy and Nacom (L--Carbidopa and Levodopa) treatment of 67 Parkinson patients. Five types of photic-driving responses were distinguished in the EISA results: (1) all-band response, (2) Beta-dominant, (3) Alpha-Beta-dominant, (4) Alpha-Theta-dominant, (5) non-response. Twenty patients received a daily dose of 750--1000 mg of Nacom orally, and 47 patients 1000--1500 mg for a period of 3 to 4 weeks. In most cases the medication produced no change in photic-driving and EEG patterns. The photic-driving response showed no significant correlation with clinical signs and background EEG. Unilateral thalamotomy was performed in ten Parkinson patients. In two of these patients the EEG-driving response diminished in the first post-operative week for low frequency stimuli but increased after the second week.

Adult↗
PubMed1979

Effects of meperidine on operant behavioral thermoregulation in mice under conditions of symmetrical thermal drive.

The effects of meperidine on operant behavioral thermoregulation were investigated using a convective thermal controller and mice trained to alternate at will the thermal-drive condition, changing it from an air flow of 15 degrees C to one of 45 degrees C, and vice versa. Administration of 15 mg/kg meperidine resulted in significantly lower response rates, a significantly larger fraction of time spent in one (mostly cold) drive condition, and significantly lower body temperatures than administration of saline. In a second experiment the animal was automatically returned to the hot-drive condition every 3 min unless it had been exposed to this condition in the previous 0.4 min although otherwise it remained free to alternative drive conditions at will. Under these conditions, meperidine-treated animals also spent significantly more time in cold drive and had significantly lower body temperatures than control animals, in spite of lower response rates. Pretreatment with 4.5 mg/kg tranylcypromine (4 h prior) did not significantly alter the effects of meperidine administration in either experiment.

Animals↗
PubMed1998

Assessing the roles of glutamatergic and cholinergic synaptic drive in the control of fictive swimming frequency in young Xenopus tadpoles.

This paper investigates the proposal that the frequency of the swimming central pattern generator in young Xenopus tadpoles is partly determined by the population of glutamatergic premotor interneurons active on each cycle. During fictive swimming spinal neurons also receive cholinergic and electrotonic excitation from motoneurons. As frequency changes during swimming we make two predictions: first, since most motoneurons fire very reliably at all frequencies, the electrotonic and nicotinic drive from motoneurons should remain constant, and second, when swimming frequency decreases, the glutamatergic drive should decrease as the number of active premotor excitatory interneurons decreases. We have tested these predictions by measuring the excitatory synaptic drive to motoneurons as frequency changes during fictive swimming. The components of synaptic drive were revealed by the local microperfusion of strychnine together with different excitatory antagonists. After blocking the nicotinic acetylcholine receptor, the mainly glutamatergic excitatory synaptic drive still changed with frequency. However, when glutamate receptors or all chemical transmission was blocked, excitation did not change with frequency. Our predictions are confirmed, suggesting that premotor excitatory interneurons are a major factor in frequency control in the tadpole central pattern generator and that motoneurons provide a stable background excitation.

Animals↗
PubMed1978

The contribution of the reflex hypoxic drive to the hyperpnoea of exercise.

Oxygen breath tests have been applied to six normal subjects at rest and during steady state exercise on a bicycle ergometer (200, 400 and 600 kpm) to estimate the contribution of the reflex hypoxic drive to total ventilation. The subjects were changed without their knowledge from air to 100% oxygen for 4--5 breaths, the fall in ventilation was recorded and expressed as a percentage of total ventilation (hypoxic drive). The average reflex hypoxic drive was 16.2% (SE +/- 2.6; n = 35) this remianed unaltered during all levels of steady state exercise. The maximum fall in ventilation occurred earlier in exercise (P less than 0.0005). At rest the maximum fall occurred on average 31.2 s (SE +/- 2.6) from the start of the first breath of oxygen. During the first level of steady state exercise the maximum fall occurred 19.4 s (SE +/- 0.5) from the start of the first breath of oxygen. It is concluded that the contribution of the reflex hypoxic drive to the total ventilation is unaltered by exercise although a substantial part of the hyperpnoea can be accounted for by the presence of this drive.

Adult↗
PubMed1983

Central respiratory drive and recruitment order of phrenic and inspiratory laryngeal motoneurones.

Central respiratory drive and recruitment order of phrenic motoneurones and inspiratory laryngeal motoneurones were studied in anaesthetized, paralyzed and artificially ventilated cats. Unitary activities of pairs of motoneurones originating from the same population were recorded on thin filaments. Differences of recruitment during inspiration enabled distinction to be made between early (E) and late (L) recruited motoneurones. 'On-line' cross-correlation analyses were performed on either homogeneous pairs (2E or 2L) or heterogeneous pairs (1E and 1L). In 14/30 pairs of phrenic motoneurones and 26/32 pairs of inspiratory laryngeal motoneurones cross-correlation analysis revealed a bell-shaped increase of probability of firing whose characteristics indicate synchronization by central shared excitatory inputs originating from central respiratory drive. For phrenic motoneurones synchronization appeared mainly in homogeneous pairs (2E:7/11; 2L:5/9) whereas motoneurones of heterogeneous pairs rarely shared the same central respiratory drive (2/10). For inspiratory laryngeal motoneurones, cases of synchronization were equally obtained in homogeneous (2E:8/10; 2L:14/16) and heterogeneous (4/6) pairs. These results suggest that differences of recruitment order during inspiration are related: (i) for phrenic motoneurones, partly to differences of excitability but mainly to a dual central respiratory drive which is assumed to divide the population into two components; (ii) for inspiratory laryngeal motoneurones to differences of excitability since all the motoneurones share the same drive.

Animals↗