Examination of Winter Driving using In-vehicle Devices and the Perceptions of Older Drivers

Introduction: Although several studies have examined self-regulatory practices in older drivers, most have relied on self-report. Blanchard (2008) was the first to examine actual driving patterns more objectively (using in-vehicle devices), and the associations between driver perceptions and self-regulatory practices. However, her sample of older drivers living in Southwestern Ontario was only monitored for one week between June and October. Winter conditions in northern climates appear to influence the driving patterns of older adults, however the only evidence to date is based on self-report (e.g., Sabback & Mann, 2005). Purposes: The aims of the thesis were to: 1) replicate Blanchard’s findings on the associations between driver perceptions and self-regulatory practices in older drivers; and 2) extend this investigation by examining driving over a longer monitoring period in the winter. Methods: A convenience sample of 47 drivers aged 65 to 91 (49% female) from Southwestern Ontario was monitored for two consecutive weeks between late November and March. Driving data was collected using two electronic devices (one with GPS), which were installed at the first of two home visits. Information on weather and road conditions was collected from archives and descriptions in participant trip logs. Participants completed questionnaires concerning background and usual driving habits. Driver perceptions were assessed using the Driving Comfort (DCS) and Perceived Driving Abilities (PDA) scales, while self-reported usual practices were examined using the Situational Driving Frequency (SDF) and Avoidance (SDA) scales. Functional driving-related abilities were assessed using the AAA/CAA’s Roadwise Review and interviews were conducted at the second home visit, at which point devices were removed and trip logs collected. Results: Driver perceptions (particularly night comfort) were significantly related to multiple indictors of driving (distance, duration, radius from home and night driving) in the expected directions. Men had higher comfort scores and better perceptions of their driving abilities and concurrently drove more often, greater distances and further from home. Participants drove on average five days a week over the winter monitoring period. Over half the 94-day monitoring period had inclement weather, while 67% of the period had poor road conditions. Nonetheless, all 46 participants drove at least once in bad weather and 73% did so in darkness. Distance driven at night varied by month of participation, with people driving more at night during December (average 50 km), compared to March (average of only 13 km). Those with lower daytime comfort scores (>50%) scores drove less on days with inclement weather (p=.03). The sample was also more likely to make social trips on clear days (p=.002) and out-of-town trips on days with good road conditions (p=.02). Conclusions: The study replicated Blanchard’s (2008) findings that driver perceptions are strongly associated with actual behaviour, regardless of the season. And both studies indicate that older drivers may not self-regulate as much as they say they do on avoidance questionnaires. Driving was fairly consistent over the two weeks, except for radius and night distance and the additional week of monitoring was more likely to capture night driving. Nonetheless, the present study provides only a snapshot of behaviour and findings should not be generalized beyond urban dwelling, well-educated, healthy and active older drivers from one part of Canada. Further studies, with larger more diverse samples (living in different regions) and longer monitoring periods, are required to advance our knowledge of self-regulatory practices in older drivers and related decision-making processes

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Empowering patients and caregivers with knowledge: The development of a nurse-led gynecologic oncology chemotherapy education class

At a Canadian cancer centre, rising patient volumes made it difficult to provide quality chemotherapy education to patients and families in the clinical setting. The gynecology oncology site identified several barriers to the provision of timely and comprehensive teaching. These barriers included receiving education after learning of a cancer diagnosis, the efficacy of written information, time constraints nurses experienced, and absence of standardized side effect management. This prompted an interdisciplinary team to review current teaching practices and engage the Patient Education Program to collaboratively develop strategies to overcome these challenges. This paper describes the development of a nurse-led chemotherapy education class tailored to patients with gynecologic cancers and focused on common chemotherapy treatment protocols. The purpose of the class was to help patients and caregivers know what to expect during their chemotherapy routine, lower anxiety, and to equip them with knowledge and skills to manage side effects of treatment

Autonomiser les patients et les soignants grâce au savoir : Élaboration d’une formation sur la chimiothérapie en gynécologie oncologique dirigée par le personnel infirmier

L’augmentation du nombre de patients vus en clinique dans un centre de cancérologie du Canada est venue nuire à l’offre d’un enseignement de qualité sur la chimiothérapie pour les patients et leur famille. Le département de gynéco-oncologie a cerné plusieurs obstacles à la transmission d’un enseignement complet et opportun. Une fois le diagnostic de cancer tombé, l’accès à l’enseignement, l’efficacité de l’information transmise par écrit, les contraintes de temps des infirmières et l’absence d’uniformité dans la prise en charge des effets secondaires figurent parmi les obstacles relevés. Une équipe interdisciplinaire s’est donc rassemblée pour revoir les pratiques d’enseignement actuelles et se pencher sur le programme d’enseignement aux patients afin de développer, conjointement, des stratégies pour régler ces problèmes. Cet article décrit les étapes ayant mené à l’élaboration, par le personnel infirmier, d’une formation sur la chimiothérapie (protocoles courants) destinée aux patients atteints de cancers gynécologiques et visant à aider les patients et les soignants à mieux se préparer aux séances de chimiothérapie, à calmer l’anxiété et à savoir comment gérer les effets secondaires liés au traitement

Twelve-Month Outcomes of the AFFINITY Trial of Fluoxetine for Functional Recovery After Acute Stroke: AFFINITY Trial Steering Committee on Behalf of the AFFINITY Trial Collaboration

Background and Purpose: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. Methods: AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization. The primary outcome was function, measured by the modified Rankin Scale, at 6 months. Secondary outcomes for these analyses included measures of the modified Rankin Scale, mood, cognition, overall health status, fatigue, health-related quality of life, and safety at 12 months. Results: Adherence to trial medication was for a mean 167 (SD 48) days and similar between randomized groups. At 12 months, the distribution of modified Rankin Scale categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio, 0.93 [95% CI, 0.76–1.14]; P =0.46). Compared with placebo, patients allocated fluoxetine had fewer recurrent ischemic strokes (14 [2.18%] versus 29 [4.55%]; P =0.02), and no longer had significantly more falls (27 [4.21%] versus 15 [2.35%]; P =0.08), bone fractures (23 [3.58%] versus 11 [1.72%]; P =0.05), or seizures (11 [1.71%] versus 8 [1.25%]; P =0.64) at 12 months. Conclusions: Fluoxetine 20 mg daily for 6 months after acute stroke had no delayed or sustained effect on functional outcome, falls, bone fractures, or seizures at 12 months poststroke. The lower rate of recurrent ischemic stroke in the fluoxetine group is most likely a chance finding. REGISTRATION: URL: http://www.anzctr.org.au/ ; Unique identifier: ACTRN12611000774921