Executive Function Capacities, Negative Driving Behavior and Crashes in Young Drivers

Motor vehicle crashes remain a leading cause of injury and death in adolescents, with teen drivers three times more likely to be in a fatal crash when compared to adults. One potential contributing risk factor is the ongoing development of executive functioning with maturation of the frontal lobe through adolescence and into early adulthood. Atypical development resulting in poor or impaired executive functioning (as in Attention-Deficit/Hyperactivity Disorder) has been associated with risky driving and crash outcomes. However, executive function broadly encompasses a number of capacities and domains (e.g., working memory, inhibition, set-shifting). In this review, we examine the role of various executive function sub-processes in adolescent driver behavior and crash rates. We summarize the state of methods for measuring executive control and driving outcomes and highlight the great heterogeneity in tools with seemingly contradictory findings. Lastly, we offer some suggestions for improved methods and practical ways to compensate for the effects of poor executive function (such as in-vehicle assisted driving devices). Given the key role that executive function plays in safe driving, this review points to an urgent need for systematic research to inform development of more effective training and interventions for safe driving among adolescents

Voices Raised, Spring 2022

Director\u27s column; workforce diversification; women\u27s leadership immersion; staff spotlight on Leah Ward; focus on equity, education, and research (UD Men for Gender Equity; Gender Equity Research Colloquium); diversity and inclusion; Women of UD; student organization spotlight; Voice of Black Women; staff summaries.https://ecommons.udayton.edu/wc_newsletter/1057/thumbnail.jp

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Design Of An Experimental Protocol To Examine Medication Non-Adherence Among Young Drivers Diagnosed With Adhd: A Driving Simulator Study

The diagnosis of ADHD among teens and young adults has been associated with a higher likelihood of motor vehicle crashes. Some studies suggest a beneficial effect of ADHD medication but the exact efficacy is still being debated. Further, medication adherence, which is low in this age group, can further reduce effectiveness. Our long-term objective is to reduce unsafe driving among drivers with ADHD by detecting medication non-adherence through driver behavior modeling and monitoring. As a first step, we developed the described lab study protocol to obtain reliable driver behavior data that will then be used to design and train behavior models built through machine learning. This experimental study protocol was developed to systematically compare driving behaviors under two medication conditions (before and after intake of medication) among young adults with ADHD and a control group of non-ADHD. A driving simulator was used to examine driving behaviors and interactions with traffic. The primary outcome was speed management for two comparisons (ADHD vs. non-ADHD and before vs. after medication), and secondary objectives involved understanding differences among the participants utilizing self-reported surveys about ADHD symptoms, drivers’ knowledge, and perception about safety. The study protocol was designed to maximize participant safety and efficiency of data collection, as multiple measures were collected over two 2-h study visits. The sampled ADHD drivers were demographically and psychosocially similar but clinically different from the non-ADHD group. Overall, this protocol was effective in participant recruitment and retention, allowed staggered data collection, and can be incorporated in a subsequent clinical trial that examines the efficacy of a machine-learning based driver monitoring intervention

Keep It Brief and Targeted: Driving Performance Feedback Report Features to Use with Novice Drivers

Driving evaluations aim to ensure adequate skills; however, feedback beyond pass/fail is needed for improvement. Therefore, the goal of this study was to inform driving feedback report design to ensure ease of use and understandability while motivating improvements. Participants ages 18&ndash;25 years (n = 521) were recruited from CloudResearch Prime Panels to rate one of nine report design conditions with various combinations of five key features: performance summary presence, action plan (AP) length, AP order, AP grading system, and peer comparison presence; they then completed questionnaires. Participants were more motivated to improve when a summary was present (p = 0.02); they rated reports easier to use if they had a long AP (p = 0.01), a short AP paired with a summary (p = 0.007), or an AP with a number grade (p = 0.016); and they rated reports easier to understand if they had a short AP (p = 0.002) or an AP ordered by worst-to-best performance (p = 0.05). These results suggest that feedback reports designed with a performance summary and short, targeted action plan starting with the biggest area for improvement are likely to motivate action to improve driving skills while being easy to use and understand. Future research should evaluate the effect of such a redesigned report on driving outcomes among young drivers

Keep It Brief and Targeted: Driving Performance Feedback Report Features to Use with Novice Drivers

Driving evaluations aim to ensure adequate skills; however, feedback beyond pass/fail is needed for improvement. Therefore, the goal of this study was to inform driving feedback report design to ensure ease of use and understandability while motivating improvements. Participants ages 18–25 years (n = 521) were recruited from CloudResearch Prime Panels to rate one of nine report design conditions with various combinations of five key features: performance summary presence, action plan (AP) length, AP order, AP grading system, and peer comparison presence; they then completed questionnaires. Participants were more motivated to improve when a summary was present (p = 0.02); they rated reports easier to use if they had a long AP (p = 0.01), a short AP paired with a summary (p = 0.007), or an AP with a number grade (p = 0.016); and they rated reports easier to understand if they had a short AP (p = 0.002) or an AP ordered by worst-to-best performance (p = 0.05). These results suggest that feedback reports designed with a performance summary and short, targeted action plan starting with the biggest area for improvement are likely to motivate action to improve driving skills while being easy to use and understand. Future research should evaluate the effect of such a redesigned report on driving outcomes among young drivers

Magnetoencephalography during Simulated Driving: A New Paradigm for Driver Assessment

Increasingly, vehicles are equipped with assistive devices and advanced warning systems to mitigate driver errors, which account for 94% of motor vehicle crashes. However, these technologies require humans to appropriately respond or take over the vehicle. If we want to design effective aids, we need to better understand the neural mechanisms underlying driver error and test how the brain responds to countermeasures. For this, we need sensitive measures of brain activity during driving. This paper present a new paradigm for driver assessment, using magnetoencephalographic (MEG) recording of whole cortex neural oscillatory activity while participants undergo an ecologicallyrelevant simulated driving experience of graded complexity. A pilot experiment set out to demonstrate that expected and motor cortex responses to basic drivingrelated movements (without salient cues) could be recorded, without significant artifact. Following this, a preliminary study of adults (n=5) explored if additional cognitive neural responses to increasing driving task demands can be identified. This paradigm was successfully piloted and preliminary results reveal localized brain regions of expected motor cortex activity, as well as power increases in the frontal lobe. This paradigm can be used to identify not only the neural mechanisms underlying driver errors, but also measure the impact of assistive and alert/warning technologies on these mechanisms in both typical and impaired populations of drivers

Design of an experimental protocol to examine medication non-adherence among young drivers diagnosed with ADHD: A driving simulator study

The diagnosis of ADHD among teens and young adults has been associated with a higher likelihood of motor vehicle crashes. Some studies suggest a beneficial effect of ADHD medication but the exact efficacy is still being debated. Further, medication adherence, which is low in this age group, can further reduce effectiveness. Our long-term objective is to reduce unsafe driving among drivers with ADHD by detecting medication non-adherence through driver behavior modeling and monitoring. As a first step, we developed the described lab study protocol to obtain reliable driver behavior data that will then be used to design and train behavior models built through machine learning. This experimental study protocol was developed to systematically compare driving behaviors under two medication conditions (before and after intake of medication) among young adults with ADHD and a control group of non-ADHD. A driving simulator was used to examine driving behaviors and interactions with traffic. The primary outcome was speed management for two comparisons (ADHD vs. non-ADHD and before vs. after medication), and secondary objectives involved understanding differences among the participants utilizing self-reported surveys about ADHD symptoms, drivers' knowledge, and perception about safety. The study protocol was designed to maximize participant safety and efficiency of data collection, as multiple measures were collected over two 2-h study visits. The sampled ADHD drivers were demographically and psychosocially similar but clinically different from the non-ADHD group. Overall, this protocol was effective in participant recruitment and retention, allowed staggered data collection, and can be incorporated in a subsequent clinical trial that examines the efficacy of a machine-learning based driver monitoring intervention. Keywords: Attention-deficit/hyperactivity disorder (ADHD), Driving, Medication adherence, Machine learning, Driving simulato

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe