Stress can lead to an increase in smartphone use in the context of texting while walking.

Texting while walking (TWW) is a dangerous behavior that can lead to injury and even death. While several studies have examined the relationship between smartphone use and stress, to our knowledge no studies have yet investigated the relationship between stress and TWW. The objective of the present study was to investigate this relationship by examining the effects of stress on TWW, the effects of TWW on subsequent stress, and the effect of stress on multitasking performance. A total of 80 participants completed two sequential tasks in a laboratory while they walked on a treadmill and responded to a biological motion stimulus imitating the movement of another pedestrian. In the unrestricted task, participants were given the choice to use their personal phones. In the controlled task, they carried a text conversation with a research assistant while they walked and responded to the stimulus. Stress was measured via questionnaire and saliva collection for measure of cortisol (a stress hormone) before and after each task. Results show that greater psychological stress and cortisol variations were associated with a greater number of phone uses during the unrestricted task. Greater phone use during the unrestricted task was associated with lower subsequent psychological stress in women and total time of phone use was correlated with subsequent cortisol levels. Stress measured before the controlled task had no effect on multitasking performance, but participants with moderate performance were those with the highest cortisol levels. Our results suggest that stress could be a precursor to TWW and that it could affect a pedestrian's ability to stay safe when using their smartphone.

Measuring the Switch Cost of Smartphone Use While Walking.

This paper presents a study protocol to measure the task-switching cost of using a smartphone while walking. This method involves having participants walk on a treadmill under two experimental conditions: a control condition (i.e., simply walking) and a multitasking condition (i.e., texting while walking). During these conditions, the participants must switch between the tasks related to the experimental condition and a direction determining task. This direction task is done with a point-light walker figure, seemingly walking towards the left or the right of the participant. Performance on the direction task represents the participant's task-switching costs. There were two performance measures: 1) correct identification of the direction and 2) response time. EEG data are recorded in order to measure the alpha oscillations and cognitive engagement occurring during the task switch. This method is limited in its ecological validity: pedestrian environments have many stimuli occurring simultaneously and competing for attention. Nonetheless, this method is appropriate for pinpointing task-switching costs. The EEG data allow the study of the underlying mechanisms in the brain that are related to differing task-switching costs. This design allows the comparison between task switching when doing one task at a time, as compared to task switching when multitasking, prior to the stimulus presentation. This allows understanding and pinpointing both the behavioral and neurophysiological impact of these two different task-switching conditions. Furthermore, by correlating the task-switching costs with the brain activity, we can learn more about what causes these behavioral effects. This protocol is an appropriate base for studying the switching cost of different smartphone uses. Different tasks, questionnaires, and other measures can be added to it in order to understand the different factors involved in the task-switching cost of smartphone use while walking.

Using a smartphone while walking: The cost of smartphone-addiction proneness.

Distracted walking is an ever-increasing problem. Studies have already shown that using a smartphone while walking impairs attention and increases the risk of accidents. This study seeks to determine if smartphone-addiction proneness magnifies the risks of using a smartphone while walking. In an experimental design, participants, while walking on a treadmill and engaged in a smartphone task, were required to switch tasks by responding to an external stimulus, i.e., determining the direction of movement of a point-light walker. Participants were chosen to cover a range of smartphone-addiction proneness. Four smartphone-use conditions were simulated: a control condition with no smartphone-use, an individual conversation condition, a gaming condition, and a group conversation condition. Our results show that using a smartphone while walking decreases accuracy and increases the number of missed stimuli. Moreover, participants with higher smartphone-addiction proneness scores were also prone to missing more stimuli, and this effect was found regardless of experimental condition. The effect of the smartphone task on accuracy and the number of missed stimuli was mediated by the emotional arousal caused by the smartphone task. Smartphone-addiction proneness was positively correlated with a declared frequency of smartphone use while walking. Furthermore, of all the smartphone tasks, the gaming condition was found to be the most distracting.

Texting while walking: An expensive switch cost.

Texting while walking has been highlighted as a dangerous behavior that leads to impaired judgment and accidents. This impairment could be due to task switching which involves activation of the present task and the inhibition of the previous task. However, the relative contributions of these processes and their brain activity have not yet been studied. We addressed this gap by asking participants to discriminate the orientation of an oncoming human shape in a virtual environment while they were: i) walking on a treadmill, or ii) texting while walking on a treadmill. Participants' performance (i.e., correctly identifying if a walker would pass them to their left or right) and electroencephalography (EEG) data was collected. Unsurprisingly, we found that participants performed better while they were only walking than when texting while walking. However, we also found that the diminished performance is differently related to task set inhibition and task set activation in the two conditions. The alpha oscillations, which can be used as an index of task inhibition, have a significantly different relation to performance in the two conditions, the relation being negative when subjects are texting. This may indicate that the more inhibition is needed, the more the performance is affected by texting. To our knowledge, this is the first study to investigate the brain signature of task switching in texting while walking. This finding is the first step in identifying the source of impaired judgment in texting pedestrians and in finding viable solutions to reduce the risks.

Regulatory focus, time perspective, locus of control and sensation seeking as predictors of risky driving behaviors.

Empirical evidence shows that most of the road safety efforts fail to reach the most risk-prone drivers. In light of this issue, we have developed this study in order to distinguish between high-risk drivers and low-risk drivers based on variables that have already been shown to affect the effectiveness of preventive messages: regulatory focus orientation, time perspective, locus of control and sensation seeking. We sent paper and pencil questionnaires to five thousand low-risk drivers and five thousand high-risk drivers randomly selected based on their driving records. A driver who has been convicted of two or more traffic infractions with demerit points (e.g., exceeding speed limits, red light violation, no seatbelt, etc.) in the last two years was considered a high-risk driver whereas a low-risk driver had no traffic offense registered in his driving record in the last four years. We received two thousand and sixty-four completed questionnaires for a response rate of 20.6%. Seven hundred and ninety-eight belonged to the group of high-risk drivers and one thousand two hundred and sixty-six to the group of low-risk drivers. The results show that a promotion focused orientation, a present hedonistic perspective, an internal locus of control, and sensation seeking are associated with more risky driving behaviors and could therefore distinguish between high-risk and low-risk drivers. These results increase the understanding of risky drivers' personalities and motivations. The literature review provides insight into how these findings might be considered in developing more effective road safety programs and campaigns, and the conclusion encourages researchers to explore these new avenues in future research.

Survival forests for data with dependent censoring.

Tree-based methods are very powerful and popular tools for analysing survival data with right-censoring. The existing methods assume that the true time-to-event and the censoring times are independent given the covariates. We propose different ways to build survival forests when dependent censoring is suspected, by using an appropriate estimator of the survival function when aggregating the individual trees and/or by modifying the splitting rule. The appropriate estimator used in this paper is the copula-graphic estimator. We also propose a new method for building survival forests, called p-forest, that may be used not only when dependent censoring is suspected, but also as a new survival forest method in general. The results from a simulation study indicate that these modifications improve greatly the estimation of the survival function in situations of dependent censoring. A real data example illustrates how the proposed methods can be used to perform a sensitivity analysis.

Driving simulator scenarios and measures to faithfully evaluate risky driving behavior: A comparative study of different driver age groups.

To investigate the links between mental workload, age and risky driving, a cross-sectional study was conducted on a driving simulator using several established and some novel measures of driving ability and scenarios of varying complexity. A sample of 115 drivers was divided into three age and experience groups: young inexperienced (18-21 years old), adult experienced (25-55 years old) and older adult (70-86 years old). Participants were tested on three different scenarios varying in mental workload from low to high. Additionally, to gain a better understanding of individuals' ability to capture and integrate relevant information in a highly complex visual environment, the participants' perceptual-cognitive capacity was evaluated using 3-dimensional multiple object tracking (3D-MOT). Results indicate moderate scenario complexity as the best suited to highlight well-documented differences in driving ability between age groups and to elicit naturalistic driving behavior. Furthermore, several of the novel driving measures were shown to provide useful, non-redundant information about driving behavior, complementing more established measures. Finally, 3D-MOT was demonstrated to be an effective predictor of elevated crash risk as well as decreased naturally-adopted mean driving speed, particularly among older adults. In sum, the present experiment demonstrates that in cases of either extreme high or low task demands, drivers can become overloaded or under aroused and thus task measures may lose sensitivity. Moreover, insights from the present study should inform methodological considerations for future driving simulator research. Importantly, future research should continue to investigate the predictive utility of perceptual-cognitive tests in the domain of driving risk assessment.

L1 splitting rules in survival forests.

The log-rank test is used as the split function in many commonly used survival trees and forests algorithms. However, the log-rank test may have a significant loss of power in some circumstances, especially when the hazard functions or when the survival functions cross each other in the two compared groups. We investigate the use of the integrated absolute difference between the two children nodes survival functions as the splitting rule. Simulations studies and applications to real data sets show that forests built with this rule produce very good results in general, and that they are often better compared to forests built with the log-rank splitting rule.

Effects of introducing an administrative .05% blood alcohol concentration limit on law enforcement patterns and alcohol-related collisions in Canada.

Except for Quebec, all Canadian provinces have introduced administrative laws to lower the permitted blood alcohol concentration (BAC) to .05% or .04% for driving-or having the care of-a motor vehicle. Using linear mixed effects models for longitudinal data, this study evaluates the effect of administrative BAC laws on fatal alcohol related crashes and law enforcement patterns in Canada from 1987 to 2010. Results reveal a significant decrease of 3.7% (95% C.I.: 0.9-6.5%) in fatally injured drivers with a BAC level equal or greater than .05% following the introduction of these laws. Reductions were also observed for fatally injured drivers with BAC levels greater that .08% and .15%. The introduction of administrative BAC laws led neither to significant changes in the rate of driving while impaired (DWI) incidents reported by police officers nor in the probability of being charged for DWI under the Criminal Code.

Pentagastrin-induced hemoconcentration in healthy volunteers and patients with panic disorder: effect of pretreatment with ethinyl estradiol.

Panic disorder has been associated with both an increased risk of coronary events as well as an increased risk of stroke. Hemoconcentration, with both a decrease in plasma volume and an increase in plasma viscosity, is a possible contributor to the risk of acute ischemic events. Our objectives were to demonstrate the process of hemoconcentration in response to induced panic symptoms and to assess the effect of pretreatment with ethinyl estradiol on panic-induced hemoconcentration. Fifteen male patients with panic disorder and 10 male healthy volunteers were included in a double-blind cross-over placebo-controlled design consisting of two injections of pentagastrin following randomized pretreatment with placebo and ethinyl estradiol. Plasma levels of hematocrit and hemoglobin were assessed at baseline and post-injections, and used to calculate an indirect estimation of the change in plasma volume. Pentagastrin-induced panic symptoms were associated with a mean decrease in plasma volume of 4.8% in the placebo pretreatment condition. Pretreatment with ethinyl estradiol attenuated this effect. The acute hemoconcentration observed in relation to pentagastrin-induced panic symptoms may be relevant to the increased risk of stroke and acute coronary events found in patients with panic disorder.

Occupant injury severity from lateral collisions: a literature review.

PROBLEM: Side impacts are a serious automotive injury problem; they represent about 30% of all fatalities for passenger vehicle occupants. This literature review focuses on occupant injuries resulting from real lateral collisions. It emphasizes the interaction between injury patterns and crash factors, taking into account type of injuries and their severity. It highlights what is known on the subject and suggests further studies. METHOD: We reviewed papers identified by searches in two electronic databases for the 1996-2009 publication period, and in specific journals and conference proceedings. RESULTS: Studies on the Primary Direction of Force (PDOF) have revealed that fatal crashes occur most frequently when the PDOF is at 3 or 9 o'clock. The risk of serious injury is two to three times higher for the near-side occupant than for the far-side occupant. Head injuries predominate in oblique impacts and thoracic injuries in perpendicular ones. A few results are also reported on side airbag protection. CONCLUSIONS: This literature review presents an overall picture of the injuries caused by lateral collisions, though each of the papers or articles examined focuses mostly on some particular aspect of the problem. The incidence of specific injuries depends on the data source used. Very few population-based analyses of lateral collision injuries were found. IMPACT ON INDUSTRY: New studies are needed to evaluate new protective devices (e.g., lateral airbags, inflatable curtains). Without interfering with their care duties, Emergency Medical Technicians could be systematically trained to observe the collision's specific characteristics and to report all their relevant observations to the emergency physicians to increase the likelihood of prompt diagnosis and proper care.

The value of a statistical life: a meta-analysis with a mixed effects regression model.

The value of a statistical life (VSL) is a very controversial topic, but one which is essential to the optimization of governmental decisions. We see a great variability in the values obtained from different studies. The source of this variability needs to be understood, in order to offer public decision-makers better guidance in choosing a value and to set clearer guidelines for future research on the topic. This article presents a meta-analysis based on 39 observations obtained from 37 studies (from nine different countries) which all use a hedonic wage method to calculate the VSL. Our meta-analysis is innovative in that it is the first to use the mixed effects regression model [Raudenbush, S.W., 1994. Random effects models. In: Cooper, H., Hedges, L.V. (Eds.), The Handbook of Research Synthesis. Russel Sage Foundation, New York] to analyze studies on the value of a statistical life. We conclude that the variability found in the values studied stems in large part from differences in methodologies.

Safety impacts due to the incompatibility of SUVs, minivans, and pickup trucks in two-vehicle collisions.

This research sets out to estimate the effects of vehicle incompatibility on the risk of death or major injury to drivers involved in two-vehicle collisions. Based on data for 2,999,395 drivers, logistic regression was used to model the risk of driver death or major injury (defined has being hospitalized). Our analyses show that pickup trucks, minivans and sport utility vehicles (SUVs) are more aggressive than cars for the driver of the other vehicle and more protective for their own drivers. The effect of the pickups is more pronounced in terms of aggressivity. The point estimates are comparable to those in the Toy and Hammitt study [Toy, E.L., Hammitt, J.K., 2003. Safety impacts of SUVs, minivans, and pickup trucks in two-vehicle crashes. Risk Analysis 23, 641-650], but, in contrast to that study, we are now able to establish that a greater number of these effects are statistically significant with a larger sample size. Like vehicle mass and type, other characteristics of drivers and the circumstances of the collision influence the driver's condition after impact. Male drivers, older drivers, drivers who are not wearing safety belts, collisions occurring in a higher speed zone and head-on collisions significantly increase the risk of death. Except for the driver's sex, all of these categories are also associated with an increased risk of death or of being hospitalized after being involved in a two-vehicle collision. For this risk, a significant increase is associated with female drivers.

Sex and cultural differences in the acceptance of functional foods: a comparison of American, Canadian, and French college students.

OBJECTIVE: Functional foods (FF)--foods containing nutritional supplements in addition to natural nutrients--have an increasing presence in the marketplace. Expanding on previous research, the authors investigated college students' acceptance of FF. PARTICIPANTS: In September--March 2004, 811 undergraduates in Canada, the United States, and France participated in the study. METHODS: A self-administered questionnaire measured students' general food attitudes and beliefs as well as FF-related knowledge, attitudes, beliefs, and purchase intention. RESULTS: Overall, participants slightly favored FF over traditional foods. However, although most respondents associated FF with positive health benefits, many remained dubious of currently available FF information. In terms of culture and sex, the authors found small but significant divergences in FF knowledge, attitudes, and behaviors. CONCLUSIONS: Stronger labeling and education efforts may increase cross-cultural acceptance of FF by college students.

Proton magnetic resonance spectroscopy measurement of brain glutamate levels in premenstrual dysphoric disorder.

BACKGROUND: Women who suffer from premenstrual dysphoric disorder (PMDD) classically display depressive and anxiety symptoms in the premenstrum. Preclinical and clinical studies have suggested a role of glutamate in anxiety and depression. This investigation aims at demonstrating fluctuations of glutamate across the menstrual cycle in the medial prefrontal cortex of women who suffer from PMDD and healthy control subjects (HCs). METHODS: Twelve PMDD women and 13 HCs were randomized to two single-voxel 3 Tesla proton magnetic resonance spectroscopy examinations of the medial prefrontal cortex during the follicular phase and the luteal phase. RESULTS: A phase effect was observed; the levels of glutamate/creatine plus phosphocreatine (Cr) were significantly lower during the luteal phase compared with the follicular phase. However, no statistically significant diagnosis or phase x diagnosis effects were found. CONCLUSIONS: The optimized stimulated echo acquisition mode (STEAM) pulse timings selected in this study (echo time [TE], mixing time [TM] = 240, 27 msec) allow us to interpret our results as the first report of alterations of brain glutamate levels across the menstrual cycle. Hormonal fluctuations associated with the menstrual cycle likely contribute to these glutamate level variations. Although PMDD women undergo a similar decrease in glutamate during the luteal phase as the HCs, PMDD women may display an increased behavioral sensitivity to those phase-related alterations. These menstrual cycle-related variations of glutamate levels may also contribute to the influence of the phases of the menstrual cycle in other neuropsychiatric disorders.

Comparing the validity of different sources of information on emergency department visits: a latent class analysis.

BACKGROUND: Emergency department (ED) use in Quebec may be measured from varied sources, eg, patient's self-reports, hospital medical charts, and provincial health insurance claims databases. Determining the relative validity of each source is complicated because none is a gold standard. OBJECTIVE: We sought to compare the validity of different measures of ED use without arbitrarily assuming one is perfect. SUBJECTS: Data were obtained from a nursing liaison intervention study for frail seniors visiting EDs at 4 university-affiliated hospitals in Montreal. MEASURES: The number of ED visits during 2 consecutive follow-up periods of 1 and 4 months after baseline was obtained from patient interviews, from medical charts of participating hospitals, and from the provincial health insurance claims database. METHODS: Latent class analysis was used to estimate the validity of each source. The impact of the following covariates on validity was evaluated: hospital visited, patient's demographic/clinical characteristics, risk of functional decline, nursing liaison intervention, duration of recall, previous ED use, and previous hospitalization. RESULTS: The patient's self-report was found to be the least accurate (sensitivity: 70%, specificity: 88%). Claims databases had the greatest validity, especially after defining claims made on consecutive days as part of the same ED visit (sensitivity: 98%, specificity: 98%). The validity of the medical chart was intermediate. Lower sensitivity (or under-reporting) on the self-report appeared to be associated with higher age, low comorbidity and shorter length of recall. CONCLUSION: The claims database is the most valid method of measuring ED use among seniors in Quebec compared with hospital medical charts and patient-reported use.

Response to flumazenil in the late luteal phase and follicular phase of the menstrual cycle in healthy control females.

RATIONALE: Animal studies of short-term progesterone administration and withdrawal model the natural increase and abrupt decrease in progesterone levels which occur in the late luteal phase (LP) of the human menstrual cycle (MC). Previously, studies in animals have shown that abrupt cessation of chronic or short-term progesterone administration results in pharmacological changes at the GABAA receptor, resulting in altered sensitivity to GABAA receptor neuromodulators such as benzodiazepines and flumazenil, a GABAA receptor antagonist. OBJECTIVES: This study's goal was to compare the response to flumazenil in the follicular phase (FP) and late LP in female healthy controls (HCs). We postulated that HC females would exhibit a greater psychological and somatic response to flumazenil in the late LP, a period of progesterone withdrawal, compared to the FP. METHODS: Twelve healthy females, without history of psychiatric disorder, were randomized to receive two injections of a 2 mg bolus injection of flumazenil (one in the late LP and one in the FP) and two injections of placebo (one in the late LP and one in the FP). Following injection, subjects were asked to rate the occurrence and intensity of panic symptoms on the panic symptom scale (PSS). RESULTS: A main treatment effect was detected for the PSS score response after flumazenil injection (P=0.008). However, there was no significant treatment-by-phase interaction observed (P=0.449). CONCLUSIONS: These findings indicate that MC phase did not affect the response to flumazenil in HC females. This result is contrary to our hypothesis of altered sensitivity to flumazenil in the late LP.

Temporal modulation visual fields, normal aging, Parkinson's disease and methyl-mercury in the James Bay Cree: a feasibility study

We assessed temporal modulation visual field (TMFs) for 91 observers including controls, Parkinson patients and members of the James Bay Cree community of Northern Québec suspected of being chronically exposed to relatively low levels of methyl-mercury. The main goal was to establish the feasibility of using such procedures to rapidly evaluate visual function in a large field study with the James Bay Cree community. The results show clear normal aging effects on TMFs and the pattern of loss differed depending on the flicker rates used. Group data comparisons between the controls and the experimental groups showed significant effects only between the Cree and normal controls in the 40 and 49 year-old age category for the low temporal frequency condition (2 Hz). Examples of individual analysis shows a Cree observer with severe visual field constriction at the 2 Hz condition with a normal visual field at the 16 Hz condition and a reverse pattern was demonstrated for a ParkinsonÆs patient where a visual field constriction was evident only for the 16 Hz condition. The general conclusions are: Such a technique can be used to evaluate the visual consequences of neuropathological disorders and it may lead to dissociation between certain neurotoxic and neurodegenerative effects depending on the parameters used; this technique can be used for a large field study because it is rapid and easily understood and performed by the subjects; the TMF procedure used showed good test-retest correlations; normal aging causes changes in TMF profiles but the changes will show different patterns throughout the visual field depending on the parameters used.

Wireless telephones and the risk of road crashes.

In light of the rapidly increasing development of the cell phone market, the use of such equipment while driving raises the question of whether it is associated with an increased accident risk; and if so, what is its magnitude. This research is an epidemiological study on two large cohorts, namely users and non-users of cell phones, with the objective of verifying whether an association exists between cell phone use and road crashes, separating those with injuries. The Société de l'Assurance Automobile du Québec (SAAQ) mailed a questionnaire and letter of consent to 175000 licence holders for passenger vehicles. The questionnaire asked about exposure to risk, driving habits, opinions about activities likely to be detrimental to driving and accidents within the last 24 months. For cell phone users, questions pertaining to the use of the telephone were added. We received 36078 completed questionnaires, with a signed letter of consent. Four wireless phone companies provided the files on cell phone activity, and the SAAQ the files for 4 years of drivers' records and police reports. The three data sources were merged using an anonymized identification number. The statistical methods include logistic-normal regression models to estimate the strength of the links between the explanatory variables and crashes. The relative risk of all accidents and of accidents with injuries is higher for users of cell phones than for non-users. The relative risks (RR) for injury collisions and also for all collisions is 38% higher for men and women cell phone users. These risks diminish to 1.1 for men and 1.2 for women if other variables, such as the kilometres driven and driving habits are incorporated into the models. Similar results hold for several sub-groups. The most significant finding is a dose-response relationship between the frequency of cell phone use, and crash risks. The adjusted relative risks for heavy users are at least two compared to those making minimal use of cell phones; the latter show similar collision rates as do the non-users.

Pulmonary and systemic nitric oxide measurements during CCK-5-induced panic attacks.

Nitric oxide (NO) plays a major role in cardiopulmonary regulation as illustrated by the alterations of the NO system described in cardiopulmonary illnesses. Recent studies have found an association between panic disorder and cardiovascular death and illness, as well as pulmonary diseases. Our objective was to investigate whether pulmonary or systemic NO production was altered during induced panic attacks (PAs). We used a double-blind placebo-controlled crossover design with randomization of the order of an injection of placebo and pentagastrin, a cholecystokinin-B receptor agonist that induces PAs in healthy volunteers (HVs). A total of 17 HVs experienced a PA after pentagastrin challenge. Exhaled NO and NO metabolites were measured by chemiluminescence. During pentagastrin-induced PAs, HVs displayed significant decreases in plateau concentrations of NO exhaled, which were associated with proportional increases in minute ventilation. There were no significant changes in pulmonary or systemic NO production. These results suggest that the decrease in exhaled NO concentration observed during pentagastrin-induced PAs is related to the associated hyperventilation, rather than to any change in lung NO production. This study is the first to evaluate changes in NO measurements during acute anxiety.