The effect of human-machine interface modality, specificity, and timing on driver performance and behavior while using vehicle automation.

The effectiveness of the human-machine interface (HMI) in a driving automation system during takeover situations is based, in part, on its design. Past research has indicated that modality, specificity, and timing of the HMI have an impact on driver behavior. The objective of this study was to examine the effectiveness of two HMIs, which vary by modality, specificity, and timing, on drivers' takeover time, performance, and eye glance behavior. Drivers' behavior was examined in a driving simulator study with different levels of automation, varying traffic conditions, and while completing a non-driving related task. Results indicated that HMI type had a statistically significant effect on velocity and off-road eye glances such that those who were exposed to an HMI that gave multimodal warnings with greater specificity exhibited better performance. There were no effects of HMI on acceleration, lane position, or other eye glance metrics (e.g., on road glance duration). Future work should disentangle HMI design further to determine exactly which aspects of design yield between safety critical behavior.

A simulator study assessing the effectiveness of training and warning systems on drivers' response performance to vehicle cyberattacks.

Modern vehicles are vulnerable to cyberattacks and the consequences can be severe. While technological efforts have attempted to address the problem, the role of human drivers is understudied. This study aims to assess the effectiveness of training and warning systems on drivers' response behavior to vehicle cyberattacks. Thirty-two participants completed a driving simulator study to assess the effectiveness of training and warning system according to their velocity, deceleration events, and count of cautionary behaviors. Participants, who held a valid United States driving license and had a mean age of 20.4 years old, were equally assigned to one of four groups: control (n = 8), training-only (n = 8), warning-only (n = 8), training and warning groups (n = 8). For each drive, mixed ANOVAs were implemented on the velocity variables and Poisson regression was conducted on the normalized time with large deceleration events and cautionary behavior variables. Overall, the results suggest that drivers' response behaviors were moderately affected by the training programs and the warning messages. Most drivers who received training or warning messages responded safely and appropriately to cyberattacks, e.g., by slowing down, pulling over, or performing cautionary behaviors, but only in specific cyberattack events. Training programs show promise in improving drivers' responses toward vehicle cyberattacks, and warning messages show rather moderate improvement but can be further refined to yield consistent behavior.

Evaluation of a 3M (mistakes, mentoring, and mastery) training program for transfer of control situations in a level 2 automated driving system.

Drivers must actively supervise automation as it can only function in limited conditions. A failure to supervise the system has negative consequences in terms of missed requests to take over control and may cause crashes or jeopardize safety. The objective of this study is to determine the effect of a novel, 3M (Mistakes, Mentoring, and Mastery) training program on drivers' behavior while using level 2 driving automation systems. To achieve this, 36 participants were assigned randomly to three different training programs (3M training, User manual, and Placebo) and drove through scenarios on a fixed-based driving simulator. The results showed that drivers in the 3M training group took back control more effectively when the driving automation system reached its limits compared to drivers who received User manual or Placebo training. Drivers in the 3M training Group also had higher situation awareness and improved trust in automation. The results indicate that an interactive approach to training with regards to vehicle automation can help drivers more safely interact with automation systems.

Novice driver crashes: The relation between putative causal factors, countermeasures, real world implementations, and policy - A case study in simple, scalable solutions.

Novice drivers are at a greatly inflated risk of crashing. This led in the 20th century to numerous attempts to develop training programs that could reduce their crash risk. Yet, none proved effective. Novice drivers were largely considered careless, not clueless. This article is a case study in the United States of how a better understanding of the causes of novice driver crashes led to training countermeasures targeting teen driving behaviors with known associations with crashes. These effects on behaviors were large enough and long-lasting enough to convince insurance companies to develop training programs that they offered around the country to teen drivers. The success of the training programs at reducing the frequency of behaviors linked to crashes also led to several large-scale evaluations of the effect of the training programs on actual crashes. A reduction in crashes was observed. The cumulative effect has now led to state driver licensing agencies considering as a matter of policy both to include items testing the behaviors linked to crashes on licensing exams and to require training on safety critical behaviors. The effort has been ongoing for over a quarter century and is continuing. The case study highlights the critical elements that made it possible to move from a paradigm shift in the understanding of crash causes to the development and evaluation of crash countermeasures, to the implementation of those crash countermeasures, and to subsequent policy changes at the state and federal level. Key among these elements is the development of simple, scalable solutions.

Advance Care Planning in Primary Care: A Step toward Normalizing the Conversation.

Despite the number of advance care planning (ACP) conversation guides and tools, ACP conversations are not common in healthcare. In this quality improvement project, we took a different approach and applied complex adaptive systems theory to develop an intervention that emerged from the users (family physicians) themselves - a standardized e-form with prompts. By listening to the users, we were able to integrate ACP best practices, including shifting the focus of ACP conversations from treatment decisions to patient values, in a way that met both users' and patients' needs, addressed barriers and will help normalize ACP conversations in primary care. The intervention was designed for any patient and family physician and may have utility for other family practice groups.

Frequency and Quality of Exposure to Adaptive Cruise Control and Impact on Trust, Workload, and Mental Models.

Advanced Driver Assistance Systems (ADAS) support drivers with some driving tasks. However, drivers may lack appropriate knowledge about ADAS resulting in inadequate mental models. This may result in drivers misusing ADAS, or mistrusting the technologies, especially after encountering edge-case events (situations beyond the capability of an ADAS where the system may malfunction or fail) and may also adversely affect driver workload. Literature suggests mental models could be improved through exposure to ADAS-related driving situations, especially those related to ADAS capabilities and limitations. The objective of this study was to examine the impact of frequency and quality of exposure on drivers' understanding of Adaptive Cruise Control (ACC), their trust, and their workload after driving with ACC. Sixteen novice ACC users were recruited for this longitudinal driving simulator study. Drivers were randomly assigned to one of two groups - the 'Regular Exposure' group encountering 'routine' edge-case events, and the 'Enhanced Exposure' group encountering 'routine' and 'rare' events. Each participant undertook four different simulator sessions, each separated by about a week. Each session comprised a simulator drive featuring five edge-case scenarios. The study followed a mixed-subject design, with exposure frequency as the within-subject variable, and quality of exposure (defined by two groups) as the between-subject variable. Surveys measured drivers' trust, workload, and mental models. The results from the analyses using linear regression models revealed that drivers' mental models about ACC improve with frequency of exposure to ACC and associated edge-case driving situations. This was more the case for drivers who experienced 'rare' ACC edge cases. The findings also indicate that for those who encountered 'rare' edge cases, workload was higher and trust was lower than those who did not. These findings are significant since they underline the importance of experience and familiarity with ADAS for safe operation. While these findings indicate that drivers benefit from increased exposure to ACC and edge cases in terms of appropriate use of ADAS, and ultimately promise crash reductions and injury prevention, a challenge remains regarding how to provide drivers with appropriate exposure in a safe manner.

The Use of Artificial Intelligence in Clinical Care: A Values-Based Guide for Shared Decision Making.

Clinical applications of artificial intelligence (AI) in healthcare, including in the field of oncology, have the potential to advance diagnosis and treatment. The literature suggests that patient values should be considered in decision making when using AI in clinical care; however, there is a lack of practical guidance for clinicians on how to approach these conversations and incorporate patient values into clinical decision making. We provide a practical, values-based guide for clinicians to assist in critical reflection and the incorporation of patient values into shared decision making when deciding to use AI in clinical care. Values that are relevant to patients, identified in the literature, include trust, privacy and confidentiality, non-maleficence, safety, accountability, beneficence, autonomy, transparency, compassion, equity, justice, and fairness. The guide offers questions for clinicians to consider when adopting the potential use of AI in their practice; explores illness understanding between the patient and clinician; encourages open dialogue of patient values; reviews all clinically appropriate options; and makes a shared decision of what option best meets the patient's values. The guide can be used for diverse clinical applications of AI.

Looking out or Looking Away?-Exploring the Impact of Driving With a Passenger on Young Drivers' Eye Glance Behavior.

OBJECTIVE: To explore how passenger presence and the degree of association between young driver and passenger influences young drivers' eye glance behavior when they are subjected to distraction. BACKGROUND: Young drivers (18-20 years old) are at an elevated crash risk when subjected to distraction. They are likely to be distracted even further when they drive with passengers. However, the eye glance behavior of these drivers when driving with passengers has not been explored. METHOD: Eye glance data of 34 young drivers between the ages of 18 and 20 years were collected. Participants drove with and without a passenger while subjected to three distracting tasks (visual-manual, cognitive, or visual-cognitive) and driving scenarios that required driver attention. RESULTS: Visual-cognitive as well as visual-manual states of distraction result in higher mean and standard deviation of glance duration, along with higher number of glances away from road. Passenger presence is found to negatively influence young drivers' eye glance behavior. The degree of association between the young driver and the passenger may help reduce the deviation of eye glances towards the task-related objects. CONCLUSION: In addition to distraction, passengers have a negative influence on the eye glance behavior of young drivers. However, a high degree of association between driver and passenger may mitigate the negative impact of distraction on the eye glance behavior of young drivers. APPLICATION (NON-THEORETICAL WORKS): This research may aid in the design of interventions that improve young drivers' eye glance behavior when they drive with their peers.

Factors affecting drivers' off-road glance behavior while interacting with in-vehicle voice interfaces.

In-vehicle voice-based interfaces have been massively embedded in modern vehicles as a countermeasure to visual-manual distractions. However, limited data are available regarding the actual visual demands imposed on the driver when interacting with such an interface. How those factors that are associated with the drivers themselves affect their visual behavior when interacting with an in-vehicle voice-based interface remains understudied. This study focused on investigating factors affecting drivers' off-road visual behavior while interacting with a voice-based interface. A secondary data analysis leveraging structural equation modeling was performed based on data collected from a large-scale field experiment wherein participants drove a vehicle on the highway and performed a series of tasks using an in-vehicle voice interface. The results indicate that while voice-based interfaces are designed to help reduce drivers' visual demands, drivers can still direct their eyes off the road for a prolonged period of time during the interaction and exhibit potentially risky visual behavior. In addition, individual-level factors can exert influence on drivers' off-road visual behavior in such a way that older drivers and drivers with higher trust in technologies are associated with more long eyes-off-road glances when interacting with a voice-based interface. To promote the general public's adoption of in-vehicle voice interfaces and support safe interactions, we recommend relevant research and system design consider drivers' trust in, perceptions, and previous usage of similar technologies, as well as their individual characteristics such as age.

Sacroiliac Joint Anatomy.

The sacroiliac joint can be a source of low back pain. This review article summarizes current anatomic evidence of the innervation of the intraarticular and extraarticular parts of the sacroiliac joint relative to bony landmarks identifiable with fluoroscopy and ultrasound. This article aims to provide clinicians with an anatomic basis for clinical application to diagnostic blocks and radiofrequency ablation for sacroiliac pain to optimize clinical outcomes.

Driver behavior and performances on in-vehicle display based speed compliance.

Traffic safety, and the inherent risks associated with speeding, continue to remain a national priority. Advances in both roadway and vehicle technology have created potential mechanisms to mitigate speeding behaviors. This driving simulator study evaluated the effects of alternative ways to increase driver safety by investigating the characteristics of specific driving cues and drivers' response rates to those cues. The study builds upon existing approaches to symbolically deliver Traffic Control Devices (TCDs), specifically speed alerts, at different locations within the vehicle to reduce cognitive distraction and prevent visual crowding so that drivers can properly select their speed and focus upon the roadway environment. Twenty-three participants received five visual treatments (e.g., combinations of speed alert style, presentation, and location) in a simulated environment. Participants also responded to a set of survey questions following the simulated drive. Participants were evaluated on various response factors to each visual treatment. Results showed that younger participants of the age group 18-23 responded to the visual treatment and stayed within speed limits as compared to other older and more experienced participants. Results also showed that alerts falling in the mid-peripheral visual region and alerts that flashed received an increased response rate for observing speed limits.

Impact of L2 automated systems on hazard anticipation and mitigation behavior of young drivers with varying levels of Attention Deficit Hyperactivity Disorder symptomatology.

Level 2 (L2) driving automation systems that maintain latitudinal and longitudinal control of the vehicle decrease mental workload and result in drivers failing to monitor and respond to potential roadway hazards. This issue is potentially important for young drivers with symptoms of Attention Deficit Hyperactivity Disorder (ADHD) since they have known difficulties anticipating and mitigating potential hazards on the road, a skill which requires attention. The objective of this study is to investigate how the use of partially automated (L2) systems and manual systems impacts hazard anticipation and mitigation among young drivers with varying levels of ADHD symptomatology. Sixty-eight drivers, classified into two groups - high and low ADHD symptomatology-navigated twice through three scenarios on a driving simulator, once with an L2 and once with a manual system. The results indicated that: (i) the hazard anticipation skills of drivers with both high and low ADHD symptomatology were depressed in the L2 condition relative to the manual condition; (ii) the hazard mitigations skills of drivers with both high and low ADHD symptomatology were depressed in the L2 condition relative to the manual condition on two measures, but improved on a third measure; and (iii) the hazard anticipation and mitigation skills of drivers with high and low ADHD symptomatology were differentially impacted, both within and across the two levels of automation. Taken together, the results indicate the pernicious and often hard to predict consequences of higher levels of automation for different populations of younger drivers.

The effect of hazard awareness training on teen drivers of varying socioeconomic status.

OBJECTIVE: To compare the effectiveness of the Risk Awareness and Perception Training (RAPT) program among teens of various socioeconomic status (SES). METHODS: A secondary analysis was undertaken of data collected from 5036 teen participants for a study in 2011. They were randomly assigned to either receive RAPT or a placebo training. The total number of crashes (property damage only and injury) within the first 12 months after licensure was recorded. A Poisson regression model was employed to investigate the effectiveness of RAPT in terms of crash frequency among teens in different levels of SES, as measured by SES level (high or low) or poverty rate. RESULTS: Poverty rate was significantly associated with participants' crash frequency within the first 12 months after licensure such that when poverty rate increased, the crash frequency increased. The interacting effect of poverty rate and training was also significant. When compared to participants who did not receive RAPT, participants who received RAPT had fewer crashes when poverty rate increased. CONCLUSION: The RAPT program attenuated the negative effect of teen drivers' SES on crashes. No significant effect of sex or age was found, indicating that in terms of crashes, regardless of age or sex, RAPT is equally effective at reducing crashes for lower SES teens.

A Controlled Trial Evaluating the Safety and Effectiveness of Ultrasound-Guided Looped Thread Carpal Tunnel Release.

Background: Open carpal tunnel release typically requires several weeks of recovery. A less invasive, ultrasound-guided percutaneous technique of releasing the transverse carpal ligament using a thread (thread carpal tunnel release [TCTR]) has been described. To date, its clinical effectiveness and safety have been evaluated exclusively by the group that developed the technique, using a single outcome measure without a control comparison. The objective of this study was to independently evaluate the safety and effectiveness of TCTR using multiple outcome measures and a control comparison. Methods: A convenience sample of 20 participants with refractory moderate or severe carpal tunnel syndrome underwent TCTR of their most symptomatic hand. Outcome measures included pre-TCTR and 1-, 3-, and 6-month post-TCTR Boston questionnaire; pre-, 3-, and 6-month post-TCTR monofilament sensibility, strength, ultrasound, and electrodiagnostic testing; weekly post-TCTR phone interviews for 1 month; and satisfaction surveys at 3 and 6 months post-TCTR. Results: No complications were reported. During the month post-TCTR, significant prompt improvements in hand pain and dysfunction occurred. The following significant improvements were demonstrated in the treated versus control hand: Boston Questionnaire scores, median nerve distal motor latency, transcarpal tunnel motor and sensory conduction velocities and sensory nerve action potential amplitudes. No significant differences in sensibility, pinch or grip strength, median nerve cross-sectional area (CSA) at the carpal tunnel inlet, or wrist: forearm median nerve CSA ratio were documented between TCTR and control sides. Satisfaction with the TCTR procedure was high (85%-90%). Conclusions: This study supports previous reports that the TCTR procedure is safe and effective.

Accounting for drivers' bicycling frequency and familiarity with bicycle infrastructure treatments when evaluating safety.

Municipalities in the United States often encourage bicycling for the health, economic, and environmental benefits by implementing new and innovative bicycle infrastructure treatments. Unfortunately, many treatments are unfamiliar to or misunderstood by drivers, especially when lacking explicit rules (e.g., shared lanes). To date, research has largely investigated bicycle infrastructure from a bicyclist's perspective, but with little research from the driver's perspective. The objective of this research is to utilize a driving simulator to investigate driver behavior towards different bicycle infrastructure treatments when driver behavior is not provoked by an interaction with bicyclists. More specifically, this research intends to investigate the impact of bicycling frequency and treatment familiarity, as well as the combined effect of the two, on driver behavior at each treatment type. The treatments investigated are shared lane markings called "sharrows", standard bike lanes, bike boxes, and merge lanes. The results show that bicycling frequency significantly affects the proportion of drivers making eye glances at treatments. In addition, drivers more familiar with bike boxes stopped significantly further back from bike boxes, and drivers more familiar with merge lanes performed the merge maneuver significantly earlier. Furthermore, driver speed and lane positioning at bike lanes was significantly affected by the combination of bike lane familiarity and bicycling frequency, but not individually. This research is a first step towards understanding driver behavior and expectation of bicyclists; an essential understanding for infrastructure treatments that do not provide physical barriers between bicycles and automobiles, and instead rely on driver behavior for safety.

Review of Knee Joint Innervation: Implications for Diagnostic Blocks and Radiofrequency Ablation.

OBJECTIVE: To determine if commonly used knee radiofrequency ablation (RFA) techniques would be able to completely denervate the knee joint. METHODS: A comprehensive search of the literature on knee joint innervation was conducted using the databases Medline, Embase, and PubMed from inception through February 1, 2019. Google Scholar was also searched. Data on the origin, number of articular branches, course, distribution, and frequency of each nerve innervating the knee joint were extracted from the included studies and compared in order to identify variations. RESULTS: Twelve studies of anterior knee joint innervation and six studies of posterior knee joint innervation were included. The anterior knee joint was innervated by 10 nerves and further subdivided into two parts (anteromedial and anterolateral) or four quadrants (superomedial, inferomedial, superolateral, and inferolateral) based on innervation patterns; the posterior knee joint was innervated by two or three nerves, most commonly via the popliteal plexus. There is a lack of precise, validated anatomic targets identifiable with fluoroscopy and ultrasound for knee diagnostic blocks and RFA. Only three of the 12 or potentially 13 nerves innervating the knee joint are targeted by commonly used knee RFA techniques. CONCLUSIONS: Commonly used knee RFA techniques would not be able to completely denervate the knee joint. It may not be necessary to capture all of the nerves, but only the nerves mediating a patient's pain. Further clinical studies are required to validate specific diagnostic blocks and evaluate clinical outcomes using rigorous diagnostic blocks and anatomically specific knee RFA techniques.

Driving distracted with friends: Effect of passengers and driver distraction on young drivers' behavior.

Both passengers and driver distraction can have negative effects on young driver behavior. However, it is not known how these two concepts interact to influence driver behavior. The objective of this study was to examine the effect of passenger presence and driver distraction on young drivers' behavior. Forty-eight participants aged 18-20 participated in a driving simulator study. Participants completed three distracting tasks (visual, cognitive, or combined) while navigating a highway scenario. Results indicated that passenger presence interacted with driver distraction to have an effect on elevated g-force events in curves. Separately, distraction affected driving performance differently according to whether the task was visual, cognitive or combined. Having a close friendship resulted in less speeding and male drivers tended to maintain a better lane position compared to females. The results have implications for licensing laws as well as intervention programs aimed at improving young driver behavior.

Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain.

Objective: To compare the percentage of sacral lateral branches (LBs) that would be captured if lesions were created by seven current sacroiliac joint (SIJ) radiofrequency ablation (RFA) techniques: three monopolar and four bipolar. Design: Cadaveric fluoroscopy study. Setting: Anatomy and surgical skills laboratories. Subjects: Forty cadaveric SIJs. Methods: LBs were exposed, radiopaque wires were sutured to LBs, and anterior-posterior fluoroscopic images through the S1 superior endplate were obtained. Lesions that would be created by 17 versions of seven current SIJ RFA techniques were mapped on the fluoroscopic images. These 17 versions were compared: 1) percentage of LBs that would be captured; 2) percentage of SIJ specimens in which 100% of LBs would be captured; and 3) percentage of LBs that would not be captured at each level (S1-S4). Results: Both the mean LB and 100% capture rates were greater for the bipolar techniques (93.4-99.7% and 62.5-97.5%, respectively) than for the monopolar techniques (49.6-99.1% and 2.5-92.5%, respectively) evaluated. For the bipolar techniques, 1.5-29.2% of LBs would not be captured at S1 and 0% at S2-S4 vs 0-29.2% at S1-S4 for the cooled monopolar techniques vs 36.9-100% at S1-S4 for the conventional monopolar technique. Conclusions: The findings suggest that, if lesions were created, the RFA needle placement locations of the bipolar techniques evaluated may be capable of capturing all LBs, but those of the current monopolar techniques evaluated may not. Future in vivo imaging studies are required to compare the lesion morphology generated by different SIJ RFA techniques and correlate the findings with clinical outcomes.