Development and preliminary validation of a health-related family quality of life instrument.

The researchers' aims for this preliminary study was to develop an instrument, guided by the Theory of Health-related Family Quality of Life, to measure health-related family quality of life (HR-FQoL) as perceived by women with cancer. The researchers used a two phase design for instrument development: (1) establishing face validity of a 38-item instrument with an expert panel and patient review, and (2) focusing on the internal structure and construct validity of the instrument with responses from female patients (N = 236) with a cancer diagnosis (breast, gynecologic). The researchers identified a final 25-item HR-FQoL instrument with four sub-scales that each captured multiple concepts within the Theory of HR-FQoL. The resulting instrument maybe used by researchers and clinicians to assess various aspects of health-related family quality of life among female breast and gynecological cancer survivors.

Replacing Synperonic® N in the physical developer fingermark visualisation process: Pseudo-operational trial and parameter studies.

A reformulated physical developer (PD) solution has been devised to replace the use of Synperonic® N for environmental reasons. The performance of the replacement solution has proved promising in laboratory trials using planted fingermarks [1] however; this may not always represent how a reagent works on real world samples. This paper therefore explores the effectiveness of the decaethylene glycol monododecyl ether (DGME)-based PD formulation through a pseudo-operational trial. A range of naturally handled, porous substrates were processed, which totalled over 600 samples that had been previously treated with amino acid reagents (1,2-indandione (IND) or 1,8-diazafluoren-9-one (DFO) and ninhydrin). The trial was representative of the operational use of PD at the end of a processing sequence for porous exhibits. The results from the trial establish that DGME is an effective replacement detergent for Synperonic® N in PD solutions and demonstrated the added benefit of using PD as a sequential treatment. Planted mark studies to assess the parameters of the DGME-based PD formulation are also included in this paper. These studies explored the preparation, processing and storage temperature required for the solution as well as the shelf life. The effectiveness of DGME-based PD on items that have been previously wetted was also investigated. These studies show the formulation is suitable for use in an operational laboratory and is therefore an effective replacement formulation for the Synperonic® N-based PD.

Replacing Synperonic® N in the Physical Developer fingermark visualisation process: Reformulation.

The Physical Developer solution currently recommended for use in the United Kingdom for fingermark visualisation uses two surfactants: n-dodecylamine acetate (nDDAA) and Synperonic® N. Synperonic® N is covered by the EU directive 82/242/EEC, which sought to phase out chemicals with degradation products more harmful than their precursor. This study explores the replacement of Synperonic® N with alternative detergents and examines their ability to produce clear, stable solutions that are effective at developing fingermarks. The critical properties of the detergents were investigated, such as the critical micelle concentration and the hydrophilic-lipophilic balance, and planted mark comparisons were performed on promising formulations. Tween® 20 was deemed unsuitable due to the production of cloudy solutions and the requirement to age the formulation to improve effectiveness. Brij® C10 produced clear formulations; however, these were too stable causing unacceptably long exhibit processing times, and an additional preparation stage was necessary. Brij® L23, Brij® S10, Igepal® CO-630, Polyoxyethylene (10) tridecyl ether and Tergitol™ 15-S-9 also proved to be unsuccessful alternatives. Decaethylene glycol monododecyl ether (DGME) was found to be a suitable alternative to Synperonic® N and depletion series experiments suggested that a range of DGME and nDDAA detergent quantities were effective at developing marks. The processing time using DGME was similar to Synperonic® N and the most favourable ratio of reagents is proposed in this paper as a reformulated Physical Developer solution.

Variability of the Positive Predictive Value of PI-RADS for Prostate MRI across 26 Centers: Experience of the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel.

Background Prostate MRI is used widely in clinical care for guiding tissue sampling, active surveillance, and staging. The Prostate Imaging Reporting and Data System (PI-RADS) helps provide a standardized probabilistic approach for identifying clinically significant prostate cancer. Despite widespread use, the variability in performance of prostate MRI across practices remains unknown. Purpose To estimate the positive predictive value (PPV) of PI-RADS for the detection of high-grade prostate cancer across imaging centers. Materials and Methods This retrospective cross-sectional study was compliant with the HIPAA. Twenty-six centers with members in the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel submitted data from men with suspected or biopsy-proven untreated prostate cancer. MRI scans were obtained between January 2015 and April 2018. This was followed with targeted biopsy. Only men with at least one MRI lesion assigned a PI-RADS score of 2-5 were included. Outcome was prostate cancer with Gleason score (GS) greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2). A mixed-model logistic regression with institution and individuals as random effects was used to estimate overall PPVs. The variability of observed PPV of PI-RADS across imaging centers was described by using the median and interquartile range. Results The authors evaluated 3449 men (mean age, 65 years ± 8 [standard deviation]) with 5082 lesions. Biopsy results showed 1698 cancers with GS greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2) in 2082 men. Across all centers, the estimated PPV was 35% (95% confidence interval [CI]: 27%, 43%) for a PI-RADS score greater than or equal to 3 and 49% (95% CI: 40%, 58%) for a PI-RADS score greater than or equal to 4. The interquartile ranges of PPV at these same PI-RADS score thresholds were 27%-44% and 27%-48%, respectively. Conclusion The positive predictive value of the Prostate Imaging and Reporting Data System was low and varied widely across centers. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Milot in this issue.

Associations between changes in resilient coping and posttraumatic stress disorder symptoms.

The pervasive, damaging nature of posttraumatic stress disorder (PTSD) presents enormous clinical challenges. Understanding the relationship between patients' perceptions of PTSD symptoms and resilient coping strategies may prompt investigation of clinical interventions that improve adaptive, resilient coping skills. In this study, we examined whether changes in resilient coping were related to changes over time in the PTSD symptoms of intrusion and avoidance. A secondary analysis was conducted using longitudinal data from the community-based Washington State Twin Registry. Participants completed the four-item Brief Resilient Coping Scale (BRCS) and the Avoidance and Intrusion subscales of the Impact of Events Scale (IES) at two points in time that were at least 2 years apart. To limit analyses to participants reporting PTSD symptoms at baseline, an initial value of at least 1.0 on either Avoidance (n = 1,337) or Intrusion (n = 1,206) was required for inclusion in the sample. Using linear regression, we assessed associations of change in BRCS with a change in IES scores, controlling for the respective initial scores on each measure. Controlling for initial BRCS and IES-Intrusion values, we observed a small, statistically significant association between change in BRCS and change in IES-Intrusion scores (b* = -0.07; p = .003). There was no statistically significant association between change in BRCS and change in IES-Avoidance (b* < 0.01; p = .869). In this large, longitudinal sample, increases in resilient coping were related to decreases in intrusive thoughts over time. Because coping patterns can be taught, these results warrant further investigations into adaptive coping patterns associated with diminishing PTSD symptoms.

An evaluation of the effect of incorporating metal salts into 1,8 diazafluoren-9-one (DFO) formulations for fingermark enhancement.

A study into the modification of 1,8-diazafluoren-9-one (DFO) formulations by the additions of metal salts into the working solution is reported. Similar additions have been found to increase the fluorescence of marks developed using other amino acid reagents including 1,2-indandione and the ninhydrin analogue 5-methylthioninhydrin. It was found that adding zinc chloride to give a 1:1 ratio of zinc ions:DFO molecules gave optimum fluorescence, and improvements in performance over the standard DFO formulation were achieved. Attempts to produce equivalent formulations with iron, nickel and palladium chlorides were unsuccessful. In a comparative trial with a 1,2-indandione-zinc formulation on brown paper and cardboard substrates, 1,2-indandione-zinc gave superior results and it was decided to focus further research on this reagent instead of DFO-zinc.

Fingermark visualisation with iron oxide powder suspension: The variable effectiveness of iron (II/III) oxide powders, and Tween® 20 as an alternative to Triton™ X-100.

The effectiveness of the current UK iron oxide powder suspension formulation, 'C-IOPS-09' (Triton X-100 based), for fingermark or latent fingerprint visualization is shown to be affected by variations between batches of the recommended iron oxide powder from Fisher Scientific (I/1100/53). When incorporated into the C-IOPS-09 formulation, a 2015 powder batch resulted in the detection of ∼19% fewer fingermarks, of broadly reduced contrast, when compared to powder suspension prepared with a 2008 batch of the same product. Furthermore, the 2015 powder batch was found to be unsuitable in experimental reduced-surfactant concentration powder suspension, because it caused surface-wide or background staining. The studies in this paper also investigated the use of Tween 20 surfactant as an alternative to the currently utilised Triton X-100, in preparation for the potential unavailability of Triton X-100 in the future. Powder suspensions prepared with Tween 20 surfactant solutions of 4% and 40% were shown to offer similar effectiveness to the currently recommended C-IOPS-09 formulation, when compared using the same batch of Fisher Scientific iron oxide powder (2008 or 2015). The difference between the 2008 and 2015 iron oxide batches was hence also evident with these alternative surfactant solutions. Particle size distribution analysis of the iron oxide powders in Tween 20 and Triton X-100 based surfactant solutions show that the more effective powder exhibits a higher sub-micrometre particle population than the less effective powder. This work leads to an improved specification for powder suspension formulations. This is demonstrated with an example powder suspension formulation which uses a 10% Tween 20 surfactant solution and iron oxide nanopowder (50-100nm) from Sigma Aldrich, which was shown to visualise 27% more fingermarks than the C-IOPS-09 formulation prepared with the 2015 Fisher Scientific powder batch, in a comparative study.

3.0 T relaxation time measurements of human lymph nodes in adults with and without lymphatic insufficiency: Implications for magnetic resonance lymphatic imaging.

The purpose of this work was to quantify 3.0 T (i) T1 and T2 relaxation times of in vivo human lymph nodes (LNs) and (ii) LN relaxometry differences between healthy LNs and LNs from patients with lymphatic insufficiency secondary to breast cancer treatment-related lymphedema (BCRL). MR relaxometry was performed over bilateral axillary regions at 3.0 T in healthy female controls (105 LNs from 20 participants) and patients with BCRL (108 LNs from 20 participants). Quantitative T1 maps were calculated using a multi-flip-angle (20, 40, 60°) method with B1 correction (dual-TR method, TR1 /TR2  = 30/130 ms), and T2 maps using a multi-echo (TE  = 9-189 ms; 12 ms intervals) method. T1 and T2 were quantified in the LN cortex and hilum. A Mann-Whitney U-test was applied to compare LN relaxometry values between patients and controls (significance, two sided, p < 0.05). Linear regression was applied to evaluate how LN relaxometry varied with age, BMI, and clinical indicators of disease. LN substructure relaxation times (mean ± standard deviation) in healthy controls were T1 cortex, 1435 ± 391 ms; T1 hilum, 714 ± 123 ms; T2 cortex, 102 ± 12 ms, and T2 hilum, 119 ± 21 ms. T1 of the LN cortex was significantly reduced in the contralateral axilla of BCRL patients compared with the axilla on the surgical side (p < 0.001) and compared with bilateral control values (p < 0.01). The LN cortex T1 asymmetry discriminated cases from controls (p = 0.004) in a multiple linear regression, accounting for age and BMI. Human 3.0 T T1 and T2 relaxation times in axillary LNs were quantified for the first time in vivo. Measured values are relevant for optimizing acquisition parameters in anatomical lymphatic imaging sequences, and can serve as a reference for novel functional and molecular LN imaging methods that require quantitative knowledge of LN relaxation times.

Sequential processing strategies for fingermark visualisation on uncirculated £10 (Bank of England) polymer banknotes.

An investigation was undertaken to assess the relative effectiveness of five fingermark visualisation process sequences on new, uncirculated £10 polymer banknotes from the Bank of England (BoE). Each sequence was challenged with the visualisation of 64 natural fingermarks on eight banknotes, of which half were aged for 2-3days and half were aged for 12-13days (32 donors contributed in each set). The sequences investigated were; After each process was applied, fingermark development was assessed under primary viewing conditions appropriate to the technique (white light or fluorescence). All samples were also assessed under secondary viewing conditions; provided by the optical processes infrared reflection and long-wave ultraviolet reflection, and by gelatin lifting (with scanning). These additional techniques reduced the interfering effect of the complex banknote backgrounds and improved the contrast of enhanced fingermarks. Overall, with all assessment conditions considered, sequence 4 and sequence 3 visualised the most identifiable quality fingermarks (92.2% and 89.1% respectively). The most effective overall process used singularly was found to be black magnetic powder, provided that reflected infrared was used to image the results (82.8%). Further data analysis revealed that sequence 1 was the most effective sequence for fresh marks (aged 2-3days) when only primary viewing conditions within the visible part of the spectrum are considered. The need for further work which considers the sensitivity of the processes, and how they perform on BoE polymer banknotes that have become worn in circulation, is emphasised.

Theoretical Approaches to Enhancing Motivation for Adherence to Antidepressant Medications.

PROBLEM: Adherence to antidepressants is a major challenge in our health care system, with a high percentage of patients discontinuing their medications within six months. AIMS: The purpose of this position paper is to discuss theoretical frameworks that address the psychological beliefs, benefits and barriers and feelings of autonomy that affect a person's willingness and motivation to take anti-depressant medications within a therapeutic relationship with a nurse practitioner. METHODS: Three theoretical frameworks were selected to highlight particular perspectives relevant to enhancing patient motivation for medication adherence. The Self-Regulation Model, Health Belief Model, and Self-Determination Theory combined with motivational interviewing all offer guidance on strategies for improving adherence to antidepressants. CONCLUSIONS: The Self-Regulation Model underscores the importance of illness representations that prompt considering patient perceptions of depression that affect adherence. The Health Belief Model focuses on cost-benefit considerations that affect patient's adherence, along with perceived control. Finally, Self-Determination Theory combined with motivational interviewing offers strategies that enhance autonomy and optimize collaboration and motivation for adherence. RELEVANCE FOR CLINICAL PRACTICE: These three theoretical models are applied to a vignette for a patient who is having difficulty with adherence to antidepressant medication.

Fingermark visualisation on uncirculated £5 (Bank of England) polymer notes: Initial process comparison studies.

Experiments were conducted to investigate the effectiveness of a range of fingermark visualisation processes on brand new, uncirculated, £5 polymer banknotes (and their test note predecessors), as produced by the Bank of England (BoE). In the main study of this paper, a total of 14 individual processes were investigated on BoE £5 polymer banknotes, which included both 'Category A' processes (as recommended in the Home Office Fingermark Visualisation Manual) as well as recently developed processes, including fpNatural® 2 powder (cuprorivaite) from Foster+Freeman and a vacuum metal deposition sequence that evaporates silver followed by zinc. Results from this preliminary investigation indicate that fpNatural® 2, multimetal deposition, Wet Powder™ Black, iron oxide powder suspension and black magnetic powder are the most effective processes on these uncirculated £5 BoE polymer banknotes, when viewed under "primary viewing" conditions (white light or fluorescence). Additional fingermarks were visualised on the polymer banknotes following the subsequent use of reflected infrared imaging and lifting techniques, and with the benefit of these techniques taken into consideration, the aforementioned processes remained amongst the most effective overall. This work provides initial insight into fingermark visualisation strategies for BoE £5 polymer banknotes, and the need for further studies in order to generate mature operational guidance is emphasised.

Measurement properties of the brief resilient coping scale in patients with systemic lupus erythematosus using rasch analysis.

BACGROUND: Resilience has been defined as the capacity or the ability to rebound from and positively adapt to significant stressors, despite experiences of significant adversity or trauma. To capture to what extent an individual copes with stress in a resilient fashion the Brief Resilient Coping Scale (BRCS) was developed. This tool was validated in people with chronic disease, such as rheumatoid arthritis using standard psychometric techniques of classical test theory, but not yet in patients with Systemic lupus erythematosus (SLE). The aim of this study was to explore the psychometric properties of the Brief Resilient Coping Scale in patients with SLE using Rasch analysis. METHOD: This study used cross-sectional data. The BRCS was administered to 232 patients with systemic lupus erythematosus. The aspects analyzed were unidimensionality, local independence and differential item functioning (DIF) to construct an interpretative scale of scores with the Rasch model. RESULTS: Rating scale mode (RSM) showed that the four categories used in the items of the BRCS are properly ordered. The four items provided a good fit to the polytomous Rasch model. Moreover, the parameters were sufficiently separated to measure resilience in patients with SLE. BRCS is a unidimensional scale (eigenvalue = 1.843) of resilience and the items were locally independent. There was no DIF between males and females in the sample. Only marginally significant differences depending on the level of education were found. The BRCS showed adequate discriminant validity between groups of scores. CONCLUSIONS: BRCS is a suitable scale for measuring resilience in patients with SLE. This scale might be useful for clinicians to obtain information concerning the degree of resilience that each patient has, allowing individuals with low resilience to be identified who need interventions aimed at developing coping skills.

Resilient Coping Moderates the Effect of Trauma Exposure on Depression.

Posttraumatic depression rates are increasing in the United States, and there is a great need to identify malleable factors that could moderate posttraumatic depression levels. The purpose of this study was to examine whether resilient coping moderates the effects of trauma exposure on depression, while controlling for neuroticism-an established predictor of depressive symptoms. This study used data from 3,734 pairs of twins from the community-based University of Washington Twin Registry. Each twin pair was randomized with twin A in one subsample and twin B in the second subsample. The four-item Brief Resilient Coping Scale measured resilient coping. The two-item Patient Health Questionnaire measured depression. Multiple linear regression analyses were performed on each subsample, controlling for neuroticism. In addition to significant effects of neuroticism and trauma exposure on depression (p < .001), the effect of the interaction of resilient coping and trauma exposure on depression was significant in both subsamples (p < .01). High levels of resilient coping were associated with lower depression scores in the context of previous trauma exposure. Individuals high in resilient coping who experienced significant life traumas were less depressed after trauma exposure, even after controlling for neuroticism. Because coping skills may be learned, interventions that teach resilient coping to individuals with traumatic histories merit investigation. © 2016 Wiley Periodicals, Inc.

Evidence for validity of the brief resilient coping scale in a young spanish sample

The aim of the present study was to provide evidence of validity of the Brief Resilient Coping Scale for use in Spanish young population. A total of 365 university students responded to the Spanish version of the BRCS as well as to other tools for measuring personal perceived competence, life satisfaction, depression, anxiety, negative and positive affect, and coping strategies. Confirmatory factor analysis confirmed the unidimensional structure of the scale. Internal consistency reliability and temporal stability through Cronbach’s alpha and test-retest correlations, respectively, were comparable to those found in the initial validation of the tool. The BRCS showed positive and significant correlations with personal perceived competence, optimism, life satisfaction, positive affect (p < .01), and some coping strategies (p < .05). Significant negative correlations were observed with depression, anxiety and negative affect. (p < .01). Multiple regression analysis with stepwise method showed that positive affect, negative affect, optimism and problem solving explained 41.8% of the variance of the BRCS (p < .001). The Spanish adaptation of the BRCS in a young population is satisfactory and comparable to those of the original version and with the Spanish version adapted in an elderly population. This supports its validity as a tool for the assessment of resilient coping tendencies in young people who speak Spanish and offers researchers and professionals interested in this area of study a simple tool for assessing it (AU)

No disponible

Evidence for validity of the brief resilient coping scale in a young Spanish sample.

The aim of the present study was to provide evidence of validity of the Brief Resilient Coping Scale for use in Spanish young population. A total of 365 university students responded to the Spanish version of the BRCS as well as to other tools for measuring personal perceived competence, life satisfaction, depression, anxiety, negative and positive affect, and coping strategies. Confirmatory factor analysis confirmed the unidimensional structure of the scale. Internal consistency reliability and temporal stability through Cronbach's alpha and test-retest correlations, respectively, were comparable to those found in the initial validation of the tool. The BRCS showed positive and significant correlations with personal perceived competence, optimism, life satisfaction, positive affect (p < .01), and some coping strategies (p < .05). Significant negative correlations were observed with depression, anxiety and negative affect. (p < .01). Multiple regression analysis with stepwise method showed that positive affect, negative affect, optimism and problem solving explained 41.8% of the variance of the BRCS (p < .001). The Spanish adaptation of the BRCS in a young population is satisfactory and comparable to those of the original version and with the Spanish version adapted in an elderly population. This supports its validity as a tool for the assessment of resilient coping tendencies in young people who speak Spanish and offers researchers and professionals interested in this area of study a simple tool for assessing it.

The effects of polymer pigmentation on fingermark development techniques.

The effectiveness of latent fingerprint development techniques is heavily influenced by the physical and chemical properties of the deposition surface. The use of powder suspensions is increasing for development of prints on a range of surfaces. We demonstrate that carbon powder suspension development on polymers is detrimentally affected by the presence of common white pigment, titanium dioxide. Scanning electron microscopy demonstrates that patches of the compound are clearly associated with increased levels of powder adhesion. Substrates with nonlocalized titanium dioxide content also exhibit increased levels of carbon powder staining on a surface-wide basis. Secondary ion mass spectrometry and complementary techniques demonstrate the importance of levels of the pigment within the top 30 nm. The association is independent of fingermark deposition and may be related to surface energy variation. The detrimental effect of the pigment is not observed with small-particle reagent (MoS2 SPR) or cyanoacrylate (superglue) fuming techniques that exploit different development mechanisms.

Voices from the shadows: living with lymphedema.

BACKGROUND: Breast cancer survivors with lymphedema face a lifetime of stressful physical and emotional symptoms and challenging self-care demands. An in-depth understanding of the perceptions and feelings surrounding life with lymphedema is critical to developing effective supportive care approaches. OBJECTIVE: The objective of the study was to explore perceptions and feelings related to lymphedema in breast cancer survivors. METHOD: The expressive writings of 39 individuals were evaluated for this descriptive qualitative study. Data were analyzed using conventional content analysis. RESULTS: Qualitative analyses produced 4 major themes: (1) marginalization and minimization, (2) multiplying losses, (3) yearning to return to normal, and (4) uplifting resources. Subthemes for each major theme were also identified. CONCLUSION: The lymphedema experiences of breast cancer survivors reveal perceptions of marginalization from healthcare providers who are not well informed about lymphedema management and minimizing its impact. Multiple distressing losses confront these patients on a daily basis, including body image disturbances, loss of functionality and control over time, permanent uncertainty, and adverse effects on relationships. The daily challenges of lymphedema often result in cumulative frustration and resentment that contribute to failure to perform self-care. Normalcy has been lost, never to return. These women find solace, encouragement, and hope to meet the challenges of lymphedema through support from others and their spiritual beliefs. IMPLICATIONS FOR PRACTICE: Healthcare providers need greater awareness of the physical and psychosocial effects of lymphedema in breast cancer survivors. Nurses have unique opportunities to serve as advocates for reducing perceived marginalization and promoting effective self-care and other activities that promote psychological well-being and reduce physical deterioration.

Nanoscale analysis of the interaction between cyanoacrylate and vacuum metal deposition in the development of latent fingermarks on low-density polyethylene.

Vacuum metal deposition (VMD) has been previously demonstrated as an effective development technique for latent fingermarks and in some cases has been shown to enhance prints developed with cyanoacrylate (CA) (superglue) fuming. This work utilizes scanning electron microscopy (SEM) to investigate the interactions of the two development techniques when applied to latent fingermarks on low-density polyethylene. CA is shown to act principally on the eccrine deposits around sweat pores, where polymerization results in long polymer fibrils a few 100 nm in width. Subsequent VMD processing results in additional areas of development, for example, between pores. However, the primary mode of deposition of zinc is by interaction with the polymerized CA, the fibrils of which become decorated with zinc nanoparticles. Areas with limited CA deposition and no significant polymerization are also enhanced with the VMD process, resulting in increased print development.

Mopeds: the legal loophole for repeat driving while intoxicated offenders.

BACKGROUND: Mopeds have less stringent licensing laws than automobiles. Moped operators in motorized vehicle collisions (MVCs) exhibit significantly higher rates of driving while intoxicated (DWI) and higher blood alcohol levels than automobile or motorcycle operators. This study evaluates the public safety issue of DWI recidivism among moped operators. METHODS: Moped operators evaluated after MVCs were identified from 2007 to 2009. Demographics, hospital data, and Department of Motor Vehicles records were reviewed. RESULTS: Sixty-five moped operators were evaluated. Thirty-two (49%) had a positive blood alcohol level, 29 (45%) had a previous DWI, and 21 (72%) of those were repeat offenders. Twenty-five (38%) had a revoked license at the time of injury. Of these, 19 (76%) incurred multiple revocations. Twenty-two (34%) showed prior charges of driving with a revoked license (DWRL), with 15 (68%) incurring multiple DWRL charges. CONCLUSIONS: Moped operators are often intoxicated at the time of injury and represent a public safety hazard. The majority are recidivists with multiple alcohol-related traffic charges. Current laws allow repeat offenders the sustained opportunity to operate motorized vehicles. Re-evaluation of current moped laws is needed to keep habitual offenders off the road.