The Driver Behaviour Questionnaire for older drivers: Do errors, violations and lapses change over time?

The aim of the current study was to examine how self-reported aberrant driving behaviours change across a three time-points in a group of older drivers. Two hundred and twenty-seven older drivers (males = 69.6%) from the Candrive/Ozcandrive longitudinal study completed the Driving Behaviour Questionnaire (DBQ) each yearacross three time-points (i.e., Year 1, Year 2, Year 3). At the third time-point, older drivers ranged in age from 77 to 96 years (M = 81.74 years; SD = 3.44 years). A longitudinal confirmatory factor analysis showed that a modified 21-item, 3-factor (errors, lapses and violations) DBQ was invariant across the time period, suggesting that the structure of the questionnaire was stable across each time-point. Further, multiple domain latent growth analysis on the resultant factors for errors, lapses and violations showed that the frequency of errors remained similar across the three-year period, while violations and lapses showed very marginal decreases in frequency. These changes were independent of the absolute number of these behaviours; Drivers with higher violations or lapses in Year one, showed similar decreases in frequency as those who self-reported lower frequencies of the behaviours. These results suggest that the DBQ is a reliable tool to measure older drivers' self-reported aberrant driving behaviours, and that these behaviours do not show much change across time. Future research should validate the self-reported responses from the DBQ with more objective measures such as those collected through naturalistic driving study (NDS) methodology or on-road driving tasks.

Are older drivers' driving patterns during an on-road driving task representative of their real-world driving patterns?

OBJECTIVE: The current study investigated whether older drivers' driving patterns during a customized on-road driving task were representative of their real-world driving patterns. METHODS: Two hundred and eight participants (male: 68.80%; mean age = 81.52 years, SD = 3.37 years, range = 76.00-96.00 years) completed a customized on-road driving task that commenced from their home and was conducted in their own vehicle. Participants' real-world driving patterns for the preceding 4-month period were also collected via an in-car recording device (ICRD) that was installed in each participant's vehicle. RESULTS: During the 4-month period prior to completing the on-road driving task, participants' median real-world driving trip distance was 2.66 km (interquartile range [IQR] = 1.14-5.79 km) and their median on-road driving task trip distance was 4.41 km (IQR = 2.83-6.35 km). Most participants' on-road driving task trip distances were classified as representative of their real-world driving trip distances (95.2%, n = 198). CONCLUSIONS: These findings suggest that most older drivers were able to devise a driving route that was representative of their real-world driving trip distance. Future research will examine whether additional aspects of the on-road driving task (e.g., average speed, proportion of trips in different speed zones) are representative of participants' real-world driving patterns.

The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards.

AIM: To determine whether the implementation of a Reading-Modified Early Warning Scoring (R-MEWS) system, is associated with an increased recording of respiratory rate (RR) in hospital inpatients, and whether the presence of a critical care outreach (CCO) service has a further impact on the recording of patient's vital signs. METHOD: Five annual point prevalence surveys of all adult, non-obstetric acute inpatients (n=2638) in two Hospitals (A and B) were carried out between 2001 and 2005. The R-MEWS system was implemented incrementally in both hospitals to include all study group patients, but a CCO service was only available in Hospital A. Data were collected on numbers of patients, routinely documented physiological observations and R-MEW score. RESULTS: Respiratory rate (RR) recording increased from 6.0% in the first survey to 77.9% in the last, which correlated with the incremental implementation of the R-MEWS system. Hospital A that had the CCO service showed a greater increase in RR recording than Hospital B with no CCO service. CONCLUSION: The introduction of an early warning scoring (EWS) was associated with improved respiratory rate recording, which may have been further enhanced by the presence of a CCO service.

Crystal structure of eukaryotic DNA ligase-adenylate illuminates the mechanism of nick sensing and strand joining.

Chlorella virus DNA ligase is the smallest eukaryotic ATP-dependent ligase known; it has an intrinsic nick-sensing function and suffices for yeast cell growth. Here, we report the 2.0 A crystal structure of the covalent ligase-AMP reaction intermediate. The conformation of the adenosine nucleoside and contacts between the enzyme and the ribose sugar have undergone a significant change compared to complexes of T7 ligase with ATP or mRNA capping enzyme with GTP. The conformational switch allows the 3' OH of AMP to coordinate directly the 5' PO(4) of the nick. The structure explains why nick sensing is restricted to adenylated ligase and why the 5' phosphate is required for DNA binding. We identify a metal binding site on ligase-adenylate and propose a mechanism of nick recognition and catalysis supported by mutational data.

The patient's thoughts and feelings about their transfer from intensive care to the general ward.

This qualitative, phenomenological study was undertaken to find out how patients felt about being transferred from the intensive care unit to the ward. The six patients who took part in the study, had been in intensive care for more than 4 days. Their transfer was planned as part of their recovery from a critical illness. Following transfer to the ward, the patients were interviewed using a semi-structured approach. The interviews were audio-taped, and transcriptions from the tapes were analysed for meaning and interpretation. Findings supported the literature that was reviewed, in that transfer from intensive care to the ward was a traumatic experience for the patient, who often found it confusing, stressful and tiring. Improvements to the transfer process can be guided using the information from the literature review and findings of the study.

Position statement on nurse-patient ratios in critical care.

The level of nurse-to-patient staffing ratios in critical care environments is a controversial issue. Tracy Pilcher and Mandy Odell review the literature and examine some of the main factors that influence staffing levels. The British Association of Critical Care Nurses' (BACCN) position statement is outlined.

Extensive biliary excretion of the sulfasalazine analogue, susalimod, but different concentrations in the bile duct in various animal species correlating to species-specific hepatobiliary toxicity.

Studies on biliary concentrations of susalimod were conducted in rat, dog and monkey to clarify the interspecies differences observed in toxicology studies with respect to hepatobiliary toxicity after long-term administration of the compound. Dose-related bile duct hyperplasia appeared only in dogs at doses > or =75 mg/kg/day, while in rats and monkeys it did not appear at doses up to 1500 and 2000 mg/kg/day respectively. Biliary excretion was investigated after intraduodenal administration of susalimod in anaesthetised animals. In addition excretion routes were determined by collecting urine and faeces following a radiolabelled intravenous dose. Susalimod was extensively excreted via the bile in all animal species, > or =90%, mainly as non-conjugated parent compound. However, the local concentrations in bile varied between the species. Highest concentrations were obtained in the dog. The bile/plasma concentration ratio was 3400 in the dog, 300 in the monkey and 50 in the rat. In the dog, bile duct concentrations of susalimod about 30,000 micromol/l was obtained at plasma concentrations approximately similar to those at which hepatobiliary toxicity occurred, while in rat and monkey the levels were < or =7000 micromol/l at plasma concentrations similar to those obtained at the highest doses in the toxicology studies. From these results supported by a previous biliary excretion study in conscious dogs with chronic bile fistula receiving repeated administration of susalimod (Påhlman et al. 1999), it is likely that the hepatotoxic findings in dog are induced by the high concentrations of susalimod in the bile duct.

Does percutaneous fine-needle aspiration biopsy aid in the diagnosis and surgical management of lung masses?

OBJECTIVES: To evaluate the ability of percutaneous, transthoracic fine-needle aspiration biopsy (FNAB) to correctly diagnose intrathoracic masses, to determine what complications were experienced and at what rate they occurred and to define more clearly the role of this technique in the surgical management of lung masses. DESIGN: A chart review. SETTING: Kingston General Hospital, Kingston, Ont., a tertiary care centre and university-affiliated teaching hospital. PATIENTS: One hundred and thirteen patients who underwent 117 percutaneous transthoracic FNABs between Jan. 1, 1991, and July 1, 1996. OUTCOME MEASURES: Patient demographics, size and location of the lesion, diagnostic result of FNAB, complications of the procedure, smoking history, number of needle passes made by the radiologist and results of any other available biopsy (i.e., through bronchoscopy, mediastinoscopy, pleuroscopy) and of surgical resection, as well clinical information pertaining to the disease state in patients with nondiagnostic or negative FNAB. RESULTS: Eighty-six masses (73.5%) were diagnosed as malignant, 31 biopsy specimens (26.5%) were either nondiagnostic or negative for malignancy. Of these specimens, 15 (48.4%) were subsequently shown to be cancer. In 64 biopsies (54.7%), the patient suffered pneumothorax, requiring hospitalization and chest tube insertion in 35 (29.9%) and 24 (20.5%) cases respectively. The size of the lesion was related to both the diagnostic accuracy and the incidence of pneumothorax. CONCLUSIONS: Percutaneous transthoracic FNAB should not be used routinely in the assessment of patients with lung masses who are medically fit to withstand surgery and are free of widespread disease. The results of FNAB do little to modify the course of surgical management in these patients.

Footprinting of Chlorella virus DNA ligase bound at a nick in duplex DNA.

The 298-amino acid ATP-dependent DNA ligase of Chlorella virus PBCV-1 is the smallest eukaryotic DNA ligase known. The enzyme has intrinsic specificity for binding to nicked duplex DNA. To delineate the ligase-DNA interface, we have footprinted the enzyme binding site on DNA and the DNA binding site on ligase. The size of the exonuclease III footprint of ligase bound a single nick in duplex DNA is 19-21 nucleotides. The footprint is asymmetric, extending 8-9 nucleotides on the 3'-OH side of the nick and 11-12 nucleotides on the 5'-phosphate side. The 5'-phosphate moiety is essential for the binding of Chlorella virus ligase to nicked DNA. Here we show that the 3'-OH moiety is not required for nick recognition. The Chlorella virus ligase binds to a nicked ligand containing 2',3'-dideoxy and 5'-phosphate termini, but cannot catalyze adenylation of the 5'-end. Hence, the 3'-OH is important for step 2 chemistry even though it is not itself chemically transformed during DNA-adenylate formation. A 2'-OH cannot substitute for the essential 3'-OH in adenylation at a nick or even in strand closure at a preadenylated nick. The protein side of the ligase-DNA interface was probed by limited proteolysis of ligase with trypsin and chymotrypsin in the presence and absence of nicked DNA. Protease accessible sites are clustered within a short segment from amino acids 210-225 located distal to conserved motif V. The ligase is protected from proteolysis by nicked DNA. Protease cleavage of the native enzyme prior to DNA addition results in loss of DNA binding. These results suggest a bipartite domain structure in which the interdomain segment either comprises part of the DNA binding site or undergoes a conformational change upon DNA binding. The domain structure of Chlorella virus ligase inferred from the solution experiments is consistent with the structure of T7 DNA ligase determined by x-ray crystallography.

Continuing Education Programme - Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University.

Given the increasing requirement of the courts for forensic experts to engage in ongoing education, a continuing education programme was developed in forensic medicine at the Victorian Institute of Forensic Medicine to cater for both clinicians and pathologists. The programme consists of a series of cases which are circulated several times per year. All are actual cases and are reflective of the types of presentations experienced in forensic medicine. Each case includes relevant and appropriate details/findings and may include photographs. A series of questions follow which are answered usually in short-answer format. The answers are returned and correlated by a review panel, and a commentary with the response outcome is distributed to all those involved. The cases presented here are selected from this programme.

Continuing education programme - Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University.

Given the increasing requirement of the courts for forensic experts to engage in ongoing education, a continuing education programme was developed in forensic medicine at the Victorian Institute of Forensic Medicine to cater for both clinicians and pathologists. The programme consists of a series of cases which are circulated several times per year. All are actual cases and are reflective of the types of presentations experienced in forensic medicine. Each case includes relevant and appropriate details/findings and may include photographs. A series of questions follow which are answered usually in short-answer format. The answers are returned and correlated by a review panel, and a commentary with the response outcome is distributed to all those involved. The cases presented here are selected from this programme.

Therapist and client behaviors in the first interview: effects on session impact and treatment duration.

The first-session behaviors of therapists and clients in 38 cases were observationally coded and their relations to client ratings of session impact and treatment duration were examined. Results indicate that few first-session global types of behaviors of participants affect treatment duration. Clients may suspend judgment about continuing in therapy until after they have attended more than one session, regardless of the first interview's impact. Thus, the first interview may be less crucial than traditionally asserted. It also appears that first-session behaviors of therapists and clients that are associated with greater impact may vary as a function of client type, that is, individuals as opposed to couples and families.

Continuing education programme - Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University.

Given the increasing requirement of the courts for forensic experts to engage in ongoing education, a continuing education programme was developed in forensic medicine at the Victorian Institute of Forensic Medicine to cater for both clinicians and pathologists. The programme consists of a series of cases which are circulated several times per year. All are actual cases and are reflective of the types of presentations experienced in forensic medicine. Each case includes relevant and appropriate details/findings and may include photographs. A series of questions follow which are answered usually in short-answer format. The answers are returned and correlated by a review panel, and a commentary with the response outcome is distributed to all those involved. The cases presented here are selected from this programme.

Drug-induced anisocoria in two detainees.

Two suspects held by the police were examined for fitness to be interviewed. It was noticed that both had a persistent unilateral dilated pupil in the absence of a history of pre-existing disease or acute head injury. They subsequently admitted to misuse of eye drops. A brief review of the significance of anisocoria (unequal pupils) and drugs that may cause altered pupillary size follows.

Breath testing in patients with respiratory disability.

The presence of chronic respiratory disease is sometimes claimed as a defence by drivers who refuse or fail a breath test. Trials have been conducted with two breath analysis instruments used in the state of Victoria, Australia in order to determine the respiratory parameters compatible with a satisfactory test. Patients with restrictive and obstructive conditions participated in the trial that was conducted in the respiratory unit of a large teaching hospital. The results showed that the evidential breath analyzer currently used in Victoria was able to accept breath samples from subjects at the limit of respiratory function likely to be encountered in drivers. It was also found that a subject capable of providing a breath sample for the current screening device should also be able to provide an evidential sample. The trials provided useful information in evaluating defences of inability to provide a breath sample due to respiratory incapacity.

The human body as an electric circuit.

This is a review of the effects of electricity on the human body with an emphasis on the clinical effects which may be of forensic interest, both in the living and after death. The review will explore the interaction between electricity and the human body in its functional and pathological aspects. Electricity interacts with the body in many ways ranging from a manifestation of normal physiological activity to a cause of severe tissue injury and death. Its mode of action and the pathogenesis of injuries caused by electricity are sometimes difficult to understand because it is invisible and intangible.

The duration of impairment of autonomic control after anticholinergic drug administration in humans.

Impaired parasympathetic control of heart rate is associated with increased incidence of cardiac dysrhythmias and ischemia. Anticholinergic drugs, commonly administered during reversal of neuromuscular blockade, suppress parasympathetic control in the early postoperative period. This could potentially be detrimental in patients at risk of cardiovascular complications. The duration of parasympathetic impairment by two anticholinergic drugs were compared in this double-blind randomized cross-over study. Fourteen healthy volunteers received a single intravenous injection of atropine 20 micrograms/kg or glycopyrrolate 8 micrograms/kg during two different study sessions. The methods of spontaneous baroreflex analysis and spectral analysis of heart rate variability generated indices of beat-by-beat parasympathetic modulation of heart rate. Both drugs resulted in a marked decrease in baroreflex sensitivity and high-frequency heart rate variability. The times to return to baseline values were approximately doubled after atropine compared to glycopyrrolate (177 +/- 22 vs 82 +/- 8 min for baroreflex sensitivity, 212 +/- 16 vs 111 +/- 14 min for high-frequency power, and 171 +/- 18 vs 95 +/- 18 min for high-frequency power normalized to total power; P < 0.01 for all variables). Atropine leads to more prolonged impairment of parasympathetic control than equipotent doses of glycopyrrolate, and its use may thus be less desirable in high-risk patients in the early postoperative period.

Intracranial pressure monitoring: nursing in a district general ICU.

Factors influencing intracranial pressure are summarised. The Codman subdural bolt is presented as a useful tool for monitoring intracranial pressure in a district general hospital. Implications for nursing care of patients with a Codman subdural bolt are discussed.

Ligation of double-stranded and single-stranded [oligo(dT)] DNA by vaccinia virus DNA ligase.

Vaccinia virus DNA ligase has been expressed in Escherichia coli, purified, and biochemically characterized. The enzyme ligates double-stranded (ds) DNA substrates with either cohesive or blunt-end termini and the latter reaction is stimulated by PEG. Vaccinia virus DNA ligase can also ligate oligo(dT) when annealed to either a poly(dA) or a poly(rA) backbone and, remarkably, free oligo(dT). This ligation of a single-stranded (ss) substrate is unique among eukaryotic DNA ligases. The enzyme requires high ATP concentrations with a Km for the overall ligation of a ssDNA substrate of 0.8 mM. The salt, divalent cation, temperature, and pH requirements of the enzyme for the optimal ligation of ss and ds substrate are described.