Longitudinal Degradation of Pavement Marking Detectability for Mobile LiDAR Sensing Technology in Real-World Use.

Recent advancements in vehicle automation and driver-assistance systems that detect pavement markings has increased the importance of the detectability of pavement markings through various sensor modalities across weather and road conditions. Among the sensing techniques, light detection and ranging (LiDAR) sensors have become popular for vehicle-automation applications. This study used low-cost mobile multi-beam LiDAR to assess the performance of several types of pavement marking materials installed on a limited-access highway in various conditions, and quantified the degradation in detection performance over three years. Four marking materials, HPS-8, polyurea, cold plastic, and sprayable thermoplastic, were analyzed in the current study. LiDAR reflectivity data extracted from a total of 210 passes through the test sections were analyzed. A new detectability score based on LiDAR intensity data was proposed to quantify the marking detectability. The results showed that the pavement marking detectability varied across the material types over the years. The results provide guidance for selecting materials and developing maintenance schedules when marking detectability by LiDAR is a concern.

Design, synthesis, and evaluation of peptide-imidazo[1,2-a]pyrazine bioconjugates as potential bivalent inhibitors of the VirB11 ATPase HP0525.

Helicobacter pylori (H. pylori) infections have been implicated in the development of gastric ulcers and various cancers: however, the success of current therapies is compromised by rising antibiotic resistance. The virulence and pathogenicity of H. pylori is mediated by the type IV secretion system (T4SS), a multiprotein macromolecular nanomachine that transfers toxic bacterial factors and plasmid DNA between bacterial cells, thus contributing to the spread of antibiotic resistance. A key component of the T4SS is the VirB11 ATPase HP0525, which is a hexameric protein assembly. We have previously reported the design and synthesis of a series of novel 8-amino imidazo[1,2-a]pyrazine derivatives as inhibitors of HP0525. In order to improve their selectivity, and potentially develop these compounds as tools for probing the assembly of the HP0525 hexamer, we have explored the design and synthesis of potential bivalent inhibitors. We used the structural details of the subunit-subunit interactions within the HP0525 hexamer to design peptide recognition moieties of the subunit interface. Different methods (cross metathesis, click chemistry, and cysteine-malemide) for bioconjugation to selected 8-amino imidazo[1,2-a]pyrazines were explored, as well as peptides spanning larger or smaller regions of the interface. The IC50 values of the resulting linker-8-amino imidazo[1,2-a]pyrazine derivatives, and the bivalent inhibitors, were related to docking studies with the HP0525 crystal structure and to molecular dynamics simulations of the peptide recognition moieties.

An examination of teen drivers' car-following behavior under naturalistic driving conditions: With and without an advanced driving assistance system.

Teen drivers are overrepresented in motor vehicle crashes, and most studies concluded it was mainly due to their lack of experiences and tendencies of risk-taking. The design of advanced driving assistance systems (ADAS) aims to provide assistance in multiple stages in human information processing during driving, including environmental sensing, information processing, decision making, and vehicle controlling, in order to improve driving safety. It is expected that novice drivers may benefit more from using ADAS than adult drivers as such technologies can compensate for their frequent errors. This study examined whether and how an integrated crash warning system impacted on drivers' following behavior, and what were the corresponding age-related differences through an analysis of two unique naturalistic driving study datasets. Significant age-related differences in car-following behavior were found. Results showed potential negative effects of ADAS on teen drivers' following behavior that teen drivers tended to have less controlled pedal use during treatment weeks with ADAS than during baseline weeks without ADAS, while such behavior was not observed in adult drivers. All adult drivers tended to keep longer headways when driving at night than during daytime to compensate for poor vision conditions, but no such compensation behavior was observed in the teens. In addition, teen and young-adult drivers had more aggressive following behavior (with shorter mean time headway) than middle-aged and older drivers. One limitation of this study is that the findings of this study are only addressing the short-term effect of ADAS exposure, and future studies are needed to examine the longitudinal effect. The findings of this study suggest that the design of future ADAS should consider minimizing potential negative impacts on teen driver behavior.

Motion sickness in passenger vehicles during test track operations.

As automation transforms drivers into passengers, the deployment of automated vehicles (AVs) has the potential to greatly increase the incidence of motion sickness. A study was conducted to quantify motion sickness response of front-seat passengers performing ecologically relevant passenger activities during conditions consistent with driving on public roadways. Fifty-two adults with a large range of self-reported levels of motion sickness susceptibility and age participated in data collection on a closed test track in a passenger sedan. Motion sickness ratings increased with task vs. no-task and moderate vs. low acceleration test conditions. Increased motion sickness susceptibility was associated with higher motion sickness ratings. In comparison to older participants (age > 60), younger participants (age < 60) experienced increased motion sickness. This is the first in-vehicle study that systematically compared normative passenger activities and acceleration magnitudes typical of normative driving conditions on motion sickness response for a large, diverse sample of passengers, enabling the exploration of the effects of covariates. Practitioner summary: The data demonstrate that a relatively large range of motion sickness response can be expected to result from passengers performing visual tasks in passenger vehicles. Measurement and modelling efforts should seek to elucidate relationships among the factors contributing to motion sickness for the purpose of informing and prioritising future countermeasures for automated vehicles (AVs). Abbreviations: AV(S): automated vehicles; BMI: body mass index; BVP: blood volume pulse; EDA: electrodermal activity; FMS: fast motion sickness scale; GPS: global positioning system; IMU: inertial measurement unit; ISO: International Organization for Standardization; MISC: misery scale; MSDV: motion sickness dose value; NDS: naturalistic driving study; SAE: Society of Automotive Engineers International; UMTRI: The University of Michigan Transportation Research Institute Key Aspect of Research: Motion sickness may be an important barrier to widespread adoption of automated vehicles @UMTRI.

Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist.

Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED). Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED. Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3-5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5min (interquartile range (IQR) 3.25-18.00min) compared with 25min (IQR 10.00-56.00min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07-1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P=0.002). Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients. What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time, providing good-quality care and enhanced patient satisfaction. What does this paper add? Within their primary contact capacity, AMPs also manage patients who are brought in by ambulance presenting with musculoskeletal conditions. To the authors' knowledge, there is currently no available literature documenting the performance of AMPs in the management of this cohort of patients. What are the implications for practitioners? This study has added to the body of evidence that AMPs improve patient flow in the ED and illustrates that AMPs, by seeing patients brought in by ambulance, are able to have a positive impact on the pressures increasingly facing the Victorian Ambulance Service and emergency hospital care.

Efficacy of percutaneous radiofrequency ablation may vary with clear cell renal cell cancer histologic subtype.

PURPOSE: The purpose of the study is to determine if clear cell renal cell cancer (RCC) subtype predicts efficacy in percutaneous radiofrequency (RF) ablation of RCC. METHODS AND MATERIALS: Patients who underwent percutaneous RF ablation for histologically proven RCC subtypes were retrospectively reviewed. Group comparisons were done using univariate and multivariate logistic regression analysis to determine factors impacting primary, secondary, and total technique effectiveness. A p value less than 0.05 was considered significant. RESULTS: One hundred pathologically proven RCC lesions in 84 patients were analyzed. The median (mean) follow-up was 24 (27) months (range 1-106 months). Overall RF ablation primary, secondary and total technique effectiveness was 86%, 9%, and 95%, respectively. Clear cell subtype demonstrated worse treatment efficacy with primary, secondary, and total technique effectiveness of 42/55 (76.4%), 8/55 (14.5%), and 50/55 (90.9%), respectively. Non-clear cell subtypes had primary, secondary, and total technique effectiveness of 44/45(97.8%), 1/45 (2.2%), 45/45 (100%), respectively. The difference in primary (p = 0.002), secondary (p = 0.032), and total (p = 0.038) technique effectiveness between the two groups was statistically significant. CONCLUSION: Clear cell RCC was a novel predictor of primary, secondary, and total technique efficacy in the percutaneous RF ablation of clear cell RCC.

Advanced musculoskeletal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency departments.

Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners). Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED. Results One thousand and eighty-nine patients with low back pain were seen during AMP service hours (360 in the AMP group, 729 in the non-AMP group). Patients seen by the AMP had a significantly shorter ED wait time (median 13 vs 32min; P<0.001) and ED length of stay (median 141 vs 175min; P<0.001). Significantly fewer patients seen by the AMP were admitted (P<0.001), and this difference remained after accounting for the difference in triage code between the groups. Conclusions Improved ED metrics were demonstrated in patients with low back pain when managed by an AMP compared with patients seen by doctors and nurse practitioners. What is known about the topic? There is a growing body of literature regarding the role of AMPs in the Australian healthcare system in providing clinical services for patients with musculoskeletal conditions, including settings such as the ED. AMPs have proven to be safe and cost-effective, achieving high patient satisfaction and improved patient outcomes. However, there is little to no information regarding their effect on ED metrics, such as ED length of stay, wait time and admission rates for patients presenting to the ED with low back pain. What does this paper add? This paper demonstrates improved ED metrics for patients presenting to the ED with low back pain when seen by an AMP compared with patients seen by doctors and nurse practitioners. The specific improved metrics for these patients were decreased admission rates, decreased ED length of stay and decreased wait time. What are the implications for clinicians? This paper provides evidence that the AMPs effectively discharge patients admitted to the ED in a timely manner, without evidence of increased readmissions, compared with their medical and nursing colleagues. Support for the role of the AMP within the ED setting is strengthened by these results.

Physiotherapists' perceptions of workplace competency: a mixed-methods observational study.

Objectives Workplace-based competency is increasingly considered fundamental to patient safety and quality healthcare. The aim of the present study was to identify and describe physiotherapists' perceptions of workplace competency. Methods The present study was a mixed-methods cross-sectional observational study. Thematic and descriptive analysis of qualitative and survey data were undertaken. Forty-six physiotherapists employed at a metropolitan acute public hospital participated in interviews or focus groups; a subgroup of 31 participants also completed an online survey. Results Five main themes were identified: (1) despite the availability of workplace learning opportunities and supports, less-experienced staff reported limited confidence; (2) assessment and feedback around workplace competency was limited, predominantly informal and unstructured, with less than half of the cohort (42%) agreeing feedback received was useful for improving their workplace skills; (3) practicing within individual scope is an important aspect of workplace competency as a physiotherapist; (4) most (81%) agreed it was important for them to self-determine their learning and development goals, and they relied primarily on informal discussion to achieve these goals; and, (5) physiotherapists felt motivated regarding workplace learning, with 97% interested in developing their workplace skills however, nearly half (45%) did not feel they had sufficient time to do so. Conclusions The perceptions of physiotherapists working in a metropolitan acute public hospital are reflected in five themes. These themes elucidate how workplace competency is supported, maintained and developed among physiotherapists in this setting. These themes also highlight key challenges of workplace learning faced by this cohort of physiotherapists and allude to methods that may assist with improving feedback mechanisms and knowledge acquisition. What is known about this topic? Studies investigating employee perceptions around workplace competency, knowledge, skills and learning are found across a range of industries. Workplace-based competency is increasingly considered fundamental to patient safety and quality health care. There is little known about physiotherapists' perceptions of workplace competency. What does this paper add? This study has identified and described themes around physiotherapists' perceptions of their workplace knowledge and skills. What are the implications for practitioners? The themes identified provide support for the development, implementation and evaluation of a workplace-based competency framework for physiotherapists.

Examining drivers' eye glance patterns during distracted driving: Insights from scanning randomness and glance transition matrix.

INTRODUCTION: Visual attention to the driving environment is of great importance for road safety. Eye glance behavior has been used as an indicator of distracted driving. This study examined and quantified drivers' glance patterns and features during distracted driving. METHOD: Data from an existing naturalistic driving study were used. Entropy rate was calculated and used to assess the randomness associated with drivers' scanning patterns. A glance-transition proportion matrix was defined to quantity visual search patterns transitioning among four main eye glance locations while driving (i.e., forward on-road, phone, mirrors and others). All measurements were calculated within a 5s time window under both cell phone and non-cell phone use conditions. RESULTS: Results of the glance data analyses showed different patterns between distracted and non-distracted driving, featured by a higher entropy rate value and highly biased attention transferring between forward and phone locations during distracted driving. Drivers in general had higher number of glance transitions, and their on-road glance duration was significantly shorter during distracted driving when compared to non-distracted driving. CONCLUSIONS: Results suggest that drivers have a higher scanning randomness/disorder level and shift their main attention from surrounding areas towards phone area when engaging in visual-manual tasks. PRACTICAL APPLICATIONS: Drivers' visual search patterns during visual-manual distraction with a high scanning randomness and a high proportion of eye glance transitions towards the location of the phone provide insight into driver distraction detection. This will help to inform the design of in-vehicle human-machine interface/systems.

Can vehicle longitudinal jerk be used to identify aggressive drivers? An examination using naturalistic driving data.

This paper investigated the characteristics of vehicle longitudinal jerk (change rate of acceleration with respect to time) by using vehicle sensor data from an existing naturalistic driving study. The main objective was to examine whether vehicle jerk contains useful information that could be potentially used to identify aggressive drivers. Initial investigation showed that there are unique characteristics of vehicle jerk in drivers' gas and brake pedal operations. Thus two jerk-based metrics were examined: (1) driver's frequency of using large positive jerk when pressing the gas pedal, and (2) driver's frequency of using large negative jerk when pressing the brake pedal. To validate the performance of the two metrics, drivers were firstly divided into an aggressive group and a normal group using three classification methods (1) traveling at excessive speed (speeding), (2) following too closely to a front vehicle (tailgating), and (3) their association with crashes or near-crashes in the dataset. The results show that those aggressive drivers defined using any of the three methods above were associated with significantly higher values of the two jerk-based metrics. Between the two metrics the frequency of using large negative jerk seems to have better performance in identifying aggressive drivers. A sensitivity analysis shows the findings were largely consistent with varying parameters in the analysis. The potential applications of this work include developing quantitative surrogate safety measures to identify aggressive drivers and aggressive driving, which could be potentially used to, for example, provide real-time or post-ride performance feedback to the drivers, or warn the surrounding drivers or vehicles using the connected vehicle technologies.

A spectral power analysis of driving behavior changes during the transition from nondistraction to distraction.

OBJECTIVE: This article investigated and compared frequency domain and time domain characteristics of drivers' behaviors before and after the start of distracted driving. METHOD: Data from an existing naturalistic driving study were used. Fast Fourier transform (FFT) was applied for the frequency domain analysis to explore drivers' behavior pattern changes between nondistracted (prestarting of visual-manual task) and distracted (poststarting of visual-manual task) driving periods. Average relative spectral power in a low frequency range (0-0.5 Hz) and the standard deviation in a 10-s time window of vehicle control variables (i.e., lane offset, yaw rate, and acceleration) were calculated and further compared. Sensitivity analyses were also applied to examine the reliability of the time and frequency domain analyses. RESULTS: Results of the mixed model analyses from the time and frequency domain analyses all showed significant degradation in lateral control performance after engaging in visual-manual tasks while driving. Results of the sensitivity analyses suggested that the frequency domain analysis was less sensitive to the frequency bandwidth, whereas the time domain analysis was more sensitive to the time intervals selected for variation calculations. Different time interval selections can result in significantly different standard deviation values, whereas average spectral power analysis on yaw rate in both low and high frequency bandwidths showed consistent results, that higher variation values were observed during distracted driving when compared to nondistracted driving. CONCLUSIONS: This study suggests that driver state detection needs to consider the behavior changes during the prestarting periods, instead of only focusing on periods with physical presence of distraction, such as cell phone use. Lateral control measures can be a better indicator of distraction detection than longitudinal controls. In addition, frequency domain analyses proved to be a more robust and consistent method in assessing driving performance compared to time domain analyses.

Effects of an integrated collision warning system on teenage driver behavior.

INTRODUCTION: Crash warning systems have been shown to provide safety benefits, but no studies have examined how teenagers respond. This study sought to find out whether young, inexperienced drivers change behavior in response to warnings. METHODS: Forty 16-17 year-olds drove an instrumented vehicle equipped with a system that warned for lane departures and potential rear-end and lane change/merge crashes. Participants were randomly assigned to experimental or control groups, and their driving was monitored for 14weeks during 2011-12. For the experimental group, this included a treatment period, when crash alerts were received by drivers, and baseline and post-treatment periods, when warnings were recorded but not received. The control group never received warnings. Data were analyzed to determine whether warnings were associated with changes in driving behavior. RESULTS: A total of 15,039 trips were analyzed. Lane drifts accounted for 73% of warnings. Forward collision warning rates doubled for all drivers during the treatment period and continued at an increased rate post-treatment. This was likely a result of the fact that, as time went on, all drivers spent more time following vehicles at close distances. Receiving alerts was associated with effects on following and lane-changing behavior, including more time spent following at close distances (17%), fewer lateral drifts (37%) and fewer unsignaled lane changes (80%). Receiving warnings wasn't associated with an increased likelihood of engaging in secondary tasks. CONCLUSIONS: Warning systems may result in improved lane-keeping and turn-signal behaviors by novice drivers, but there is some indication they may result in more close-following behaviors. PRACTICAL APPLICATIONS: There is some evidence that lane departure warning may improve turn-signal use for young drivers. While there is no evidence of safety benefits from the other types of warnings, there is some evidence of an increase in close-following behavior but no increase in secondary tasks due to the presence of those capabilities.

HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial.

OBJECTIVES: To investigate the effects of intensive acute hospital physiotherapy for patients with isolated hip fractures. DESIGN, SETTING: Single-institution, prospective, randomised trial at a level 1 trauma centre in Melbourne, March 2014 - January 2015. PARTICIPANTS: 92 patients aged 65 years or more with isolated hip fractures. Patients were excluded if the fracture was subtrochanteric or pathological, or if post-operative orders required the patient to be non-weight-bearing on the operated leg. INTERVENTIONS: Randomisation to usual care physiotherapy (daily; control group) or intensive physiotherapy (three times daily; intervention group). MAIN OUTCOME MEASURES: Outcomes were assessed at post-operative Day 5, at discharge, and at 6 months. The primary outcome was the modified Iowa Level of Assistance (mILOA) score, with other outcome measures including Timed Up and Go test performance and hospital length of stay (LOS). RESULTS: After controlling for sex, anaesthetic type and home setting, the between-group difference in Day 5 mILOA score favoured the intervention group (mean difference v control group, -2.7 points; P = 0.04). Hospital LOS was also shorter for the intervention group (median, 24.4 days v 35.0 days; P = 0.01). A Cox proportional hazard model that controlled for potential confounders indicated that the probability of discharge was greater for intervention group patients at all time points following surgery (P < 0.001). Re-admission and complication rates and 6-month outcomes for the two groups were not significantly different. CONCLUSIONS: Intensive acute hospital physiotherapy is safe and reduces hospital LOS after an isolated hip fracture. This has the potential to improve bed flow, given the large numbers of inpatient beds occupied by this patient population. TRIAL REGISTRATION: Clinical Trials Registry #NCT02088437.

How do drivers behave during indecision zone maneuvers?

Yellow signal indications at intersections are well-known to be a contributor to traffic crashes. This study examined drivers' behavior during yellow signal indication (i.e., indecision zone) maneuvers. Data from a driving simulator study was used, which included drivers' performance data when they encountered a yellow signal indication at intersections under different secondary-task conditions. This study calculated drivers' likelihood to go through a yellow signal indication and examined factors that are related to drivers' decision making on intersection traversing. The results showed that drivers' decision on stopping or not at a yellow signal indication was associated with different variables including age, distraction, pedal conditions, and time to stop line. Distracted drivers' insensitive behavior was also captured from the significant interaction effect between time to stop line and distraction conditions, which implied that intersection related crash risk may increase when drivers were distracted.

Assessing the Reliability and Validity of a Physical Therapy Functional Measurement Tool--the Modified Iowa Level of Assistance Scale--in Acute Hospital Inpatients.

BACKGROUND: Functional outcome measurement tools exist for individual diagnoses (eg, stroke), but no prospectively validated mobility measure is available for physical therapists' use across the breadth of acute hospital inpatients. The modified Iowa Level of Assistance Scale (mILOA), a scale measuring assistance required to achieve functional tasks, has demonstrated functional change in inpatients with orthopedic conditions and trauma, although its psychometric properties are unknown. OBJECTIVE: The aim of this study was to assess interrater reliability, known-groups validity, and responsiveness of the mILOA in acute hospital inpatients. DESIGN: This was a cohort, measurement-focused study. METHODS: Patients at a large teaching hospital in Melbourne, Australia, were recruited. One hundred fifty-two inpatients who were functionally stable across 5 clinical groups had an mILOA score calculated during 2 independent physical therapy sessions to assess interrater reliability. Known-groups validity ("ready for discharge"/"not ready for discharge") and responsiveness also were assessed. RESULTS: The mean age of participants in the reliability phase of the study was 62.5 years (SD=17.7). The interrater reliability was excellent (intraclass correlation coefficient [2,1]=.975; 95% confidence interval=.965, .982), with a mean difference between scores of -.270 and limits of agreement of ±5.64. The mILOA score displayed a mean difference between 2 known groups of 15.3 points. Responsiveness was demonstrated with a minimal detectable change of 5.8 points. LIMITATIONS: Participants were included in the study if able to give consent for themselves, thereby limiting generalizability. Construct validity was not assessed due to the lack of a gold standard. CONCLUSIONS: The mILOA has excellent interrater reliability and good known-groups validity and responsiveness to functional change across acute hospital inpatients with a variety of diagnoses. It may provide opportunities for physical therapists to collect a functional outcome measure to demonstrate the effectiveness of inpatient therapy and allow for benchmarking across institutions.

Real-world effects of using a phone while driving on lateral and longitudinal control of vehicles.

INTRODUCTION: Technologies able to augment human communication, such as smartphones, are increasingly present during all daily activities. Their use while driving, in particular, is of great potential concern, because of the high risk that distraction poses during this activity. Current countermeasures to distraction from phone use are considerably different across countries and not always widely accepted/adopted by the drivers. METHODS: This study utilized naturalistic driving data collected from 108 drivers in the Integrated Vehicle-Based Safety Systems (IVBSS) program in 2009 and 2010 to assess the extent to which using a phone changes lateral or longitudinal control of a vehicle. The IVBSS study included drivers from three age groups: 20­30 (younger), 40­50 (middle-aged), and 60­70 (older). RESULTS: Results from this study show that younger drivers are more likely to use a phone while driving than older and middle-aged drivers. Furthermore, younger drivers exhibited smaller safety margins while using a phone. Nevertheless, younger drivers did not experience more severe lateral/longitudinal threats than older and middle-aged drivers, probably because of faster reaction times. While manipulating the phone (i.e., dialing, texting), drivers exhibited larger lateral safety margins and experienced less severe lateral threats than while conversing on the phone. Finally, longitudinal threats were more critical soon after phone interaction, suggesting that drivers terminate phone interactions when driving becomes more demanding. CONCLUSIONS: These findings suggest that drivers are aware of the potential negative effect of phone use on their safety. This awareness guides their decision to engage/disengage in phone use and to increase safety margins (self-regulation). This compensatory behavior may be a natural countermeasure to distraction that is hard to measure in controlled studies. Practical Applications: Intelligent systems able to amplify this natural compensatory behavior may become a widely accepted/adopted countermeasure to the potential distraction from phone operation while driving.

Advanced musculoskeletal physiotherapy clinical education framework supporting an emerging new workforce.

OBJECTIVE: A project, funded by the Department of Health and Human Services, was conducted with the aim of developing a clinical education framework that included an agreed competency standard and credentialing process to support advanced musculoskeletal physiotherapy roles. This paper describes the process undertaken to achieve this and presents the outcomes of implementation. METHODS: A multistep approach was taken. Initial steps included conducting a scoping review of the literature and focus groups of advanced musculoskeletal physiotherapists. The project team mapped out the structure of the framework. This was followed by a working party of subject matter experts developing an agreed competency standard. The framework was implemented at six hospitals across Australia and formally evaluated by an external evaluator. RESULTS: The clinical education framework developed includes a competency-based training and assessment program supported by learning resources and a mentoring program. It was successfully implemented across a diverse range of hospitals and received a positive evaluation. CONCLUSIONS: As the prevalence of musculoskeletal conditions increases, a new workforce of advanced musculoskeletal physiotherapists is emerging. A clinical education framework has been developed to address the specific needs of the population, organisations and experienced musculoskeletal physiotherapists recruited to these roles. A competent workforce has direct benefits for the community, healthcare organisations and the physiotherapy profession.

Using naturalistic driving data to examine drivers' seatbelt use behavior: Comparison between teens and adults.

PROBLEM: Teens and young drivers are often reported as one driver group that has significantly lower seatbelt use rates than other age groups. OBJECTIVE: This study was designed to address the questions of whether and how seatbelt-use behavior of novice teen drivers is different from young adult drivers and other adult drivers when driving on real roads. METHOD: Driving data from 148 drivers who participated in two previous naturalistic driving studies were further analyzed. The combined dataset represents 313,500 miles, 37,695 valid trips, and about 9500 h of driving. Drivers did not wear their seatbelts at all during 1284 trips. Two dependent variables were calculated, whether and when drivers used seatbelts during a trip, and analyzed using logistic regression models. RESULTS: Results of this study found significant differences in the likelihood of seatbelt use between novice teen drivers and each of the three adult groups. Novice teen drivers who recently received their driver's licenses were the most likely to use a seatbelt, followed by older drivers, middle-aged drivers, and young drivers. Young drivers were the least likely to use a seatbelt. Older drivers were also more likely to use seatbelts than the other two adult groups. The results also showed that novice teen drivers were more likely to fasten their seatbelts at the beginning of a trip when compared to the other three adult groups. SUMMARY: Novice teen drivers who were still in the first year after obtaining their driver's license were the most conservative seatbelt users, when compared to adult drivers. PRACTICAL APPLICATION: Findings from this study have practical application insights in both developing training programs for novice teen drivers and designing seatbelt reminder and interlock systems to promote seatbelt use in certain driver groups.

Examination of drivers' cell phone use behavior at intersections by using naturalistic driving data.

INTRODUCTION: Many driving simulator studies have shown that cell phone use while driving greatly degraded driving performance. In terms of safety analysis, many factors including drivers, vehicles, and driving situations need to be considered. Controlled or simulated studies cannot always account for the full effects of these factors, especially situational factors such as road condition, traffic density, and weather and lighting conditions. Naturalistic driving by its nature provides a natural and realistic way to examine drivers' behaviors and associated factors for cell phone use while driving. METHOD: In this study, driving speed while using a cell phone (conversation or visual/manual tasks) was compared to two baselines (baseline 1: normal driving condition, which only excludes driving while using a cell phone, baseline 2: driving-only condition, which excludes all types of secondary tasks) when traversing an intersection. RESULTS: The outcomes showed that drivers drove slower when using a cell for both conversation and visual/manual (VM) tasks compared to baseline conditions. With regard to cell phone conversations, drivers were more likely to drive faster during the day time compared to night time driving and drive slower under moderate traffic compared to under sparse traffic situations. With regard to VM tasks, there was a significant interaction between traffic and cell phone use conditions. The maximum speed with VM tasks was significantly lower than that with baseline conditions under sparse traffic conditions. In contrast, the maximum speed with VM tasks was slightly higher than that with baseline driving under dense traffic situations. PRACTICAL APPLICATIONS: This suggests that drivers might self-regulate their behavior based on the driving situations and demand for secondary tasks, which could provide insights on driver distraction guidelines. With the rapid development of in-vehicle technology, the findings in this research could lead the improvement of human-machine interface (HMI) design as well.

2- and 3-substituted imidazo[1,2-a]pyrazines as inhibitors of bacterial type IV secretion.

A novel series of 8-amino imidazo[1,2-a]pyrazine derivatives has been developed as inhibitors of the VirB11 ATPase HP0525, a key component of the bacterial type IV secretion system. A flexible synthetic route to both 2- and 3-aryl substituted regioisomers has been developed. The resulting series of imidazo[1,2-a]pyrazines has been used to probe the structure-activity relationships of these inhibitors, which show potential as antibacterial agents.