Over-speeding trend across self-reported driving aberrant behaviors: A simulator study.

The aim of the present study is to investigate the relation between self-reported aberrant behaviors as measured by using the Italian version of the Manchester Driver Behavior Questionnaire (DBQ) and actual driving performance during a virtual simulation, focusing particularly on over-speeding. Individual variables are considered based on participants' behavior, and driving styles are derived from both the self-report questionnaire and the kinematic variables obtained through a moped simulator after the simulated driving task. The experiment was carried out on an Italian sample of 79 individuals aged between 18 and 35 who had to drive throughout virtual road environments. A cluster analysis of the kinematic variables provided by the simulator was used to individuate two different groups of drivers: 45 fell into the cluster named "Prudent" and 34 participants fell into the "Imprudent" cluster. The Prudent participants were characterized by lower acceleration, lower speed, better overall evaluations, and a smaller number of accidents. Correlations showed that self-report responses correlated positively with performance variables in terms of acceleration, speed, and over-speeding. Furthermore, the results from a MANOVA supported and complemented this evidence by emphasizing the usefulness of the integrated approach employed. Overall, these results reflect the suitability of experimental sample-splitting into two clusters, pointing out the appropriateness and relevance of self-report DBQ use with particular emphasis on Ordinary Violations and Lapses. The integrated use of the driving simulator and the self-report DBQ instrument with reference to driving behavior made it possible to support previous theoretical considerations regarding the relations between on-road aberrant behaviors and over-speeding behaviors. It also enabled the addition of evidence on the effectiveness of the simulator in detecting drivers' actual performance. These results are relevant to allow the integration of useful information to expand intervention and training designs that can be used to reduce risky behavior and promote road safety.

Right Ventricle Dysfunction in Patients With Adult Cystic Fibrosis Enlisted for Lung Transplant.

Knowledge of preoperative right heart function of adult patients with cystic fibrosis (CF) awaiting lung transplant (LUTX) is limited. The echocardiography of adult patients with CF enlisted for LUTX was retrospectively analyzed and compared with standards and invasive analyses (right heart catheterization, multigated radionuclide ventriculography). We included 49 patients (reported as mean ± standard deviation; 29 ± 9 years of age; forced expiratory volume in first second of expiration, 31% ± 11% predicted; lung allocation score, 36 ± 5; invasive mean pulmonary artery pressure, 17 ± 5 mm Hg; multigated radionuclide ventriculography right ventricle [RV] ejection fraction, 50% ± 9%). Patients had increased RV end-diastolic area, RV wall thickness, and increased pulmonary artery acceleration time with subnormal tricuspid annular plane systolic excursion, tissue Doppler positive peak systolic velocity, and fraction area change. Subnormal tricuspid annular plane systolic excursion (< 23 mm), tissue Doppler positive peak systolic velocity (< 14 cm/s), and fraction area change (< 49%) had high sensitivity and negative predictive value in predicting impaired RV. EJECTION FRACTION: A good correlation between echocardiographic estimated and invasively measured systolic pulmonary artery pressure was observed (R2 = 0.554, P < .001). Adults with CF awaiting LUTX have morphologic alterations of the right heart, with subclinical impairment of RV systolic function. Echocardiography may be used as a bedside, repeatable, and reliable noninvasive test to screen further deterioration in RV function while on the waiting list for LUTX. More prospective follow-up echocardiographic studies are necessary to confirm such a hypothesis.

The diagnosis of GH deficiency in obese patients: a reappraisal with GHRH plus arginine testing after pharmacological blockade of lipolysis.

BACKGROUND: The diagnosis of GH deficiency (GHD) in obese patients is complicated by the reduced GH secretion associated with overweight. A GH response to GHRH+arginine lower than 4.2 microg/l is currently considered indicative of GHD in obesity. The aim of the study was to investigate the effect of acute pharmacological blockade of lipolysis on the GH response to GHRH+arginine in obese patients. PATIENTS AND METHODS: Two groups of patients were studied: 12 obese patients with proven GHD and 14 patients with essential obesity. On separate occasions, two tests were carried out in each patient: GHRH+arginine and GHRH+arginine preceded by acipimox. RESULTS: The mean GH peak after GHRH+arginine was significantly lower in hypopituitary patients than in subjects with essential obesity. Acipimox significantly increased the mean GH response in patients with essential obesity, but not in hypopituitary subjects. All hypopituitary patients and 7/14 patients with essential obesity displayed GH peaks lower than 4.2 microg/l after GHRH+arginine: the GH response to the test increased after acipimox pretreatment in five of these seven essentially obese subjects. After acipimox administration, free fatty acids (FFAs) significantly fell in both groups with comparable mean absolute decreases. All IGF1 values were normal in both groups of subjects. CONCLUSIONS: Our study has demonstrated that the acipimox-induced acute reduction of circulating FFA levels increases mean somatotropin response to GHRH+arginine in patients with essential obesity, whereas it has no effect in hypopituitary subjects. The current criterion for the diagnosis of GHD in obese patients may be misleading. Indeed, subjects affected by third degree obesity, like most of our patients, may be erroneously classified as really GH-deficient and started on an expensive unjustified treatment. It appears therefore that the current criteria for the diagnosis of GHD in obesity should be reconsidered in the light of further studies also taking into account different body mass index groups.