Visual and steering behaviours during lane departures: a longitudinal study of interactions between lane departure warning system, driving task and driving experience.

Lane Departure Warning Systems (LDWS) generate a warning in case of imminent lane departure. LDWS have proven to be effective and associated human-machine cooperation modelled. In this study, LDWS acceptance and its impact on visual and steering behaviour have been investigated over 6 weeks for novice and experienced drivers. Unprovoked lane departures were analysed along three driving tasks gradually more demanding. These observations were compared to a baseline condition without automation. The number of lane departures and their duration were dramatically reduced by LDWS, and a narrower visual spread of search during lane departure events was recorded. The findings confirmed LDWS effectiveness and suggested that these benefits are supported by visuo-attentional guidance. No specific influence of driving experience on LDWS was found, suggesting that similar cognitive processes are engaged with or without driving experience. Drivers' acceptance of LDWS lowered after automation use, but LDWS effectiveness remained stable during prolonged use.Practitioner summary: Lane Departure Warning Systems (LDWS) have been designed to prevent lane departure crashes. Here, LDWS assessment over a 6-week period showed a major drop in the number of lane departure events increasing over time. LDWS effectiveness is supported by the guidance of drivers' visual attention during lane departure events.

Childhood abuse/neglect and temporal patterns in late-life anxiety.

OBJECTIVES: Anxiety has been associated with childhood abuse/neglect, but this relationship and its mechanisms are poorly documented in older adults. This study examined the association between childhood abuse/neglect and late-life anxiety temporal patterns (i.e. absence, remission, incidence, persistence), testing for mediators. METHODS: Data were derived for 724 French-speaking community-living older adults participating in the Étude sur la santé des ainés - Services study with available information at baseline and 4-year follow-up. Past-month anxiety was based on a cutoff score ≥5 on a French translation of the 7-item Generalized Anxiety Disorder at interviews. Questions on childhood abuse/neglect (e.g. psycho-emotional, physical, sexual) were administered. Adjusted multinomial regression analyses and mediation bootstrapping models were used. Tested mediators included traumatic events (excluding childhood abuse/neglect), daily hassles, psychological resilience, and cortisol activity. RESULTS: The absence, remission, incidence and persistence of anxiety was found in 45.3%, 25.3%, 8.7% and 20.7% of the sample, respectively. Participants with incident and persistent late-life anxiety experienced more childhood abuse/neglect. Participants with persistent anxiety also reported lower psychological resilience. The association between childhood abuse/neglect with anxiety incidence was mediated by daily hassles, while its association with anxiety persistence was mediated by daily hassles and psychological resilience. CONCLUSION: Past childhood abuse/neglect was associated with late-life anxiety incidence and persistence, with psychological resilience and daily hassles potentially explaining this relationship. Further research should focus on ascertaining the clinical applications of psychosocial and biological profiles in informing the prevention and personalized treatment of anxiety in older adults.

Comparison of Experienced and Novice Drivers' Visual and Driving Behaviors during Warned or Unwarned Near-Forward Collisions.

Forward collision warning systems (FCWSs) monitor the road ahead and warn drivers when the time to collision reaches a certain threshold. Using a driving simulator, this study compared the effects of FCWSs between novice drivers (unlicensed drivers) and experienced drivers (holding a driving license for at least four years) on near-collision events, as well as visual and driving behaviors. The experimental drives lasted about six hours spread over six consecutive weeks. Visual behaviors (e.g., mean number of fixations) and driving behaviors (e.g., braking reaction times) were collected during unprovoked near-collision events occurring during a car-following task, with (FCWS group) or without FCWS (No Automation group). FCWS presence reduced the number of near-collision events drastically and enhanced visual behaviors during those events. Unexpectedly, brake reaction times were observed to be significantly longer with FCWS, suggesting a cognitive cost associated with the warning process. Still, the FCWS showed a slight safety benefit for novice drivers attributed to the assistance provided for the situation analysis. Outside the warning events, FCWS presence also impacted car-following behaviors. Drivers took an extra safety margin, possibly to prevent incidental triggering of warnings. The data enlighten the nature of the cognitive processes associated with FCWSs. Altogether, the findings support the general efficiency of FCWSs observed through a massive reduction in the number of near-collision events and point toward the need for further investigations.

Restricted mean survival time of older adults with severe aortic stenosis referred for transcatheter aortic valve replacement.

BACKGROUND: Few studies have measured frailty as a potential reason for foregoing transcatheter aortic valve replacement (TAVR) in older adults with severe aortic stenosis (AS). This study sought to determine the impact of frailty and other clinician-cited reasons on restricted mean survival time (RMST). METHODS: An analysis of the McGill Frailty Registry was conducted between 2014 and 2018 at the McGill University Health Center Structural Valve Clinic. Consecutive nonsurgical patients referred for TAVR were included. In those that underwent balloon aortic valvuloplasty or medical management, the primary clinician-cited reason for foregoing TAVR was codified. Vital status was ascertained at 1 year and analysed using RMST and Kaplan-Meier analyses. RESULTS: The study consisted of 373 patients with a mean age of 82.4 years, of which 233 underwent TAVR and 140 did not. Patients who did not undergo TAVR were more likely to be nonagenarians, with left ventricular dysfunction, chronic kidney disease, dementia, disability, depression, malnutrition, and frailty. The primary clinician-cited reason was: comorbidity in 34%, frailty in 23%, procedural feasibility and risks in 16%, and mild or unrelated symptoms in 27%. Compared to the TAVR group, 1-year RMST was reduced by 2.0 months in the medical management group (95% CI 1.2, 2.7) and by 1.1 months in the valvuloplasty group (95% CI -0.2, 2.5). CONCLUSIONS: Patients with severe AS referred for TAVR may never undergo the procedure on the basis of comorbidity, frailty, procedural issues, and symptoms. The best treatment decision is one that follows from multi-disciplinary assessment encompassing frailty.

The Role of Behavioral Phenotypes on Impaired Driving Recidivism Risk and Treatment Response to Brief Intervention: A Preliminary Study.

BACKGROUND: Heterogeneity in the driving while impaired (DWI) offender population and modest outcomes from remedial programs are fueling interest in clarifying clinically significant DWI subtypes to better assess recidivism risk and target interventions. Our previous research identified 2 putative behavior phenotypes of DWI offenders with distinct behavioral, personality, cognitive, and neurobiological profiles: (i) offenders primarily engaging in DWI (pDWI); and (ii) offenders engaging in DWI and other traffic violations (MIXED). Here, we evaluate these phenotypes' clinical significance for prediction of recidivism and intervention targeting. METHODS: DWI recidivists participating in a previous randomized controlled trial (N = 184 comparing brief motivational interviewing (BMI) and an information and advice control condition (IA) were retrospectively classified as either pDWI (n = 97) or MIXED (n = 87). Secondary analyses then evaluated the effect of this phenotypic classification on self-reported 6- and 12-month alcohol misuse outcomes and documented 5-year DWI recidivism violations, and in response to either BMI or IA (i.e., pDWI-BMI, n = 46; MIXED-BMI, n = 45; pDWI-IA, n = 51; MIXED-IA, n = 42). Two hypotheses were tested: (i) MIXED classification is associated with poorer alcohol misuse outcomes and recidivism outcomes than pDWI classification; and (ii) pDWI paired with BMI is associated with better outcomes compared to MIXED paired with BMI. RESULTS: MIXED classification was associated with significantly greater risk of recidivism over the 5-year follow-up compared to pDWI classification. Moreover, the pDWI-BMI pairing was associated with significantly decreased recidivism risk compared to the MIXED-BMI pairing. Analyses of 6- and 12-month alcohol use outcomes produced null findings. CONCLUSIONS: The clinical significance of phenotypic classification for risk assessment and targeting intervention was partially supported with respect to recidivism risk. Prospective investigation of this and other behavioral phenotypes is indicated.

Distracted driving and risk of road crashes among novice and experienced drivers.

BACKGROUND: Distracted driving attributable to the performance of secondary tasks is a major cause of motor vehicle crashes both among teenagers who are novice drivers and among adults who are experienced drivers. METHODS: We conducted two studies on the relationship between the performance of secondary tasks, including cell-phone use, and the risk of crashes and near-crashes. To facilitate objective assessment, accelerometers, cameras, global positioning systems, and other sensors were installed in the vehicles of 42 newly licensed drivers (16.3 to 17.0 years of age) and 109 adults with more driving experience. RESULTS: During the study periods, 167 crashes and near-crashes among novice drivers and 518 crashes and near-crashes among experienced drivers were identified. The risk of a crash or near-crash among novice drivers increased significantly if they were dialing a cell phone (odds ratio, 8.32; 95% confidence interval [CI], 2.83 to 24.42), reaching for a cell phone (odds ratio, 7.05; 95% CI, 2.64 to 18.83), sending or receiving text messages (odds ratio, 3.87; 95% CI, 1.62 to 9.25), reaching for an object other than a cell phone (odds ratio, 8.00; 95% CI, 3.67 to 17.50), looking at a roadside object (odds ratio, 3.90; 95% CI, 1.72 to 8.81), or eating (odds ratio, 2.99; 95% CI, 1.30 to 6.91). Among experienced drivers, dialing a cell phone was associated with a significantly increased risk of a crash or near-crash (odds ratio, 2.49; 95% CI, 1.38 to 4.54); the risk associated with texting or accessing the Internet was not assessed in this population. The prevalence of high-risk attention to secondary tasks increased over time among novice drivers but not among experienced drivers. CONCLUSIONS: The risk of a crash or near-crash among novice drivers increased with the performance of many secondary tasks, including texting and dialing cell phones. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Highway Traffic Safety Administration.).

Peer Passenger Norms and Pressure: Experimental Effects on Simulated Driving Among Teenage Males.

OBJECTIVE: Serious crashes are more likely when teenage drivers have teenage passengers. One likely source of this increased risk is social influences on driving performance. This driving simulator study experimentally tested the effects of peer influence (i.e., risk-accepting compared to risk-averse peer norms reinforced by pressure) on the driving risk behavior (i.e., risky driving behavior and inattention to hazards) of male teenagers. It was hypothesized that peer presence would result in greater driving risk behavior (i.e., increased driving risk and reduced latent hazard anticipation), and that the effect would be greater when the peer was risk-accepting. METHODS: Fifty-three 16- and 17-year-old male participants holding a provisional U.S., State of Michigan driver license were randomized to either a risk-accepting or risk-averse condition. Each participant operated a driving simulator while alone and separately with a confederate peer passenger. The simulator world included scenarios designed to elicit variation in driving risk behavior with a teen passenger present in the vehicle. RESULTS: Significant interactions of passenger presence (passenger present vs. alone) by risk condition (risk-accepting vs. risk-averse) were observed for variables measuring: failure to stop at yellow light intersections (Incident Rate Ratio (IRR)=2.16; 95% Confidence Interval [95CI]=1.06, 4.43); higher probability of overtaking (IRR=10.17; 95CI=1.43, 73.35); shorter left turn latency (IRR=0.43; 95CI=0.31,0.60); and, failure to stop at an intersection with an occluded stop sign (IRR=7.90; 95CI=2.06,30.35). In all cases, greater risky driving by participants was more likely with a risk-accepting passenger versus a risk-averse passenger present and a risk-accepting passenger present versus driving alone. CONCLUSIONS: Exposure of male teenagers to a risk-accepting confederate peer passenger who applied peer influence increased simulated risky driving behavior compared with exposure to a risk-averse confederate peer passenger or driving alone. These results are consistent with the contention that variability in teenage risky driving is in part explained by social influences.

Buffering social influence: neural correlates of response inhibition predict driving safety in the presence of a peer.

Adolescence is a period characterized by increased sensitivity to social cues, as well as increased risk-taking in the presence of peers. For example, automobile crashes are the leading cause of death for adolescents, and driving with peers increases the risk of a fatal crash. Growing evidence points to an interaction between neural systems implicated in cognitive control and social and emotional context in predicting adolescent risk. We tested such a relationship in recently licensed teen drivers. Participants completed an fMRI session in which neural activity was measured during a response inhibition task, followed by a separate driving simulator session 1 week later. Participants drove alone and with a peer who was randomly assigned to express risk-promoting or risk-averse social norms. The experimentally manipulated social context during the simulated drive moderated the relationship between individual differences in neural activity in the hypothesized cognitive control network (right inferior frontal gyrus, BG) and risk-taking in the driving context a week later. Increased activity in the response inhibition network was not associated with risk-taking in the presence of a risky peer but was significantly predictive of safer driving in the presence of a cautious peer, above and beyond self-reported susceptibility to peer pressure. Individual differences in recruitment of the response inhibition network may allow those with stronger inhibitory control to override risky tendencies when in the presence of cautious peers. This relationship between social context and individual differences in brain function expands our understanding of neural systems involved in top-down cognitive control during adolescent development.

Aspergillus galactosaminogalactan mediates adherence to host constituents and conceals hyphal ß-glucan from the immune system.

Aspergillus fumigatus is the most common cause of invasive mold disease in humans. The mechanisms underlying the adherence of this mold to host cells and macromolecules have remained elusive. Using mutants with different adhesive properties and comparative transcriptomics, we discovered that the gene uge3, encoding a fungal epimerase, is required for adherence through mediating the synthesis of galactosaminogalactan. Galactosaminogalactan functions as the dominant adhesin of A. fumigatus and mediates adherence to plastic, fibronectin, and epithelial cells. In addition, galactosaminogalactan suppresses host inflammatory responses in vitro and in vivo, in part through masking cell wall ß-glucans from recognition by dectin-1. Finally, galactosaminogalactan is essential for full virulence in two murine models of invasive aspergillosis. Collectively these data establish a role for galactosaminogalactan as a pivotal bifunctional virulence factor in the pathogenesis of invasive aspergillosis.

Teen Drivers' Perceptions of Their Peer Passengers: Qualitative Study.

BACKGROUND: The presence of peer passengers increases teenage drivers' fatal crash risk. Distraction and social influence are the two main factors that have been associated with increased risk. Teen drivers' perceptions of their peer passengers on these factors could inform our understanding of the conditions under which peer passengers increase crash risk or promote safer driving. The purpose of this study was to examine teen drivers' perceptions of their peer passengers on distraction and social influence. METHOD: A convenience sample of male and female drivers participated in a semi-structured interview that included questions on their perceptions of the effects of peer passengers on driving on distraction and social influence. The analysis of the interviews was guided by a grounded theory approach. FINDINGS: Teenage drivers were aware of the risk that peer passengers posed. Some described having passengers in the vehicle as distracting, and recognized that the level of distraction increased with the number of passengers in the vehicle. Drivers that felt responsible for the safety of their peer passengers described strategies they used to control the in-vehicle environment. Drivers described driving with passengers as a performance, and articulated direct and indirect sources of pressure, gender norms, and unspoken expectations of their passengers as influencing their driving behavior. CONCLUSIONS: The influence of passengers is situation specific and dependent on whom the passenger(s) may be. Passenger influence may be either protective or harmful, depending on the circumstances. Some passengers exert direct influence, but often their influence appears more indirect and subtle.

Protein and Exercise to Reverse Frailty in Older Men and Women Undergoing Transcatheter Aortic Valve Replacement: Design of the PERFORM-TAVR Trial.

Despite the high procedural success of transcatheter aortic valve replacement (TAVR), 2 out of 5 older adults report poor physical performance and health-related quality of life (HRQOL) in the ensuing months, particularly those with frailty. There has yet to be a trial examining the synergistic effects of exercise and protein supplementation to counteract frailty and improve patient-centred outcomes following TAVR. The PERFORM-TAVR trial is a multicentre parallel-group randomised clinical trial that is enrolling 200 frail older adults ≥ 70 years of age undergoing TAVR. Patients will be randomly allocated to 1 of 2 treatment groups: standard-of-care lifestyle education (control group) or protein-rich oral nutritional supplement for 4 weeks before TAVR with the addition of home-based supervised exercise sessions for 12 weeks after TAVR (intervention group). The primary outcome will be physical performance as measured by a blinded observer using the Short Physical Performance Battery at 3 months. Secondary outcomes at 3, 6, and 12 months will include HRQOL, as measured by the Short-Form 36 Physical and Mental Component summary scores, and a composite safety end point. The PERFORM-TAVR trial is testing a novel frailty intervention in older adults undergoing TAVR to optimise recovery and downstream HRQOL. This represents a potential paradigm shift that highlights the value of assessing and treating patients' frailty in parallel with their underlying heart valve disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03522454.

Variability in crash and near-crash risk among novice teenage drivers: a naturalistic study.

OBJECTIVE: Using video monitoring technologies, we investigated teenage driving risk variation during the first 18 months of independent driving. STUDY DESIGN: Driving data were collected on 42 teenagers whose vehicles were instrumented with sophisticated video and data recording devices. Surveys on demographic and personality characteristics were administered at baseline. Drivers were classified into 3 risk groups using a K-mean clustering method based on crash and near-crash (CNC) rate. The change in CNC rates over time was evaluated by mixed-effect Poisson models. RESULTS: Compared with the first 3 months after licensure (first quarter), the CNC rate for participants during the third, fourth, and fifth quarters decreased significantly to 59%, 62%, and 48%, respectively. Three distinct risk groups were identified with CNC rates of 21.8 (high-risk), 8.3 (moderate-risk), and 2.1 (low-risk) per 10 000 km traveled. High- and low-risk drivers showed no significant change in CNC rates throughout the 18-month study period. CNC rates for moderate-risk drivers decreased substantially from 8.8 per 10 000 km in the first quarter to 0.8 and 3.2 in the fourth and fifth quarters, respectively. The 3 groups were not distinguishable with respect to personality characteristics. CONCLUSION: Teenage CNC rates varied substantially, with distinct high-, moderate-, and low-risk groups. Risk declined over time only in the moderate-risk group. The high-risk drivers appeared to be insensitive to experience, with CNC rates consistently high throughout the 18-month study period, and the moderate-risk group appeared to learn from experience.

A randomized controlled trial of brief motivational interviewing in impaired driving recidivists: a 5-year follow-up of traffic offenses and crashes.

BACKGROUND: In a previously published randomized controlled trial (Brown et al. Alcohol Clin Exp Res 2010; 34, 292-301), our research team showed that a 30-minute brief motivational interviewing (BMI) session was more effective in reducing percentages of risky drinking days in drunk driving recidivists than a control information-advice intervention at 12-month follow-up. In this sequel to the initial study, 2 main hypotheses were tested: (i) exposure to BMI increases the time to further arrests and crashes compared with exposure to the control intervention (CTL) and (ii) characteristics, such as age, moderate the benefit of BMI. METHODS: A sample of 180 community-recruited recidivists who had drinking problems participated in the study. Participants gave access to their provincial driving records at baseline and were followed up for a mean of 1,684.5 days (SD = 155.7) after randomization to a 30-minute BMI or CTL session. Measured outcomes were driving arrests followed by convictions including driving while impaired (DWI), speeding, or other moving violations as well as crashes. Age, readiness to change alcohol consumption, alcohol misuse severity, and number of previous DWI convictions were included as potential moderators of the effect of the interventions. RESULTS: For arrests, Cox proportional hazards modeling revealed no significant differences between the BMI and the CTL group. When analyses were adjusted to age tertile categories, a significant effect of BMI in the youngest age tertile (<43 years old) emerged. For crashes, no between-group differences were detected. CONCLUSIONS: BMI was better at delaying DWI and other dangerous traffic violations in at-risk younger drivers compared with a CTL similar to that provided in many remedial programs. BMI may be useful as an opportunistic intervention for DWI recidivism prevention in settings such as DWI courts. Treatment effectiveness studies are needed to ascertain how the present findings generalize to the real-world conditions of mandated relicensing programs.

A randomized controlled pilot trial of brief online mindfulness training in young drivers.

OBJECTIVE: Driver distraction contributes to fatal and injury crashes in young drivers. Mind wandering (MW) is a covert form of distraction involving task-unrelated thoughts. Brief online mindfulness training (MT) may reduce unsafe driving by enhancing recognition (meta-awareness) of MW and reducing its occurrence. This pilot trial tested these proposed mechanisms of MT and explored its specificity of action, effects on driving behaviour in simulation, as well as intervention adherence and acceptability in young drivers. METHODS: A pre-post (T1, T2), randomized, active placebo-controlled, double-blinded design was used. Twenty-six drivers, aged 21-25, received either brief online MT (experimental) or progressive muscle relaxation (PMR, control) over 4-6 days. A custom website blindly conducted randomization, delivered interventions, administered questionnaires, and tracked adherence. At T1 and T2, a simulator measured driving behaviour while participants indicated MW whenever they recognized it, to assess meta-awareness, and when prompted by a thought-probe, to assess overall MW. RESULTS: MT reduced MW while driving in simulation. The MT group reported higher state mindfulness following sessions. Motivation did not account for MW or mindfulness results. MT and meta-awareness were associated with more focus-related steering behaviour. Intervention groups did not significantly differ in adherence or attrition. No severe adverse effects were reported, but MT participants reported more difficulty following intervention instructions. CONCLUSION: Results support a plausible mechanism of MT for reducing MW-related crash risk (i.e., reduction of MW) in young drivers. This preliminary evidence, alongside promising online adherence and acceptability results, warrants definitive efficacy and effectiveness trials of online MT.

Did the cannabis recreational use law affect traffic crash outcomes in Toronto? Building evidence for the adequate number of authorised cannabis stores' thresholds.

INTRODUCTION: In the past decade, a group of studies has begun to explore the association between cannabis recreational use policies and traffic crashes. After these policies are set in place, several factors may affect cannabis consumption, including the number of cannabis stores (NCS) per capita. This study examines the association between the enactment of Canada's Cannabis Act (CCA) (18 October 2018) and the NCS (allowed to function from 1 April 2019) with traffic injuries in Toronto. METHODS: We explored the association of the CCA and the NCS with traffic crashes. We applied two methods: hybrid difference-in-difference (DID) and hybrid-fuzzy DID. We used generalised linear models using CCA and the NCS per capita as the main variables of interest. We adjusted for precipitation, temperature and snow. Information is gathered from Toronto Police Service, Alcohol and Gaming Commission of Ontario, and Environment Canada. The period of analysis was from 1 January 2016 to 31 December 2019. RESULTS: Regardless of the outcome, neither the CCA nor the NCS is associated with concomitant changes in the outcomes. In hybrid DID models, the CCA is associated with non-significant decreases of 9% (incidence rate ratio 0.91, 95% confidence interval 0.74,1.11) in traffic crashes and in the hybrid-fuzzy DID models, the NCS are associated with nonsignificant decreases of 3% (95% confidence interval - 9%, 4%) in the same outcome. DISCUSSION AND CONCLUSIONS: This study observes that more research is needed to better understand the short-term effects (April to December 2019) of NCS in Toronto on road safety outcomes.

The Caulobacter crescentus chromosome replication origin evolved two classes of weak DnaA binding sites.

The Caulobacter crescentus replication initiator DnaA and essential response regulator CtrA compete to control chromosome replication. The C. crescentus replication origin (Cori) contains five strong CtrA binding sites but only two apparent DnaA boxes, termed G-boxes (with a conserved second position G, TGATCCACA). Since clusters of DnaA boxes typify bacterial replication origins, this discrepancy suggested that C. crescentus DnaA recognizes different DNA sequences or compensates with novel DNA-binding proteins. We searched for novel DNA sites by scanning mutagenesis of the most conserved Cori DNA. Autonomous replication assays showed that G-boxes and novel W-boxes (TCCCCA) are essential for replication. Further analyses showed that C. crescentus DnaA binds G-boxes with moderate and W-boxes with very weak affinities significantly below DnaA's capacity for high-affinity Escherichia coli-boxes (TTATCCACA). Cori has five conserved W-boxes. Increasing W-box affinities increases or decreases autonomous replication depending on their strategic positions between the G-boxes. In vitro, CtrA binding displaces DnaA from proximal G-boxes and from distal W-boxes implying CtrA-DnaA competition and DnaA-DnaA cooperation between G-boxes and W-boxes. Similarly, during cell cycle progression, CtrA proteolysis coincides with DnaA binding to Cori. We also observe highly conserved W-boxes in other replication origins lacking E. coli-boxes. Therefore, strategically weak DnaA binding can be a general means of replication control.

Recidivism prevention for impaired driving: Longitudinal 5-year outcomes from Quebec's severity-based intervention assignment program.

INTRODUCTION: Driving while impaired by alcohol (DWI) is a persistent problem. Tailoring intervention modality to client risk and needs (i.e., risk/needs) is posited to both reduce recidivism more efficiently than uniform approaches and circumvent overtreatment or undertreatment. DWI drivers in Quebec must participate in a severity-based intervention assignment program to be relicensed, but like most tailoring programs it has yet to undergo systematic scrutiny. The current longitudinal cohort study tests two main hypotheses underpinning this approach: 1) drivers classified at higher recidivism risk based on their arrest characteristics (DWIR) show poorer outcomes over up to 5-years postassessment compared to drivers classified at lower risk (DWIF); and 2) for both DWIR and DWIF groups, assignment of drivers with greater risk/needs to intensive intervention (II) will be advantageous for reducing recidivism risk compared to assignment into brief intervention (BI) for those with lower risk/needs. METHODS: Drivers who entered the program from 2012 to 2016 were followed to the end of 2018 (N = 37,612). Survival analysis examined the predictive validity of the initial classification into DWIR or DWIF groups for documented recidivism over a follow-up of up to 5 years. Logistic regression discontinuity evaluated the relative outcomes of drivers who were assigned to either BI or II. The study explored interaction effects between classification and intervention assignment with age and sex. RESULTS: In line with the hypothesis, the average hazard of recidivism was 58 % greater in DWIR drivers compared to DWIF drivers. In both DWIF and DWIR drivers, assignment of drivers with greater risk/needs to II was associated with reduced recidivism compared to assignment of drivers with lower risk/needs to BI, with 57 % and 35 % decreased probability of recidivism, respectively. Younger age was more strongly associated with recidivism risk in DWIF drivers than in DWIR drivers. CONCLUSIONS: The current study found that Quebec's severity-based intervention assignment approach accurately identifies DWI drivers who: i) by their arrest characteristics pose a greater risk for recidivism, which may require expeditious exposure to preventative countermeasures; and ii) as a function of their greater risk/needs, benefit from assignment to more intensive intervention to mitigate their recidivism risk.

A new alcohol-related traffic law, a further reduction in traffic fatalities? Analyzing the case of Turkey.

BACKGROUND: In June 2013, an alcohol-related traffic law took effect in Turkey. The law 6487 introduced administrative fines for not respecting blood alcohol concentration limits, health warning messages on alcohol containers (bottles, cans), and prohibited the sale of alcohol beverages in retail facilities between 10 p.m. and 6 a.m.. This article examines how this law is associated with traffic fatality variation. METHODS: Data from the Turkish Statistical Institute for the 2008-2019 period were analyzed. Outcomes were traffic fatality rates per 100,000 population and 10,000 motor vehicles. Exposure variable was the presence of law 6487. Alcohol, tobacco, and related beverages' household expenditure, unemployment rate, number of health professionals, number of crashes, and lags of the outcomes represented control variables. A time-series cross-regional fixed effect model was applied. RESULTS: Empirical estimates suggest that the law 6487 was associated with a reduction of 15% (Incidence Rate Ratio (IRR) 0.85, 95% Confidence Interval (CI): 082, 0.94) in the traffic fatality per population rate and with a reduction of 14% (IRR: 0.86 (95% CI: 0.78, 0.92) in the traffic fatality per motor-vehicle rate. After 6 years of its implementation, this intervention was associated with an absolute reduction of 1519 (95% reduction interval: 1177, 1810) traffic fatalities. CONCLUSIONS: Our research emphasizes that legislation with direct and indirect measures targeting driving under the influence of alcohol (DUIA) may be related to traffic fatalities reduction. PRACTICAL APPLICATIONS: This finding has important implications for policy and future research in contexts in which alcohol consumption is low such is in Turkey. Future research should seek to identify mechanisms that explain how laws are ultimately associated with DUIA variation.

Estimate of the magnitude of risky and protective behaviors associated with road traffic injuries in capitals participating in the Life in Traffic Project of Brazil.

BACKGROUND: Brazil occupies the fifth position in the ranking of the highest mortality rates due to RTI in the world. With the objective of promoting traffic safety and consequently reducing deaths, Brazil created the Life in Traffic Project (LTP). The main goal of LTP is reducing 50% of RTI deaths, by promoting interventions to tackle risk factors, such as driving under the influence of alcohol and excessive and/or inappropriate speed. Thus, the aim of this study was to estimate the magnitude of risky and protective factors for RTI in capitals participating in the LTP in Brazil. We estimated these factors according to sociodemographic (age group, sex, education, race and, type of road user). METHODS: A total of 5,922 car drivers and motorcyclists from 14 Brazilian capitals participating in the LTP were interviewed. Data collection was carried out in sobriety checkpoints at night and consisted of the administration of an interview and a breathalyzer test. Risky and protective behaviors associated with RTI were investigated. Covariates of the study were: age, sex, education, race and, type of road user. Poisson multiple regression analysis was used to assess the relationship between variables of interest. RESULTS: The prevalence of individuals with positive blood alcohol concentration (BAC) was 6.3% and who reported driving after drinking alcohol in the last 30 days was 9.1%. The others risky behaviors reported were: driving at excessive speed on roads of 50 km/h, using a cell phone for calls while driving, using a cell phone to send or read calls while driving, running a red light. Use of seatbelts and helmets showed prevalence above 96,0% Use of seatbelts showed prevalence of 98.6% among car drivers, and helmet use was described by 96.6% of motorcycle drivers. Most risky behaviors were more prevalent in younger age groups (except BAC measurement higher in older participants), in males (except for cell phone use), in participants with higher education level and without a driver's license. CONCLUSION: Excessive speed and driving under the influence of alcohol, defined as priorities within the LTP, need more consistent interventions, as they still have considerable prevalence in the cities investigated. The factors described such as cell phone usage and passing red traffic lights should also need to be prioritized as a focus on promoting traffic safety.

Mycobacterium tuberculosis origin of replication and the promoter for immunodominant secreted antigen 85B are the targets of MtrA, the essential response regulator.

Efficient proliferation of Mycobacterium tuberculosis (Mtb) inside macrophage requires that the essential response regulator MtrA be optimally phosphorylated. However, the genomic targets of MtrA have not been identified. We show by chromatin immunoprecipitation and DNase I footprinting that the chromosomal origin of replication, oriC, and the promoter for the major secreted immunodominant antigen Ag85B, encoded by fbpB, are MtrA targets. DNase I footprinting analysis revealed that MtrA recognizes two direct repeats of GTCACAgcg-like sequences and that MtrA approximately P, the phosphorylated form of MtrA, binds preferentially to these targets. The oriC contains several MtrA motifs, and replacement of all motifs or of a single select motif with TATATA compromises the ability of oriC plasmids to maintain stable autonomous replication in wild type and MtrA-overproducing strains, indicating that the integrity of the MtrA motif is necessary for oriC replication. The expression of the fbpB gene is found to be down-regulated in Mtb cells upon infection when these cells overproduce wild type MtrA but not when they overproduce a nonphosphorylated MtrA, indicating that MtrA approximately P regulates fbpB expression. We propose that MtrA is a regulator of oriC replication and that the ability of MtrA to affect apparently unrelated targets, i.e. oriC and fbpB, reflects its main role as a coordinator between the proliferative and pathogenic functions of Mtb.