An exploratory study of parent acceptance of sanctions for driving offenses committed by their children.

OBJECTIVE: Graduated driver licensing (GDL) systems are effective at reducing young driver crashes but rely on active parental involvement. However, some parents may accept sanctions (e.g., demerit points, monetary fines) for traffic offenses committed by their children, leading to experiences of punishment avoidance by young drivers. This aim of this exploratory study was to investigate several demographic and psychosocial influences that could possibly be associated with parent acceptance of sanctions. METHOD: An online survey was completed by parents of young drivers (N = 149, M = 48.88 years, SD = 4.76 years; female = 86%) from 3 Australian states. The survey included measures of sociodemographic characteristics and driving history (e.g., crash involvement), socioeconomic status, parenting style, knowledge of their child's driving behavior, perceptions of their ability to manage their child's driving, attitudes toward GDL, and previous or potential acceptance of demerit points or payment of fines for road offenses committed by their child. RESULTS: Twenty-nine percent of parents had accepted or would accept a sanction on behalf of their child. Number of children overall, number of children licensed, and household income were associated with parent acceptance of a sanction. Parenting style, attitude toward GDL restrictions, parent confidence in their knowledge of GDL restrictions and ability to manage their child's driving, and belief that their child would follow rules were not associated with (non)acceptance of a sanction. CONCLUSIONS: These exploratory findings suggest that family size and income may be important influences on parent acceptance of sanctions on behalf of their offending children. The findings related to the psychosocial variables are discussed considering other research and the limitations of the study.

"It's more than just a conversation about the heart": exploring barriers, enablers, and opportunities for improving the delivery and uptake of cardiac neurodevelopmental follow-up care.

Introduction: Surveillance, screening, and evaluation for neurodevelopmental delays is a pivotal component of post-surgical care for children with congenital heart disease (CHD). However, challenges exist in implementing such neurodevelopmental follow-up care in international practice. This study aimed to characterise key barriers, enablers, and opportunities for implementing and delivering outpatient cardiac neurodevelopmental follow-up care in Australia. Methods: an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis. Results: fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data. Discussion: Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.

Submental muscular medialization and suspension.

BACKGROUND: Many techniques have been presented over recent decades to address the neck contour in facial rejuvenation surgery. Despite advances, limitations remain when dealing with the obtuse cervical angle. OBJECTIVE: The authors describe a technique for improving the obtuse cervicomental angle. METHODS: The authors reviewed the charts of 295 patients who underwent the authors' submental muscular medialization and suspension (SMMS) technique to improve their neck contour, either alone or in combination with a facelift, between January 1, 2001, and December 30, 2003. The technique medializes and suspends the medial free edges of the platysma muscle and, when anatomy dictates, the anterior bellies of the digastric muscle to the deeper mylohyoid muscle. RESULTS: Eighty-seven (30.5%) of the 285 facelift patients examined underwent SMMS, and 10 additional patients underwent isolated SMMS. No patient required reoperation for hemostasis or evacuation. Three (1.05%) of the facelift with SMMS patients required reoperation for dehiscence of the submental suspension. None of the isolated SMMS patients had muscular suspension dehiscence or required reoperation. Seven (2.4%) patients (5 with SMMS and 2 without SMMS) with excessive facial and cervical tissue preoperatively developed a small amount of postoperative submental skin redundancy and subsequently underwent submental skin excision at 1 year postoperatively. CONCLUSIONS: Submental muscular medialization and suspension is a simple yet highly effective surgical technique that can result in dramatic and enduring improvement in the cervicomental angle.

Perceptions of novice driver education needs; Development of a scale based on the Goals for driver education using young driver and parent samples.

Professional driver education and training has traditionally been used to improve the driving skills of young people with the expectation that they will drive more safely and therefore be less likely to crash. Despite this, much research has failed to find such an effect. The Goals for Driver Education (GDE) is a theoretical framework developed to improve the effectiveness of driver education. The GDE seeks to draw attention to a broader array of factors that may influence the driving of young people and hence increase the scope of what is included in driver education and training. Within the GDE, factors affecting driving and driver education are grouped into combinations of four hierarchical levels that represent influences on driving at increasing levels of abstraction (GDE level 1: Vehicle manoeuvring; GDE level 2: Mastery of traffic situations; GDE level 3: Goals and contexts of driving; GDE level 4: Goals for life and skills for living) and three types of individual competencies (Knowledge and skills; Risk-increasing factors; Self-evaluation skills). However, to date there have been few, if any, attempts to operationalise the GDE in a quantitative way. In response, the Perceptions of Driver Education Scale (PDES) was developed to gain an understanding of what two important stakeholder groups in the driver education and training ecosystem perceived to be important to be taught to novice drivers. Understanding these perceptions may lead to greater acceptance of the driver education and training that is designed and make it more effective. Following rigorous scale development procedures, thirty-five items were developed a priori using expert opinion and deployed, via an online survey, to a sample of parents of novice drivers (N = 518) and a separate sample of novice drivers (N = 247), both from Queensland, Australia. Exploratory Factor Analysis was performed on the parent responses and Confirmatory Factor Analysis was performed using the novice driver responses. A 29-item 9 factor solution was judged to be the best fit with the overall scale and each of the factors displaying strong levels of internal consistency. The 9 factors cover most hierarchical level and competency combinations, although removal of items meant that there is no representation concerning perceptions of Self-evaluation skills related to Level 3: Goals and contexts of driving within the PDES. Overall, the PDES is a valid and reliable instrument for investigating the aspects of driver education and training that are perceived as important by novice drivers and parents. The scale may also be applicable for use with other stakeholder groups and could also be used to evaluate pre-existing driver education and training programs.

The prototype willingness model: An application to adolescent driver speeding.

INTRODUCTION: Many young drivers are involved in crashes due to speeding. Some studies have used the Prototype Willingness Model (PWM) to explain the risky driving behavior of young people. However, many have measured PWM constructs in a manner inconsistent with its formulation. The PWM asserts that the social reaction pathway is underpinned by a heuristic comparison of oneself with a cognitive prototype of someone who engages in a risky behavior. This proposition has not been comprehensively examined and few PWM studies specifically examine social comparison. The current study investigates intentions, expectations, and willingness to speed by teen drivers using operationalizations of PWM constructs more aligned with their original conceptualizations. Additionally, the influence of dispositional social comparison tendency on the social reaction pathway is examined to further test the original propositions underpinning the PWM. METHOD: Two hundred and eleven independently driving adolescents completed an online survey including items measuring PWM constructs and social comparison tendency. Hierarchical multiple regression was used to investigate the influence of perceived vulnerability, descriptive and injunctive norms, and prototypes on speeding intentions, expectations, and willingness. A moderation analysis examined the effect of social comparison tendency on the association between prototype perceptions and willingness. RESULTS: The regression models explained substantial amounts of variance in intentions (39%), expectations (49%), and willingness (30%) to speed. There was no evidence that social comparison tendency influences the relationship between prototypes and willingness. CONCLUSIONS: The PWM is useful for predicting teenage risky driving. More studies should confirm that social comparison tendency does not moderate the social reaction pathway. However, there may be need for further theoretical development of the PWM. PRACTICAL APPLICATIONS: The study suggests that it may be possible to develop interventions to reduce adolescent driver speeding based on manipulation of PWM constructs such as speeding driver prototypes.

Identifying barriers and facilitators to successful implementation of computerized clinical decision support systems in hospitals: a NASSS framework-informed scoping review.

BACKGROUND: Successful implementation and utilization of Computerized Clinical Decision Support Systems (CDSS) in hospitals is complex and challenging. Implementation science, and in particular the Nonadoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, may offer a systematic approach for identifying and addressing these challenges. This review aimed to identify, categorize, and describe barriers and facilitators to CDSS implementation in hospital settings and map them to the NASSS framework. Exploring the applicability of the NASSS framework to CDSS implementation was a secondary aim. METHODS: Electronic database searches were conducted (21 July 2020; updated 5 April 2022) in Ovid MEDLINE, Embase, Scopus, PyscInfo, and CINAHL. Original research studies reporting on measured or perceived barriers and/or facilitators to implementation and adoption of CDSS in hospital settings, or attitudes of healthcare professionals towards CDSS were included. Articles with a primary focus on CDSS development were excluded. No language or date restrictions were applied. We used qualitative content analysis to identify determinants and organize them into higher-order themes, which were then reflexively mapped to the NASSS framework. RESULTS: Forty-four publications were included. These comprised a range of study designs, geographic locations, participants, technology types, CDSS functions, and clinical contexts of implementation. A total of 227 individual barriers and 130 individual facilitators were identified across the included studies. The most commonly reported influences on implementation were fit of CDSS with workflows (19 studies), the usefulness of the CDSS output in practice (17 studies), CDSS technical dependencies and design (16 studies), trust of users in the CDSS input data and evidence base (15 studies), and the contextual fit of the CDSS with the user's role or clinical setting (14 studies). Most determinants could be appropriately categorized into domains of the NASSS framework with barriers and facilitators in the "Technology," "Organization," and "Adopters" domains most frequently reported. No determinants were assigned to the "Embedding and Adaptation Over Time" domain. CONCLUSIONS: This review identified the most common determinants which could be targeted for modification to either remove barriers or facilitate the adoption and use of CDSS within hospitals. Greater adoption of implementation theory should be encouraged to support CDSS implementation.

Road users' engagement in prosocial and altruistic behaviors: A systematic review.

INTRODUCTION: Engagement in prosocial and altruistic on-road behaviors is a new area of research with potential safety benefits for road users. This paper systematically reviewed studies on road users' engagement in prosocial and altruistic behaviors to provide guidance regarding the next steps in this area of research, particularly to inform targeted interventions. The objective was to identify the types of on-road prosocial and altruistic behaviors that have been studied, and the factors associated with these behaviors. Road users were defined as drivers, passengers, or vulnerable road users (e.g., pedestrian, motorcyclists, and bicyclists). METHOD: The database search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMSA) guidelines and was conducted in June 2021. A total of 23,090 articles were identified in four databases including APA PsycINFO, Embase, Web of Science, and the Transportation Research Information Database. Eleven articles (13 studies) published between 2004 and 2021 met the inclusion criteria and were included in the review. RESULTS: Six studies focused on intervening behaviors, specifically relating to passengers' willingness or intentions to speak up to a driver engaging in unsafe driving behaviors, four studies focused on drivers' yielding behaviors at crosswalks, and one study each focused on altruistic driving behaviors, prosocial driving behavior at long-wait stops, and prosocial behavior towards cyclists. Studies typically examined characteristics of the prosocial road user, including self-esteem, efficacy, and subjective norms, as well as contextual factors, such as other road users' behaviors and on-road messaging. CONCLUSIONS: This review highlights specific factors that may predict road users' engagement in prosocial and altruistic on-road behaviors. PRACTICAL APPLICATIONS: The outcomes from this review may be used to guide the development of future road safety public education messages designed to encourage greater participation in prosocial and altruistic on-road behaviors that act to benefit all road users.

Users' acceptance of private automated vehicles: A systematic review and meta-analysis.

INTRODUCTION: This research systematically reviewed relevant studies on users' acceptance of conditional (Level 3) to full (Level 5) automated vehicles when such vehicles are to be used privately (herein referred to as 'private automated vehicles or private AVs). METHOD: The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and was undertaken in three databases: APA PsycINFO, Transport Research International Documentation, and Web of Science. Articles were required to focus on individuals' acceptance of private SAE Level 3-5 AVs. Acceptance was defined as individuals' attitudes towards or intentions and/or willingness to use AVs in the future. A total of 2,354 articles were identified in the database search. Thirty-five articles were included in the review, six of which included multiple studies and/or comparison groups. RESULTS: Most studies (n = 31) applied self-reported measures to assess user acceptance together with a range of psychosocial factors predicting such acceptance. The meta-analytic correlations revealed that perceived behavioral control, perceived benefits/usefulness, perceived ease of use, and subjective/social norms had significant positive pooled relationships with attitudes and intentions. Trust and sensation seeking also had significant positive pooled correlations with intentions, while knowledge of AVs had a significant and negative pooled correlation with intentions. Age did not show any significant pooled relationship with attitudes, intentions, or willingness. CONCLUSIONS: The findings obtained from the systematic review and meta-analysis provide support for psychosocial models to aid understanding of users' acceptance of private AVs. Practical applications: Examining acceptance of AVs after participants have experienced these vehicles on closed tracks or open roads would advance contemporary knowledge of users' intentions to use these vehicles in the future. Further, experiencing these vehicles firsthand may also help with addressing any perceived barriers reducing acceptance of future use of private AVs.

Hepatocellular ultrastructure after ischemia/reperfusion injury in human orthotopic liver transplantation.

The number of patients requiring organ transplants still outpaces the number of available transplantable organs. During the process of orthotopic liver transplantation (OLTx), donor organs undergo significant stress resulting from ischemia and reperfusion. Healthy organs respond to this stressful environment with compensatory mechanisms that ideally allow for complete recovery. However, "marginal" organs do not compensate as well. Hepatic steatosis typically renders an organ nontransplantable; a liver with 30% or more fat has a 25% chance of primary nonfunction (PNF) or graft failure after a technically sound operation. In this study, we report on the significant markers of cellular ultrastructural change in steatotic livers. These include glycogen content, mitochondrial swelling, and hepatocellular blebbing. The data disclosed here argue that further investigation of these factors in marginal organs subjected to I/R may better facilitate our understanding of PNF.

Surgical manipulation of the periorbital musculature.

This article presents a review of the contribution of the periorbital musculature and brow depressors to the overall brow aesthetics. Special focus is given to the role of transblepharoplasty brow lift as well as myotomy of the corrugator and procerus muscles. The authors' preferred surgical technique and patient results are reviewed in detail.

Latest chemical peel innovations.

For decades, chemical peels have remained a trusted option for treatment of aging facial skin. However, emerging technologies are being adopted by many practitioners who may not have had sufficient opportunity to learn the art of chemical peeling. Properly performed peels can improve the condition of the skin, are less expensive than light-based machines, and exfoliate the skin without the thermal damage associated with light-based machines. This article presents a new variation of a trusted method, using a series of low-strength trichloroacetic acid peels and proper skin preparation that is cost-effective and produces excellent results in selected patients.

Short-term administration of (-)-epigallocatechin gallate reduces hepatic steatosis and protects against warm hepatic ischemia/reperfusion injury in steatotic mice.

Hepatic steatosis increases the extent of cellular injury incurred during ischemia/reperfusion (I/R) injury. (-)-Epigallocatechin gallate (EGCG), the major flavonoid component of green tea (camellia sinensis) is a potent antioxidant that inhibits fatty acid synthase (FAS) in vitro. We investigated the effects of EGCG on hepatic steatosis and markers of cellular damage at baseline and after I/R injury in ob/ob mice. Animals were pretreated with 85 mg/kg EGCG via intraperitoneal (ip) injection for 2 days or oral consumption in the drinking water for 5 days before 15 minutes of warm ischemia and 24 hours of reperfusion. After EGCG administration, total baseline hepatic fat content decreased from baseline. Palmitic acid and linoleic acid levels also were reduced substantially in all ECGC-treated animals before I/R. Alanine aminotransferase (ALT) levels decreased in all EGCG-treated animals compared with control animals after I/R. Histologic analysis demonstrated an average decrease of 65% necrosis after EGCG administration. EGCG administration also increased resting hepatic energy stores as determined by an increase in cellular adenosine triphosphate (ATP) with a concomitant decrease in uncoupling protein 2 (UCP2) before I/R. Finally, there was an increased level of glutathione (GSH) in the EGCG-treated mice compared with the vehicle-treated mice both at baseline and after I/R. In conclusion, taken together, this study demonstrates that treatment with ECGC by either oral or ip administration, significantly protects the liver after I/R, possibly by reducing hepatic fat content, increasing hepatic energy status, and functioning as an antioxidant.

Development of an unbiased method for the estimation of liver steatosis.

BACKGROUND: Steatosis significantly contributes to an organ's transplantability. Livers with >30% fat content have a 25% chance of developing primary non-function (PNF). The current practice of evaluating a hematoxylin and eosin (H&E) stained donor biopsy by visual interpretation is subjective. We hypothesized that H&E staining of frozen sections fails to accurately estimate the degree of steatosis present within a given liver biopsy. To address this problem of evaluating steatosis in prospective donor organs, we developed a fast, user friendly computer methodology to objectively assess fat content based on the differential quantification of color pixels in Oil Red O (ORO) stained liver biopsies. METHODS: The accuracy of human visual estimation of fat content by H&E and ORO stains was compared with computer-based measurements of the same slides from 25 frozen sections of donor biopsies. RESULTS: Samples with a fat content >20% showed marked variation between human interpretation and computer analysis. There was also a significant difference in the human interpretation of fat based on the method of staining. This difference ranged from 3 to 37% with H&E. DISCUSSION: Use of ORO resulted in a more consistent estimation of liver steatosis compared with H&E, but human interpretations failed to correlate with computer measurements. Such differences in fat content estimations might result in the rejection of a potentially transplantable organ or the acceptance of a marginal one. Ideally, our protocol can rapidly be applied to clinical practice for accurate and consistent measurement of fat in liver sections for the ultimate purpose of increasing the number of successful transplantable organs.

Fatty acid synthase blockade protects steatotic livers from warm ischemia reperfusion injury and transplantation.

Cerulenin has been shown to reduce body weight and hepatic steatosis in murine models of obesity by inhibiting fatty acid synthase (FAS). We have shown that attenuating intrahepatocyte lipid content diminished the sensitivity of ob/ob mice to ischemia/reperfusion injury and improved survival after liver transplantation. The mechanism of action is by inhibition of fatty acid metabolism by downregulating PPARalpha, as well as mitochondrial uncoupling protein 2 (UCP2), with a concomitant increase in ATP. A short treatment course of cerulenin prior to I/R injury is ideal for protection of steatotic livers. Cerulenin opens the potential for expanding the use of steatotic livers in transplantation.

Anti-endotoxin monoclonal antibodies are protective against hepatic ischemia/reperfusion injury in steatotic mice.

Steatotic mice are particularly susceptible to hepatic ischemia/reperfusion injury compared with their lean littermates. We have previously demonstrated that livers of mice having a spontaneous mutation in the leptin gene (ob/ob), resulting in global obesity and liver steatosis, are ATP depleted, are endotoxin sensitive, and do not survive (I/R) injury. We hypothesize that administration of an anti-LPS monoclonal antibody (mAb) prior to initiation of I/R would be protective from that insult. Steatotic mice (ob/ob) were subjected to 15 min of ischemia via complete porta-hepatis occlusion and varying lengths of reperfusion with or without pre-treatment with an anti-LPS mAb. There was 14-31% survival of isotype matched control mAb treated ob/ob mice after 15 min of ischemia and 24 h of reperfusion. In contrast, 75-83% of ob/ob mice pre-treated with an anti-LPS mAb prior to initiation of I/R survived both ischemia and 24 h of reperfusion. Furthermore, there was a decrease in ALT and circulating endotoxin levels when treated with an anti-LPS mAb compared with control antibodies. Attenuation of the endotoxin load with anti-LPS mAb, prior to initiation of I/R, was cytoprotective and improved survival. Consequently, these studies might offer a solution to the problems associated with using steatotic livers in clinical transplantation.