Muir, Carlyn; Charlton, Judith L; Odell, Morris; Keeffe, Jill; Wood, Joanne; Bohensky, Megan; Fildes, Brian; Oxley, Jennifer; Bentley, Sharon; Rizzo, Matthew
Background Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. Methods A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field-related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. Results Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n=194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self-referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority’s Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. Conclusion The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be
The Kentucky Department of Vehicle Regulation is exploring the possibility of developing and implementing online : drivers license renewal. The objective of this project was to: 1) evaluate online drivers license and REAL ID renewal : programs ...
Okafor, I P; Odeyemi, K A; Dolapo, D C; Adegbola, A A
To determine the level of compliance with driver's license laws among commercial bus drivers in Lagos, Nigeria. Two intercity motor parks were selected by simple random sampling and all consenting minibus drivers participated in the study. Key Informant Interviews (KIIs) were also conducted with selected officials in the driver training and licensing authorities. Compliance with the minimum age for driving was high (93.6%), so also was having driving test prior to driver's license procurement (83.3%). Formal driver training and VA testing were very low, (26.1% and 32.9% respectively) Overall, only 9.3% of them were found to have fulfilled all the pre-license obligations before obtaining their first driver's license. The odds of a driver with a secondary education having formal driver training is 3.33 times higher than those with no education (OR 3.33, 95% CI 1.01-11.35). Drivers who were 60 years or older were 3.62 times more likely to be compliant than those who were between 20-29 years (OR 3.62, 95% CI 0.56-29.19). For the 98.3% of them who possessed valid licenses, 52.3% of them obtained them illegally. All the key officials saw RTIs as a serious public health problem but faced several challenges in the course of their work. Overall compliance with pre-license regulations was very poor. There is need for a review and strict enforcement of driver's license laws to improve compliance. Also vital are fostering inter-sectoral collaboration and improvement in the operations of all establishments involved in driver training and license procurement in Nigeria.
This is the second of three reports examining driver medical review practices in the United States and how : they fulfill the basic functions of identifying, assessing, and rendering licensing decisions on medically at-risk : drivers. This volume pre...
...-28480] Commercial Driver's License (CDL) Standards: Exemption AGENCY: Federal Motor Carrier Safety... commercial driver's license (CDL) as required by current regulations. FMCSA reviewed NAAA's application for... demonstrate alternatives its members would employ to ensure that their commercial motor vehicle (CMV) drivers...
Naz, Sehana; Scott-Parker, Bridie
Young novice drivers remain at greater risk of injury and death despite a wealth of interventions including graduated driver licensing (GDL) programs. The key to implementing safer practices inherent in GDL appears to lie with optimising the role of parents. This qualitative research explored the parent's perspectives of obstacles to engaging in the driver licensing process within a GDL program. Parents also shared advice on what they found helpful, and where relevant, recommended changes in the process to enable safer practices for young drivers. Twenty-three parents (aged 35-60 years, M=49.52, SD=8.01, 11 males) participated in semi-structured interviews regarding licensing experiences with their young driver children. The young drivers included learner (n=11), provisional (restricted/intermediate) (n=9) and open (unrestricted/full) licence drivers (n=3), ranging from 16 to 24 years (M=18.04, SD=2.21, 13 males). Content analysis revealed that most obstacles were encountered at the learner licensing phase, with the parent-reported difficult temperament of the learner driver the most prominent. Unsurprisingly, advice to other parents to be patient and remain calm featured heavily during the same phase. Anxiety from not having control of the vehicle was another obstacle at the learner phase, translating to anxieties for child safety in the early stages of provisional driving. Recommendations for the current GDL included more rigorous road rule testing, with general support for the program, professional driver training at learner and provisional stages facilitated parental engagement through the licensing phases. The findings overwhelmingly suggest a need for parents to be educated regarding their importance in, and of, the driver licensing process, and the efficacy of their instruction, content and practices. Copyright © 2016 Elsevier Ltd. All rights reserved.
Poirier, Brigitte; Blais, Etienne; Faubert, Camille
In keeping with the differential deterrence theory, this article assesses the moderating effect of license type on the relationship between social control and intention to violate road rules. More precisely, the article has two objectives: (1) to assess the effect of license type on intentions to infringe road rules; and (2) to pinpoint mechanisms of social control affecting intentions to violate road rules based on one's type of driver license (a restricted license or a full license). This effect is examined among a sample of 392 young drivers in the province of Quebec, Canada. Drivers taking part in the Graduated Driver Licensing (GDL) program have limited demerit points and there is zero tolerance for drinking-and-driving. Propensity score matching techniques were used to assess the effect of the license type on intentions to violate road rules and on various mechanisms of social control. Regression analyses were then conducted to estimate the moderating effect of license type. Average treatment effects from propensity score matching analyses indicate that respondents with a restricted license have lower levels of intention to infringe road rules. While moral commitment and, to a lesser extent, the perceived risk of arrest are both negatively associated with intentions to violate road rules, the license type moderates the relationship between delinquent peers and intentions to violate road rules. The effect of delinquent peers is reduced among respondents with a restricted driver license. Finally, a diminished capability to resist peer pressure could explain the increased crash risk in months following full licensing. Copyright © 2017 Elsevier Ltd. All rights reserved.
Waller, Patricia F.
Driver licensing, the only state program with the opportunity for routine personal contact with every driver, has unmatched potential for both general and specific countermeasures to the problem of drunk driving. General countermeasures apply to large groups of drivers prior to the occurrence of any infraction. They may be considered basically…
..., and 385 [Docket No. FMCSA-2007-27659] Commercial Driver's License Testing and Commercial Learner's... published a final rule titled ``Commercial Driver's License Testing and Commercial Learner's Permit... additional drivers, primarily those transporting certain tanks temporarily attached to the commercial motor...
Walsh, Matthew C; Trentham-Dietz, Amy; Palta, Mari
Although the percentage of US drivers with valid driver's licenses varies from state to state, it has historically been high enough to constitute a useful sampling frame for many public health purposes. Over the past decade, states have had to restrict access to this information to comply with the Driver's Privacy Protection Act (18 U.S.C. 2721-2725). In 2009 and 2010, the authors conducted a survey of all 50 states on the availability of master lists of licensed drivers to be used to contact citizens of each state for research purposes. A hypothetical situation requiring driver's license data was sent to each state's responsible government agency for review. In addition, the authors collected data on opt-out mechanisms available to drivers, costs to researchers, and additional state privacy policies pertaining to driver's license files. A total of 42 states (84%) responded; 16 (32%) states allowed access to data, 4 (8%) states were unable to respond to the hypothetical situation, and 22 (44%) states denied access to data. A total of 74,697,574 records were available from the 16 states providing driver's license data. Although the Driver's Privacy Protection Act has restricted access to data on licensed drivers, these data are still an available resource in many states.
Dobbs, Bonnie M
In less than 5 years, the first wave of baby boomers will begin turning 65, with the last wave of boomers entering their senior years in January 2029. Currently, boomers make up a significant percentage of the population in Canada, the United States, and other developed countries. The baby boom generation has had a profound impact on our society over the last six decades, and this large cohort will continue to exert its influence for several decades to come. Central to this article is the rapid growth in the number of persons 65 years of age and older, beginning in 2011, with a corresponding increase in the number of older drivers. The demographic shift has important implications for licensing authorities, the regulatory bodies charged with licensing and 'fitness to drive' decisions. The objectives of this paper are to summarize the published scientific literature on licensing policies and procedures currently in use for older drivers, discuss their limitations, and provide recommendations for meeting the upcoming challenges of an aging baby boomer population of drivers. Online searches were conducted using the following databases: PsycINFO, MEDLINE, Scopus, and TRIS. Google and Google Scholar also were searched for scientific articles. References identified from database and online searches were examined for relevant articles. A number of studies have investigated the utility of different licensing policies and procedures for identifying older drivers who may be at risk for impaired driving performance. Overall, results suggest that current policies and procedures are ineffective in identifying high-risk older drivers. The results also emphasize the need for a different approach for the identification of high risk older drivers by licensing agencies. Recommendations to assist with that goal are provided. The aging of the baby boomer population, combined with the projected high crash rates for this cohort of drivers as it moves through the senior years, underscores
Begg, Dorothy J; Langley, John D; Brookland, Rebecca L; Ameratunga, Shanthi; Gulliver, Pauline
The aim of this study was to determine whether pre-licence driving experiences, that is driving before beginning the licensing process, increased or decreased crash risk as a car driver, during the learner or the restricted licence stages of the graduated driver licensing system (GDLS). Study participants were 15-24 year old members of the New Zealand Drivers Study (NZDS) - a prospective cohort study of newly licensed car drivers. The interview stages of the NZDS are linked to, the three licensing stages of the GDLS: learner, restricted and full. Baseline demographic (age, ethnicity, residential location, deprivation), personality (impulsivity, sensation seeking, aggression) and, behavioural data, (including pre-licensed driving behaviour), were obtained at the learner licence interview. Data on distance driven and crashes that occurred at the learner licence and restricted licence stages, were reported at the restricted and full licence interviews, respectively. Crash data were also obtained from police traffic crash report files and this was combined with the self-reported crash data. The analysis of the learner licence stage crashes, when only supervised driving is allowed, was based on the participants who had passed the restricted licence test and undertaken the NZDS, restricted licence interview (n=2358). The analysis of the restricted licence stage crashes, when unsupervised driving is first allowed, was based on those who had passed the full licence test and completed the full licence interview (n=1428). After controlling for a range of demographic, personality, behavioural variables and distance driven, Poisson regression showed that the only pre-licence driving behaviour that showed a consistent relationship with subsequent crashes was on-road car driving which was associated with an increased risk of being the driver in a car crash during the learner licence period. This research showed that pre-licensed driving did not reduce crash risk among learner or
... [Docket No. FMCSA-2007-27659] RIN 2126-AB59 Commercial Driver's License Testing and Commercial Learner's.... The 2011 final rule amended the commercial driver's license (CDL) knowledge and skills testing standards and established new minimum Federal standards for States to issue the commercial learner's permit...
... [Docket No. FMCSA-2007-27659] RIN 2126-AB02 Commercial Driver's License Testing and Commercial Learner's... effective on July 8, 2011. That final rule amended the commercial driver's license (CDL) knowledge and skills testing standards and established new minimum Federal standards for States to issue the commercial...
Alpena Community Coll., MI.
The Alpena Community College (ACC) Drivers Education Program was developed to deliver a basic skills program providing specific job-related basic skills instruction to approximately 300 workers throughout Michigan who desired to pass the Commercial Drivers License (CDL) examination. Other program goals were to establish greater partnerships…
California State Dept. of Motor Vehicles, Sacramento.
The development of a 6-hour motorcycle course of instruction for personnel responsible for motorcycle licensing is described in this project report. The primary goals are stated and include (1) training driver licensing personnel in motorcycle safety and principles of operation, and (2) purchasing and installing appropriate motorcycle skill…
... 6 Domestic Security 1 2010-01-01 2010-01-01 false Machine readable technology on the driver's..., Verification, and Card Issuance Requirements § 37.19 Machine readable technology on the driver's license or identification card. For the machine readable portion of the REAL ID driver's license or identification card...
Kentucky uses federally funded, time-limited (FFTL) employees to handle some of the administrative work necessary to : meet federal compliance standards for commercial drivers licenses (CDLs). The Federal Motor Carrier Safety : Administration (FMC...
... [Docket No. FMCSA-2007-27659] RIN 2126-AB02 Commercial Driver's License Testing and Commercial Learner's..., 2011, that will be effective on July 8, 2011. This final rule amends the commercial driver's license... to issue the commercial learner's permit (CLP). Since the final rule was published, FMCSA identified...
... America-Domiciled Carriers § 385.605 New entrant registration driver's license and drug and alcohol... carrier must subject each of the drivers described in paragraph (a) of this section to drug and alcohol... 49 Transportation 5 2010-10-01 2010-10-01 false New entrant registration driver's license and drug...
Tefft, Brian C; Williams, Allan F; Grabowski, Jurek G
Motor vehicle crashes are the leading cause of death for teens and young adults in the United States. Graduated driver licensing (GDL) systems were designed to protect young novice drivers by limiting their exposure to specific risks while they gain experience driving. In the United States, most states' GDL systems only apply to new drivers younger than 18. Some experts suggest that GDL might encourage young people to wait until age 18 to obtain a license, to avoid GDL requirements, resulting in older teenagers having less driving experience and higher crash risk than they might have had without GDL. This study examined the prevalence and timing of licensure among young adults, and explored factors associated with delaying licensure among those not licensed before age 18. An online questionnaire was completed by 1,039 persons aged 18-20 years, recruited from a representative panel of United States households. Main outcome measures were acquisition of driver's license (a) within 12 months of the state minimum age for licensure, (b) before age 18. Associations of timing of licensure with demographic characteristics were assessed using multivariable logistic regression. Respondents not licensed before age 18 were asked to rate the importance of various possible reasons for delaying licensure. 54% of respondents were licensed before age 18. Blacks (37%; adjusted Prevalence Ratio 0.67, 95% Confidence Interval 0.48-0.93) and Hispanics (29%; adjusted Prevalence Ratio 0.60, 95% Confidence Interval 0.45-0.81) were less likely than non-Hispanic whites (67%) to be licensed before age 18. Lower household income was independently associated with delayed licensure (P self-reported reasons for not becoming licensed sooner were not having a car, being able to get around without driving, and costs associated with driving. There was little evidence that GDL is a major contributor to delayed licensure; however, a substantial minority of young people do not obtain a driver
National Highway Traffic Safety Administration (DOT), Washington, DC.
This manual explains what graduated driver licensing (GDL) is and why the National Highway Traffic Safety Administration believes it is so important for every jurisdiction to take steps towards its implementation. Section I introduces the need by defining the teen driving problem: inexperience, risk-taking behavior and immaturity, and greater risk…
McCartt, Anne T; Oesch, Nathan J; Williams, Allan F; Powell, Tara Casanova
On May 1, 2010, New Jersey implemented a law requiring teenagers with learner's permits or probationary licenses to display reflective decals on the front and rear license plates when they drive. The current study examined attitudes of parents and teenagers toward this requirement, use of decals, and reported violations and police enforcement of the graduated driver license law. Statewide telephone surveys of representative samples of parents and teenagers were conducted in February to April 2010 and March to June 2011. Use of decals among probationary license holders was observed at 4 high schools in fall 2010 and in spring 2011 and hand-out surveys were distributed. Data on citations issued for violations of the graduated driver license law were obtained. When interviewed in spring 2011, a large majority of parents of probationary license holders, parents of learner's permit holders, and teenagers with probationary licenses disapproved of decals for probationary licenses. About two thirds of both sets of parents and about half of teenagers disapproved of decals for learner's permits. Support for decals for both license types declined significantly from 2010 to 2011. For parents and teenagers alike, opposition was mainly attributed to concern about identifying and/or targeting teenage drivers by other drivers, predators, or police. In 2011, 77 percent of parents of probationary license holders said that their teenagers had decals for the vehicles driven most often; 46 percent said their teenagers always used decals. Fifty-six percent of parents of learner's permit holders said that their teenagers had decals for the vehicles driven most often; 37 percent said that their teenagers always used decals. Teenagers' reported violations of license restrictions either increased or were similar in 2011 compared to 2010. Observed rates of decal use by probationary license holders at high schools in spring 2011 ranged from 24 to 64 percent. The number of statewide citations
Siren, Anu Kristiina; Haustein, Sonja
Objectives: Driving cessation is a gradual process, where driver’s self-regulation plays an important role. Age-based license renewal procedures may interfere with this process and trigger premature driving cessation. The present study compares drivers aged 69 years at the baseline who either renewed their driver’s license (“renewers”) or did not (“non-renewers”) over a two-year period.Methods: Data were collected by interviewing a sample of older Danish people in 2009 (n = 1,792) and in 2012...
Tefft, Brian C; Williams, Allan F; Grabowski, Jurek G
Background Motor vehicle crashes are the leading cause of death for teens and young adults in the United States. Graduated driver licensing (GDL) systems were designed to protect young novice drivers by limiting their exposure to specific risks while they gain experience driving. In the United States, most states? GDL systems only apply to new drivers younger than 18. Some experts suggest that GDL might encourage young people to wait until age 18 to obtain a license, to avoid GDL requirements...
Carr, David B; O'Neill, Desmond
Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients' fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients' social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.
Preusser, David F.; And Others
The relationship of driver licensure rate to 16-year-old lifestyles was assessed in three states: Michigan (where 56% of 16-year-olds are licensed), New York (14% licensure), and New Jersey (2% licensure). For the most part, the differences in 16-year-old licensure and mobility were not reflected in lifestyle differences. (KH)
Preusser, D F; Leaf, W A; Ferguson, S A; Williams, A F
High school students were surveyed every 6 months from their freshman through senior years concerning licensing, driving, and transportation to and from their various activities. Students in Delaware (learner's permit can be issued at age 15 years, 10 months; driver's license at age 16) were compared with students in Connecticut and New York (permit at age 16; license at age 16) and in New Jersey (license at age 17). During the junior year, most Delaware students, some New York and Connecticut students, and few New Jersey students were licensed. However, even during the junior year, students in the respective states did not differ significantly with respect to time spent at activities such as a paying job, homework, watching television, dating, parties, being with friends, talking on the phone, or participating in sports or school activities. Graduated licensing systems can delay full-privilege teenage licensure and reduce teenage crash rates. These systems also can increase the number of times parents and others must drive. However, the present study's results indicate that licensing delays of as much as 1 year have minimal effects on the nondriving activities of high school students.
Siren, Anu Kristiina; Haustein, Sonja
Objectives: Driving cessation is a gradual process, where driver’s self-regulation plays an important role. Age-based license renewal procedures may interfere with this process and trigger premature driving cessation. The present study compares drivers aged 69 years at the baseline who either...... should try to prevent unwarranted mobility loss. Licensing policies signaling that in old age continuing to drive is an exception rather than the rule may work against this goal....... renewed their driver’s license (“renewers”) or did not (“non-renewers”) over a two-year period. Methods: Data were collected by interviewing a sample of older Danish people in 2009 (n = 1,792) and in 2012 (n = 863). The standardized interviews covered respondents’ background information, health and well...
This is the third of three reports examining driver medical review practices in the United States and how : they fulfill the basic functions of identifying, assessing, and rendering licensing decisions on medically or : functionally at-risk drivers. ...
Porter, Dawn M; Miller, Beverly K; Mullins, Samantha H; Porter, Mary E; Aitken, Mary E
Motor vehicle crashes are the leading cause of death for teens 14-19 years of age, with younger teen drivers at higher risk than older teens. Graduated driver licensing has been proven to reduce teen driver-related motor vehicle crashes and fatalities. Arkansas allows parents to request age waivers, which allow a teen to obtain a license for independent driving before the sixteenth birthday. The objectives of this study were to: (1) determine the prevalence of age waivers issued in Arkansas and (2) determine motor vehicle crash risks associated with 14 and 15 year old drivers. This is a brief report on an informative query exploring risk factors related to age waivers. Publicly available databases were utilized for across state comparisons. The Web-based Injury Statistics Query and Reporting Systems (WISQARS) was utilized to calculate motor vehicle crash crude death rates. National Highway Traffic Safety Administration data were utilized to identify seat belt use rates. The Fatal Analysis Reporting System (FARS) was utilized to identify crash fatality risks for 14 and 15 year old drivers in Arkansas (N = 24). Age waiver data were obtained from the Arkansas Driver Control Administration. De-identified data on fatal crashes and rates of age waiver issuance in Arkansas for 14 and 15 year olds from 2004 through 2016 were calculated. We reviewed crash data for 14 and 15 year old drivers in Arkansas between 2004 and 2014 to determine fatality risks. Thirty-one out of seventy-five counties in Arkansas were above the state age waiver issuance rate of 30.4 per 1000 14 to 15 year old teens. Among the four states that had similar age waivers for 14 to 15 year olds, Arkansas had the highest motor vehicle death rate of 10.2 per 100,000 young teens and the lowest seat belt use rate at 73%. Arkansas had the highest reported teen crash fatality rates among 4 states with age waivers. The volume of age waivers issued in Arkansas is concerning. Further research is needed
Siren, Anu Kristiina; Haustein, Sonja
This study focuses on the decision to either stop or continue driving among a cohort of Danish seniors whose driving licenses expire, for the first time, at the age of 70. Based on 1,537 standardized telephone interviews with licensed drivers, we compared persons who intended to renew or not to r...
Graduated driver licensing (GDL) programs in the United States do not represent a single homogeneous intervention; rather, they contain different combinations and variations of program components. Programs vary by the duration of each stage of the GD...
Vincent, Claude; Lachance, Jean-Paul; Deaudelin, Isabelle
This study sought to compare road safety of new drivers with low vision who have followed a specific pilot bioptic training program with other groups of drivers all matched for age and driving experience. A quasi-experimental design was used two years after drivers obtained their license. Drivers were classified in the experimental group (n = 10,…
This project examines the effects of age, experience, and video-based feedback on the rate and type of safety-relevant events captured on video event : recorders in the vehicles of three groups of newly licensed young drivers: : 1. 14.5- to 15.5-year...
... Driver's license or identification card number. This cannot be the individual's SSN, and must be unique... University Street, Montreal, Quebec, Canada H3C 5H7, e-mail: [email protected] You may inspect a copy of the...
This report is the first of three examining driver medical review practices in the United States and how they fulfilled the basic functions of identifying, assessing, and rendering licensing decisions on medically at-risk drivers. The aim was not to ...
McCartt, Anne T; Teoh, Eric R
This study examined U.S. teenagers' crash rates since 1996, when the first graduated driver licensing (GDL) program in the United State was implemented. Passenger vehicle driver crash involvement rates for 16-19 and 30-59 (middle-aged) year-olds were examined, using data from the Fatality Analysis Reporting System, National Automotive Sampling System General Estimates System, Census Bureau, and National Household Travel Surveys. Per capita fatal and police-reported crash rates in 2012 were lower for 16year-olds than for middle-aged drivers but older teenagers' rates were higher. Mileage-based fatal and police-reported crash rates in 2008 were higher for teenagers than for middle-aged drivers and higher for 16-17year-olds than for older teenagers. In 1996-2012, teenagers' per capita fatal and police-reported crash rates declined sharply, especially for 16-17year-olds, and more so than for middle-aged drivers. Substantial declines also occurred in teenagers' mileage-based fatal and police-reported crash rates from 1995-96 to 2008, generally more so than for middle-aged drivers. Regarding factors in fatal crashes in 1996 and 2012, proportions of young teenagers' crashes occurring at night and with multiple teenage passengers declined, more so than among older teenagers and middle-aged drivers. The proportion of fatally injured drivers who had been drinking declined for teenagers but changed little for middle-aged drivers. Improvements were not apparent in rates of driver errors or speeding among teenage drivers in fatal crashes. Teenage drivers' crash risk dropped during the period of implementation of GDL laws, especially fatal crash types targeted by GDL. However, teenagers' crash risk remains high, and important crash factors remain unaddressed by GDL. Although this study was not designed to examine the role of GDL, the results are consistent with the increased presence of such laws. More gains are achievable if states strengthen their laws. Copyright © 2015
Castillo-Manzano, José I; Castro-Nuño, Mercedes; Pedregal, Diego J
This article seeks to quantify the effects of the penalty points system driver's license during the 18-month period following its coming into force. This is achieved by means of univariate and multivariate unobserved component models set up in a state space framework estimated using maximum likelihood. A detailed intervention analysis is carried out in order to test for the effects and their duration of the introduction of the penalty points system driver's license in Spain. Other variables, mainly indicators of the level of economic activity in Spain, are also considered. Among the main effects, we can mention an average reduction of almost 12.6% in the number of deaths in highway accidents. It would take at least 2 years for that effect to disappear. For the rest of the safety indicator variables (vehicle occupants injured in highway accidents and vehicle occupants injured in accidents built-up areas) the effects disappeared 1 year after the law coming into force. Copyright 2010 Elsevier Ltd. All rights reserved.
Curry, Allison E.; Yerys, Benjamin E.; Huang, Patty; Metzger, Kristi B.
Driving may increase mobility and independence for adolescents with autism without intellectual disability (autism spectrum disorder); however, little is known about rates of licensure. To compare the proportion of adolescents with and without autism spectrum disorder who acquire a learner's permit and driver's license, as well as the rate at…
Full Text Available Purpose. Alzheimer’s disease (AD and dementia with Lewy Bodies (DLB constitute two of the most common forms of dementia in North America. Driving is a primary means of mobility among older adults and the risk of dementia increases with advanced age. The purpose of this paper is to describe the cognitive profile of licensed drivers with mild AD and mild DLB. Method. Licensed drivers with mild AD, mild DLB, and healthy controls completed neuropsychological tests measuring general cognition, attention, visuospatial/perception, language, and cognitive fluctuations. Results. The results showed differences between healthy controls and demented participants on almost all neuropsychological measures. Participants with early DLB were found to perform significantly worse on some measures of attention and visuospatial functioning in comparison with early AD. Discussion. Future research should examine the relationship between neuropsychological measures and driving outcomes among individuals with mild AD and mild DLB.
Meuser, Thomas M; Berg-Weger, Marla; Niewoehner, Patricia M; Harmon, Annie C; Kuenzie, Jill C; Carr, David B; Barco, Peggy P
This article details a systematic review of medical evaluation forms in support of licensing decisions for medically at-risk drivers. Comparisons were made between all-inclusive forms utilized by 52 State and Provincial Departments of Motor Vehicles (DMVs) in the US and Canada. Comparisons focused on length, format, content, instructional quality, medical coverage, ease of use, and other qualitative characteristics. Median page length was 2 (range 1-10), and mean word count was 1083 (494-3884). Common response options included open-ended (98%), forced choice (87%), and check box (81%). While the majority of forms (77%) required driver consent, only 24% requested information from the driver. Less than half (46%) included text on confidentiality protection. While all forms requested general medical information, just over half included specific sections for vision (54%) and cognitive/neurological conditions (56%). Most forms (81%) required that a judgment be made concerning driver safety, and half prompted for possible license restrictions. Criterion-based quality ratings were assigned on a five-point Likert scale by group consensus. One third of forms were rated as marginal or poor in comprehensiveness and utility, and just two garnered an excellent overall rating. Findings are discussed relative to current research on driver fitness and elements of a proposed model form. Best practice recommendations include a page length limitation, emphasis on in-person evaluation (i.e., as opposed to a records-only review), prompts to collect crash and other driving history information, clear instructions and stepwise format, content prompts across relevant medical categories, documentation of functional status and impairment levels, options for driving with restrictions in lieu of de-licensing, and emphasis on relative (vs. absolute) clinical judgments of overall driver safety. Copyright © 2011 Elsevier Ltd. All rights reserved.
Potvin, Louise; And Others
1983 legislation making driver training courses mandatory for any person in Quebec seeking a first driver's license had no effect on the risk of accident or the mortality/morbidity rate for newly licensed drivers over 18. However, since 1983 more women under 18 are becoming licensed, and their risks may be increased. (Author/BJV)
The first six months of unsupervised driving are the most : hazardous in a novice drivers driving experience. Most : States adopted graduated driver licensing (GDL) systems : to give novice drivers experience in a protective environment, : gradual...
Bonander, Carl; Andersson, Ragnar; Nilson, Finn
This study aimed to evaluate and quantify the effect of the introduction of the AM driving license on non-fatal moped-related injuries in Sweden. With the introduction of the new license category in October 2009, prospective moped drivers are now required to pass a mandatory theory test following a practical and theoretical course. In addition, obtaining a license to operate a moped is now considerably more costly. Time series intervention analysis on monthly aggregated injury data (1st Jan 2007-31st Dec 2013) was performed using generalized additive models for location, shape and scale (GAMLSS) to quantify the effect size on injury events involving teenage (15-17 years) moped drivers, while controlling for trend and seasonality. Exposure was adjusted for by using the number of registered mopeds in traffic as a proxy. The introduction of AM license was associated with a 41% reduction in the rate of injury events involving 15-year-old moped drivers (IRR 0.59 [95% CI: 0.48-0.72]), and a 39% and 36% decrease in those involving 16-year-old (IRR 0.61 [95% CI: 0.48-0.79]) and 17-year-old drivers (IRR 0.64 [95% CI: 0.46-0.90]), respectively. The effect in the 15-year-old stratum was decreased roughly by half after adjusting for exposure, but remained significant, and the corresponding estimates in the other age groups did not change noticeably. This study provides quasi-experimental evidence of an effect on non-fatal moped-related injuries as a result of stricter licensing rules. Only part of the effect could be explained by a reduction in the number of mopeds in traffic, indicating that other mechanisms must be studied to fully understand the cause of the reduction in injuries. Copyright © 2015 Elsevier Ltd. All rights reserved.
Evans, Kelly A; Yap, Tracey; Turner, Barbara
Obstructive sleep apnea (OSA) is a disorder characterized by a cessation of breathing during sleep, leading to poor sleep patterns and daytime somnolence. Daytime somnolence is of particular concern for commercial vehicle drivers, whose crash risk increases 50% with untreated OSA. The process of diagnosing and treating OSA in commercial drivers begins with effective and consistent screening. Therefore, the researchers screened drivers with both the STOP-Bang Questionnaire and the Obstructive Sleep Apnea Evaluation Worksheet (OSAEW) and compared the two tools. Drivers screening positive on the STOP-Bang Questionnaire, OSAEW, and both questionnaires were 28%, 23%, and 13%, respectively. Sleep study referrals were made for 50 drivers; 12 drivers were scheduled for sleep tests within 3 months. Health care provider referral rates for drivers screening at high risk (37%) and commercial driver monitoring rates (24%) were both low. Recommendations to improve OSA screening and testing practices include Federal Motor Carrier Safety Administration-mandated screening and referral guidelines, employee-facilitated sleep testing, and OSA awareness campaigns.
Hakamies-Blomqvist, L. Sirén, A. & Davidse, R.J.
The proportion of senior citizens (aged 65+) will grow from about 15 per cent in the year 2000 to about 30 per cent in the year 2050. The share of older drivers in the driver population will grow even faster because of increasing licensing rates among the ageing population. Older drivers do not have
Sharpe, G; Durham, J A; Preshaw, P M
To examine the attitudes of dental practitioners towards specialist periodontal referral in the North East of England. Semi-structured interviews were conducted with a purposive sample of 10 practitioners. Interviews continued until data saturation occurred. The data were organised using a framework and analysed by two researchers working independently. Perceptions of periodontal disease and treatment appear to be heavily influenced by the NHS remuneration system. Treatment in general practice was limited to simple scaling and there was an apparent reluctance to treat advanced periodontitis. Such cases were commonly referred to specialists, confirming the demand for a referral service in periodontics. The perceived potential for medico-legal consequences was a strong driver of referrals. Distance to the referral centre and the perceived costs of treatment were significant barriers to referral. Dentists valued the specialist's personal reputation and clinical skills more highly than academic status. Deficiencies in communication between primary and secondary care were highlighted. Increased resources are required to manage periodontal diseases within the NHS. There is a need for a periodontal referral service in the North East of England to improve accessibility to specialist care. This would appear to be most appropriately delivered by increased numbers of specialist practitioners.
... Cook Mr. Cook holds a driver's license from Virginia. He would like to drive a CMV in interstate.... Thomas Prickett Mr. Prickett holds a driver's license from Minnesota. He would like to drive a CMV in...
Pressley, Joyce C; Benedicto, Camilla B; Trieu, Lisa; Kendig, Tiffany; Barlow, Barbara
To assess the relation between strength of graduated driver licensing (GDL) laws and motor vehicle (MV) injury burden, this study examined injury mortality, hospitalizations and related charges for 15 year to 17 year olds in 36 states by strength of GDL legislation. Data sources include the CDC's Web-Based Injury Statistics Query and Reporting System (WISQARS) and the 2003 Healthcare Cost and Utilization Kids' Inpatient database (KID). Hospital admissions for injuries in 15 year to 17 year olds (n = 49,520) are unweighted. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores. The Insurance Institute for Highway Safety rating system was used to categorize legislative strength: good, fair, marginal/poor, and none. Logistic regression was used to assess independent predictors of MV injury. MV injury accounted for 14.6% of all-cause injury-related hospital admissions with 47.7% classified as drivers. Total MV occupant mortality was 14.6% lower after enactment of GDL with greater improvement observed in the good law category (26.0%). In multivariate models for hospitalized injury, all GDL law categories were protective for MV driver injury in 16 year olds. Compared with whites, black and Hispanic teens were more frequently injured as passengers than drivers. The contribution of MV occupant to all-cause injury-related hospital charges was 16.0% lower in good versus no-GDL categories and 39.5% lower for MV drivers. These findings suggest that the presence of any GDL legislation is associated with a lower burden of MV-related injury and expenditures with the largest differences observed for 16-year-old drivers.
Significant changes in Oregons teen licensing laws went into effect on March 1, 2000. The new laws expanded the provisional driving license program which had been in effect since October 1989 and established a graduated driver licensing (GDL) prog...
Long years of driving [AOR =4.6 (95%CI, 1.6-12.9)], involvement in a similar activity prior to becoming taxi driver .... full time taxi driver; produce a valid driving license; .... Self-employee .... professional car drivers in Dhaka city, Bangladesh.
Okafor Ifeoma, P; Odeyemi Kofoworola, A; Dolapo Duro, C
Road traffic injuries have persisted as a serious public health problem and much of the health burden is in developing countries. Over-speeding, poor enforcement of traffic regulations and commuter buses have been highly implicated in road traffic injuries in developing countries. The aim of this study was to determine drivers' knowledge of selected road safety measures, i.e. the pre-requisites for driver's license, road signs and speed limits. This was a cross-sectional study carried out in Lagos, Nigeria. Simple random sampling was used to select the two motor parks used for the study and all the consenting commercial minibus drivers operating within the parks (407) were included in the study. Data was collected with a pre-tested, structured, interviewer-administered questionnaire and analyzed with epi-info statistical software. Two hundred and sixty-one (64.1%) of them knew that Visual Acuity test should be done before obtaining driver's license and 53.8% knew the correct minimum age for obtaining driver's license. Only 1% of the drivers had correct knowledge of the driver's license authorities in Nigeria. The drivers had poor knowledge of road signs (59.0%) and poor knowledge of maximum speed limits (100%). The oldest, least educated and least experienced drivers had the poorest level of knowledge. The drivers demonstrated poor knowledge of road safety measures. There is need for driver education to improve their knowledge.
Begg, Dorothy; Brookland, Rebecca; Connor, Jennie
The objective of this study was to describe self-reported high alcohol use at each of the 3 licensing stages of graduated driver licensing and its relationship to drink-driving behaviors, intentional risky driving, aggressive driving, alcohol traffic offenses, non-alcohol traffic offenses, and traffic crashes. The New Zealand Drivers Study (NZDS) is a multistage, prospective cohort study of newly licensed drivers interviewed at all 3 stages of the graduated driver licensing system: learner (baseline), restricted (intermediate), and full license. At each stage, alcohol use was self-reported using the Alcohol Use Disorders Identification Test (AUDIT-C), with high alcohol use defined as a score of ≥4 for males and ≥3 for females. Sociodemographic and personality data were obtained at the baseline interview. Alcohol-related, intentional risky, and aggressive driving behaviors were self-reported following each license stage. Traffic crashes and offenses were identified from police records. Crashes were also self-reported. Twenty-six percent (n = 397) reported no high alcohol use, 22% at one license stage, 30% at 2 stages, and 22% at 3 stages. Poisson regression results (unadjusted and adjusted) showed that the number of stages where high alcohol use was reported was significantly associated with each of the outcomes. For most outcomes, and especially the alcohol-involved outcomes, the relative risk increased with the number of stages of high alcohol use. We found that high alcohol use was common among young newly licensed drivers and those who repeatedly reported high alcohol use were at a significantly higher risk of unsafe driving behaviors. Recently introduced zero blood alcohol concentration (BAC) should help to address this problem, but other strategies are required to target persistent offenders.
Karaca-Mandic, Pinar; Ridgeway, Greg
Graduated Driver Licensing (GDL) is a critical policy tool for potentially improving teenage driving while reducing teen accident exposure. While previous studies demonstrated that GDL reduces teenage involvement in fatal crashes, much remains unanswered. We explore the mechanisms through which GDL influences accident rates as well as its long term effectiveness on teen driving. In particular, we investigate; 1) whether GDL policies improve teenage driving behavior, or simply reduce teenage prevalence on the roads; 2) whether GDL exposed teens become better drivers in later years. We employ a unique data source, the State Data System, which contains all police reported accidents (fatal and non-fatal) during 1990–2005 for twelve states. We estimate a structural model that separately identifies GDL s effect on relative teenage prevalence and relative teenage riskiness. Identification of the model is driven by the relative numbers of crashes between two teenagers, two adults, or a teenager and an adult. We find that the GDL policies reduce the number of 15–17 year-old accidents by limiting the amount of teenage driving rather than by improving teenage driving. This prevalence reduction primarily occurs at night and stricter GDL policies, especially those with nighttime driving restrictions, are the most effective. Finally, we find that teen driving quality does not improve ex-post GDL exposure. PMID:19942310
Brijs, Kris; Cuenen, Ariane; Brijs, Tom; Ruiter, Robert A C; Wets, Geert
The disproportionately large number of traffic accidents of young novice drivers highlights the need for an effective driver education program. The Goals for Driving Education (GDE) matrix shows that driver education must target both lower and higher levels of driver competences. Research has indicated that current education programs do not emphasize enough the higher levels, for example awareness and insight. This has raised the importance of insight programs. On the Road (OtR), a Flemish post-license driver education program, is such an insight program that aims to target these higher levels. The program focus is on risky driving behavior like speeding and drink driving. In addition, the program addresses risk detection and risk-related knowledge. The goal of the study was to do an effect evaluation of this insight program at immediate post-test and 2 months follow-up. In addition, the study aimed to generalize the results of this program to comparable programs in order to make usable policy recommendations. A questionnaire based on the Theory of Planned Behavior (TPB) was used in order to measure participants' safety consciousness of speeding and drink driving. Moreover, we focused on risk detection and risk-related knowledge. Participants (N=366) were randomly assigned to a baseline-follow-up group or a post-test-follow-up group. Regarding speeding and driving, we found OtR to have little effect on the TPB variables. Regarding risk detection, we found no significant effect, even though participants clearly needed substantial improvement when stepping into the program. Regarding risk-related knowledge, the program did result in a significant improvement at post-test and follow-up. It is concluded that the current program format is a good starting point, but that it requires further attention to enhance high level driving skills. Program developers are encouraged to work in a more evidence-based manner when they select target variables and methods to influence
Bonham, Jennifer; Johnson, Marilyn
In Australia, the increasing public profile and policy interest in cycling contrasts with variable cycling participation rates across jurisdictions (Australian Bicycle Council, 2017) and lack of cyclist-specific infrastructure. Cyclists and drivers often share road space, usually without indication from the built environment about how to maximise each other's safety and utility. Yet despite this regular interaction, cyclists are largely absent from the driver licensing process in Australia. That is, novice drivers are not taught how to share the road with cyclists. This case study used a mixed methods approach to examine the cyclist-related content in the Graduated Driver Licensing System (GDLS) in the Australian Capital Territory (ACT). The case study was conducted in four stages: 1) content analysis of all documents used through the GDLS; 2) observations of the Road Ready course and learner driver lessons; 3) online survey; and, 4) semi-structured interviews. Cyclists are rarely mentioned in the GDLS in the ACT and references often constructed cyclists as problematic or were based in instructors' personal opinion (rather than scripted responses). Outcomes from this study have directly informed a new vulnerable road user driver licence competency in the ACT and findings include recommendations for greater inclusion of cyclists in the driver licensing system. Copyright © 2017 Elsevier Ltd. All rights reserved.
Department of Transportation — Information regarding individuals who have had their driver licenses revoked, suspended or otherwise denied for cause, or who have been convicted of certain traffic...
Toledo, Tomer; Lotan, Tsippy; Taubman-Ben-Ari, Orit; Grimberg, Einat
Young drivers in Israel, as in other parts of the world, are involved in car crashes more than any other age group. The graduated driver licensing system in Israel requires that all new drivers be accompanied by an experienced driver whenever they drive for the first 3 months after obtaining a driving license. In an effort to make the accompanied driving phase more effective, a novel program which targets both young drivers and their parents was initiated in 2005. The program administers a personal meeting with the young driver and the accompanying parent scheduled for the beginning of the accompanied driving phase. In this meeting guidance is given regarding best practices for undertaking the accompanied driving, as well as tips for dealing with in-vehicle parent-teen dynamics. Through 2008, almost 130,000 families of young drivers have participated in the program. In order to evaluate the effectiveness of the program, injury crash records of the young drivers who participated in the program were compared with those of all other young drivers that were licensed at the same time period. The results obtained indicate statistically significant lower crash records for young drivers that participated in the program. Limitations of the evaluation related to self-selection biases are discussed, and practical implications are suggested. Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available Older drivers are frequently viewed as overly represented in crashes, particularly when crash involvement per distance travelled is considered. This perception has led to a call for tighter licensing conditions for older drivers, a policy which inevitably results in mobility restrictions for at least some drivers. However there is a growing body of research evidence which shows that as a group, older drivers represent no greater road risk than drivers from other age groups once different levels of driving activity are taken into account. This paper has examined aspects of older drivers' fitness to drive based on survey data and off-road and on-road driving performance from a sample of 905 New Zealand older drivers. The results show that policies which target all older drivers and lead to licensing and mobility restrictions cannot be justified from a safety basis.
Chang, Hsin-Li; Woo, T Hugh; Tseng, Chien-Ming; Tseng, I-Yen
This study explored the driving behaviors and crash risk of 768 drivers who were under administrative lifetime driver's license revocation (ALLR). It was found that most of the ALLR offenders (83.2%) were still driving and only a few (16.8%) of them gave up driving completely. Of the offenders still driving, 67.6% experienced encountering a police roadside check, but were not detained or ticketed by the police. Within this group, 50.6% continued driving while encountering a police check, 18.0% of them made an immediate U-turn and 9.5% of them parked and exited their car. As to crash risk, 15.2% of the ALLR offenders had at least one crash experience after the ALLR had been imposed. The results of the logistic regression models showed that the offenders' crash risk while under the ALLR was significantly correlated with their personal characteristics (personal income), penalty status (incarceration, civil compensation and the time elapsed since license revocation), annual distance driven, and needs for driving (working, commuting and driving kids). Low-income offenders were more inclined to have a crash while driving under the ALLR. Offenders penalized by being incarcerated or by paying a high civil compensation drove more carefully and were less of a crash risk under the ALLR. The results also showed there were no differences in crash risk under the ALLR between hit-and-run offences and drunk driving offences or for offenders with a professional license or an ordinary license. Generally, ALLR offenders drove somewhat more carefully and were less of a crash risk (4.3 crashes per million km driven) than legal licensed drivers (23.1 crashes per million km driven). Moreover, they seemed to drive more carefully than drivers who were under short-term license suspension/revocation which previous studies have found. Copyright © 2011 Elsevier Ltd. All rights reserved.
Moafian, Ghasem; Aghabeigi, Mohammad-Reza; Heydari, Seyed Taghi; Hoseinzadeh, Amin; Lankarani, Kamran Bagheri; Sarikhani, Yaser
Road traffic accident (RTA) and its related injuries contribute to a significant portion of the burden of diseases in Iran. This paper explores the association between driver-related factors and RTA in the country. This cross-sectional study was conducted in Iran and all data regarding RTAs from March 20, 2010 to June 10, 2010 were obtained from the Traffic Police Department. We included 538 588 RTA records, which were classified to control for the main confounders: accident type, final cause of accident, time of accident and driver-related factors. Driver-related factors included sex, educational level, license type, type of injury, duration between accident and getting the driving license and driver's error type. A total of 538 588 drivers (91.83% male, sex ratio of almost 13:1) were involved in the RTAs. Among them 423 932 (78.71%) were uninjured; 224 818 (41.74%) had a diploma degree. Grade 2 driving license represented the highest proportion of all driving licenses (290 811, 54.00%). The greatest number of accidents took place at 12:00-13:59 (75 024, 13.93%). The proportion of drivers involved in RTAs decreased from 15.90% in the first year of getting a driving license to 3.13% after 10 years'of driving experience. Neglect of regulations was the commonest cause of traffic crashes (345 589, 64.17%). Non-observance of priority and inattention to the front were the most frequent final causes of death (138 175, 25.66% and 129 352, 24.02%, respectively). We found significant association between type of accident and sex, education, license type, time of accident, final cause of accident, driver's error as well as duration between accident and getting the driving license (all P less than 0.001). Our results will improve the traffic law enforcement measures, which will change inappropriate behavior of drivers and protect the least experienced road users.
Messner, Richard A.; Hludik, Frank; Crowley, Todd A.; Vidacic, Dragan; Stetson, Barrett; Nadel, Lawrence D.; Nichols, Linda J.; Harris, Carol
This paper describes the results of a collaborative effort between the University of New Hampshire (UNH) and the Mitretek Systems (MTS) Center for Criminal Justice Technology (CCJT). Mitretek conducted an investigation into the impact of anticipated biometrically encoded driver licenses (DLs) on law enforcement. As part of this activity, Mitretek teamed with UNH to leverage the results of UNH's Project54 and develop a pilot Driver License Interoperability Test Bed to explore both implementation and operational aspects associated with reading and authenticating biometrically encoded DLs in law enforcement scenarios. The test bed enables the exploration of new methods, techniques (both hardware and software), and standards in a structured fashion. Spearheaded by the American Association of Motor Vehicle Administrators (AAMVA) and the International Committee for Information Technology Standards Technical Group M1 (INCITS-M1) initiatives, standards involving both DLs and biometrics, respectively, are evolving at a rapid pace. In order to ensure that the proposed standards will provide for interstate interoperability and proper functionality for the law enforcement community, it is critical to investigate the implementation and deployment issues surrounding biometrically encoded DLs. The test bed described in this paper addresses this and will provide valuable feedback to the standards organizations, the states, and law enforcement officials with respect to implementation and functional issues that are exposed through exploration of actual test systems. The knowledge gained was incorporated into a report prepared by MTS to describe the anticipated impact of biometrically encoded DLs on law enforcement practice.
Dandona, Rakhi; Kumar, G Anil; Dandona, Lalit
Motorized two-wheeled vehicles (MTV) account for a large proportion of road traffic in India and the riders of these vehicles have a high risk of road traffic injuries. We report on the availability of drivers licenses, use of a helmet, driver behavior, and condition of vehicles for MTV drivers in Hyderabad, a city in India Drivers of a MTV aged >16 years were interviewed at petrol filling stations There were 4,183 MTV drivers who participated in the study. Four hundred sixty one (11%; 95% CI 9.7-12.3%) drivers had not obtained a drivers license and 798 (21.4%) had obtained a license without taking the mandatory driving test. Two thousand nine hundred twenty (69.8%; 95% CI 67.9-71.7%) drivers reported no/very occasional use of a helmet, the significant predictors of which included that those driving borrowed a MTV (odds ratio 7.90; 95% CI 3.40-18.40) or driving moped/scooterette/scooter as compared with motorcycle (3.32; 2.76-3.98), lower education (3.10; 2.66-3.61), age >45 years (2.41; 1.63-3.57), and males (1.57; 1.16-2.13). Two thousand five hundred and eight (59.9%) drivers reported committing a traffic law violation at least once within the last 3 months. Overall, 1,222 (29.2%) drivers reported ever being caught by traffic police for a traffic law violation with data on violations available for 1,205 of these drivers, of whom 680 (56.4%) paid a fine, 310 (25.7%) paid by bribe, and 215 (17.8%) made no payment. The proportion of those who did not make payment for committed violation was significantly higher among females (46.8%) than males (16.3%). Two thousand fifty two (49%) of all MTVs had no rearview mirror These data suggest the need to enact and enforce policy interventions for improving the drivers license system, mandatory use of a helmet, effective traffic law enforcement, and ensuring good vehicle condition to reduce the risk factors that potentially contribute to mortality and morbidity in road traffic crashes in MTV drivers in Indian cities.
The objective of the present study was to assess the effectiveness of GDL programs for reducing total, injury, and fatal crashes among drivers 15 to 20 years old by conducting a meta-analysis of GDL research since 2001 that evaluated the effectivenes...
This is the final report of a four-year study of drinking drivers. On the basis of analyses of over 4,000 cases (approximately 1400 of whom were driver's license applicants who had no convictions for drunk-driving, and the remainder had been convicte...
Full Text Available Abstract Background Young novice drivers have crash rates higher than any other age group. To address this problem, graduated driver licensing (GDL laws have been implemented in the United States to require an extended learner permit phase, and create night time driving or passenger restrictions for adolescent drivers. GDL allows adolescents to gain experience driving under low-risk conditions with the aim of reducing crashes. The restricted driving might increase riding with parents or on buses, which might be safer, or walking or biking, which might be more dangerous. We examined whether GDL increases non-driver travels, and whether it reduces total travels combining drivers and non-drivers. Methods We used data from the US National Household Travel Survey for the years 1995–1996, 2001–2002, and 2008–2009 to estimate the adjusted ratio for the number of trips and trip kilometers made by persons exposed to a GDL law, compared with those not exposed. Results Adolescents aged 16 years had fewer trips and kilometers as drivers when exposed to a GDL law: ratio 0.84 (95 % confidence interval (CI 0.71, 1.00 for trips; 0.79 (0.63, 0.98 for kilometers. For adolescents aged 17 years, the trip ratio was 0.94 (0.83, 1.07 and the kilometers ratio 0.80 (0.63, 1.03. There was little association between GDL laws and trips or kilometers traveled by other methods: ratio 1.03 for trips and 1.00 for kilometers for age 16 years, 0.94 for trips and 1.07 for kilometers for age 17. Conclusions If these associations are causal, GDL laws reduced driving kilometers by about 20 % for 16 and 17 year olds, and reduced the number of driving trips by 16 % among 16 year olds. GDL laws showed little relationship with trips by other methods.
Dugan, Elizabeth; Barton, Kelli N; Coyle, Caitlin; Lee, Chae Man
The purpose of this study was to conduct a systematic review of the literature related to state policies concerning older drivers and to draw policy conclusions about which policies appear to work to reduce older driver crashes and to identify areas needed for further research. Specific policies examined in this paper concern medical reporting and medical review, license renewal processes, and driver testing. A study was included in the systematic review if it met the following criteria: published in English between 1991and January 2013; included data on human subjects aged 65 and older residing in the United States; included information on at least one policy related to older drivers; and had a transportation-related outcome variable (e.g., crash, fatality, renewal). A total of 29 studies met inclusion criteria. Twenty-two studies investigated license renewal and seven articles examined medical reporting. In-person license renewal requirements were associated with reduced risk for fatal crashes. Restricted licenses were associated with reduced number of miles driven per week. More intensive renewal requirements and being the subject of a medical report to the licensing authority was associated with delicensure. Given the importance of driving to mobility, quality of life, and public safety, more research is needed.
Leone, Maria Isabella; Oriani, Raffaele; Reichstein, Toke
As patent licensing has become the prime driver of technology trade, understanding the rationales behind a properly-defined payment structure of the agreements is essential. Specifically, among the other remuneration components, upfront fees are critical in license negotiations since they imply a...
Full Text Available 【Abstract】Objective: Road traffic accident (RTA and its related injuries contribute to a significant portion of the burden of diseases in Iran. This paper explores the as-sociation between driver-related factors and RTA in the country. Methods: This cross-sectional study was conducted in Iran and all data regarding RTAs from March 20, 2010 to June 10, 2010 were obtained from the Traffic Police Department. We included 538 588 RTA records, which were classified to control for the main confounders: accident type, final cause of accident, time of accident and driver-related factors. Driver-related factors included sex, educational level, license type, type of injury, duration between accident and getting the driving license and driver’s error type. Results: A total of 538 588 drivers (91.83% male, sex ratio of almost 13:1 were involved in the RTAs. Among them 423 932 (78.71% were uninjured; 224 818 (41.74% had a diploma degree. Grade 2 driving license represented the highest proportion of all driving licenses (290 811, 54.00%. The greatest number of accidents took place at 12:00-13:59 (75 024, 13.93%. The proportion of drivers involved in RTAs decreased from 15.90% in the first year of getting a driving license to 3.13% after 10 years’ of driving experience. Ne-glect of regulations was the commonest cause of traffic crashes (345 589, 64.17%. Non-observance of priority and inattention to the front were the most frequent final causes of death (138 175, 25.66% and 129 352, 24.02%, respectively. We found significant association between type of acci-dent and sex, education, license type, time of accident, final cause of accident, driver’s error as well as duration between accident and getting the driving license (all P<0.001. Conclusion: Our results will improve the traffic law enforcement measures, which will change inappropriate be-havior of drivers and protect the least experienced road users. Key words: Accidents, traffic; Automobile
Apanovitch, Audrey; Champany, Victoria; Wilson, Meghan; Emam, Hadeer; Ruiz, Kelly; Borrup, Kevin; Lapidus, Garry
Motor vehicle crashes are the leading cause of fatality among teens in the United States. Beginning in the 1990s, many states enacted graduated driver licensing (GDL) systems to delay full licensure while allowing beginners to obtain experience under lower-risk conditions. Many high schools require parent and guardians of newly licensed teen drivers to complete a student parking pass application (PPA) for their son/daughter to drive, park, and transport themselves to and from school activities. The objective of this study was to describe the content of these PPAs for compliance with Connecticut's GDL law. PPAs were requested via e-mail, fax, or telephone from all Connecticut's high schools (n = 233). PPA variables included school demographics, parking rules, prohibitions and sanctions for violations, as well as reference to GDL law. Seventy-four schools were excluded because students were not allowed to park and schools did not require PPAs or declined to send us a copy of their PPAs. Of the remaining 159 schools, 122 (76.7%) sent us their PPAs. Responding schools were more likely to be suburban or rural. Most PPAs included a section on prohibitions and sanctions for driving misbehavior. Forty-three percent prohibited students from going to car during school hours, and 34% prohibited driving off campus/parking lot. Seventy percent warned of consequences for dangerous driving in parking lot, and 88% included the possibility of revocation for infractions. Only 14% had any reference to Connecticut's GDL law on their PPAs. A small percentage of Connecticut high schools include information about GDL laws on their PPAs. All states should examine their PPA content and adopt a uniform high school PPA that includes key provisions of their state's GDL laws in an effort to promote teen driving safety. Therapeutic study, level V.
Subasish Das; Xiaoduan Sun; Fan Wang; Charles Leboeuf
At-fault crash-prone drivers are usually considered as the high risk group for possible future incidents or crashes. In Louisiana, 34% of crashes are repeatedly committed by the at-fault crash-prone drivers who represent only 5% of the total licensed drivers in the state. This research has conducted an exploratory data analysis based on the driver faultiness and proneness. The objective of this study is to develop a crash prediction model to estimate the likelihood of future crashes for the a...
Motor vehicle collisions are the leading cause of death for individuals between the ages of 15-20 years old in the United States. Top safety concerns involving teen drivers include; safety belt use, impaired driving, and distracted driving. Rules tha...
Tønning, Charlotte; Agerholm, Niels
be expected from advanced driver training, and if possible to identify, which measures there have the best effect on traffic safety. Method or methodological issues The method is literature studies. All Scandinavian-written reports and articles are screened. Likewise, are ScienceDirect, Google Scholar...
Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas
To create and validate an objective and reliable score to assess referral quality in gastroenterology. An observational multicentre study. 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Correlation between the TPS and a visual analogue scale (VAS) for referral quality. The 327 referrals had an average TPS of 13.2 (range 1-25) and an average VAS of 4.7 (range 0.2-9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Zhu, Motao; Cummings, Peter; Zhao, Songzhu; Coben, Jeffrey H; Smith, Gordon S
Graduated driver licensing (GDL) laws are associated with reduced crash rates per person-year among adolescents. It is unknown whether adolescents crash less per miles driven or drive less under GDL policies. We used data from the US National Household Travel Survey and Fatality Analysis Reporting System for 1995-1996, 2001-2002 and 2008-2009. We compared adolescents subject to GDL laws with those not by estimating adjusted IRRs for being a driver in a crash with a death per person-year (aIRRpy) and per miles driven (aIRRm), and adjusted miles driven ratios (aMR) controlling for changes in rates over time. Comparing persons subject to GDL policies with those not, 16 year olds had fewer fatal crashes per person-year (aIRRpy 0.63, 95% CI 0.47 to 0.91), drove fewer miles (aMR 0.79, 95% CI 0.63 to 0.98) and had lower crash rates per miles driven (aIRRm 0.83, 95% CI 0.65 to 1.06). For age 17, the aIRRpy was 0.83 (95% CI 0.60 to 1.17), the aMR 0.80 (95% CI 0.63 to 1.03) and the aIRRm 1.03 (95% CI 0.80 to 1.35). For age 18, the aIRRpy was 0.93 (95% CI 0.72 to 1.19), the aMR 0.92 (95% CI 0.77 to 1.09) and the aIRRm 1.01 (95% CI 0.84 to 1.23). If these associations are causal, GDL laws reduced crashes per person-year by about one-third among 16 year olds; half the reduction was due to fewer crashes per miles driven and half to less driving. For ages 17 and 18, there was no evidence of reduced crash rates per miles driven. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Shults, Ruth A; Bergen, Gwen; Smith, Tracy J; Cook, Larry; Kindelberger, John; West, Bethany
Teens' crash risk is highest in the first years of independent driving. Circumstances surrounding fatal crashes have been widely documented, but less is known about factors related to nonfatal teen driver crashes. This study describes single vehicle nonfatal crashes involving the youngest teen drivers (15-17 years), compares these crashes to single vehicle nonfatal crashes among adult drivers (35-44 years) and examines factors related to nonfatal injury producing crashes for teen drivers. Police crash data linked to hospital inpatient and emergency department data for 2005-2008 from the South Carolina Crash Outcomes Data Evaluation System (CODES) were analyzed. Nonfatal, single vehicle crashes involving passenger vehicles occurring on public roadways for teen (15-17 years) drivers were compared with those for adult (35-44 years) drivers on temporal patterns and crash risk factors per licensed driver and per vehicle miles traveled. Vehicle miles traveled by age group was estimated using data from the 2009 National Household Travel Survey. Multivariable log-linear regression analysis was conducted for teen driver crashes to determine which characteristics were related to crashes resulting in a minor/moderate injury or serious injury to at least one vehicle occupant. Compared with adult drivers, teen drivers in South Carolina had 2.5 times the single vehicle nonfatal crash rate per licensed driver and 11 times the rate per vehicle mile traveled. Teen drivers were nearly twice as likely to be speeding at the time of the crash compared with adult drivers. Teen driver crashes per licensed driver were highest during the afternoon hours of 3:00-5:59 pm and crashes per mile driven were highest during the nighttime hours of 9:00-11:59 pm. In 66% of the teen driver crashes, the driver was the only occupant. Crashes were twice as likely to result in serious injury when teen passengers were present than when the teen driver was alone. When teen drivers crashed while
Menéndez, Cammie K.C.; Amandus, Harlan E.; Damadi, Parisa; Wu, Nan; Konda, Srinivas; Hendricks, Scott A.
Background Taxicab drivers historically have had one of the highest work-related homicide rates of any occupation. In 2010 the taxicab driver homicide rate was 7.4 per 100,000 drivers, compared to the overall rate of 0.37 per 100,000 workers. Purpose Evaluate the effectiveness of taxicab security cameras and partitions on citywide taxicab driver homicide rates. Methods Taxicab driver homicide rates were compared in 26 major cities in the U.S. licensing taxicabs with security cameras (n=8); bullet-resistant partitions (n=7); and cities where taxicabs were not equipped with either security cameras or partitions (n=11). News clippings of taxicab driver homicides and the number of licensed taxicabs by city were used to construct taxicab driver homicide rates spanning 15 years (1996–2010). Generalized estimating equations were constructed to model the Poisson-distributed homicide rates on city-specific safety equipment installation status, controlling for city homicide rate and the concurrent decline of homicide rates over time. Data were analyzed in 2012. Results Cities with cameras experienced a threefold reduction in taxicab driver homicides compared with control cities (RR=0.27; 95% CI=0.12, 0.61; p=0.002). There was no difference in homicide rates for cities with partitions compared with control cities (RR=1.15; 95% CI=0.80, 1.64; p=0.575). Conclusions Municipal ordinances and company policies mandating security cameras appear to be highly effective in reducing taxicab driver deaths due to workplace violence. PMID:23790983
Simons-Morton, Bruce G.; Hartos, Jessica L.
Motor vehicle crashes (MVCs) are the leading cause of injury and death among adolescents 16 to 19 years of age. Three areas of countermeasures for decreasing young driver risk are driver education, licensing policies, and parental management. Driver education is an essential part of teaching adolescents the rules of the road and operating a…
Haque, Md Mazharul; Washington, Simon
The use of mobile phones while driving is more prevalent among young drivers-a less experienced cohort with elevated crash risk. The objective of this study was to examine and better understand the reaction times of young drivers to a traffic event originating in their peripheral vision whilst engaged in a mobile phone conversation. The CARRS-Q advanced driving simulator was used to test a sample of young drivers on various simulated driving tasks, including an event that originated within the driver's peripheral vision, whereby a pedestrian enters a zebra crossing from a sidewalk. Thirty-two licensed drivers drove the simulator in three phone conditions: baseline (no phone conversation), hands-free and handheld. In addition to driving the simulator each participant completed questionnaires related to driver demographics, driving history, usage of mobile phones while driving, and general mobile phone usage history. The participants were 21-26 years old and split evenly by gender. Drivers' reaction times to a pedestrian in the zebra crossing were modelled using a parametric accelerated failure time (AFT) duration model with a Weibull distribution. Also tested where two different model specifications to account for the structured heterogeneity arising from the repeated measures experimental design. The Weibull AFT model with gamma heterogeneity was found to be the best fitting model and identified four significant variables influencing the reaction times, including phone condition, driver's age, license type (provisional license holder or not), and self-reported frequency of usage of handheld phones while driving. The reaction times of drivers were more than 40% longer in the distracted condition compared to baseline (not distracted). Moreover, the impairment of reaction times due to mobile phone conversations was almost double for provisional compared to open license holders. A reduction in the ability to detect traffic events in the periphery whilst distracted
Yu, Wenya; Li, Meina; Nong, Xin; Ding, Tao; Ye, Feng; Liu, Jiazhen; Dai, Zhixing; Zhang, Lulu
downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Motor vehicle collisions are the leading cause of death for individuals between the ages of 15-20 years old in the United States. Top safety concerns involving teen drivers include; safety belt use, impaired driving, and distracted driving. Rules tha...
This paper reviews the predominant features and empirical evidence surrounding post licensing advanced driver training programs focused on novice drivers. A clear articulation of differences between the renewed and current US advanced driver training programs is provided. While the individual quantitative evaluations range from marginally to significantly effective in reducing novice driver crash risk, they have been criticized for evaluation deficiencies ranging from small sample sizes to confounding variables to lack of exposure metrics. Collectively, however, the programs sited in the paper suggest at least a marginally positive effect that needs to be validated with further studies. If additional well controlled studies can validate these programs, a pilot program in the US should be considered.
Li, Qing; Tay, Richard
Although a proficient knowledge of the road rules is important to safe driving, many drivers do not retain the knowledge acquired after they have obtained their licenses. Hence, more innovative and appealing methods are needed to improve drivers' knowledge of the road rules. This study examines the effect of game based learning on drivers' knowledge acquisition and retention. We find that playing an entertaining game that is designed to impart knowledge of the road rules not only improves players' knowledge but also helps them retain such knowledge. Hence, learning by gaming appears to be a promising learning approach for driver education. Copyright © 2013 Elsevier Ltd. All rights reserved.
Bates, Lyndel; Watson, Barry; King, Mark Johann
Though many jurisdictions internationally now require learner drivers to complete a specified number of hours of supervised driving practice before being able to drive unaccompanied, very few require learner drivers to complete a log book to record this practice and then present it to the licensing authority. Learner drivers in most Australian jurisdictions must complete a log book that records their practice, thereby confirming to the licensing authority that they have met the mandated hours of practice requirement. These log books facilitate the management and enforcement of minimum supervised hours of driving requirements. Parents of learner drivers in 2 Australian states, Queensland and New South Wales, completed an online survey assessing a range of factors, including their perceptions of the accuracy of their child's learner log book and the effectiveness of the log book system. The study indicates that the large majority of parents believe that their child's learner log book is accurate. However, they generally report that the log book system is only moderately effective as a system to measure the number of hours of supervised practice a learner driver has completed. The results of this study suggest the presence of a paradox, with many parents possibly believing that others are not as diligent in the use of log books as they are or that the system is too open to misuse. Given that many parents report that their child's log book is accurate, this study has important implications for the development and ongoing monitoring of hours of practice requirements in graduated driver licensing systems.
Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah
Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.
Biglari, Hamed; Ebrahimi, Mohammad Hossein; Salehi, Maryam; Poursadeghiyan, Mohsen; Ahmadnezhad, Iman; Abbasi, Milad
Of all work stressors, occupational stress is the leading cause of many disorders among workers. Drivers are classified as a high risk group for work related stress. This study set out to determine the relationship between risk factors of cardiovascular diseases and occupational stress among drivers. Two hundred and twenty two Ilam's intercity drivers were selected for the study. For measuring work stress, the Osipow work stress questionnaire was used. After a 10-h fasting period, systolic and diastolic blood pressure was recorded. Intravenous blood samples were taken to determine cholesterol, triglyceride and blood glucose levels. The independent samples t-test and Pearson's correlation test were used to assess the relationship between variables and occupational stress. Seventy-one percent of the intercity drivers suffered from average to acute stress, and 3.1% of them suffered from acute stress. There was no significant relationship between occupational stress and diastolic blood pressure (p = 0.254) among the drivers. Nevertheless, the Pearson's correlation test demonstrated a strong relationship between work stress and blood glucose (p stress were observed in the Ilam's intercity drivers. Occupational stress may have effect on blood glucose levels but the results did not suggest a considerable relationship between risk factors of cardiovascular diseases and occupational stress among intercity drivers. Int J Occup Med Environ Health 2016;29(6):895-901. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Full Text Available Driving a car does not mean only controlling it and bringing it to the destination but it is also a social interaction of drivers towards each other, where emotions play an important role. Destructive emotions e.g. anger worsen the ability of making a decision. And it also holds for the people behind the steering wheel.Abroad, the questionnaires used for the detection of potential aggressive drivers, or diagnostics of drivers who already have a driving license, have a form of survey. In year 2010 was realized a questionnaire about aggressive behavior of drivers in Slovak republic from which came out very interesting information. Some information is mentioned in this paper.
... system that allows the exchange of commercial driver licensing information among all the States. CDLIS includes the databases of fifty-one licensing jurisdictions and the CDLIS Central Site, all connected by a... that her husband Michael Lail had a seizure as a child when he ``collided with another kid on the the...
Fan, Jessie X; Hanson, Heidi A; Zick, Cathleen D; Brown, Barbara B; Kowaleski-Jones, Lori; Smith, Ken R
Empirical studies of the association between neighbourhood food environments and individual obesity risk have found mixed results. One possible cause of these mixed findings is the variation in neighbourhood geographic scale used. The purpose of this paper was to examine how various neighbourhood geographic scales affected the estimated relationship between food environments and obesity risk. Cross-sectional secondary data analysis. Salt Lake County, Utah, USA. 403,305 Salt Lake County adults 25-64 in the Utah driver license database between 1995 and 2008. Utah driver license data were geo-linked to 2000 US Census data and Dun & Bradstreet business data. Food outlets were classified into the categories of large grocery stores, convenience stores, limited-service restaurants and full-service restaurants, and measured at four neighbourhood geographic scales: Census block group, Census tract, ZIP code and a 1 km buffer around the resident's house. These measures were regressed on individual obesity status using multilevel random intercept regressions. Obesity. Food environment was important for obesity but the scale of the relevant neighbourhood differs for different type of outlets: large grocery stores were not significant at all four geographic scales, limited-service restaurants at the medium-to-large scale (Census tract or larger) and convenience stores and full-service restaurants at the smallest scale (Census tract or smaller). The choice of neighbourhood geographic scale can affect the estimated significance of the association between neighbourhood food environments and individual obesity risk. However, variations in geographic scale alone do not explain the mixed findings in the literature. If researchers are constrained to use one geographic scale with multiple categories of food outlets, using Census tract or 1 km buffer as the neighbourhood geographic unit is likely to allow researchers to detect most significant relationships. Published by the BMJ
Fell, James C; Scherer, Michael
Administrative license revocation (ALR) laws, which provide that the license of a driver with a blood alcohol concentration at or over the illegal limit is subject to an immediate suspension by the state department of motor vehicles, are an example of a traffic law in which the sanction rapidly follows the offense. The power of ALR laws has been attributed to how swiftly the sanction is applied, but does the length of suspension matter? Our objectives were to (a) determine the relationship of the ALR suspension length to the prevalence of drinking drivers relative to sober drivers in fatal crashes and (b) estimate the extent to which the relationship is associated to the general deterrent effect compared to the specific deterrent effect of the law. Data comparing the impact of ALR law implementation and ALR law suspension periods were analyzed using structural equation modeling techniques on the ratio of drinking drivers to nondrinking drivers in fatal crashes from the Fatality Analysis Reporting System (FARS). States with an ALR law with a short suspension period (1-30 days) had a significantly lower drinking driver ratio than states with no ALR law. States with a suspension period of 91-180 days had significantly lower ratios than states with shorter suspension periods, while the three states with suspension lengths of 181 days or longer had significantly lower ratios than states with shorter suspension periods. The implementation of any ALR law was associated with a 13.1% decrease in the drinking/nondrinking driver fatal crash ratio but only a 1.8% decrease in the intoxicated/nonintoxicated fatal crash ratio. The ALR laws and suspension lengths had a significant general deterrent effect, but no specific deterrent effect. States might want to keep (or adopt) ALR laws for their general deterrent effects and pursue alternatives for specific deterrent effects. States with short ALR suspension periods should consider lengthening them to 91 days or longer.
Cook, Steven; Shank, Danielle; Bruno, Tara; Turner, Nigel E; Mann, Robert E
This article describes the patterns of self-reported driving under the influence of alcohol (DUIA) and driving under the influence of cannabis (DUIC) among licensed Ontario students in 2009 and examines their associations with graduated licensing, risk taking, and substance use problems for understanding DUIA and DUIC behaviors. Ontario's graduated licensing system requires new drivers to hold a G1 license for a minimum of 8 months and a G2 license for a minimum of 12 months before a full and unrestricted G license can be obtained. Among other restrictions, G1 drivers must maintain a 0 blood alcohol content (BAC), have an experienced driver in the passenger seat, not drive on any high-speed expressways, and not drive between the hours of midnight and 5 a.m. A G2 license is more similar to a G license, with fewer restrictions. This study analyzed data from the 2009 Ontario Student Drug Use and Health Survey (OSDUHS). The OSDUHS is a biennial population-based survey of students (grades 7 to 12) in Ontario, Canada. The results showed that 16.3% of licensed students in Ontario reported DUIC and 11.5% reported DUIA during the past year. After controlling for the effect of age, type of license emerged as a robust predictor for both DUIA and DUIC behavior, because students with a G2 and full license were significantly more likely to report DUIA and DUIC than drivers with a G1 license. Multivariate analyses suggested that risk-seeking behaviors were more important for understanding DUIA behavior than for DUIC behavior. Elevated problem indicators for alcohol and for cannabis were associated with DUIA and DUIC, respectively. Though much attention has been paid to drinking and driving among adolescents, this research shows that more Ontario students now report driving after cannabis use than after drinking alcohol. The results identify important correlates of both behaviors that may be useful for prevention purposes.
state and municipal payments (GIS GMP.The fragmentation of administrative-legal regulation first of all necessitates considerable strengthening of coordination in the execution of judgments of the judges on deprivation of drivers of the right of control of the vehicle in terms of deprivation of the right of management by a tractor, self-propelled machine and other types of equipment.In order to solve this problem the authors propose the organization of a number of organisational measures.Developed one of possible algorithms of interaction of the organization and uniformity of actions of officials of the specified services for the execution of penalties of deprivation of rights management.Conclusions. The question of the effectiveness of the existing norms of administrative law regulating the execution of deprivation of the driver’s license, requires additional justifica-tion.In the long term it is required the creation of a single Federal interagency information area. Common use of it by the judges, employees of State Traffic Safety Inspectorate and State Technical Supervision Authority, court bailiff, etc. will minimize legal risks.
Hartos, Jessica; Huff, David C
The widespread adoption of graduated driver licensing (GDL) policies has effectively reduced crash risk for young drivers; however, parents must support, reinforce, and enforce GDL for it to be effective, and research indicates that parents need better information and instruction for adhering to GDL requirements, conducting supervised practice driving, and restricting independent teenage driving. Because teenagers in most states must take driver education to enter the licensing process prior to age 18, integrating parent involvement into driver education may be an effective way to inform and instruct parents on a large scale about teen driver safety. This study assessed parent attitudes (overall and by rural status, minority status, and income level) toward integrating parent involvement into teenage driver education classes. In this study, 321 parents of teenagers enrolled in driver education classes across the state of Montana completed surveys about current involvement in driver education and attitudes toward required involvement. The results indicated that parents were not very involved currently in their teenagers' driver education classes, but 76% reported that parents should be required to be involved. If involvement were required, parents would prefer having written materials sent home, access to information over the Internet, or discussions in person with the instructor; far fewer would prefer to attend classes or behind-the-wheel driving instruction. There were few differences in parent attitudes by rural or minority status but many by income level. Compared to higher income parents, lower income parents were more likely to endorse required parent involvement in teenage driver education classes and to want parent information from driver education about many teen driving issues. That the majority of parents are open to required involvement in their teenagers' driver education classes is promising because doing so could better prepare parents to understand
Evans, Bridie Angela; Ali, Khalid; Bulger, Jenna; Ford, Gary A; Jones, Matthew; Moore, Chris; Porter, Alison; Pryce, Alan David; Quinn, Tom; Seagrove, Anne C; Snooks, Helen; Whitman, Shirley; Rees, Nigel
To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. Scoping review. PubMed, CINAHL Web of Science, Scopus. Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes. 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6-10% predicted rate to 1.3-2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways. Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. ISRCTN85516498. Stage: pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Full Text Available In many situations, driving is essential for senior citizens to maintain their independent lifestyle. A systematic literature review was conducted that summarized the age-related physical, visual and cognitive functional declines and their associated risk to driving. Based on these findings, we explored whether the skills required in playing Xbox Kinect video games were correlated with measures of driving performance among older drivers. Fifty-two participants, 65 years of age or older (Mean = 72; SD = 3.84; range 65 – 85 years; 29 males who have access to a car and drive frequently were invited to play Just dance, Table Tennis (ping pong, Bowling, and Dr Kawashima’s Brain Training Exercises on an Xbox Kinect 360. Participants also completed a 25-minute on-road driving task along a predetermined route to assess and identify critical driving errors using a similar instrument as that used by a driving license tester. Bivariate correlation examined the relationship between game scores and these objective driving skills. There was a significant correlation between the Xbox Kinect video games and on-road driving scores (r = 0.861, p <0.001, indicating that ‘good gamers are good drivers’. This was correlation was significant for the males (r = 0.864, p <0.001 as well as for the females (r = 0.878, p <0.001. We suggest that performance on Xbox games may be a suitable, cost-effective and less-risky indicator of on-road driving skills for older drivers, particularly in jurisdictions in which mandatory testing of older citizens has been introduced or is being considered as a requirement in the driver licensing process.
Hassan, Hany M; Abdel-Aty, Mohamed A
The present study aims at identifying and quantifying significant factors (i.e., demographic, aberrant driving behavior) associated with young drivers' involvement in at-fault crashes or traffic citations at the ages of 16-17 (while having the Operational License) and 18-24 years old (while having the Full License). A second objective was to investigate the main reason(s) for involvement in risky driving behavior by young drivers. The data used for the analyses were obtained from a self-reported questionnaire survey carried out among 680 young drivers in Central Florida. To achieve these goals, the structural equation modeling approach was adopted. The results revealed that aggressive violations, in-vehicle distractions and demographic characteristics were the significant factors affecting young drivers' involvement in at-fault crashes or traffic violations at the age of 16-17. However, in-vehicle distractions, attitudes toward speeding and demographic characteristics were the significant factors affecting young drivers' crash risk at 18-24. Additionally, the majority of participants reported that "running late" is the main reason for taking risk while driving (i.e., speeding, accept short gaps, or drive so close to the car in front) followed by "racing other cars". Additionally, "exceed speed limits" was the main reason for receiving traffic citations at 16-17 and 18-24 age groups. Practical suggestions on how to reduce crash risk and promote safe driving among young drivers are also discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Background: Post-traumatic stress disorder (PTSD is an anxiety disorder that may develop following a trauma. Iranian commercial motor vehicle drivers experience many road traffic accidents during their working life; this may increase the probability for developing PTSD, which in turn may lead to increased human errors as well as decreased work efficiency. Objective: To examine the prevalence of PTSD and its associated factors among a group of Iranian commercial motor vehicle drivers. Methods: In a cross-sectional study, 424 drivers who referred to participate in an annually training program were selected using a simple random sampling technique. They were requested to complete the Persian version of PCL-C and a data collection sheet about their occupational and demographic features. Results: 385 (90.8% of 424 studied drivers completed the study. 265 (68.8% of the drivers had first-grade driving license. The mean±SD on-the-job daily driving was 10.2±2.8 h. 74 of 385 (19.2%; 95% CI: 15.3%–23.2% met the PTSD criteria. Higher age and job experience as a professional driver, and having past history or past familial history of psychiatric disorders, were independent predictors of developing PTSD. The disease was more prevalent among drivers with first-grade driving license. Conclusion: The prevalence of PTSD among Iranian commercial motor vehicle drivers is higher than the figures reported elsewhere. Measures to diagnose of such drivers and to ensure optimum follow-up of victims before return to professional driving should be considered.
Hu, P.S. [Oak Ridge National Lab., TN (United States); Young, J.R. [Tennessee Univ., Knoxville, TN (United States); Lu, An [Oak Ridge Associated Universities, Inc., TN (United States)
American society is undergoing a major demographic transformation that is resulting in a larger proportion of older individuals in the population. Moreover, recent travel surveys show that an increasing number of older individuals are licensed to drive and that they drive more than their same age cohort a decade ago. However, they continue to take shorter trips than younger drivers and they avoid driving during congested hours. This recent demographic transformation in our society, the graying of America, coupled with the increasing mobility of the older population impose a serious highway safety issue that cannot be overlooked. Some of the major concerns are the identification of ``high-risk`` older drivers and the establishment of licensing guidelines and procedures that are based on conclusive scientific evidence. Oak Ridge National Laboratory`s (ORNL) objectives in this project can be characterized by the following tasks: Review and evaluate the 1980 American Association of Motor Vehicle Administrators (AAMVA) and National Highway Traffic Safety Administration (NHTSA) licensing guidelines. Determine whether the license restriction recommended in the 1980 AAMVA and NHTSA guidelines was based on scientific evidence or on judgement of medical advisors. Identify in the scientific literature any medical conditions which are found to be highly associated with highway crashes, and which are not mentioned in the 1980 guidelines. Summarize States` current licensing practices for drivers with age-related physical and mental limitations. Identify potential data sources to establish conclusive evidence on age-related functional impairments and highway crashes.
Kuntohadi, Hendro; Pahala, Yosi; Sitanggang, Rohana
Car drivers in Indonesia will always face many kinds of risks. This research contains the context determination of this research, identifies all the significant risks, measures the frequency and impact of all the risks, draws all the identified risks in the chart, and describes how to manage or mitigate the risks. The dangerous risks which have high frequency and high impact are: 1) Many car drivers get the driving license without taking a driving course and without learning carefully the the...
Zhang, Qian; Jiang, Zuhua; Zheng, Dongpeng; Wang, Yifan; Man, Dong
Carless young drivers refers to those drivers aged between 18 and 25 years who have a driver's license but seldom have opportunities to practice their driving skills because they do not have their own cars. Due to China's lower private car ownership, many young drivers turn into carless young drivers after licensure, and the safety issue associated with them has become a matter of great concern in China. Because few studies have examined the driving behaviors of these drivers, this study aims to utilize the Driver Behavior Questionnaire (DBQ) to investigate the self-reported driving behaviors of Chinese carless young drivers. A total of 523 Chinese carless young drivers (214 females, 309 males) with an average age of 21.91 years completed a questionnaire including the 27-item DBQ and demographics. The data were first randomized into 2 subsamples for factor analysis and then combined together for the following analyses. Both an exploratory factor analysis (EFA, n = 174) and a confirmatory factor analysis (CFA, n = 349) were performed to investigate the factor structure of the DBQ. Correlation analysis was conducted to examine the relationships between the demographics and the DBQ scales' variables. Multivariate linear regression and logistic regression were performed to investigate the prediction of the DBQ scales and crash involvement in the previous year. The EFA produced a 4-factor structure identified as errors, violations, attention lapses, and memory lapses, and the CFA revealed a good model fit after the removal of one item with a low factor loading and the permission of the error covariance between some items. The Chinese carless young drivers reported a comparatively low level of aberrant driving behaviors. The 3 most frequently reported behaviors were all lapses and the 3 least were all violations. Gender was the only significant predictor of the 2 lapses scales and lifetime mileage was the only significant predictor of the violations scale. Only the
Young adult drivers 21 to 34 years old are a particularly highrisk : group for impaired-driving-related crashes. Numerous : studies have found that approximately half of intoxicated drivers : had their last drink at a licensed bar or restaurant, and ...
Cucuras, Maria; Chun, Robert; Lee, Patrick; Jay, Walter M; Pusateri, Gregg
We surveyed bioptic and non-bioptic low-vision drivers in Illinois, USA, to determine their usage of global positioning system (GPS) devices. Low-vision patients completed an IRB-approved phone survey regarding driving demographics and usage of GPS while driving. Participants were required to be active drivers with an Illinois driver's license, and met one of the following criteria: best-corrected visual acuity (BCVA) less than or equal to 20/40, central or significant peripheral visual field defects, or a combination of both. Of 27 low-vision drivers, 10 (37%) used GPS while driving. The average age for GPS users was 54.3 and for non-users was 77.6. All 10 drivers who used GPS while driving reported increased comfort or safety level. Since non-GPS users were significantly older than GPS users, it is likely that older participants would benefit from GPS technology training from their low-vision eye care professionals.
... and Redding (joint FMCSA-2009-0010... application). Rotel Rotel provides motorcoach tours of the... individual, filed a joint application seeking relief for 20 CMV drivers who transport jet fuel in tank CMVs... all public comments received. The Agency concluded in each case that the application for exemption...
The results of this research note are based on 1996data for fatal crashes, driver licenses, and estimates of total crashes based upon data obtained from the nationally representative sample of crashes gathered in the General Estimates System (GES). T...
... buses is equipped with a galley that allows Rotel to offer dining with European cuisine. In addition... each driver is subject to the same driver disqualification rules under 49 CFR parts 383 and 391 that...
Liddy, Clare; Arbab-Tafti, Sadaf; Moroz, Isabella; Keely, Erin
In many countries, the referral-consultation process faces a number of challenges from inefficiencies and rising demand, resulting in excessive wait times for many specialties. We collected referral data from a sample of family doctors across the province of Ontario, Canada as part of a larger program of research. The purpose of this study is to describe referral patterns from primary care to specialist and allied health services from the primary care perspective. We conducted a prospective study of patient referral data submitted by primary care providers (PCP) from 20 clinics across Ontario between June 2014 and January 2016. Monthly referral volumes expressed as a total number of referrals to all medical and allied health professionals per month. For each referral, we also collected data on the specialty type, reason for referral, and whether the referral was for a procedure. PCPs submitted a median of 26 referrals per month (interquartile range 11.5 to 31.8). Of 9509 referrals eligible for analysis, 97.8% were directed to medical professionals and 2.2% to allied health professionals. 55% of medical referrals were directed to non-surgical specialties and 44.8% to surgical specialties. Medical referrals were for procedures in 30.8% of cases and non-procedural in 40.9%. Gastroenterology received the largest share (11.2%) of medical referrals, of which 62.3% were for colonoscopies. Psychology received the largest share (28.3%) of referrals to allied health professionals. We described patterns of patient referral from primary care to specialist and allied health services for 30 PCPs in 20 clinics across Ontario. Gastroenterology received the largest share of referrals, nearly two-thirds of which were for colonoscopies. Future studies should explore the use of virtual care to help manage non-procedural referrals and examine the impact that procedural referrals have on wait times for gastroenterology.
A. O. Adejumo
Full Text Available Abstract Background Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. Methods We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs, TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. Results CWs referred 4–22 % of presumptive TB clients tested, and 4–24 % of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr and mean TB diagnoses (7.1/yr per CW (H =70.850, p < 0.001 was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model. The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001 to explaining presumptive TB referral after controlling for other variables. Conclusion All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a
Coxon, Kristy; Keay, Lisa
Safe-transport is important to well-being in later life but balancing safety and independence for older drivers can be challenging. While self-regulation is a promising tool to promote road safety, more research is required to optimise programs. Qualitative research was used to inform the choice and adaptation of a safe-transport education program for older drivers. Three focus groups were conducted with older drivers living in northwest Sydney to explore four key areas related to driving in later life including aged-based licensing, stopping or limiting driving, barriers to driving cessation and alternative modes of transportation. Data were analysed using content analysis. Four categories emerged from the data; bad press for older drivers, COMPETENCE not age, call for fairness in licensing regulations, and hanging up the keys: It's complicated! Two key issues being (1) older drivers wanted to drive for as long as possible but (2) were not prepared for driving cessation; guided the choice and adaption of the Knowledge Enhances Your Safety (KEYS) program. This program was adapted for the Australian context and focus group findings raised the need for practical solutions, including transport alternatives, to be added. Targeted messages were developed from the data using the Precaution Adoption Process Model (PAPM), allowing the education to be tailored to the individual's stage of behaviour change. Adapting our program based on insights gained from community consultation should ensure the program is sensitive to the needs, skills and preferences of older drivers.
Kawooya, M.; Perez, M.; Lau, L.; Reeed, M.
The medical imaging specialists called for global referral guidelines which would be made available to referring doctors. These referral guidelines should be:- Applicable in different health care settings, including resource-poor settings; Inclusive in terms of the range of clinical conditions; User-friendly and accessible (format/media); Acceptable to stakeholders, in particular to the referrers as the main target audience. To conceive evidence-based medicine as an integration of best research evidence with clinical expertise and patient values. The Direct recipients of the Referral Guidelines would be:- Referrers: general practitioners / family doctors; paediatricians; emergency department doctors; other specialists and health workers. Providers (medical imaging practitioners): radiologists; nuclear medicine physicians; radiographers; other appropriately qualified practitioners providing diagnostic imaging services. For the Referral Guidelines to be effective there need to be: Credibility evidence-based Practicality end user involvement Context local resources, disease profiles Endorsement, opinion leaders Implementation- policy, education, CPOE - Monitoring of the use clinical audit, report feedback. The aim of the Referral Guidelines Project was to: Produce global referral guidelines that are evidence-based, cost effective and appropriate for the local setting, and include consideration of available equipment and expertise (RGWG; SIGs); Include supporting information about radiation doses, potential risks, protection of children and pregnant women (introductory chapter); Facilitate the implementation of the guidelines through guidance and tools (e.g. implementation guides, checklists, capacity building tools, guides on stakeholders engagement, audit support criteria); Conduct pilot testing in different clinical settings from each of the six WHO regions; Promote the inclusion of the referral guidelines in the curricula of medical schools; Develop and implement
Kervick, Aoife A; Hogan, Michael J; O'Hora, Denis; Sarma, Kiran M
There is growing interest in the potential value of using phone applications that can monitor driver behaviour (Smartphone Driver Support Systems, 'SDSSs') in mitigating risky driving by young people. However, their value in this regard will only be realised if young people are willing to use this technology. This paper reports the findings of a study in which a novel structural model of willingness to use SDSSs was tested. Grounded in the driver monitoring and Technology Acceptance (TA) research literature, the model incorporates the perceived risks and gains associated with potential SDSS usage and additional social cognitive factors, including perceived usability and social influences. A total of 333 smartphone users, aged 18-24, with full Irish driving licenses completed an online questionnaire examining willingness or Behavioural Intention (BI) to uptake a SDSS. Following exploratory and confirmatory factor analyses, structural equation modelling indicated that perceived gains and social influence factors had significant direct effects on BI. Perceived risks and social influence also had significant indirect effects on BI, as mediated by perceived gains. Overall, this model accounted for 72.5% of the variance in willingness to uptake SDSSs. Multi-group structural models highlighted invariance of effects across gender, high and low risk drivers, and those likely or unlikely to adopt novel phone app technologies. These findings have implications for our understanding of the willingness of young drivers to adopt and use SDSSs, and highlight potential factors that could be targeted in behavioural change interventions seeking to improve usage rates. Copyright © 2015 Elsevier Ltd. All rights reserved.
Kofi Wireko, Joseph; Skouby, Knud Erik
Most developing countries, especially in Africa are fighting corruption as a major barrier to development, and e-government is seen as a new way of addressing it. Besides generally being recognized as cost-efficient, e-government is thought to reduce corruption through increased transparency......, better accountability and, the disappearance of the “middle-man” in the acquisition of public services by the citizenry. This paper discusses the extent to which this has been achieved in Ghana by analyzing the implementation of e-government service of the Driver and Vehicle Licensing Authority (DVLA......) of Ghana using the “stages of growth” mode from a sociotechnical perspective. The outcome of the analysis suggests that the e-government service implementation by DVLA is still at its basic and rudimentary stage (Catalogue stage) and continuous presence of the “middle-man,” high level of corruption, lack...
Statistics show that in the U.S., there are about 38 million licensed drivers over age 65; about 1/8 of our : population. By 2024, this figure will DOUBLE to 25%. The current research is intended to address the : driving capabilities of our older pop...
Owsley, Cynthia; McGwin, Gerald; Elgin, Jennifer; Wood, Joanne M
To compare self-assessed driving habits and skills of licensed drivers with central visual loss who use bioptic telescopes to those of age-matched normally sighted drivers, and to examine the association between bioptic drivers' impressions of the quality of their driving and ratings by a "backseat" evaluator. Participants were licensed bioptic drivers (n = 23) and age-matched normally sighted drivers (n = 23). A questionnaire was administered addressing driving difficulty, space, quality, exposure, and, for bioptic drivers, whether the telescope was helpful in on-road situations. Visual acuity and contrast sensitivity were assessed. Information on ocular diagnosis, telescope characteristics, and bioptic driving experience was collected from the medical record or in interview. On-road driving performance in regular traffic conditions was rated independently by two evaluators. Like normally sighted drivers, bioptic drivers reported no or little difficulty in many driving situations (e.g., left turns, rush hour), but reported more difficulty under poor visibility conditions and in unfamiliar areas (P Driving exposure was reduced in bioptic drivers (driving 250 miles per week on average vs. 410 miles per week for normally sighted drivers, P = 0.02), but driving space was similar to that of normally sighted drivers (P = 0.29). All but one bioptic driver used the telescope in at least one driving task, and 56% used the telescope in three or more tasks. Bioptic drivers' judgments about the quality of their driving were very similar to backseat evaluators' ratings. Bioptic drivers show insight into the overall quality of their driving and areas in which they experience driving difficulty. They report using the bioptic telescope while driving, contrary to previous claims that it is primarily used to pass the vision screening test at licensure.
... a Class A Commercial Driver's License (CDL) from Virginia. His driving record for the last 3 years... last 3 years shows no crashes and no convictions for moving violations in a CMV. Ronnie E. Henderson Mr. Henderson, 64, has had loss of vision in his left eye since 2007. The best corrected visual acuity in his...
Full Text Available At-fault crash-prone drivers are usually considered as the high risk group for possible future incidents or crashes. In Louisiana, 34% of crashes are repeatedly committed by the at-fault crash-prone drivers who represent only 5% of the total licensed drivers in the state. This research has conducted an exploratory data analysis based on the driver faultiness and proneness. The objective of this study is to develop a crash prediction model to estimate the likelihood of future crashes for the at-fault drivers. The logistic regression method is used by employing eight years' traffic crash data (2004–2011 in Louisiana. Crash predictors such as the driver's crash involvement, crash and road characteristics, human factors, collision type, and environmental factors are considered in the model. The at-fault and not-at-fault status of the crashes are used as the response variable. The developed model has identified a few important variables, and is used to correctly classify at-fault crashes up to 62.40% with a specificity of 77.25%. This model can identify as many as 62.40% of the crash incidence of at-fault drivers in the upcoming year. Traffic agencies can use the model for monitoring the performance of an at-fault crash-prone drivers and making roadway improvements meant to reduce crash proneness. From the findings, it is recommended that crash-prone drivers should be targeted for special safety programs regularly through education and regulations.
Young, Kristie L; Stephens, Amanda N; Logan, David B; Lenné, Michael G
Roadside advertising has the potential to create a crash risk for drivers as it may distract attention from driving at critical times. In an on-road instrumented vehicle study, we examined if and how static advertising billboards affect drivers' situation awareness across different driving environments. Nineteen fully licensed drivers drove an instrumented vehicle around a 38 km urban test route comprising freeway, busy urban retail and arterial road sections. The route contained a number of static billboards. Drivers provided continuous verbal protocols throughout the drive. Results indicated that the structure and content of drivers' situation awareness was not appreciably affected by the billboards in any of the road environments examined. Drivers focused their attention on the billboards when driving demand was low, such as when driving on the freeway with light to moderate traffic, in lower speed zones, or when stationary. However, when drivers were required to perform a manoeuvre or driving demands increased, drivers directed less attention to the billboards and focussed their awareness on the immediate driving task. This suggests that drivers can, at least under some conditions, effectively self-regulate their attention to billboards when required to focus on the immediate traffic or driving situation. Copyright © 2016 Elsevier Ltd. All rights reserved.
Wang, Huarong; Mo, Xian; Wang, Ying; Liu, Ruixue; Qiu, Peiyu; Dai, Jiajun
Road traffic accidents resulting in group deaths and injuries are often related to coach drivers' inappropriate operations and behaviors. Thus, the evaluation of coach drivers' fitness to drive is an important measure for improving the safety of public transportation. Previous related research focused on drivers' age and health condition. Comprehensive studies about commercial drivers' cognitive capacities are limited. This study developed a toolkit consisting of nine cognition measurements across driver perception/sensation, attention, and reaction. A total of 1413 licensed coach drivers in Jiangsu Province, China were investigated and tested. Results indicated that drivers with accident history within three years performed overwhelmingly worse (panalysis, in which the eliminated 5% tail was calculated from on integrated index. Methods to categorizing qualified, good, and excellent coach drivers and criteria for evaluating and training Chinese coach drivers' fitness to drive were also proposed. Copyright © 2015 Elsevier Ltd. All rights reserved.
... exemption. David W. Bateman Mr. Bateman holds a class A commercial driver's license (CDL) from the state of... for a period of 2 years with annual medical certification required: David W. Bateman (MN); William B...
Lysdahl, Kristin Bakke; Hofmann, Bjoern Morten; Espeland, Ansgar
To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)
On April 1, 1994, Ontario, Canada, instituted a new graduated driver license (GDL) system that effectively set the legal blood alcohol content (BAC) threshold at zero for the first few years of a youth's driving eligibility. I use data from the 1983-2001 Ontario Student Drug Use Surveys (OSDUS) to examine whether the Zero Tolerance (ZT) policy…
Ivers, Rebecca; Senserrick, Teresa; Boufous, Soufiane; Stevenson, Mark; Chen, Huei-Yang; Woodward, Mark; Norton, Robyn
We explored the risky driving behaviors and risk perceptions of a cohort of young novice drivers and sought to determine their associations with crash risk. Provisional drivers aged 17 to 24 (n = 20 822) completed a detailed questionnaire that included measures of risk perception and behaviors; 2 years following recruitment, survey data were linked to licensing and police-reported crash data. Poisson regression models that adjusted for multiple confounders were created to explore crash risk. High scores on questionnaire items for risky driving were associated with a 50% increased crash risk (adjusted relative risk = 1.51; 95% confidence interval = 1.25, 1.81). High scores for risk perception (poorer perceptions of safety) were also associated with increased crash risk in univariate and multivariate models; however, significance was not sustained after adjustment for risky driving. The overrepresentation of youths in crashes involving casualties is a significant public health issue. Risky driving behavior is strongly linked to crash risk among young drivers and overrides the importance of risk perceptions. Systemwide intervention, including licensing reform, is warranted.
Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B
Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia. A cross-sectional, health referral survey of a representative sample of health facilities in Montserrado County, Liberia was performed. A systematic random sample of all primary health care (PHC) clinics, fraction proportional to district population size, and all secondary and tertiary health facilities were included in the study sample. Collected data included baseline information about the health facility, patient flow, and qualitative and quantitative data regarding referral practices. A total of 62 health facilities-41 PHC clinics, 11 health centers (HCs), and 10 referral hospitals (RHs)-were surveyed during the 6-week study period. In sum, three percent of patients were referred to a higher-level of care. Communication between health facilities was largely unsystematic, with lack of specific protocols (n=3; 5.0%) and standardized documentation (n=26; 44.0%) for referral. While most health facilities reported walking as the primary means by which patients presented to initial health facilities (n=50; 81.0%), private vehicles, including commercial taxis (n=37; 60.0%), were the primary transport mechanism for referral of patients between health facilities. This study identified several weaknesses in acute care referral systems in Liberia, including lack of systematic care protocols for transfer, documentation, communication, and transport. However, several informal, well-functioning mechanisms for
Weiss, Eve; Fisher Thiel, Megan; Sultana, Nahida; Hannan, Chloe; Seacrist, Thomas
From the advent of airbags to electronic stability control, technological advances introduced into automobile design have significantly reduced injury and death from motor vehicle crashes. These advances are especially pertinent among teen drivers, a population whose leading cause of death is motor vehicle crashes. Recently developed advanced driver assistance systems (ADAS) have the potential to compensate for skill deficits and reduce overall crash risk. Yet, ADAS is only effective if drivers are willing to use it. Limited research has been conducted on the suitability of ADAS for teen drivers. The goal of this study is to identify teen drivers' perceived need for ADAS, receptiveness to in-vehicle technology, and intervention preferences. The long-term goal is to understand public perceptions and barriers to ADAS use and to help determine how these systems must evolve to meet the needs of the riskiest driving populations. Three focus groups (N = 24) were conducted with licensed teen drivers aged 16-19 years and 2 focus groups with parents of teen drivers (N = 12). Discussion topics included views on how ADAS might influence driving skills and behaviors; trust in technology; and data privacy. Discussions were transcribed; the team used conventional content analysis and open coding methods to identify 12 coding domains and code transcripts with NVivo 10. Interrater reliability testing showed moderate to high kappa scores. Overall, participants recognized potential benefits of ADAS, including improved safety and crash reduction. Teens suggested that ADAS is still developing and therefore has potential to malfunction. Many teens reported a greater trust in their own driving ability over vehicle technology. They expressed that novice drivers should learn to drive on non-ADAS-equipped cars and that ADAS should be considered a supplemental aid. Many teens felt that overreliance on ADAS may increase distracted driving or risky behaviors among teens. Parents also
Boufous, Soufiane; Ivers, Rebecca; Senserrick, Teresa; Norton, Robyn; Stevenson, Mark; Chen, Huei-Yang; Lam, Lawrence T
To examine differences in risky driving behavior and likelihood of traffic crash according to the country of birth of recently licensed young drivers. The groups examined include those born in Australia, those born in Asia, and those born in other countries. The DRIVE study is a prospective cohort study of drivers aged 17-24 years holding their first-year provisional driver license in New South Wales, Australia. Information obtained from 20,822 participants who completed a baseline questionnaire was linked to police-reported traffic crashes. Self-reported risky driving behaviors and police-reported traffic crashes in young drivers. Young drivers who were born in Asian countries were less likely to report engaging in risky driving behaviors than their Australian-born counterparts. The proportion of participants reporting a high level of risky driving was 31.5 percent (95% confidence intervale [CI], 30.8-32.1) among Australian-born drivers compared to 25.6 percent (95% CI, 23.1-28.2) among Asian-born drivers and 30.4 percent (95% CI, 28.4-32.5) among those born in other regions. Asian-born participants had half the risk of a crash as a driver than their Australian-born counterparts (relative risk [RR] 0.55; 95% CI, 0.41-0.75) after adjusting for a number of demographic factors and driving and risk-taking behaviors. The comparative risk was even lower among those aged 17 years (RR 0.29; 95% CI, 0.29-0.75). Risk estimates for people born in other regions did not differ to those for Australian-born respondents. The study highlights the lower level of risky driving and significantly reduced crash risk for Australian drivers born in Asian countries relative to those born locally. Further research is needed to examine factors underlying this reduced risk and the impact of the length of residence in the host country.
Rowlands, G; Willis, S; Singleton, A
GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted
Claus, B.; Geyskens, K.; Millet, K.; Dewitte, S.
The present paper shows that when a person has the experience of giving advice but that advice is not acted upon, there is a reduced openness to external information. We call this the "referral backfire effect". We argue that this referral backfire effect is due to the identity threatening nature of
Ergun Y Uç
Full Text Available OBJECTIVE: To assess the ability to negotiate curves in drivers with Parkinson’s disease (PD. METHODS: Licensed active drivers with mild-moderate PD (n= 76; 65 male, 11 female and elderly controls (n= 51; 26 male, 25 female drove on a simulated 2-lane rural highway in a high-fidelity simulator scenario in which the drivers had to negotiate 6 curves during a 37-mile drive. The participants underwent motor, cognitive, and visual testing before the simulator drive. RESULTS: Compared to controls, the drivers with PD had less vehicle control and driving safety, both on curves and straight baseline segments, as measured by significantly higher standard deviation of lateral position (SDLP and lane violation counts. The PD group also scored lower on tests of motor, cognitive, and visual abilities. In the PD group, lower scores on tests of motion perception, visuospatial ability, executive function, postural instability, and general cognition, as well as a lower level of independence in daily activities predicted low vehicle control on curves. CONCLUSION: Drivers with PD had less vehicle control and driving safety on curves compared to controls, which was associated primarily with impairments in visual perception and cognition, rather than motor function
Previous research suggests newly licensed teen drivers often fail to anticipate where unexpected hazards might materialize. One : training program designed to address these apparent deficiencies in knowledge and skills that has shown promise in previ...
Mitchell, Rachael; Jacob, Hannah; Morrissey, Benita; Macaulay, Chloe; Gomez, Kumudini; Fertleman, Caroline
Although a great deal of paediatric consultations are not urgent, doctors in training spend so much time providing service for acute conditions that they spend little time focusing on outpatient work before they become a consultant. Engaging clinicians in the managerial aspects of providing clinical care is a key to improving outcomes, and this article addresses these aspects of the outpatient consultation from referral to discharge. We aim to provide doctors in training with a tool to use during their training and their first few years as a consultant, to think about how outpatient work is organised and how it can be improved to maximise patient experience. The non-urgent consultation varies across the world; this article is aimed to be relevant to an international audience. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Lysdahl, Kristin Bakke [Oslo University College, Faculty of Health Sciences, Oslo (Norway); University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Hofmann, Bjoern Morten [University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Gjoevik University College, Faculty of Health Care and Nursing, Gjoevik (Norway); Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway)
To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)
Schall, Mark C.; Rusch, Michelle L.; Lee, John D.; Dawson, Jeffrey D.; Thomas, Geb; Aksan, Nazan; Rizzo, Matthew
Objective Evaluate the effectiveness of augmented reality (AR) cues in improving driving safety in elderly drivers who are at increased crash risk due to cognitive impairments. Background Cognitively challenging driving environments pose a particular crash risk for elderly drivers. AR cueing is a promising technology to mitigate risk by directing driver attention to roadway hazards. This study investigates whether AR cues improve or interfere with hazard perception in elderly drivers with age-related cognitive decline. Methods Twenty elderly (Mean= 73 years, SD= 5 years), licensed drivers with a range of cognitive abilities measured by a speed of processing (SOP) composite participated in a one-hour drive in an interactive, fixed-base driving simulator. Each participant drove through six, straight, six-mile-long rural roadway scenarios following a lead vehicle. AR cues directed attention to potential roadside hazards in three of the scenarios, and the other three were uncued (baseline) drives. Effects of AR cueing were evaluated with respect to: 1) detection of hazardous target objects, 2) interference with detecting nonhazardous secondary objects, and 3) impairment in maintaining safe distance behind a lead vehicle. Results AR cueing improved the detection of hazardous target objects of low visibility. AR cues did not interfere with detection of nonhazardous secondary objects and did not impair ability to maintain safe distance behind a lead vehicle. SOP capacity did not moderate those effects. Conclusion AR cues show promise for improving elderly driver safety by increasing hazard detection likelihood without interfering with other driving tasks such as maintaining safe headway. PMID:23829037
Chikritzhs, Tanya; Stockwell, Tim
To examine the impact of later trading hours for licensed hotels in Perth, Western Australia on levels of associated impaired driver road crashes and driver breath alcohol levels (BALs). Police data on the "last place of drinking" for impaired drivers involved in road crashes and their corresponding BALs were examined to identify those associated with Perth hotels between 1 July 1990 and 30 June 1997. During this period, 43 (23%) of the 186 hotels meeting study criteria were granted an Extended Trading Permit for 1 a.m. closing (ETP hotels), while the rest continued to close at midnight (non-ETP hotels). Time-series analyses employing multiple linear regressions were applied to determine whether an association existed between the introduction of extended trading and (i) monthly levels of impaired driver road crashes associated with ETP hotels and (ii) driver BALs associated with ETP hotels. Trends associated with non-ETP hotels were included as controls and possible confounders were considered. After controlling for the trend in crash rates associated with non-ETP hotels and the introduction of mobile police breath testing stations to Perth freeways, a significant increase in monthly crash rates for ETP hotels was found. This relationship was largely accounted for by higher volumes of high-alcohol content beer, wine and spirits purchased by ETP hotels. No relation was found between driver BALs and the introduction of ETPs. Late trading was associated with increased levels of impaired driver road crashes and alcohol consumption, particularly high-risk alcoholic beverages. Greater numbers of patrons and characteristics specific to clientele of hotels which applied for late trading hours (i.e. younger age, greater propensity to drunk-drive, preference for high-risk beverages) were suggested as having contributed to this increase.
Ebrahimi, Mohammad Hossein; Sadeghi, Masoumeh; Dehghani, Mohsen; Niiat, Khosro Sadegh
The aim of this study is to assess the sleep quality and sleep disorders (prevalence of obstructive sleep apnea and sleepiness) among occupational drivers in Iran and to determine which demographic factors and occupational habits are linked to road traffic accidents. In this analytic cross-sectional study 556 occupational road drivers from Shahroud city (in the northeast of Iran) participated, upon a prior verbal informed consent, during 2013-2014. The Pittsburgh Sleep Quality Index (PSQI) standard questionnaire that scored on 7 point scale, the 8-item Epworth Sleepiness Scale (ESS) questionnaire and the 8-question STOP-Bang questionnaire along with demographic information and occupational data were used. To explore the independent factors associated with odds of poor sleep quality and road accident, multiple logistic regression models were used. Prevalence of previous road accidents, sleepiness while driving, and obstructive sleep apnea scored ≥ 3 in the study, and drivers accounted for 23.8%, 29%, and 24.8%, respectively. The global mean score of sleep quality and excessive sleepiness score were 5.2 and 4.8, respectively. The main factors related to the odds of poor sleep quality were snoring (odds ratio (OR) = 2.34; 95% confidence interval (CI): 1.15-4.77), smoking (OR = 2.12; 95% CI: 1.15-3.97), and driving times in a day (OR = 1.12; 95% CI: 1.03-1.21). The Epworth Sleepiness Scale (OR = 1.13; 95% CI: 1.07-1.23) and suffering from apnea (OR = 4.89; 95% CI: 1.07-23.83) were the best predictors for odds (increased risk) of road accidents. A considerable proportion of Iranian drivers had records of road accidents; poor sleep quality, sleepiness while driving, and sleep disorder breathing (obstructive sleep apnea - OSA). Snoring, smoking, driving time in a day, excessive sleepiness, and presumably apnea increase the odds of poor sleep quality and road traffic accident for Iranian occupational drivers. This work is available in Open Access model and licensed under
Biza, Mohamed; Mossie, Andualem; Woldemichael, Kifle; Gelaw, Yeshigeta
Vision play a vital role in driving where good and efficient visual functioning of the driver is essential. Any significant loss of visual function will diminish a driver's ability to operate a motor vehicle safely and will thus contribute to road traffic injury. However, there is little evidence indicating that defects of vision alone cause road traffic accidents. To determine the impact of visual impairment and other factors on road traffic accident among vehicle drivers. A cross-sectional descriptive study was conducted on 249 sampled drivers in Southwest Ethiopia. A pretested interviewer led questionnaire was used for interview and vision tests were done using Snellen's acuity chart and Ishihara pseudo-isochromatic plates. Statistical analyses were performed using SPSS version 16.0. The mean age of drivers was 33.6 years (SD +/- 10.3). The relative frequency of self reported road traffic accident was 15.3%. The prevalence of uncorrected binocular visual impairment was 1.6% and there was a significant association between visual impairment and road traffic accident (P road traffic accident. There is need for consistent inspection and screening, strict rules and regulations of licensing and health education for drivers to minimize road traffic accident.
Full Text Available Introduction. This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference service. Method. The data analysed for this study were 420 chat reference transaction transcripts along with corresponding online survey questionnaires submitted by the service users. Both sets of data were collected from an electronic archive of a southeastern state public library system that has participated in 24/7 Reference of the Metropolitan Cooperative Library System (MCLS. Results. Referrals in the collaborative chat reference service comprised approximately 30% of the total transactions. Circulation-related questions were the most often referred among all question types, possibly because of the inability of 'outside' librarians to access patron accounts. Most importantly, user satisfaction with referrals was found to be significantly lower than that of completed answers. Conclusion. The findings of this study addressed the importance of distinguishing two types of referrals: the expert research referrals conducive to collaborative virtual reference services; and the re-directional local referrals that increase unnecessary question traffic, thereby being detrimental to effective use of collaborative reference. Continuing efforts to conceptualize referrals in multiple dimensions are anticipated to fully grasp complex phenomena underlying referrals.
Twisk, Divera; Bos, Niels; Shope, Jean T; Kok, Gerjo
Whereas the safety of teens in early licensing countries has been extensively studied, little is known about the safety of pre-license teens in late licensing countries, where these teens also may be at risk. This risk exists because of the combination of a) increasing use of travel modes with a high injury risk, such as bicycles and mopeds, b) inexperience, and c) teens' developmental stage, known to be associated with risk taking and novelty seeking, especially among males. To explore the magnitude and nature of pre-license road risk, this study analysed epidemiological data from the Netherlands, and hypothesized that in this late licensing country, 'independent travel' and the use of riskier modes of transport increase among pre-license teens 10 to 17 years of age, resulting in higher fatality rates, with 'experience' and 'gender' as risk modifying factors. National travel and fatality data of pre-license adolescents in the Netherlands were analysed by traffic role (cyclist, pedestrian, car passenger and moped rider), and compared to a younger age group (0-9 years) and an older age group (18+ years). The study of travel data showed that teens migrate from being car occupants to being users of riskier modes of transport, specifically bicycles and mopeds. This migration resulted in a strong rise in road fatalities, illustrating the importance of mobility patterns for understanding changes in road fatalities in this age group. The data further suggested a protective role of early cycle experience for young adolescent cyclists, particularly for young males. But further study into the underlying mechanism is needed to confirm this relationship. Moped risk was extremely high, especially among young males, and even higher than that of young male car drivers. The study confirmed the importance of changes in mobility patterns for understanding the rising road mortality when youngsters enter into their teens. The focus on fatalities has led to an underestimation of the
Simba, Daudi O; Warsame, Marian; Kimbute, Omari; Kakoko, Deodatus; Petzold, Max; Tomson, Goran; Premji, Zul; Gomes, Melba
WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers' adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories. The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions taken post-referral: taking their children to a drug shop, a traditional healer, or not seeking further treatment, and added to a random selection of patients who complied with referral advice. Caretakers of the children were interviewed about their socio-economic status (SES), knowledge about malaria, referral advice given and actions they took following pre-referral treatment. Interview data for 587 caretakers were matched with symptoms of the children, the time of treatment, arrival at a health facility or other actions taken post-pre-referral treatment. The majority (93.5%) of caretakers reported being given referral advice by the community drug dispenser. The odds of adherence with this advice were three times greater for children with altered consciousness and/or convulsions than for children with other symptoms [odds ratio (OR) 3.47, 95% confidence interval (CI) 2.32-5.17, P < 0.001]. When questioned, caretakers who remembered when (OR 2.19, 95% CI 1.48-3.23, P < 0.001) and why (OR 1.77, 95% CI 1.07-2.95, P = 0.026) they were advised to proceed to health facility - were more likely to follow referral advice. Cost did not influence adherence except within a catchment area of facilities that charged for services. In these areas, costs deterred adherence by
Kugler, Adriana D.
Many workers believe that personal contacts are crucial for obtaining jobs in high-wage sectors. On the other hand, firms in high-wage sectors report using employee referrals because they help provide screening and monitoring of new employees. This Paper develops a matching model that can explain the link between inter-industry wage differentials and the use of employee referrals. Referrals lower monitoring costs because high-effort referees can exert peer pressure on co-workers, allowing fir...
Wu, Connor Y H; Loo, Becky P Y
An increasing number of motorcycle taxis have been involved in traffic crashes in many developing countries. This study examines the characteristics of both motorcycle taxi drivers and nonoccupational motorcyclists, investigates the risks they pose to road safety, and provides recommendations to minimize their risks. Based on the data collected from a questionnaire survey of 867 motorcycle taxi drivers and 2,029 nonoccupational motorcyclists in Maoming, South China, comparisons were made to analyze differences of personal attributes, attitudes toward road safety, and self-reported behavior of the 2 groups. Results of the chi-square tests show that not only motorcycle taxi drivers but also nonoccupational motorcyclists in Maoming held poor attitudes toward road safety and both groups reported unsafe driving behavior. There is much room for improving local road safety education among all motorcyclists in Maoming. Yet, motorcycle taxi drivers were more likely to pose road safety risks than nonoccupational motorcyclists under some circumstances, such as speeding late at night or early in the morning, not requiring passengers to wear helmets, and running a red light. The results of the binary logistic regression model show that possessing a vehicle license for a motorcycle or not was the common significant predictor for unsafe driving behavior of motorcycle taxi drivers and nonoccupational motorcyclists. Therefore, enforcement against all motorcyclists not showing vehicle licenses for their motorcycles should be stepped up. Motorcycle safety is largely poor in Maoming. Therefore, efforts to improve motorcycle safety should be strengthened by targeting not only motorcycle taxi drivers but also nonoccupational motorcyclists.
Full Text Available Background: The aim of the study is to present the health predispositions to drive, assessed during certifying people referred to the Regional Centre for Occupational Medicine in Kielce due to drunk driving or driving after using alcohol. The article mainly presents the results regarding the prevalence of alcohol dependence and other psychiatric disorders in this group. We analyzed health condition at 3 year intervals in the years 2004, 2007 and 2010, adding the population of those who were examined in 2011. Material and Methods: A total of 5701 people were involved, both men and women. Drivers test cards along with the results of biochemical tests and specialist consultations were analyzed. The analysis of the results was performed using the statistical package PQStat 188.8.131.524 Results: Certificates with health contraindications to drive were issued to 6.7% of investigated individuals. Very significant correlation between alcohol dependence syndrome and the level of γ-glutamyl transferase (GGT, alanine aminotransferase (ALT, and aspartate aminotransferase (AST were confirmed. Alcohol dependence was diagnosed in 3.8% of the group. Conclusions: The health state of the drivers met the required certification criteria necessary for obtaining a driving license in more than 93% of the group. The study revealed many diseases in the group of investigated drivers, including 3.8% of alcohol dependence and 5% of mental disorders. The threat of losing driving license has become an important factor motivating drivers to undertake therapy. However, it seems advisable to develop principles for treatment monitoring and exchange of information between the certifying physician and the treating psychiatrist or psychologist. Med Pr 2014;65(4:497–506
Hogben, M; St Lawrence, J S; Montaño, D E; Kasprzyk, D; Leichliter, J S; Phillips, W R
The United States has relied upon partner notification strategies to help break the chain of infection and re-infection for sexually transmitted diseases (STD). Physicians are a vital link in the system of STD control, but little is known of physician opinions about partner notification strategies. We collected opinions about partner notification from a national probability sample of physicians in specialties diagnosing STDs. Physicians responded to 17 questions about three relevant forms of STD partner notification: patient based referral, provider based referral, and case reporting. Exploratory factor analyses showed that responses for each form of partner notification could be grouped into four categories: perceived practice norms, infection control, patient relationships, and time/money. Multivariate analyses of the factors showed that physicians endorsed patient based referral most favourably and provider based referral least favourably. Physicians' opinions about partner notification strategies appear to reflect objective reality in some areas, but not in others. Strategies that improve the fit between physicians' opinions and effective notification are needed: some are discussed here.
Eichelberger, Angela H; Teoh, Eric R; McCartt, Anne T
Previous research has shown that many newly licensed teenagers in the United States are driving vehicles with inferior crash protection. The objective of this study was to update and extend previous research on U.S. parents' choices of vehicles for their teenagers. Telephone surveys were conducted with parents in May 2014 using a random sample of U.S. households likely to include teenagers. Participation was restricted to parents or guardians of teenagers who lived in the household and held either an intermediate or full driver's license. Parents were interviewed about the vehicle their teenager drives, the reason they chose the vehicle for their teenager, and the cost of purchased vehicles. Teenagers most often were driving 2000-06 model year vehicles (41%), with 30% driving a more recent model year and 19% driving an older model year. Teenagers most often were driving midsize or large cars (27%), followed by SUVs (22%), mini or small cars (20%), and pickups (14%). Far fewer were driving minivans (6%) or sports cars (1%). Forty-three percent of the vehicles driven by teenagers were purchased when the teenager started driving or later. A large majority (83%) were used vehicles. The median cost of the vehicles purchased was $5300, and the mean purchase price was $9751. Although parents report that the majority of teenagers are driving midsize or larger vehicles, many of these vehicles likely do not have key safety features, such as electronic stability control, which would be especially beneficial for teenage drivers. Many teenagers were driving older model year vehicles or vehicle types or sizes that are not ideal for novice drivers. Parents, and their teenage drivers, may benefit from consumer information about optimal vehicle choices for teenagers. Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.
Warren, Jim; Gu, Yulong; Day, Karen; White, Sue; Pollock, Malcolm
Between September 2010 and May 2011 we evaluated three implementations of electronic referral (eReferral) systems at Hutt Valley, Northland and Canterbury District Health Boards in New Zealand. Qualitative and quantitative data were gathered through project documentation, database records and stakeholder interviews. This paper reports on the user perspectives based on interviews with 78 clinical, management and operational stakeholders in the three regions. Themes that emerge across the regions are compared and synthesised. Interviews focused on pre-planned domains including quality of referral, ease of use and patient safety, but agendas were adapted progressively to elaborate and triangulate on themes emerging from earlier interviews and to clarify indications from analysis of database records. The eReferral users, including general practitioners, specialists and administrative staff, report benefits in the areas of: (1) availability and transparency of referral-related data; (2) work transformation; (3) improved data quality and (4) the convenience of auto-population from the practice management system into the referral forms. eReferral provides enhanced visibility of referral data and status within the limits of the implementation (which only goes to the hospital door in some cases). Users in all projects indicated the desire to further exploit IT to enhance two-way communication between community and hospital. Reduced administrative handling is a clear work transformation benefit with mixed feedback regarding clinical workload impact. Innovations such as GP eReferral triaging teams illustrate the further potential for workflow transformation. Consistent structure in eReferrals, as well as simple legibility, enhances data quality. Efficiency and completeness is provided by auto-population of forms from system data, but opens issues around data accuracy. All three projects highlight the importance of user involvement in design, implementation and refinement. In
Logroscino, Giancarlo; Marin, Benoit; Piccininni, Marco; Arcuti, Simona; Chiò, Adriano; Hardiman, Orla; Rooney, James; Zoccolella, Stefano; Couratier, Philippe; Preux, Pierre-Marie; Beghi, Ettore
Despite concerns about the representativeness of patients from ALS tertiary centers as compared to the ALS general population, the extent of referral bias in clinical studies remains largely unknown. Using data from EURALS consortium we aimed to assess nature, extent and impact of referral bias. Four European ALS population-based registries located in Ireland, Piedmont, Puglia, Italy, and Limousin, France, covering 50 million person-years, participated. Demographic and clinic characteristics of ALS patients diagnosed in tertiary referral centers were contrasted with the whole ALS populations enrolled in registries in the same geographical areas. Patients referred to ALS centers were younger (with difference ranging from 1.1 years to 2.4 years), less likely to present a bulbar onset, with a higher proportion of familial antecedents and a longer survival (ranging from 11% to 15%) when compared to the entire ALS population in the same geographic area. A trend for referral bias is present in cohorts drawn from ALS referral centers. The magnitude of the possible referral bias in a particular tertiary center can be estimated through a comparison with ALS patients drawn from registry in the same geographic area. Studies based on clinical cohorts should be cautiously interpreted. The presence of a registry in the same area may improve the complete ascertainment in the referral center.
Chikritzhs, Tanya; Stockwell, Tim
To examine the impact of extended trading permits (ETPs) for licensed hotels in Perth, Western Australia on impaired driver breath alcohol levels (BALs) between July 1993 and June 1997. Forty-three hotels obtained ETPs allowing later closing hours and 130 maintained standard closing time (controls). Impaired driver BALs were linked to 'last place of drinking' hotels. Before and after period BALs of drivers who last drank at ETP or non-ETP hotels were compared by time of day of apprehension and sex, controlling for age. Impaired female drivers apprehended between 10.01 p.m. and 12 midnight (before closing time) had significantly lower BALs after drinking at ETP hotels. Male drivers aged 18-25 years and apprehended between 12.01 and 2.00 a.m. after drinking at ETP hotels had significantly higher BALs than drivers who drank at non-ETP hotels. At peak times for alcohol-related offences, late trading is associated with higher BALs among those drinkers most at risk of alcohol-related harm.
Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.
Maria Arbatskaya; Hideo Konishi
We consider the optimal pricing and referral strategy of a monopoly that uses a simple consumer communication network (a chain) to spread product information. The first-best policy with fully discriminatory position-based referral fees involves standard monopoly pricing and referral fees that provide consumers with strictly positive referral incentives. Effective price discrimination among consumers based on their positions in the chain occurs in both the first-best solution and the second-be...
Al Azri, Mohammed; Al Reesi, Hamed; Al-Adawi, Samir; Al Maniri, Abdullah; Freeman, James
Drivers' behaviors such as violations and errors have been demonstrated to predict crash involvement among young Omani drivers. However, there is a dearth of studies linking risky driving behaviors to the personality of young drivers. The aim of the present study was to assess such traits within a sample of young Omani drivers (as measured through the behavioral inhibition system [BIS] and the behavioral activation system [BAS]) and determine links with aberrant driving behaviors and self-reported crash involvement. A cross-sectional study was conducted at the Sultan Qaboos University that targeted all licensed Omani's undergraduate students. A total of 529 randomly selected students completed the self-reported questionnaire that included an assessment of driving behaviors (e.g., Driver Behaviour Questionnaire, DBQ) as well as the BIS/BAS measures. A total of 237 participants (44.8%) reported involvement in at least one crash since being licensed. Young drivers with lower BIS-Anxiety scores and higher BAS-Fun Seeking tendencies as well as male drivers were more likely to report driving violations. Statistically significant gender differences were observed on all BIS and BAS subscales (except for BAS-Fun) and the DBQ subscales, because males reported higher trait scores. Though personality traits were related to aberrant driving behaviors at the bivariate level, the constructs were not predictive of engaging in violations or errors. Furthermore, consistent with previous research, a supplementary multivariate logistic regression analysis revealed that only driving experience was predictive of crash involvement. The findings highlight that though personality traits influence self-reported driving styles (and differ between the genders), the relationship with crash involvement is not as clear. This article further outlines the key findings of the study in regards to understanding core psychological constructs that increase crash risk.
... will be test-driving Daimler vehicles on U.S. roads in order to meet future vehicle safety and... safety systems and emissions reductions. These Daimler drivers will typically drive for no more than 6... application, including the extensive driving experience and safety records of Georg Weiberg and Klaus-Dieter...
Senserrick, Teresa M; Kallan, Michael J; Winston, Flaura K
Several international jurisdictions allow family exemptions to graduated driver licensing passenger restrictions. The objective of this research was to examine differences in injury risk to US child passengers in crashes involving sibling versus non-sibling teen drivers, and to compare outcomes with crashes involving adult drivers. Insurance claim and telephone survey data were collected on 16 233 child passengers (representing 289 329 children) in 17 US jurisdictions. There was a trend toward higher restraint non-use by child passengers in the non-sibling group than in the sibling group (9.6% vs 4.7%; p = 0.08). Children in the sibling group had a 40% lower risk of injury than those in the non-sibling group (adjusted OR 0.60, 95% CI 0.40 to 0.90); however, injury risk was higher in the sibling group than in children traveling with adults (adjusted OR 1.57, 95% CI 1.09 to 2.26). Child passengers riding with sibling teen drivers may be safer than those riding with non-sibling teens, but not as safe as those riding with adult drivers.
Siren, Anu Kristiina; Haustein, Sonja
Chronological age, per se, seems to be, in the case of mature drivers, only a weak predictor of safe driving performance. However, screening policies based on chronological age are widely used. Nevertheless, lately, more evidence-based policies have been called for. In this paper we first......, investigate the evidence for and against having an age-based driver screening policy in place; second, we map and compare the current driving licensing policies in European Union (EU) member states in order to examine the variation; and third, we draw conclusions based on the literature and the policy mapping...... are likely to limit the mobility and potentially worsen the safety of older persons....
Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.
Petrella, S.; Dermarkar, F.; Austman, D.; Chun, R.
The use of risk criteria and information has always been an important component of the licensing of nuclear reactors in Ontario. Early applications included the development of Safety Design Matrices in the early 80's for more comprehensive design reviews, the use of the Darlington Probabilistic Safety Evaluation in the late-80's to support the C-6 event categorization process for the initial Darlington licensing, and the use of risk-insights, along with cost benefit criteria, to evaluate design options for the Pickering A special safety system design retrofits and modifications, such as Shutdown System (SDS) enhancement and Emergency Coolant Injection System (ECIS) upgrades. Operational uses have included the management of outage risk, the review of containment test frequencies, and the review of abnormal operating configurations such as maintenance of electrical power supplies. It is envisaged that such applications will continue, aided by the continued development of Probabilistic Risk Assessments techniques. To provide enhanced assurance of safety, to evaluate current and new safety-related issues as they arise, and to realize the full safety and economic benefits of risk-insights, OPG and Bruce Power have, along with their Industry partners, embarked on a path to further increase the use of risk-information in the operation and licensing of their reactors. Drivers include the resolution of long standing safety analysis issues surrounding LBLOCA analyses and generic action items, the application of risk-insights to guide the response to design, inspection, and analysis findings, and the optimization of operating, maintenance, and testing programs. As well, a major near term driver is input to plant refurbishment decisions. In moving to a more risk-informed approach to safety assessment, challenges include developing and implementing the required suite of concepts, tools, processes and criteria, and reconciling the current largely deterministic approach to safety
Chen, Karen B; Xu, Xu; Lin, Jia-Hua; Radwin, Robert G
The number of drivers over 65 years of age continues to increase. Although neck rotation range has been identified as a factor associated with self-reported crash history in older drivers, it was not consistently reported as indicators of older driver performance or crashes across previous studies. It is likely that drivers use neck and trunk rotation when driving, and therefore the functional range of motion (ROM) (i.e. overall rotation used during a task) of older drivers should be further examined. Evaluate older driver performance in an immersive virtual reality, simulated, dynamic driving blind spot target detection task. A cross-sectional laboratory study recruited twenty-six licensed drivers (14 young between 18 and 35 years, and 12 older between 65 to 75 years) from the local community. Participants were asked to detect targets by performing blind spot check movements while neck and trunk rotation was tracked. Functional ROM, target detection success, and time to detection were analyzed. In addition to neck rotation, older and younger drivers on average rotated their trunks 9.96° and 18.04°, respectively. The younger drivers generally demonstrated 15.6° greater functional ROM (p<.001), were nearly twice as successful in target detection due to target location (p=.008), and had 0.46 s less target detection time (p=.016) than the older drivers. Assessing older driver functional ROM may provide more comprehensive assessment of driving ability than neck ROM. Target detection success and time to detection may also be part of the aging process as these measures differed between driver groups. Copyright © 2015 Elsevier Inc. All rights reserved.
... Practitioners (GMPS) sent the most referrals (507 or 74.0%), specialist medical practitioners (SMPs) sent 86(12.6%) and general dental practitioners (GDPs) sent 59(8.6%) referrals. The medical specialty with most referrals was paediatrics (29.0 % of the SMPs referrals). 44.5% of the referrals had no provisional diagnosis, ...
Wu, Cai; Sandoval, Alex; Hicks, Katrina N; Edwards, Tim J; Green, Lyle D
The Office of Physician Relations at The University of Texas M. D. Anderson Cancer Center (MDACC) has developed a dynamic referral productivity reporting tool for its Multidisciplinary Care Centers (MCC). The tool leverages information within the institution's Enterprise Information Warehouse (EIW) using business intelligent software Hyperion Intelligent Explorer Suite 8.3. the referral productivity reports are intended to provide each MCC with detailed referral and registration data outlining how, and from where, patients arrive here for treatment. The reports supports operational and strategic initiatives aimed at improving referral processes and market related program development.
Lendoiro, Elena; de Castro, Ana; Jiménez-Morigosa, Cristian; Gomez-Fraguela, Xosé A; López-Rivadulla, Manuel; Cruz, Angelines
The implementation of the points-based driving license helps to change the drivers' behavior and is related to a reduction of traffic accidents and fatalities. In Spain, when a driver loses all points, the driving license is revoked, so the driver must enroll on a Driver Awareness and Re-education (DARE) course. However, at the moment offenders are not submitted to any test to confirm absence of alcohol or drugs of abuse consumption, even when 9% of Spanish drivers lose their driving license for driving under the influence (DUI). The objective of this pilot study was the comparison of the usefulness of psychological tests and hair analysis to identify those individuals with a chronic consumption of alcohol and drugs of abuse among drivers performing DARE courses. Volunteers were submitted to the AUDIT and DAST-10 tests. Also a hair sample was collected and analyzed for ethylglucuronide (EtG) (LOQ 5pg/mg) and 35 licit and illicit drugs (LOQ 5-50pg/mg) by LC-MS/MS. Sixty-one participants with a mean age of 37.2±11.6years, and mainly men (90.2%), were recruited and performed AUDIT and DAST-10 tests. All hair samples were analyzed for EtG and 17 samples for licit and illicit drugs. Mean AUDIT score was 9.6 (SD=7.5), showing a value ≥8 (indicator of hazardous and harmful alcohol use) in 52.4% of cases. Mean DAST-10 score was 2.9 (SD=3.3), but a score ≥6 was detected in 21.3% of cases (indicating drug abuse or dependence). Twenty-two samples were positive for EtG, 8 for drugs of abuse (8 cocaine, 2 opioids, 1 amphetamines, 1 cannabis), and 3 for medicines. EtG concentration (20.7-1254.1pg/mg) was higher than the Society of Hair Testing (SoHT) cut-off for chronic alcohol consumption (≥30pg/mg) in 21 cases. All positive cases for methadone and cannabis, and half of positive cases for opioids and cocaine presented higher concentrations than SoHT cut-offs for chronic consumption. Higher AUDIT score and higher EtG concentration in hair were statistically associated
Full Text Available The model proposed in this paper uses four psychological instruments for assessing driver behaviour and personality traits aiming to find a relationship between the considered constructs and the occurrence of traffic accidents. A Barratt Impulsiveness Scale (BIS-11 was used for the assessment of impulsivity, Aggressive Driving Behaviour Questionnaire (ADBQ for assessing the aggressiveness while driving, Manchester Driver Attitude Questionnaire (DAQ and the Questionnaire for self-assessment of driving ability. Besides these instruments, the participants filled out an extensive demographic survey. Within the statistical analysis, in addition to the descriptive indicators, correlation coefficients were calculated and four hierarchical regression analyses were performed to determine the predictive power of personality traits on the occurrence of traffic accidents. Further, to confirm the results and to obtain additional information about the relationship between the considered variables, the structural equation modelling and binary logistic regression have been implemented. A sample of this research covered 305 drivers, of which there were 100 bus drivers and 102 truck drivers, as well as 103 drivers of privately owned vehicles. The results indicate that BIS-11 and ADBQ questionnaires show the best predictive power which means that impulsivity and aggressiveness as personality traits have the greatest influence on the occurrence of traffic accidents. This research could be useful in many fields, such as the design of selection procedures for professional drivers, development of programs for the prevention of traffic accidents and violations of law, rehabilitation of drivers who have been deprived of the driving license, etc.
Full Text Available Mikael Björkeborn,1 Henrik Nilsson,2 Jonas Anderud1 1Department of Oral and Maxillofacial Surgery, Halmstad Hospital, Halmstad, Sweden; 2Department of Oral and Maxillofacial Surgery, Växjö Hospital, Växjö, Sweden Aim: To assess the quality of routine oral surgery referrals received at Halmstad Hospital and Växjö Hospital and to emphasize areas for improvement. Method: A retrospective study was performed on all routine oral surgery referrals received between 2014 and 2015 at both Halmstad Hospital and Växjö Hospital. A total of 1,891 referral letters were assessed for their quality against a predetermined checklist of basic requirements of a satisfactory referral. The referrals were also categorized according to if it was sent by a male, female, private dental service, or the Swedish Public Dental Health service. Results: A diagnosis was missing in 30% of all referrals. Radiographs and information about previous radiographic examinations were not included in 10% of the referrals. Of those referrals that included radiographs, only around half were deemed adequate for diagnostic purposes. The presenting complaint was missing in 40% of all referrals. Current medical history was absent in 40% and current medication was omitted in 60% of the referrals. Information about tobacco use was only included in 10% of all referrals. Overall, female referrers performed better than male colleagues. Private referrals more regularly included information about diagnosis, previous treatment, and current medication. On the other hand, referrals from the public dental health service more frequently included radiographs, tobacco use, and current medical history. Conclusion: There is plenty of room for improving the standards of oral surgery referrals. We suggest that future electronic referral systems should only allow for submission once all of the essential information has been considered. Keywords: clinical audit, referral quality, oral surgery referrals
Zhang, Qian; Jiang, Zuhua; Zheng, Dongpeng; Man, Dong; Xu, Xunnan
Carless young drivers refers to those drivers aged between 18 and 25 years who have a driver's license but seldom have opportunities to practice their driving skills because they do not have their own cars. Due to China's lower private car ownership, many young drivers become carless young drivers after licensure, and the safety issue associated with them has raised great concern in China. This study aims to provide initial insight into the self-reported driving behaviors and simulated driving performance of Chinese carless young drivers. Thirty-three carless young drivers and 32 young drivers with their own cars (as a comparison group) participated in this study. A modified Driver Behavior Questionnaire (DBQ) with a 4-factor structure (errors, violations, attention lapses, and memory lapses) was used to study carless young drivers' self-reported driving behaviors. A simulated driving experiment using a low-cost, fixed-base driving simulator was conducted to measure their simulated driving performance (errors, violations, attention lapses, driving maintenance, reaction time, and accidents). Self-reported DBQ outcomes showed that carless young drivers reported similar errors, more attention lapses, fewer memory lapses, and significantly fewer violation behaviors relative to young drivers with their own cars, whereas simulated driving results revealed that they committed significantly more errors, attention lapses, and violation behaviors than the comparison group. Carless young drivers had a lower ability to maintain the stability of speed and lane position, drove more cautiously approaching and passing through red traffic lights, and committed more accidents during simulated driving. A tendency to speed was not found among carless young drivers; their average speed and speeding frequency were all much lower than that of the comparison group. Lifetime mileage was the only significant predictor of carless young drivers' self-reported violations, simulated violations
Full Text Available There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral.
Scott-Parker, B; Senserrick, T
Young drivers continue to be over-represented in road crash fatalities despite a multitude of research, communication and intervention. Evidence-based improvement depends to a great extent upon research methodology quality and its reporting, with known limitations in the peer-review process. The aim of the current research was to review the scope of research methodologies applied in 'young driver' and 'teen driver' research and their reporting in four peer-review journals in the field between January 2006 and December 2013. In total, 806 articles were identified and assessed. Reporting omissions included participant gender (11% of papers), response rates (49%), retention rates (39%) and information regarding incentives (44%). Greater breadth and specific improvements in study designs and reporting are thereby identified as a means to further advance the field. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Haider, Rafiqul; Abdullah, Abu Yousuf Md; Christou, Aliki; Ali, Nabeel Ashraf; Rahman, Ahmed Ehsnaur; Iqbal, Afrin; Bari, Sanwarul; Hoque, D. M. Emdadul; Arifeen, Shams El; Kissoon, Niranjan; Larson, Charles P.
Background A geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project. Methods A GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities. Results Fifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project’s transport doubled and referral compliance from distant zones similarly increased. Conclusions The GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings. PMID
ITER was fortunate to have four countries interested in ITER siting to the point where licensing discussions were initiated. This experience uncovered the challenges of licensing a first of a kind, fusion machine under different licensing regimes and helped prepare the way for the site specific licensing process. These initial steps in licensing ITER have allowed for refining the safety case and provide confidence that the design and safety approach will be licensable. With site-specific licensing underway, the necessary regulatory submissions have been defined and are well on the way to being completed. Of course, there is still work to be done and details to be sorted out. However, the informal international discussions to bring both the proponent and regulatory authority up to a common level of understanding have laid the foundation for a licensing process that should proceed smoothly. This paper provides observations from the perspective of the International Team. (author)
Lee, A.G.; Labrie, J.P.; Langman, V.J.
Full text: The Operating Licence for a MAPLE reactor (i.e., a 10 MW(th), pool-type reactor), has been approved by the Atomic Energy Control Board (AECB) on August 16th, 1999. This Operating Licence has been obtained within three years of the initiation of the MDS Nordion Medical Isotopes Reactor (MMIR) project, which entails the design, construction and commissioning of two 10 MW MAPLE reactors at AECL's Chalk River Laboratories. The scope and nature of the information required by the AECB, the licensing process and highlights of the events which led to successfully obtaining the Operating Licence for the MAPLE reactor are discussed. These discussions address all phases of the licensing process (i.e., the environmental assessment in support of siting, the Preliminary Safety Analysis Report, PSAR, in support of design, procurement and construction, the Final Safety Analysis Report, FSAR, in support of commissioning and operations, and the development of suitable quality assurance subprograms for each phase). An overview of some of the unique technical aspects associated with the MAPLE reactors, and how they have been addressed during the licensing process are also provided (e.g., applying CSA N285.0, General Requirements for Pressure-Retaining Systems and Components in CANDU Nuclear Power Plants, to a small, low pressure, low temperature research reactor, confirmation of the performance of the driver fuel via laboratory and/or in-reactor testing, validation of the computer codes used to perform the safety analyses, critical parameter uncertainty assessment, full scale hydraulic testing of the performance of the design, fuel handling, human factors validation, operator training and certification). (author)
... named drivers, employed by Rotel and possessing German CDLs, to operate commercial motor vehicles (CMVs.... ADDRESSES: You may submit comments identified by Federal Docket Management System Number FMCSA-2008-0078 by... . Follow the online instructions for submitting comments. Fax: 1-202-493-2251. Mail: Docket Management...
Liu, Ching-Ming; Chang, Shuenn-Dyh; Cheng, Po-Jen
This retrospective cohort study analyzed the clinical manifestations in patients with preeclampsia and eclampsia, assessed the risk factors compared to the severity of hypertensive disorders on maternal and perinatal morbidity, and mortality between the referral and non-referral patients. 271 pregnant women with preeclampsia and eclampsia were assessed (1993 to 1997). Chi-square analysis was used for the comparison of categorical variables, and the comparison of the two independent variables of proportions in estimation of confidence intervals and calculated odds ratio of the referral and non-referral groups. Multivariate logistic regression was used for adjusting potential confounding risk factors. Of the 271 patients included in this study, 71 (26.2%) patients were referrals from other hospitals. Most of the 62 (87.3%) referral patients were transferred during the period 21 and 37 weeks of gestation. Univariate analysis revealed that referral patients with hypertensive disorder were significantly associated with SBP > or =180, DBP > or =105, severe preclampsia, haemolysis, elevated liver enzymes, low platelets (HELLP), emergency C/S, maternal complications, and low birth weight babies, as well as poor Apgar score. Multivariate logistic regression analyses revealed that the risk factors identified to be significantly associated with increased risk of referral patients included: diastolic blood pressure above 105 mmHg (adjusted odds ratio, 2.09; 95 percent confidence interval, 1.06 to 4.13; P = 0.034), severe preeclampsia (adjusted odds ratio, 3.46; 95 percent confidence interval, 1.76 to 6.81; P < 0.001), eclampsia (adjusted odds ratio, 2.77; 95 percent confidence interval, 0.92 to 8.35; P = 0.071), HELLP syndrome (adjusted odds ratio, 18.81; 95 percent confidence interval, 2.14 to 164.99; P = 0.008). The significant factors associated with the referral patients with hypertensive disorders were severe preeclampsia, HELLP, and eclampsia. Lack of prenatal care was
Background: This study was aimed at establishing the degree of conformity with the referral system, level of pre-referral investigative evaluations and degree of diagnosis concordance between the referring centres and the referral hospital in Western region of Kenya. Methods: This was a hospital based descriptive, ...
Full Text Available The “360° GH in Europe” meeting, which examined various aspects of GH diseases, was held in Lisbon, Portugal, in June 2016. The Merck KGaA (Germany funded meeting comprised three sessions entitled “Short Stature Diagnosis and Referral,” “Optimizing Patient Management,” and “Managing Transition.” Each session had three speaker presentations, followed by a discussion period, and is reported as a manuscript, authored by the speakers. The first session examined current processes of diagnosis and referral by endocrine specialists for pediatric patients with short stature. Requirements for referral vary widely, by country and by patient characteristics such as age. A balance must be made to ensure eligible patients get referred while healthcare systems are not over-burdened by excessive referrals. Late referral and diagnosis of non-GH deficiency conditions can result in increased morbidity and mortality. The consequent delays in making a diagnosis may compromise the effectiveness of GH treatment. Algorithms for growth monitoring and evaluation of skeletal disproportions can improve identification of non-GH deficiency conditions. Performance and validation of guidelines for diagnosis of GH deficiency have not been sufficiently tested. Provocative tests for investigation of GH deficiency remain equivocal, with insufficient information on variations due to patient characteristics, and cutoff values for definition differ not only by country but also by the assay used. When referring and diagnosing causes of short stature in pediatric patients, clinicians need to rely on many factors, but the most essential is clinical experience.
Polcyn, Dawn M.; Levine-Donnerstein, Deborah; Perfect, Michelle M.; Obrzut, John E.
This study examined whether consistently implementing reading fluency interventions prior to referring students for a special education evaluation led to fewer overall special education referrals, as well as more accurate special education referrals. Results indicated that the implementation of a peer-mediated reading fluency intervention…
Snenghi, Rossella; Forza, Giovanni; Favretto, Donata; Sartore, Daniela; Rodinis, Silvia; Terranova, Claudio; Nalesso, Alessandro; Montisci, Massimo; Ferrara, Santo Davide
The aim of this study was to investigate polydrug use in drunk drivers. The experimental study was conducted on 2,072 drunk drivers undergoing a driving license reissue protocol at the Department of Legal Medicine of Padova University Hospital in the period between January 2011 and December 2012. The study protocol involved anamnesis, clinical examination, toxicological history, and toxicological analyses on multiple biological samples. One thousand eight hundred seventy-seven subjects (90.6%) were assessed as fit to drive, and 195 (9.5%) were declared unfit. Among those unfit, 32 subjects (1.6%) were declared unfit due to recent use of an illicit drug (time span drive after completeness of the protocol was established in 1.2% of cases for alcohol disorders and in 5.7% of cases for illicit drug abuse; only one subject was included in both subgroups. Cocaine was the most widely used substance, followed by cannabis, opiates, and psychotropic pharmaceutical drugs. The application of the protocol presented in this study allowed the identification of underlying polydrug use in drunk drivers. The study led to the identification of 6.8% unfit subjects on the basis of alcohol disorders and/or drug abuse, compared to 1.2% of identifiable unfitness if the protocol were limited to the mere assessment of alcohol consumption. The frequent association of alcohol and cocaine is different from other patterns of use in North Europe countries.
Simons-Morton, Bruce G; Ouimet, Marie Claude; Chen, Rusan; Klauer, Sheila G; Lee, Suzanne E; Wang, Jing; Dingus, Thomas A
Preventing speed-related crashes could reduce costs and improve efficiency in the transportation industry. This research examined the psychosocial and personality predictors of observed speeding among young drivers. Survey and driving data were collected from 42 newly-licensed teenage drivers during the first 18months of licensure. Speeding (i.e., driving 10mph over the speed limit; about 16km/h) was assessed by comparing speed data collected with recording systems installed in participants' vehicles with posted speed limits. Speeding was correlated with elevated g-force event rates (r=0.335, pb0.05), increased over time, and predicted by day vs. night trips, higher sensation seeking, substance use, tolerance of deviance, susceptibility to peer pressure, and number of risky friends. Perceived risk was a significant mediator of the association between speeding and risky friends. The findings support the contention that social norms may influence teenage speeding behavior and this relationship may operate through perceived risk. Copyright © 2012 National Safety Council and Elsevier Ltd. All rights reserved.
Vanlaar, Ward; Hing, Marisela Mainegra; Robertson, Robyn; Mayhew, Dan; Carr, David
In 1996, the Ministry of Transportation in Ontario (MTO) implemented the Group Education Session (GES), which is a mandatory license renewal program for drivers aged 80 and older. This study describes an evaluation of the GES to assess its impact on road safety in Ontario, as well as its effect on the safety of individual drivers who participated in the program. Time series analysis of senior driver records both before and after implementation of the GES, and logistic regression and survival analysis examining senior driver records prior to, and following, their participation in the GES. Using time series analysis there is some evidence to suggest that the GES had a positive impact on road safety. According to the other analyses, participation in the GES is associated with a decrease in the odds of collisions and convictions, regardless of whether drivers pass their first attempt of the knowledge test or not. In addition, failing the first road test and/or having demerit points are strong indicators of future collision and conviction involvement. Results from this evaluation suggest that the GES has had a protective effect on the safety of senior drivers. The findings and discussion will help MTO improve the GES program and provide insights to other jurisdictions that have, or are considering, introducing new senior driver programs. Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.
Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy
BACKGROUND: Several malaria endemic countries have implemented community health worker (CHW) programmes to increase access to populations underserved by health care. There is considerable evidence on CHW adherence to case management guidelines, however, there is limited evidence on the compliance...... in the control arm were trained to treat malaria with ACTs based on fever symptoms. Caregivers' referral forms were linked with CHW treatment forms to determine whether caregivers complied with the referral advice. Factors associated with compliance were examined with logistic regression. RESULTS: CHW saw 18......,497 child visits in the moderate-to-high transmission setting and referred 15.2% (2815/18,497) of all visits; in the low-transmission setting, 35.0% (1135/3223) of all visits were referred. Compliance to referral was low, in both settings
... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form I...
Aksan, Nazan; Anderson, Steve W; Dawson, Jeffrey; Uc, Ergun; Rizzo, Matthew
The extent to which deficits in specific cognitive domains contribute to older drivers' safety risk in complex real-world driving tasks is not well understood. We selected 148 drivers older than 70 years of age both with and without neurodegenerative diseases (Alzheimer disease-AD and Parkinson disease-PD) from an existing driving database of older adults. Participant assessments included on-road driving safety and cognitive functioning in visuospatial construction, speed of processing, memory, and executive functioning. The standardized on-road drive test was designed to examine multiple facets of older driver safety including navigation performance (e.g., following a route, identifying landmarks), safety errors while concurrently performing secondary navigation tasks ("on-task" safety errors), and safety errors in the absence of any secondary navigation tasks ("baseline" safety errors). The inter-correlations of these outcome measures were fair to moderate supporting their distinctiveness. Participants with diseases performed worse than the healthy aging group on all driving measures and differences between those with AD and PD were minimal. In multivariate analyses, different domains of cognitive functioning predicted distinct facets of driver safety on road. Memory and set-shifting predicted performance in navigation-related secondary tasks, speed of processing predicted on-task safety errors, and visuospatial construction predicted baseline safety errors. These findings support broad assessments of cognitive functioning to inform decisions regarding older driver safety on the road and suggest navigation performance may be useful in evaluating older driver fitness and restrictions in licensing. Copyright © 2014 Elsevier Ltd. All rights reserved.
El Bcheraoui, Charbel; Basulaiman, Mohammed; Tuffaha, Marwa; Daoud, Farah; Robinson, Margaret; Jaber, Sara; Mikhitarian, Sarah; Wilson, Shelley; Memish, Ziad A; Al Saeedi, Mohammad; Almazroa, Mohammad A; Mokdad, Ali H
Road traffic injuries are the largest cause of loss of disability-adjusted life years for men and women of all ages in the Kingdom of Saudi Arabia, but data on driving habits there are lacking. To inform policymakers on drivers' abilities and driving habits, we analyzed data from the Saudi Health Interview Survey 2013. We surveyed a representative sample of 5,235 Saudi males aged 15 years or older on wearing seat belts, exceeding speed limits, and using a handheld cell phone while driving. Male and female respondents were surveyed on wearing seat belts as passengers. Among Saudi males, 71.7% reported having had a driver's license, but more than 43% of unlicensed males drove a vehicle. Among drivers, 86.1% engaged in at least one risky behavior while driving. Older and unlicensed drivers were more likely to take risks while driving. This risk decreased among the more educated, current smokers, and those who are physically active. Up to 94.9% and 98.5% of respondents reported not wearing a seat belt in the front and the back passenger seats, respectively. The high burden of road traffic injuries in the Kingdom is not surprising given our findings. Our study calls for aggressive monitoring and enforcement of traffic laws. Awareness and proper education for drivers and their families should be developed jointly by the Ministries of Health, Interior Affairs, and Education and provided through their channels.
Biggerstaff, Mary Ellen; Short, Nancy
Transition to a value-based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience. A 6-month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6-month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%. The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals. The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements. ©2017 American Association of Nurse Practitioners.
Lee, Joo-Young; Jung, Dooyoung; Kim, Won-Hyoung; Lee, Hyuk-Joon; Noh, Dong-Young; Hahm, Bong-Jin
Depression in cancer patients is under-recognized and under-treated. To better identify depression, we designed a voluntary depression screening system. Based on its data, we examined trends in oncologist-issued referrals for the psycho-oncology service (POS). The Electronic Voluntary Screening and Referral System for Depression (eVSRS-D) comprises self-screening, automated reporting, and referral guidance. Using touch-screen kiosks at a tertiary hospital in Korea, participants with cancer completed the Patient Health Questionnaire-9 at their convenience, received the results, and reported their willingness to participate in POS. At oncology appointments, oncologists received the screening reports and issued referrals following pre-recommended guidelines. The correlates of actual referrals were examined across all participants and within the willing and non-willing groups. Among the 838 participants, 56.3% reported severe depression symptoms, 30.5% wanted a referral, and 14.8% were actually referred. The correlates of participants' desire for referral were more severe depression symptoms, being unmarried, and being metastasis and recurrence free. Among all participants, the correlates of actual referrals were unemployment, less severe depression symptoms, poorer performance, treatment status, and wanting a referral. The sole correlate of actual referrals within the non-willing group was poorer performance, and no significant correlates existed within the willing group. The non-referrals were mostly (87.1%) because of postponed decisions. The eVSRS-D cannot definitively diagnose major depression but may efficiently self-select a population with significant depression symptoms. The patients' willingness to engage the POS most strongly predicted the actual referrals. Oncologist reviews of screening reports may not result in further depression severity-specific referrals. Copyright © 2015 John Wiley & Sons, Ltd.
McDonald, Catherine C; Sommers, Marilyn S
The purpose of this qualitative focus group elicitation research study was to explore teen driver perceptions of peer passengers and driver inattention. We utilized focus groups for data collection and content analysis to analyze the data, both of which were guided by the theory of planned behavior. We conducted 7 focus groups with 30 teens, ages 16-18, licensed for ≤1year to examine attitudes, perceived behavioral control, and norms related to driving inattention and peer passengers. The sample was 50% male, mean age 17.39 (SD 0.52) with mean length of licensure 173.7days (SD 109.2). Three themes emerged: 1) "Good and not good" passengers; 2) Passengers and technology as harmful and helpful; and 3) The driver is in charge. While passengers can be a source of distraction, our participants also identified passenger behaviors that reduced risk, such as assistance with technology and guidance for directions. An understanding of teens' perceptions of peer passengers can contribute to the development of effective interventions targeting teen driver inattention. Nurses are well-positioned to contribute to these teen crash prevention efforts. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Dahhan, Ali; Maddox, William R; Krothapalli, Siva; Farmer, Matthew; Shah, Amit; Ford, Benjamin; Rhodes, Marc; Matthews, Laurie; Barnes, Vernon A; Sharma, Gyanendra K
Cardiac rehabilitation (CR) is an effective preventive measure that remains underutilised in the United States. The study aimed to determine the CR referral rate (RR) after percutaneous coronary intervention (PCI) at an academic tertiary care centre, identify barriers to referral, and evaluate awareness of CR benefits and indications (CRBI) among cardiologists. Subsequently, it aimed to evaluate if an intervention consisting of physicians' education about CRBI and implementation of a formal CR referral system could improve RR and consequently participation rate (PR). Data were retrospectively collected for all consecutive patients who underwent PCI over 12 months. Referral rate was determined and variables were compared for differences between referred and non-referred patients. A questionnaire was distributed among the physicians in the Division of Cardiology to assess awareness of CRBI and referral practice patterns. After implementation of the intervention, data were collected retrospectively for consecutive patients who underwent PCI in the following six months. Referral rate and changes in PRs were determined. Prior to the intervention, RR was 17.6%. Different barriers were identified, but the questionnaire revealed lack of physicians' awareness of CRBI and inconsistent referral patterns. After the intervention, RR increased to 88.96% (Odds Ratio 37.73, 95% CI 21.34-66.70, pEducation of providers and implementation of a formal referral system can improve RR and PR. Published by Elsevier B.V.
U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...
A.K. SOMASUNDARASWARAN, Dr.
Full Text Available Despite being an important mode of transportation in the developing world, little research has been conducted to understand the factors contributing to crashes involving three wheel vehicles. This study surveyed a convenient sample of 505 professional three-wheeler drivers in Sri Lanka to explore the similarities and differences in the demographic and work characteristics between three-wheeler drivers who reported experiencing at least one collision in the past twelve months and those who reported that they were not involved in any collisions. Our study revealed some interesting results that were quite different from those obtained in the studies on professional drivers in developed countries. In particular, both drivers with less than one year and more than five years of driving experience in our study were found to be associated with higher probability of crash involvement. Also, the number of trips per day and the average travel distance per trip were found to be insignificant in delineating between crash-involved and non-crash-involved drivers. Moreover, crash-involved drivers, on average, have significantly fewer working days per week and fewer hours per day, suggesting that the conventional approach used in most developed countries to tackle fatigue among professional drivers do not appear to be suitable for solving the road safety problem involving three-wheeler drivers in a developing country. Also, since the age of most drivers falls in a narrow range, this U-shaped relationship is not likely to be a result of youth and ageing but of inexperience in newer drivers and complacency in more experienced drivers. Lastly, since a relatively large proportion of the drivers had driven without a valid driving license, legislation and enforcement interventions are likely to be less effective than education and engineering countermeasures.
... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Referrals to the Department of Justice... COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral. The... Justice, Washington, DC 20530. (2) Unless otherwise provided by DOJ regulations or procedures, EPA refers...
This article gives an overview of the process of license renewal for nuclear power plants. It explains what is meant by license renewal, the significance of license renewal, and goes over key elements involved in the process of license renewal. Those key elements are NRC requirements embodied in 10 CFR Part 54 (Reactor Safety) and 10 CFR Part 51 (Environmental Issues). In addition Industry Reports must be developed and reviewed. License renewal is essentially the process of applying for a 20 year extension to the original 40 year operating license granted for the plant. This is a very long term process, which involves a lot of preparation, and compliance with regulatory rules and guidelines. In general it is a process which is expected to begin when plants reach an operating lifetime of 20 years. It has provisions for allowing the public to become involved in the review process
Keating, Daniel P; Halpern-Felsher, Bonnie L
Despite considerable improvement in the rates of crashes, injuries, and fatalities among adolescent drivers, attributable in part to effective interventions such as graduated driver licensing, these rates and their associated health risks remain unacceptably high. To understand the sources of risky driving among teens, as well as to identify potential avenues for further advances in prevention, this article presents a review of the relevant features of contemporary research on adolescent development. Current research offers significant advances in the understanding of the sources of safe driving, proficient driving, and risky driving among adolescents. This multifaceted perspective--as opposed to simple categorization of good versus bad driving--provides new opportunities for using insights on adolescent development to enhance prevention. Drawing on recent work on adolescent physical, neural, and cognitive development, we argue for approaches to prevention that recognize both the strengths and the limitations of adolescent drivers, with particular attention to the acquisition of expertise, regulatory competence, and self-regulation in the context of perceived risk. This understanding of adolescent development spotlights the provision of appropriate and effective scaffolding, utilizing the contexts of importance to adolescents--parents, peers, and the broader culture of driving--to support safe driving and to manage the inherent risks in learning to do so.
Shults, Ruth A; Williams, Allan F
The Monitoring the Future (MTF) survey provides nationally-representative annual estimates of licensure and driving patterns among U.S. teens. A previous study using MTF data reported substantial declines in the proportion of high school seniors that were licensed to drive and increases in the proportion of nondrivers following the recent U.S. economic recession. To explore whether licensure and driving patterns among U.S. high school seniors have rebounded in the post-recession years, we analyzed MTF licensure and driving data for the decade of 2006-2015. We also examined trends in teen driver involvement in fatal and nonfatal injury crashes for that decade using data from the Fatality Analysis Reporting System and National Automotive Sampling System General Estimates System, respectively. During 2006-2015, the proportion of high school seniors that reported having a driver's license declined by 9 percentage points (11%) from 81% to 72% and the proportion that did not drive during an average week increased by 8 percentage points (44%) from 18% to 26%. The annual proportion of black seniors that did not drive was consistently greater than twice the proportion of nondriving white seniors. Overall during the decade, 17- and 18-year-old drivers experienced large declines in fatal and nonfatal injury crashes, although crashes increased in both 2014 and 2015. The MTF data indicate that licensure and driving patterns among U.S. high school seniors have not rebounded since the economic recession. The recession had marked negative effects on teen employment opportunities, which likely influenced teen driving patterns. Possible explanations for the apparent discrepancies between the MTF data and the 2014 and 2015 increases in crashes are explored. MTF will continue to be an important resource for clarifying teen driving trends in relation to crash trends and informing strategies to improve teen driver safety. Published by Elsevier Ltd.
Grace, Sherry L; Grewal, Keerat; Stewart, Donna E
Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists. A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral. Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.
The process in deciding to seek referral care is envisaged within community .... The three phases of delays model in accessing .... as dangerous at home and immediate care is required, the ... referral or is unable to pay the costs of referral, the ...
The objective of the present study was to assess the activity of the Liaison Psychiatry service of Cork University Hospital in relation to all in-patient neurology referrals over a 12-month period. Of 1685 neurology admissions, 106 (6%) were referred to liaison psychiatry for assessment. 91 referrals (86%) met criteria for a psychiatric disorder according to DSM-IV, the commonest being major depression (24%) and somatoform disorder (23%). Patients with multiple sclerosis or epilepsy comprised nearly half of all referrals (48 cases; 45%). Approximately 20% of M.S. in-patients (21 cases) were referred for psychiatric assessment, with the corresponding figure in epilepsy being 25% (18 cases). Although only 106 (6%) neurology in-patients were referred to liaison psychiatry, psychiatric diagnoses were documented in 327 (20%) discharge forms, presumably reflecting previous diagnosis. The above findings indicate that psychiatric illness is common among neurology inpatients screened by liaison psychiatry yet referral rates are relatively low in terms of the overall number of neurology in-patients. Psychiatric disorders were diagnosed in 86% of referrals indicating high concordance between neurologists and liaison psychiatry regarding the presence of a psychiatric disorder.
Carney, Cher; Harland, Karisa K; McGehee, Daniel V
While teen driver distraction is cited as a leading cause of crashes, especially rear-end crashes, little information is available regarding its true prevalence. The majority of distraction studies rely on data derived from police reports, which provide limited information regarding driver distraction. This study examined over 400 teen driver rear-end crashes captured by in-vehicle event recorders. A secondary data analysis was conducted, paying specific attention to driver behaviors, eyes-off-road time, and response times to lead-vehicle braking. Among teens in moderate to severe rear-end crashes, over 75% of drivers were observed engaging in a potentially distracting behavior. The most frequently seen driver behaviors were cell phone use, attending to a location outside the vehicle, and attending to passengers. Drivers using a cell phone had a significantly longer response time than drivers not engaged in any behaviors, while those attending to passengers did not. Additionally, in about 50% of the rear-end crashes where the driver was operating/looking at a phone (e.g., texting), the driver showed no driver response (i.e., braking or steering input) before impact, compared to 10% of crashes where the driver was attending to a passenger. The high frequency of attending to passengers and use of a cell phone leading up to a crash, compounded with the associated risks, underlines the importance of continued investigation in these areas. Parents and teens must be educated regarding the frequency of and the potential effects of distractions. Additional enforcement may be necessary if Graduated Driver Licensing (GDL) programs are to be effective. Systems that alert distracted teens could also be especially helpful in reducing rear-end collisions. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.
Many referral mechanisms can be found in the context of entrepreneurship. Networks and third party referrals play a prominent role in spotting entrepreneurial opportunities and in acquiring the resources necessary for growth. In this dissertation, the focus is on the role of referrals in acquiring
Fischer, Jane P
The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.
Casalino, Lawrence P
Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.
Abdul Hadi Abdul Razak; Mohd Hairy Manap
The focus of this paper is to highlight the design and development of an educational game prototype as an evaluation instrument for the Malaysia driving license static test. This educational game brings gaming technology into the conventional objective static test to make it more effective, real and interesting. From the feeling of realistic, the future driver can learn something, memorized and use it in the real life. The current online objective static test only make th...
Aduen, Paula A; Kofler, Michael J; Cox, Daniel J; Sarver, Dustin E; Lunsford, Erin
Although not often discussed in clinical settings, motor vehicle driving is a complex multitasking endeavor during which a momentary attention lapse can have devastating consequences. Previous research suggests that drivers with high incidence psychiatric disabilities such as ADHD contribute disproportionately to collision rates, which in turn portend myriad adverse social, financial, health, mortality, and legal outcomes. However, self-referral bias and the lack of psychiatric comparison groups constrain the generalizability of these findings. The current study addressed these limitations and examined the unique associations among ADHD, Depression, and adverse driving outcomes, independent of self-selection, driving exposure, and referral bias. The Strategic Highway Research Program (SHRP-2) Naturalistic Driving Study comprises U.S. drivers from six sites selected via probability-based sampling. Groups were defined by Barkley ADHD and psychiatric diagnosis questionnaires, and included ADHD (n = 275), Depression (n = 251), and Healthy Control (n = 1828). Primary outcomes included self-reported traffic collisions, moving violations, collision-related injuries, and collision fault (last 3 years). Accounting for demographic differences, ADHD but not Depression portended increased risk for multiple violations (OR = 2.3) and multiple collisions (OR = 2.2). ADHD but not Depression portended increased risk for collision fault (OR = 2.1). Depression but not ADHD predicted increased risk for self-reported injury following collisions (OR = 2.4). ADHD appears uniquely associated with multiple collisions, multiple violations, and collision fault, whereas Depression is uniquely associated with self-reported injury following a collision. Identification of the specific mechanisms underlying this risk will be critical to designing effective interventions to improve long-term functioning for drivers with high incidence psychiatric disability. Copyright © 2015
Musila, Nyokabi; Underwood, Martin; McCaskie, Andrew W; Black, Nick; Clarke, Aileen; van der Meulen, Jan H
Background. GPs have to respond to conflicting policy developments. As gatekeeper they are supposed to manage the growing demand for specialist services and as patient advocate they should be responsive to patients' preferences. We used an innovative approach to develop a referral guideline for patients with chronic knee pain that explicitly incorporates patients' preferences. Methods. A guideline development group of 12 members including patients, GPs, orthopaedic surgeons and other health care professionals used formal consensus development informed by systematic evidence reviews. They rated the appropriateness of referral for 108 case scenarios describing patients according to symptom severity, age, body mass, co-morbidity and referral preference. Appropriateness was expressed on scale from 1 (‘strongly disagree’) to 9 (‘strongly agree’). Results. Ratings of referral appropriateness were strongly influenced by symptom severity and patients' referral preferences. The influence of other patient characteristics was small. There was consensus that patients with severe knee symptoms who want to be referred should be referred and that patient with moderate or mild symptoms and strong preference against referral should not be referred. Referral preference had a greater impact on the ratings of referral appropriateness when symptoms were moderate or severe than when symptoms were mild. Conclusions. Referral decisions for patients with osteoarthritis of the knee should only be guided by symptom severity and patients' referral preferences. The guideline development group seemed to have given priority to avoiding inefficient resource use in patients with mild symptoms and to respecting patient autonomy in patients with severe symptoms. PMID:20817791
Shannon, Patricia J.; Vinson, Gregory A.; Cook, Tonya; Lennon, Evelyn
In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal Components Analysis yielded categories of successful referrals that included: active care coordination, proactive resolution of barriers, establishment of trust, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, language barriers, system barriers, providers being unwilling to see refugees. Recommendations for training and policy are discussed. PMID:25735618
Ortiz, C; Ortiz-Peregrina, S; Castro, J J; Casares-López, M; Salas, C
drivers). Lastly, participants' subjective responses indicated that younger drivers (18-24 years) had a higher risk of deliberately violating safe driving practices (p WhatsApp messages while driving significantly impairs the ability to drive safely, with older drivers being the group most adversely affected. It would be recommendable to include other nonstandard vision tests, which have shown associations with driving performance, in the examination for driver licensing. This would help raise the awareness of older drivers concerning their visual limitations, permitting them to adopt compensatory measures to improve their driving safety. Nevertheless, it is also necessary to raise awareness among the younger drivers of the risks involved in behaviour behind the wheel. Copyright © 2018 Elsevier Ltd. All rights reserved.
Anees, M.; Mumtaz, A.; Nazir, M.; Ibrahim, M.; Kausar, T.
To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center. This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg). In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea (>200 mg/dl) and creatinine (>8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin <11gm/dl) and 224 (90%) were hypoalbuminemic (serum albumin < 4gm/dl) on first presentation. Majority of patients were hyperkalemic, 139 (56.0%), hypocalcemic, 168 (67.7%) and serum phosphate level was high in only 117 (47%) patients. All the patients presented in emergency room to nephrologists at very late stage (100% late referral), when disease was very much advanced. All of them did not have permanent vascular access for hemodialysis on first presentation to dialysis center. Reasons for late referral were non-availability of nephrologists and nephrology services, non-renal doctors biased, unawareness and
... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by the...
Fable, D.; Prah, M.; Vrankic, K.; Lebegner, J.
The purpose of this paper is to provide information about license renewal process, as defined by Nuclear Regulatory Commission (NRC). The Atomic Energy Act and NRC regulations limit commercial power reactor licenses to an initial 40 years but also permit such licenses to be renewed. This original 40-year term for reactor licenses was based on economic and antitrust considerations not on limitations of nuclear technology. Due to this selected time period; however, some structures and components may have been engineered on the basis of an expected 40-year service life. The NRC has established a timely license renewal process and clear requirements codified in 10 CFR Part 51 and 10 CFR Part 54, that are needed to assure safe plant operation for extended plant life. The timely renewal of licenses for an additional 20 years, where appropriate to renew them, may be important to ensuring an adequate energy supply during the first half of the 21st Century. License renewal rests on the determination that currently operating plants continue to maintain adequate levels of safety, and over the plant's life, this level has been enhanced through maintenance of the licensing bases, with appropriate adjustments to address new information from industry operating experience. Additionally, NRC activities have provided ongoing assurance that the licensing bases will continue to provide an acceptable level of safety. This paper provides additional discussion of license renewal costs, as one of key elements in evaluation of license renewal justifiability. Including structure of costs, approximately value and two different approaches, conservative and typical. Current status and position of Nuclear Power Plant Krsko, related to license renewal process, will be briefly presented in this paper. NPP Krsko is designed based on NRC Regulations, so requirements from 10 CFR 51, and 10 CFR 54, are applicable to NPP Krsko, as well. Finally, this paper will give an overview of current status of
Hysong, Sylvia J; Esquivel, Adol; Sittig, Dean F; Paul, Lindsey A; Espadas, Donna; Singh, Simran; Singh, Hardeep
Successful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs) (i.e., e-referrals), lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system. We conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA) medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process. Four themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported. Despite facilitating information transfer between PCPs and subspecialists, e-referrals remain prone to coordination
Edwards, D.W.; Allen, S.R.
The NUPLEX Licensing Subcommittee was organized to seek a formal license renewal mechanism that institutionalizes the current licensing basis and consequent level of safety of a plant as the legitimate standard for acceptance and approval of an application for extended operation. Along with defining the most workable approach to and scope of review for license renewal, this paper explains the reasons why a regulatory framework is needed by the early 1990s. The initial results of development work on two key issues, licensing criteria and hearing process, are also presented. at this point six potential license renewal criteria have emerged: evaluation of existing monitoring/maintenance programs, revalidation of current licensing basis, conformance to special regulations, evaluation to a safety goal, plant performance history, and environmental assessment. The work on a hearing process has led to the development of two models for future consideration: hybrid legislative and hybrid adjudicatory
... 10 Energy 4 2010-01-01 2010-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by the...
This report describes supplemental driver training programs and online basic driver education. It coves supplemental driver training that : focused on knowledge and skills beyond those normally found in traditional driver education delivered in the U...
Senserrick, Teresa; Ivers, Rebecca; Boufous, Soufiane; Chen, Huei-Yang; Norton, Robyn; Stevenson, Mark; van Beurden, Eric; Zask, Avigdor
The research aimed to explore associations between participation in 2 education programs for school-based learner drivers and subsequent road traffic offenses and crashes among a large cohort of newly licensed drivers. DRIVE is a prospective cohort study of 20822 first-year drivers aged 17 to 24 in New South Wales (NSW), Australia. Participants completed a detailed questionnaire and consented to data linkage in 2003-2004. Questionnaire items included year of participation in 2 specific education programs: a 1-day workshop-only program focusing on driving risks ("driver-focused") and a whole-of-community program also including a 1-day workshop but also longer term follow-up activities and a broader focus on reducing risk-taking and building resilience ("resilience-focused"). Survey data were subsequently linked to police-reported crash and offense data for 1996-2005. Poisson regression models that adjusted for multiple confounders were created to explore offenses and crashes as a driver (dichotomized as 0 vs >or=1) after program participation. Offenses did not differ between groups; however, whereas the driver-focused program was not associated with reduced crash risk, the resilience-focused program was associated with a 44% reduced relative risk for crash (0.56 [95% confidence interval: 0.34-0.93]). The large effect size observed and complementary findings from a comparable randomized, controlled trial in the United States suggest programs that focus more generally on reducing risks and building resilience have the potential to reduce crashes. A large, representative, randomized, controlled trial is urgently needed to confirm road safety benefits and ensure evidence-based spending and practitioner recommendations in this field.
Poesen, K; Pottel, H; Colaert, J; De Niel, C
Guidelines for diagnosis of infective endocarditis are largely based upon epidemiological studies in referral hospitals. Referral bias, however, might impair the validity of guidelines in non-referral hospitals. Recent studies in non-referral care centres on infective endocarditis are sparse. We conducted a retrospective epidemiological study on infective endocarditis in a large non-referral hospital in a Belgian city (Kortrijk). The medical record system was searched for all cases tagged with a putative diagnosis of infective endocarditis in the period 2003-2010. The cases that fulfilled the modified Duke criteria for probable or definite infective endocarditis were included. Compared to referral centres, an older population with infective endocarditis, and fewer predisposing cardiac factors and catheter-related infective endocarditis is seen in our population. Our patients have fewer prosthetic valve endocarditis as well as fewer staphylococcal endocarditis. Our patients undergo less surgery, although mortality rate seems to be highly comparable with referral centres, with nosocomial infective endocarditis as an independent predictor of mortality. The present study suggests that characteristics of infective endocarditis as well as associative factors might differ among non-referral hospitals and referral hospitals.
Girotto, Edmarlon; de Andrade, Selma Maffei; Mesas, Arthur Eumann; González, Alberto Durán; Guidoni, Camilo Molino
The aim of this study was to identify the role that working conditions play in predicting the consumption of illicit psychoactive substances (IPS) among truck drivers. This cross-sectional study was conducted with truck drivers who transport grains to Paranaguá Port, PR, Brazil. The truck drivers were interviewed, and they completed a self-administered questionnaire regarding their sociodemographics, lifestyles, working conditions, and consumption of IPS over the past 30 days. The statistical analysis included logistic regression models progressively adjusted for sociodemographic and lifestyle variables. A total of 670 male drivers with a mean age of 41.9 (±11.1) years were assessed. The prevalence of IPS consumption over the past 30 days was 10.9% (n=73). The drugs used primarily consisted of amphetamines (n=61). After adjusting for working characteristics, sociodemographic and lifestyle variables, the following working conditions were associated with the consumption of IPS: driving mostly at night (OR=3.91; 95% CI 1.75 to 8.74), driving while tired (OR=2.26; 95% CI 1.31 to 3.89), and earning a higher monthly income (OR=2.08; 95% CI 1.16 to 3.72). Drivers who were 39 years old or younger (OR=2.11; 95% CI 1.05 to 4.25) and not living with a partner (OR=2.22; 95% CI 1.17 to 4.22) were also more likely to consume IPS. Driving mostly at night, being tired, and earning more increase the use of IPS among truck drivers, regardless of other working characteristics, sociodemographic, and lifestyle variables. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Anund, Anna; Ahlström, Christer; Fors, Carina; Åkerstedt, Torbjörn
Objective It is generally believed that professional drivers can manage quite severe fatigue before routine driving performance is affected. In addition, there are results indicating that professional drivers can adapt to prolonged night shifts and may be able to learn to drive without decreased performance under high levels of sleepiness. However, very little research has been conducted to compare professionals and non-professionals when controlling for time driven and time of day. Method The aim of this study was to use a driving simulator to investigate whether professional drivers are more resistant to sleep deprivation than non-professional drivers. Differences in the development of sleepiness (self-reported, physiological and behavioral) during driving was investigated in 11 young professional and 15 non-professional drivers. Results Professional drivers self-reported significantly lower sleepiness while driving a simulator than non-professional drivers. In contradiction, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness. They also drove faster. The reason for the discrepancy in the relation between the different sleepiness indicators for the two groups could be due to more experience to sleepiness among the professional drivers or possibly to the faster speed, which might unconsciously have been used by the professionals to try to counteract sleepiness. Conclusion Professional drivers self-reported significantly lower sleepiness while driving a simulator than non-professional drivers. However, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness, and they drove faster.
McGehee, Daniel V; Raby, Mireille; Carney, Cher; Lee, John D; Reyes, Michelle L
Teen drivers are at high risk for car crashes, especially during their first years of licensure. Providing novice teen drivers and their parents with a means of identifying their risky driving maneuvers may help them learn from their mistakes, thereby reducing their crash propensity. During the initial phase of learning, adult or parental supervision often provides such guidance. However, once teens obtain their license, adult supervision is no longer mandated, and teens are left to themselves to continue the learning process. This study is the first of its type to enhance this continued learning process using an event-triggered video device. By pairing this new technology with parental feedback in the form of a weekly video review and graphical report card, we extend parents' ability to teach their teens even after they begin driving independently. Twenty-six 16- to 17-year-old drivers were recruited from a small U.S. Midwestern rural high school. We equipped their vehicles with an event-triggered video device, designed to capture 20-sec clips of the forward and cabin views whenever the vehicle exceeded lateral or forward threshold accelerations. Preliminary findings suggest that combining this emerging technology with parental weekly review of safety-relevant incidents resulted in a significant decrease in events for the more at-risk teen drivers. Implications for how such an intervention could be implemented within GDL are also discussed.
Benson, B E; Smith, C A; McKinney, P E; Litovitz, T L; Tandberg, W D
The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning. Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation. Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.
Alain M Bron
Full Text Available Alain M Bron1, Ananth C Viswanathan2, Ulrich Thelen3, Renato de Natale4, Antonio Ferreras5, Jens Gundgaard6, Gail Schwartz7, Patricia Buchholz81Department of Ophthalmology, University Hospital, Dijon, France; 2Glaucoma Research Unit, Moorfields Eye Hospital NHS Foundation Trust and Department of Genetics, University College of London Institute of Ophthalmology, London, UK; 3Private Practice, Munster, Germany; 4Ospedale Civile di Monselice, Monselice, Italy; 5Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; 6COWI, Kolding, Denmark; 7Wilmer Eye Institute, Johns Hopkins University, Glaucoma Consultants, Baltimore, MD, USA; 8Patricia Buchholz Consulting, Karlsruhe, GermanyObjective: Low vision that causes forfeiture of driver’s licenses and collection of disability pension benefits can lead to negative psychosocial and economic consequences. The purpose of this study was to review the requirements for holding a driver’s license and rules for obtaining a disability pension due to low vision. Results highlight the possibility of using a milestone approach to describe progressive eye disease.Methods: Government and research reports, websites, and journal articles were evaluated to review rules and requirements in Germany, Spain, Italy, France, the UK, and the US.Results: Visual acuity limits are present in all driver’s license regulations. In most countries, the visual acuity limit is 0.5. Visual field limits are included in some driver’s license regulations. In Europe, binocular visual field requirements typically follow the European Union standard of ≥120°. In the US, the visual field requirements are typically between 110° and 140°. Some countries distinguish between being partially sighted and blind in the definition of legal blindness, and in others there is only one limit.Conclusions: Loss of driving privileges could be used as a milestone to monitor progressive eye disease. Forfeiture could be standardized as a
Paul Lindsey A
Full Text Available Abstract Background Successful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP, the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs (i.e., e-referrals, lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system. Methods We conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process. Results Four themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported. Conclusions Despite facilitating information transfer between PCPs and
Full Text Available Driver inattention, especially driver distraction, is an extremely influential but generally neglected contributing factor of road crashes. This paper explores some of the common behaviours associated with several common forms of driver inattention, with respect to their perceived crash risks, rates of self-reported behaviours and whether drivers regulate such behaviours depending on the road and traffic environment, and provides some policy recommendations to address issues raised.
Andersen, Merethe Kirstine Kousgaard; Torfing, Trine; Ulrichsen, Walther
and MRI regarding musculoskeletal issues. The reviews were conducted according to a preformed registration schema. Themes for the survey were: Relevance of referral, relevance of chosen modality, exhaustiveness of referral information, relevance of information and eventual suggestions for a more relevant......-scanning was the most relevant (87%). Overall, referral information was relevant in 80% of the cases, and most relevant in referrals to x-ray (87%). In 9.5% of referrals the chosen modality was not the optimal, which was most pronounced for ultrasound referrals (13%). Referral information was most insufficient...... regarding MRI, where 56.4% of information was described as less insufficient/insufficient. It was a frequent notation, that there was too much irrelevant information, which was ascribed to copy-paste from the general practitioners’ records. Conclusion A majority of referrals from general practice...
Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.
Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral
Full Text Available The primary objective of this study is to evaluate factors affecting e-bike involved crash and license plate use in China. E-bike crashes data were collected from police database and completed through a telephone interview. Noncrash samples were collected by a questionnaire survey. A bivariate probit (BP model was developed to simultaneously examine the significant factors associated with e-bike involved crash and e-bike license plate and to account for the correlations between them. Marginal effects for contributory factors were calculated to quantify their impacts on the outcomes. The results show that several contributory factors, including gender, age, education level, driver license, car in household, experiences in using e-bike, law compliance, and aggressive driving behaviors, are found to have significant impacts on both e-bike involved crash and license plate use. Moreover, type of e-bike, frequency of using e-bike, impulse behavior, degree of riding experience, and risk perception scale are found to be associated with e-bike involved crash. It is also found that e-bike involved crash and e-bike license plate use are strongly correlated and are negative in direction. The result enhanced our comprehension of the factors related to e-bike involved crash and e-bike license plate use.
Miller, Gila; Taubman-Ben-Ari, Orit
As part of the effort to ascertain why young drivers are more at risk for car crashes, attention has recently turned to the effects of family, including the intergenerational transmission of driving styles from parents to offspring. The current study sought to further understanding of the nature and aspects of the family influence with the help of Bowen's family systems theory. In Phase 1 of the prospective study, 130 young driving students completed questionnaires tapping personal and personality measures, and their parents completed driving-related instruments. In Phase 2, a year after the young drivers had obtained their driver's license, they were administered the same questionnaires their parents had previously completed. The results show significant correlations between the parents' driving styles and those of their offspring a year after licensure. Furthermore, differentiation of self and self-efficacy in newly acquired driving skills were found to moderate or heighten the similarity between the driving styles of parents and their offspring. For young drivers reporting anxiety in Phase 1, this was associated with a reported anxious driving style a year later. Among young female drivers, anxiety was also associated with a reckless and careless style. Higher sensation seeking was related to higher reckless driving among young male drivers. The findings are discussed in the context of adolescence and the role of the study variables in the development and intergenerational transmission of driving styles. In addition to its theoretical contribution to the realms of intergenerational transmission in general, and young drivers in particular, the study may have practical implications for both family therapy and the design of driving interventions. Copyright 2009 Elsevier Ltd. All rights reserved.
Winston, Flaura K; Mirman, Jessica H; Curry, Allison E; Pfeiffer, Melissa R; Elliott, Michael R; Durbin, Dennis R
Inexperienced, less-skilled driving characterises many newly licensed drivers and contributes to high crash rates. A randomised trial of TeenDrivingPlan (TDP), a new learner driver phase internet-based intervention, demonstrated effectiveness in improving safety relevant, on-road driving behaviour, primarily through greater driving practice diversity. To inform future learner driver interventions, this analysis examined TDP use and its association with practice diversity. Posthoc analysis of data from teen/parent dyads (n=107), enrolled early in learner phase and assigned to treatment arm in randomised trial. Inserted software beacons captured TDP use data. Electronic surveys completed by parents and teens assessed diversity of practice driving and TDP usability ratings at 24 weeks (end of study period). Most families (84%) used TDP early in the learner period; however, the number of TDP sessions in the first week was three times higher among dyads who achieved greater practice diversity than those with less. By week five many families still engaged with TDP, but differences in TDP use could not be detected between families with high versus low practice diversity. Usability was not a major issue for this sample based on largely positive user ratings. An engaging internet-based intervention, such as TDP, can support families in achieving high practice diversity. Future learner driver interventions should provide important information early in the learner period when engagement is greatest, encourage continued learning as part of logging practice drives, and incorporate monitoring software for further personalisation to meet family needs. NCT01498575. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Over an 8-year period, 23 consenting infertile patients/ couples were given referral for assisted conception. The median age was 36 years and mean duration of infertility was 43 months. Indications for referral as shown in Table 1 were male factor in five (21.7%) patients, female factor in seven (30.4%) patients, and both ...
Warren, J; White, S; Day, K J; Gu, Y; Pollock, M
Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007. To measure the extent of uptake of eReferral and its association with changes in referral processing. Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders. eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (psystem usability issues. With eReferrals, a referral's status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems. We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and more transparent referral processing.
Full Text Available Many original equipment manufacturers (OEMs face the choice of whether to license an independent remanufacturer (IR to remanufacture their used products. In this paper, we develop closed-loop supply chain models with licensed and unlicensed remanufacturing operations to analyze the competition and cooperation between an OEM and an IR. The OEM sells new products and collects used products through trade-ins, while the IR intercepts the OEM’s cores to produce remanufactured products and sell them in the same market. We derive optimal decisions for each of the two types of firms in licensed and unlicensed remanufacturing scenarios and identify conditions under which the OEM and the IR would be most likely to cooperate with each other in implementing remanufacturing. The results show although it is beneficial for an OEM to license an IR to remanufacture its cores, it is not always necessary for an IR to accept OEM’s authorization. Moreover, we contrast the result for licensed remanufacturing scenario in the decentralized system with that in the centrally coordinated system to quantify potential inefficiency resulting from decentralization of decision making.
Wang, Yuandi; Li-Ying, Jason; Chen, Jin
We explore the landscape of technology licensing among Chinese entities in the period 2000–12, using a unique database on technological licensing from the State Intellectual Property Office of China. We find that: first, among Chinese licensee organizations, firms have dominated in terms...... of the number of licensed technologies; second, the geographical distribution of licensed technologies among the provinces has gradually reached a new quantitative balance; third, utility models are the most popular technologies to be licensed and the majority of technology licensing in China has been between...... Chinese entities, and most transactions have been local within provinces; and finally, Chinese firms have gradually in-licensed newer and newer technologies, but the technologies in-licensed from foreign sources are by no means state-of-the-art. We make several suggestions for innovation policy...
Meng, Fanxing; Li, Shuling; Cao, Lingzhi; Li, Musen; Peng, Qijia; Wang, Chunhui; Zhang, Wei
Fatigue among truck drivers has been studied extensively; however, less is known regarding the fatigue experience of taxi drivers in heavily populated metropolitan areas. This study aimed to compare the differences and similarities between truck and taxi driver fatigue to provide implications for the fatigue management and education of professional drivers. A sample of 274 truck drivers and 286 taxi drivers in Beijing was surveyed via a questionnaire, which included items regarding work characteristics, fatigue experience, accident information, attitude toward fatigue, and methods of counteracting fatigue. Driver fatigue was prevalent among professional drivers, and it was even more serious for taxi drivers. Taxi drivers reported more frequent fatigue experiences and were involved in more accidents. Among the contributing factors to fatigue, prolonged driving time was the most important factor identified by both driver groups. Importantly, the reason for the engagement in prolonged driving was neither due to the lack of awareness concerning the serious outcome of fatigue driving nor because of their poor detection of fatigue. The most probable reason was the optimism bias, as a result of which these professional drivers thought that fatigue was more serious for other drivers than for themselves, and they thought that they were effective in counteracting the effect of fatigue on their driving performance. Moreover, truck drivers tended to employ methods that require stopping to counteract fatigue, whereas taxi drivers preferred methods that were simultaneous with driving. Although both driver groups considered taking a nap as one of the most effective means to address fatigue, this method was not commonly used. Interestingly, these drivers were aware that the methods they frequently used were not the most effective means to counteract fatigue. This study provides knowledge on truck and taxi drivers' characteristics in fatigue experience, fatigue attitude, and
Full Text Available Abstract Background Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential. This paper examines referral patterns for sick children, and factors that influence caretakers’ compliance with referral of sick children to higher-level health facilities in Afghanistan. Methods The study was conducted in 5 rural districts of 5 Afghan provinces using interviews with parents or caretakers in 492 randomly selected households with a child from 0 to 2 years old who had been sick within the previous 2 weeks with diarrhea, acute respiratory infection (ARI, or fever. Data collectors from local nongovernmental organizations used a questionnaire to assess compliance with a referral recommendation and identify barriers to compliance. Results The number of referrals, 99 out of 492 cases, was reasonable. We found a high number of referrals by community health workers (CHWs, especially for ARI. Caretakers were more likely to comply with referral recommendations from community members (relative, friend, CHW, traditional healer than with recommendations from health workers (at public clinics and hospitals or private clinics and pharmacies. Distance and transportation costs did not create barriers for most families of referred sick children. Although the average cost of transportation in a subsample of 75 cases was relatively high (US$11.28, most families (63% who went to the referral site walked and hence paid nothing. Most caretakers (75% complied with referral advice. Use of referral slips by health care providers was higher for urgent referrals, and receiving a referral slip significantly increased caretakers’ compliance with referral. Conclusions Use of referral slips is important to increase compliance with referral recommendations in rural Afghanistan.
Newbrander, William; Ickx, Paul; Werner, Robert; Mujadidi, Farooq
Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential. This paper examines referral patterns for sick children, and factors that influence caretakers' compliance with referral of sick children to higher-level health facilities in Afghanistan. The study was conducted in 5 rural districts of 5 Afghan provinces using interviews with parents or caretakers in 492 randomly selected households with a child from 0 to 2 years old who had been sick within the previous 2 weeks with diarrhea, acute respiratory infection (ARI), or fever. Data collectors from local nongovernmental organizations used a questionnaire to assess compliance with a referral recommendation and identify barriers to compliance. The number of referrals, 99 out of 492 cases, was reasonable. We found a high number of referrals by community health workers (CHWs), especially for ARI. Caretakers were more likely to comply with referral recommendations from community members (relative, friend, CHW, traditional healer) than with recommendations from health workers (at public clinics and hospitals or private clinics and pharmacies). Distance and transportation costs did not create barriers for most families of referred sick children. Although the average cost of transportation in a subsample of 75 cases was relatively high (US$11.28), most families (63%) who went to the referral site walked and hence paid nothing. Most caretakers (75%) complied with referral advice. Use of referral slips by health care providers was higher for urgent referrals, and receiving a referral slip significantly increased caretakers' compliance with referral. Use of referral slips is important to increase compliance with referral recommendations in rural Afghanistan.
Schaffer, W A; Holloman, F C
The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.
McEvoy, Suzanne P; Stevenson, Mark R; Woodward, Mark
To explore the use and effects of using mobile phones while driving. Cross-sectional survey. New South Wales and Western Australia, 20 October to 7 November 2003. 1347 licensed drivers aged 18 to 65 years. Data were weighted to reflect the corresponding driving population in each state. Mobile phone use while driving (hand-held, hands-free and text messaging); adverse effects of use. While driving, an estimated 57.3% +/- 1.5% of drivers have ever used a mobile phone and 12.4% +/- 1.0% have written text messages. Men, younger drivers and metropolitan residents were more likely to use a phone while driving and to report a higher frequency of use. Enforcement of hand-held phone restrictions was perceived to be low (69.0% +/- 1.5%) and an estimated 39.4% +/- 2.1% of people who phone while driving use a hand-held phone. Half of all drivers (50.1% +/- 1.6%) did not agree with extending the ban to include hands-free phones. Among drivers aged 18-65 years in NSW and WA, an estimated 45 800 +/- 16 466 (0.9% +/- 0.3%) have ever had a crash while using a mobile phone and, in the past year, 146 762 +/- 26 856 (3.0% +/- 0.6%) have had to take evasive action to avoid a crash because of their phone use. Phone use while driving is prevalent and can result in adverse consequences, including crashes. Despite legislation, a significant proportion of drivers continue to use hand-held mobile phones while driving. Enhanced enforcement is needed.
McCartt, Anne T; Hellinga, Laurie A; Haire, Emily R
To assess parental decision making regarding the timing of teenagers initiating driving and monitoring teenagers' driving after licensure. About 300 parents were interviewed during spring 2006 in Minnesota, North Carolina, and Rhode Island, states with varying licensing provisions, while teenagers took their first on-road driving tests. States' differences in ages of obtaining learner's permits and licenses reflected different licensing laws, but most teenagers obtained permits and took road tests within the first few months after they became eligible. Common reasons for delaying obtaining permits were fulfilling driver education requirements and lack of readiness/immaturity. Insufficient practice driving most often delayed licensure. Among the parents interviewed, 33-49% believed the minimum licensure age should be 17 or older. Almost all parents planned to supervise teenagers' driving after licensure, and most wanted to know about speeding or distractions. When asked about in-vehicle devices to monitor teenagers' driving, 37-59% of parents had heard of them. Parents were least interested in using video cameras and about equally interested in computer chips and cell-phone-based GPS systems. Disinterest in monitoring devices most often was attributed to trusting teenagers or respecting their privacy. Licensing laws influence ages of initiating driving. Although many parents support licensing at 17 or older - higher than in all but one state - most teenagers initiate driving soon after reaching the minimum age. Parents plan to supervise teenagers' driving, and many say they are open to using in-vehicle monitoring devices. Many parents support a minimum licensing age of 17 or older and would consider in-vehicle devices to extend their supervision of teenager's driving.
MacGregor, Daune; Parker, Sandra; MacMillan, Sharon; Blais, Irene; Wong, Eugene; Robertson, Chris J; Bruce-Barrett, Cindy
The provision of timely and optimal patient care is a priority in pediatric academic health science centres. Timely access to care is optimized when there is an efficient and consistent referral system in place. In order to improve the patient referral process and, therefore, access to care, an innovative web-based system was developed and implemented. The Ambulatory Referral Management System enables the electronic routing for submission, review, triage and management of all outpatient referrals. The implementation of this system has provided significant metrics that have informed how processes can be improved to increase access to care. Use of the system has improved efficiency in the referral process and has reduced the work associated with the previous paper-based referral system. It has also enhanced communication between the healthcare provider and the patient and family and has improved the security and confidentiality of patient information management. Referral guidelines embedded within the system have helped to ensure that referrals are more complete and that the patient being referred meets the criteria for assessment and treatment in an ambulatory setting. The system calculates and reports on wait times, as well as other measures.
Full Text Available AIM: Taxi drivers are among the occupational groups with the highest smoking prevalence and exposure to carbon monoxide (CO. This study aimed to measure breath CO levels of some taxi drivers working in Ankara and to find out some associated factors (if any. METHOD: The descriptive study was carried out with 173 taxi drivers from 14 different taxi stations in the center of Ankara. Data was collected by face to face interviews with a standart questionnaire, while breath CO was measured by a Pi-CO Smokerlyser. Descriptive statistics were used to summarize data, whereas chi-square, independant samples t-test and One-Way ANOVA were used to compare groups by SPSS 15.0 statistical package programme. RESULTS: In the study, all of the taxi drivers (n=173 were male with a mean age of 39.2±9.6 years. Of the drivers, 58.4% were current smokers, whereas 75.1% were exposed to enviromental tobacco smoke. The frequency of indoor smoking in the taxi stations, taxis and drivers’ homes were 48.0%, 45.1%, and 59.0%, respectively. The mean breath CO level of the drivers was 16.9±12.8 ppm. CO level was positively associated with the current smoking status, total years of smoking, number of cigarettes smoked per day and passive exposure to tobacco smoke, whereas the association was negative with the elapsed time from the last cigarette smoked (p0.05. CONCLUSION: Results of the study provide evidence in support of the previous literature that smoking is one of the most important sources of carbonmonoxide. Interventions such as awareness raising trainings, referral of smokers willing to quit smoking to smoking cessation centers and screening programmes for smoking related diseases are needed to be implemented in collaboration with the relevant drivers’ associations. [TAF Prev Med Bull 2010; 9(6.000: 591-596
Cash, Ayla; Luo, Xun; Chow, Eric K H; Bowring, Mary Grace; Shaffer, Ashton A; Doby, Brianna; Wickliffe, Corey E; Alexander, Charles; McRann, Deborah; Tobian, Aaron A R; Segev, Dorry L; Durand, Christine M
HIV-infected (HIV+) donor organs can be transplanted into HIV+ recipients under the HIV Organ Policy Equity (HOPE) Act. Quantifying HIV+ donor referrals received by organ procurement organizations (OPOs) is critical for HOPE Act implementation. We surveyed the 58 USA OPOs regarding HIV+ referral records and newly discovered HIV+ donors. Using data from OPOs that provided exact records and CDC HIV prevalence data, we projected a national estimate of HIV+ referrals. Fifty-five (95%) OPOs reported HIV+ referrals ranging from 0 to 276 and newly discovered HIV+ cases ranging from 0 to 10 annually. Six OPOs in areas of high HIV prevalence reported more than 100 HIV+ donor referrals. Twenty-seven (47%) OPOs provided exact HIV+ referral records and 28 (51%) OPOs provided exact records of discovered HIV+ cases, totaling 1450 HIV+ referrals and 39 discovered HIV+ donors in the prior year. These OPOs represented 67% and 59% of prevalent HIV cases in the USA; thus, we estimated 2164 HIV+ referrals and 66 discovered HIV+ cases nationally per year. OPOs reported a high volume of HIV+ referrals annually, of which a subset will be medically eligible for donation. Particularly in areas of high HIV prevalence, OPOs require ongoing support to implement the HOPE Act. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Pedersen-Bjergaard, Ulrik; Færch, Louise; Allingbjerg, Marie-Louise
OBJECTIVE: We test the hypotheses that the implementation in Denmark of new, stricter European Union (EU) legislation on driver's licensing, with the purpose to improve traffic safety in January 2012, has reduced the self-reported rate of severe hypoglycemia in a routine clinical setting...... of concealed severe hypoglycemia may impair the safety of affected patients and unintentionally paradoxically reduce the general traffic safety....
Berney, M J
Sagittal synostosis (SS) is the commonest form of craniosynostosis. Children with sagittal synostosis in Ireland are treated in the National Paediatric Craniofacial Centre (NPCC) in Temple Street Children’s University Hospital. This retrospective study analysed the correlation between referral patterns to the unit and age at operation. The notes of 81 patients referred over a 5 year period (April 2008 – April 2013) to the NPCC with non-syndromic SS were reviewed and demographics and referral information were recorded. Of 81 patients reviewed, 60 (74%) were referred before 6 months of age, while 21 (26%) had late referrals. Neonatologists referred 100% of infants before 6 months, paediatricians referred 71%, and GPs 64%. Later referral was associated with a more complex referral pathway, including multiple-steps of referral and unnecessary investigations. Improved clinician knowledge and emphasis on the importance of early referral may lead to a reduction in late referrals.
Reiling, Denise M; Nusbaumer, Michael R
Much has been written about the impact of the presence of a designated driver on patrons' consumption, but heretofore, its impact on the behaviour of the server has been virtually ignored. The goal of this paper, then, was to explore the potential impact of the presence of a designated driver on alcoholic beverage servers' self-reported willingness to knowingly serve an already intoxicated customer. chi(2) analysis of survey data collected from 938 licensed servers, in the state of Indiana, USA, was performed. Approximately 43% of the bartenders surveyed reported that they either would be or might be willing to over-serve an already intoxicated customer. Of those who answered the follow-up question as to under what conditions they would be willing to over-serve, almost 80% reported that they would do so if the patron were accompanied by a designated driver. The statistical significance of the relationship between these two variables (.000) raises the question of whether the Designated Driver Campaign has the latent function of enabling some servers to neutralize their responsibility for over-serving by disregarding other types of intoxication-related harm.
In accordance with the Nuclear Energy Act, the use of nuclear energy constitutes operations subject to license. The licensing process and conditions for granting a license is defined in the legislation. The licenses are applied from and granted by the Government. This paper discusses briefly the licensing process in Finland and also the roles and responsibilities of main stakeholders in licensing. Licensing of a nuclear power plant in Finland has three steps. The first step is the Decision in Principle (DiP). Goal of DiP is to decide whether using nuclear power is for the overall good for the Finnish society. The second step is Construction License (CL) and the goal of CL phase is to determine whether the design of the proposed plant is safe and that the participating organisations are capable of constructing the plant to meet safety goals. The third step is the Operating License (OL) and the goal of the OL phase is to determine whether the plant operates safely and licensee is capable to operate the plant safely. Main stakeholders in the licensing process in Finland are the utility (licensee) interested in using nuclear power in Finland, Ministry of Employment and the Economy (MEE), Government, Parliament, STUK, the municipality siting the plant and the general public. Government grants all licenses, and Parliament has to ratify Government's Decision in Principle. STUK has to assess the safety of the license applications in each step and give statement to the Ministry. Municipality has to agree to site the plant. Both STUK and the municipality have a veto right in the licensing process
... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referrals to the Department of Justice. 11.13 Section 11.13 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.13 Referrals to the Department of Justice. Referrals of debts to the Department of Justice for collection will...
Szosland, Dorota; Marcinkiewicz, Andrzej
The discussion on the relationship between diabetes and driving has continued in recent years all over the world. The issue of diabetes, its treatment models, the risk of hypoglycaemia and license to drive are receiving considerable attention. Driving ability is controlled by specific regulations. Polish legislation does not provide standard procedures for dealing with the question of diabetic drivers and driver candidates. The aim of study was to draw attention to some problems that may emerge when attempting to certify medical fitness of drivers or driver candidate to drive public service vehicles. Data were obtained from standardised prophylactic examination forms of public transport drivers employed in a small company between 2001 and 2007. Fasting capillary blood was collected to be analysed with a blood glucose meter. Diabetes and its diagnosing during obligatory preemployment or periodic medical examinations constitutes a serious problem. Abnormal fasting glucose levels were noted in 23 drivers (21.7%). Our study shows that the occupational physician must take into account the possibility of glucose metabolism disturbances. The results demonstrate that an unified approach to diagnosing of diabetes mellitus during such medical examinations is not available currently in Poland. It is necessary to develop standard procedures to be used by occupational physicians for diagnosis diabetes mellitus and intermediate hyperglycaemia. Fasting capillary blood glucose measurement with a blood glucose meter may be used for screening, because it is easier, less expensive and less invasive than venous blood tests. Screening tests must be followed by oral glucose tolerance test using standard criteria in order to make the diagnosis. Frequency of periodic medical assessments in case of diagnosed diabetes mellitus or any intermediate hyperglycaemia must be determined. Specific situations must be identified when the consultation of diabetes specialist is mandatory with respect
Scott-Parker, Bridie; Watson, Barry; King, Mark J; Hyde, Melissa K
Young novice drivers are significantly more likely to be killed or injured in car crashes than older, experienced drivers. Graduated driver licensing (GDL), which allows the novice to gain driving experience under less-risky circumstances, has resulted in reduced crash incidence; however, the driver's psychological traits are ignored. This paper explores the relationships between gender, age, anxiety, depression, sensitivity to reward and punishment, sensation-seeking propensity, and risky driving. Participants were 761 young drivers aged 17-24 (M=19.00, SD=1.56) with a Provisional (intermediate) driver's licence who completed an online survey comprising socio-demographic questions, the Impulsive Sensation Seeking Scale, Kessler's Psychological Distress Scale, the Sensitivity to Punishment and Sensitivity to Reward Questionnaire, and the Behaviour of Young Novice Drivers Scale. Path analysis revealed depression, reward sensitivity, and sensation-seeking propensity predicted the self-reported risky behaviour of the young novice drivers. Gender was a moderator; and the anxiety level of female drivers also influenced their risky driving. Interventions do not directly consider the role of rewards and sensation seeking, or the young person's mental health. An approach that does take these variables into account may contribute to improved road safety outcomes for both young and older road users. ©2011 The British Psychological Society.
... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of Justice...
... 10 Energy 1 2010-01-01 2010-01-01 false Referral to the Department of Justice. 15.67 Section 15.67 Energy NUCLEAR REGULATORY COMMISSION DEBT COLLECTION PROCEDURES Referral of a Claim § 15.67 Referral to the Department of Justice. (a) Unless excepted by DOJ, the NRC shall complete the CCLR accompanied by...
Goodwin, Arthur H; O'Brien, Natalie P; Foss, Robert D
A majority of states now restrict teenagers from using a mobile communication device while driving. The effect of these restrictions is largely unknown. In a previous study, we found North Carolina's teenage driver cell phone restriction had little influence on young driver behavior four months after the law took effect (Foss et al., 2009). The goal of the present study was to examine the longer-term effect of North Carolina's cell phone restriction. It was expected that compliance with the restriction would increase, as awareness of the restriction grew over time. Teenagers were observed at high schools in North Carolina approximately two years after the law was implemented. Observations were also conducted in South Carolina, which did not have a cell phone restriction. In both states, there was a broad decrease in cell phone use. A logistic regression analysis showed the decrease in cell phone use did not significantly differ between the two states. Although hand-held cell phone use decreased, there was an increase in the likelihood that drivers in North Carolina were observed physically manipulating a phone. Finally, a mail survey of teenagers in North Carolina showed awareness for the cell phone restriction now stands at 78% among licensed teens. Overall, the findings suggest North Carolina's cell phone restriction has had no long-term effect on the behavior of teenage drivers. Moreover, it appears many teenage drivers may be shifting from talking on a phone to texting. Copyright © 2012 Elsevier Ltd. All rights reserved.
... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration judge...
The Bundesanstalt fuer Strassenwesen (BASt) commissioned the SWOV Institute for Road Safety Research to review the literature on research into the effectiveness of: (1) post-qualification restrictive measures for novice drivers; and (2) of accompanied driving both as part of the driver training and
Naseriasl, Mansour; Adham, Davoud; Janati, Ali
around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment's and services. In order to respond these challenges and reduction of health system's transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby's index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner.
Nanyonjo, Agnes; Bagorogoza, Benson; Kasteng, Frida; Ayebale, Godfrey; Makumbi, Fredrick; Tomson, Göran; Källander, Karin
Integrated community case management (iCCM) relies on community health workers (CHWs) managing children with malaria, pneumonia, diarrhoea, and referring children when management is not possible. This study sought to establish the cost per sick child referred to seek care from a higher-level health facility by a CHW and to estimate caregivers' willingness to pay (WTP) for referral. Caregivers of 203 randomly selected children referred to higher-level health facilities by CHWs were interviewed in four Midwestern Uganda districts. Questionnaires and document reviews were used to capture direct, indirect and opportunity costs incurred by caregivers, CHWs and health facilities managing referred children. WTP for referral was assessed through the 'bidding game' approach followed by an open-ended question on maximum WTP. Descriptive analysis was conducted for factors associated with referral completion and WTP using logistic and linear regression methods, respectively. The cost per case referred to higher-level health facilities was computed from a societal perspective. Reasons for referral included having fever with a negative malaria test (46.8%), danger signs (29.6%) and drug shortage (37.4%). Among the referred, less than half completed referral (45.8%). Referral completion was 2.8 times higher among children with danger signs (p = 0.004) relative to those without danger signs, and 0.27 times lower among children who received pre-referral treatment (p average cost per case referred was US$ 4.89 and US$7.35 per case completing referral. For each unit cost per case referred, caregiver out of pocket expenditure contributed 33.7%, caregivers' and CHWs' opportunity costs contributed 29.2% and 5.1% respectively and health facility costs contributed 39.6%. The mean (SD) out of pocket expenditure was US$1.65 (3.25). The mean WTP for referral was US$8.25 (14.70) and was positively associated with having received pre-referral treatment, completing referral and increasing
Full Text Available In the mid 90s, the abundance of various electronic publications exposed libraries to the problems of licensing electronic content. Various licensing principles have been prepared recently to help libraries in the process; it can be said that in general, the knowledge of licensing issues has improved in libraries of all types. Libraries form consortia in order to gain stronger negotiating positions and obtain better conditions.In the article, new licensing principles are presented in more detail, as well as some domestic and foreign experiences with consortia forming.
Scott-Parker, Bridie; Hyde, Melissa K; Watson, Barry; King, Mark J
Young novice drivers continue to be overrepresented in fatalities and injuries arising from crashes even with the introduction of countermeasures such as graduated driver licensing (GDL). Enhancing countermeasures requires a better understanding of the variables influencing risky driving. One of the most common risky behaviours performed by drivers of all ages is speeding, which is particularly risky for young novice drivers who, due to their driving inexperience, have difficulty in identifying and responding appropriately to road hazards. Psychosocial theory can improve our understanding of contributors to speeding, thereby informing countermeasure development and evaluation. This paper reports an application of Akers' social learning theory (SLT), augmented by Gerrard and Gibbons' prototype/willingness model (PWM), in addition to personal characteristics of age, gender, car ownership, and psychological traits/states of anxiety, depression, sensation seeking propensity and reward sensitivity, to examine the influences on self-reported speeding of young novice drivers with a Provisional (intermediate) licence in Queensland, Australia. Young drivers (n=378) recruited in 2010 for longitudinal research completed two surveys containing the Behaviour of Young Novice Drivers Scale, and reported their attitudes and behaviours as pre-Licence/Learner (Survey 1) and Provisional (Survey 2) drivers and their sociodemographic characteristics. An Akers' measurement model was created. Hierarchical multiple regressions revealed that (1) personal characteristics (PC) explained 20.3%; (2) the combination of PC and SLT explained 41.1%; (3) the combination of PC, SLT and PWM explained 53.7% of variance in self-reported speeding. Whilst there appeared to be considerable shared variance, the significant predictors in the final model included gender, car ownership, reward sensitivity, depression, personal attitudes, and Learner speeding. These results highlight the capacity for
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Referral to the Corporation. 1619.3 Section 1619.3 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION DISCLOSURE OF INFORMATION § 1619.3 Referral to the Corporation. If a person requests information, not required...
Ehsani, Johnathon P; Li, Kaigang; Simons-Morton, Bruce G; Fox Tree-McGrath, Cheyenne; Perlus, Jessamyn G; O'Brien, Fearghal; Klauer, Sheila G
Personality characteristics are associated with many risk behaviors. However, the relationship between personality traits, risky driving behavior, and crash risk is poorly understood. The purpose of this study was to examine the association between personality, risky driving behavior, and crashes and near-crashes, using naturalistic driving research methods. Participants' driving exposure, kinematic risky driving (KRD), high-risk secondary task engagement, and the frequency of crashes and near-crashes (CNC) were assessed over the first 18months of licensure using naturalistic driving methods. A personality survey (NEO-Five Factor Inventory) was administered at baseline. The association between personality characteristics, KRD rate, secondary task engagement rate, and CNC rate was estimated using a linear regression model. Mediation analysis was conducted to examine if participants' KRD rate or secondary task engagement rate mediated the relationship between personality and CNC. Data were collected as part of the Naturalistic Teen Driving Study. Conscientiousness was marginally negatively associated with CNC (path c=-0.034, p=.09) and both potential mediators KRD (path a=-0.040, p=.09) and secondary task engagement while driving (path a=-0.053, p=.03). KRD, but not secondary task engagement, was found to mediate (path b=0.376, p=.02) the relationship between conscientiousness and CNC (path c'=-0.025, p=.20). Using objective measures of driving behavior and a widely used personality construct, these findings present a causal pathway through which personality and risky driving are associated with CNC. Specifically, more conscientious teenage drivers engaged in fewer risky driving maneuvers, and suffered fewer CNC. Part of the variability in crash risk observed among newly licensed teenage drivers can be explained by personality. Parents and driving instructors may take teenage drivers' personality into account when providing guidance, and establishing norms and
Blunck, Hallie; Owsley, Cynthia; MacLennan, Paul A.; McGwin, Gerald
Increasing rates of distraction-related motor vehicle collisions (MVCs) continue to raise concerns regarding driving safety. This study sought to evaluate a novel driving-related distraction, driving with a pet, as a risk factor for MVCs among older, community dwelling adults. Two thousand licensed drivers aged 70 and older were identified, of whom 691 reported pet ownership. Comparing pet owners who did and did not drive with their pets, neither overall MVC rates (rate ratio [RR] 0.97 95% confidence interval [CI] 0.75–1.26) nor at-fault MVC rates (RR 0.84 95% CI 0.57–1.24) were elevated. However, those who reported always driving with a pet in the vehicle had an elevated MVC rate (RR 1.89 95% CI 1.10–3.25), as compared to those who did not drive with a pet. The MVC rate was not increased for those reporting only sometimes or rarely driving with a pet in the vehicle. The current study demonstrates an increased risk of MVC involvement in those older drivers who always take a pet with them when they drive a vehicle. When confronted with an increased cognitive or physical workload while driving, elderly drivers in prior studies have exhibited slower cognitive performance and delayed response times in comparison to younger age groups. Further study of pet-related distracted driving behaviors among older drivers as well as younger populations with respect to driver safety and performance is warranted to appropriately inform the need for policy regulation on this issue. PMID:23708755
Plant, Bernice R C; Irwin, Julia D; Chekaluk, Eugene
Recent examinations of road safety communications, including anti-speeding advertisements, have considered the differential effects of positive and negative emotional appeals on driver behaviour. However, empirical evaluations of anti-speeding messages have largely relied on measures of viewers' reported intentions to comply with speed limits and the self-reported driving behaviour of viewers post-exposure, which might not be indicative of the direct effects that these messages have on real-world driving behaviour. The current research constitutes a first empirical evaluation of different real-world anti-speeding advertisements, as measured by their effects on young drivers' speeding behaviour, using a driving simulator. Licensed drivers (N=116) aged 17-25 years completed driving measures prior to, immediately following, and 7-10days after viewing one of four social marketing advertisements. Results indicated that young drivers' average driving speeds were modestly reduced immediately after they viewed an anti-speeding advertisement that depicted social consequences for speeding and employed a positive emotional appeal when compared to an emotion-matched control advertisement; however, this effect was not found for the anti-speeding advertisement depicting a crash. Interestingly, the results based on reported intentions to reduce speeding predicted the opposite pattern of results. However, there was no evidence that the immediate changes to speeding were maintained 7-10days later, and prompts during Phase 2 did not appear to have an effect. The implications of these findings for road safety advertisements targeting young drivers are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.
referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010 ... proportion of pregnant women are attended at childbirth ... tility; management of threatened abortion; ... refuse referral and whatever is the outcome.
Full Text Available Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. Patients are referred to specialists when investigation or therapeutic options are exhausted in primary care or when opinion or advice is needed from them. Referral has considerable implications for patients, health care system and health care costs. Good communication between primary and secondary care is essential for the smooth running of any health care system. Referral and reply letters are the sole means of communication between doctors most of the time and breakdown in communication could lead to poor continuity of care, delayed diagnoses, polypharmacy, increased litigation risk and unnecessary testing. A referral letter also helps to avoid patient dissatisfaction and loss of confidence in family physician. Studies of referral letters have reported that specialists are dissatisfied with their quality and content. Inclusion of letter writing skills in the medical curriculum, peer assessment and feedback have shown to improve the quality of referral letters. . Form letters have shown to enhance information content and communication in referral process. In Sri Lanka referral letters are usually hand written and frequent complaints are that these letters do not contain adequate information and retrieval of information is a problem due to poor legibility and clarity. Sometimes Primary care doctors refer patients to hospitals and specialists with only verbal instructions. To address these short comings this form letter was introduced. Based on the guidelines and systematic review of published articles, items of information to be included were decided. Printed forms of the letter are kept in the practice and the doctor has to just fill up relevant information under each heading. The objectives of introducing this structured referral letter was to improve the quality and standard of referral letters and save time for both general
Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip
In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector. A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members. A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers. In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.
Jensen, Anker; Kaerlev, Linda; Tüchsen, Finn
-249) and for other truck drivers (SHR: 130, 95% CI: 108-156) compared to bus drivers (SHR: 110, 95% CI: 79-149). All drivers had high SHR for lesions of the ulnar nerve (SHR: 159, 95% CI: 119-207), especially bus drivers (SHR: 197, 95% CI: 116-311). Long-haul truck drivers had high SHRs for synovitis and bursitis...
The impact of glaucoma referral refinement criteria on referral to, and first-visit discharge rates from, the hospital eye service: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project.
Ratnarajan, Gokulan; Newsom, Wendy; French, Karen; Kean, Jane; Chang, Lydia; Parker, Mike; Garway-Heath, David F; Bourne, Rupert R A
To assess the impact of referral refinement criteria on the number of patients referred to, and first-visit discharges from, the Hospital Eye Service (HES) in relation to the National Institute for Health & Clinical Excellence (NICE) Glaucoma Guidelines, Joint College Group Guidance (JCG) and the NICE commissioning guidance. All low-risk (one risk factor: suspicious optic disc, abnormal visual field (VF), raised intra-ocular pressure (IOP) (22-28 mmHg) or IOP asymmetry (>5 mmHg) and high-risk (more than one risk factor, shallow anterior chamber or IOP >28 mmHg) referrals to the HES from 2006 to 2011 were analysed. Low-risk referrals were seen by Optometrists with a specialist interest in glaucoma and high-risk referrals were referred directly to the HES. Two thousand nine hundred and twelve patient records were analysed. The highest Consultant first-visit discharge rates were for referrals based on IOP alone (45% for IOP 22-28 mmHg) and IOP asymmetry (53%), VF defect alone (46%) and for abnormal IOP and VF (54%). The lowest first-visit discharge rates were for referrals for suspicious optic disc (19%) and IOP >28 mmHg (22%). 73% of patients aged 65-80 and 60% of patients aged >80 who were referred by the OSI due to an IOP between 22-28 mmHg would have satisfied the JCG criteria for non-referral. For patients referred with an IOP >28 mmHg and an otherwise normal examination, adherence to the NICE commissioning guidance would have resulted in 6% fewer referrals. In 2010 this scheme reduced the number of patients attending the HES by 15%, which resulted in a saving of £16 258 (13%). The results support that referrals for a raised IOP alone or in combination with an abnormal VF be classified as low-risk and undergo referral refinement. Adherence to the JCG and the NICE commissioning guidance as onward referral criteria for specialist optometrists in this referral refinement scheme would result in fewer referrals. Ophthalmic & Physiological Optics © 2013 The College
This presentation discusses reactor licensing and includes the legislative basis for licensing, other relevant legislation , the purpose of the Nuclear Safety and Control Act, important regulations, regulatory document, policies, and standards. It also discusses the role of the CNSC, its mandate and safety philosophy
Detailed cost-benefit analysis of potential impairment countermeasures. Research in the framework of the European research programme IMMORTAL (Impaired Motorists, Methods of Roadside Testing and Assessment for Licensing) Deliverable P2.
Vlakveld, W. Wesemann, P. Devillers, E. Elvik, R. & Veisten, K.
Almost all kinds of driver impairments increase accident risks. This study forms part of the European IMMORTAL (Impaired Motorists, Methods Of Roadside Testing and Assessment for Licensing) project. The study provides a cost-benefit analysis (CBA) of several possible policies of impairment
Objectives: To determine the referral pattern and assess the quality and accuracy of referral letters to the ophthalmic outpatient clinic of University of Nigeria Teaching Hospital, Enugu. Methods: This study is a prospective cross-sectional survey of all new ophthalmic referrals to the ophthalmic outpatient clinic at University of ...
Uhler, Lauren M.; Kumarasamy, Nagalingeswaran; Mayer, Kenneth H.; Saxena, Anjali; Losina, Elena; Muniyandi, Malaisamy; Stoler, Adam W.; Lu, Zhigang; Walensky, Rochelle P.; Flanigan, Timothy P.; Bender, Melissa A.; Freedberg, Kenneth A.; Swaminathan, Soumya
Background Indian guidelines recommend routine referral for HIV testing of all tuberculosis (TB) patients in the nine states with the highest HIV prevalence, and selective referral for testing elsewhere. We assessed the clinical impact and cost-effectiveness of alternative HIV testing referral strategies among TB patients in India. Methods and Findings We utilized a computer model of HIV and TB disease to project outcomes for patients with active TB in India. We compared life expectancy, cost, and cost-effectiveness for three HIV testing referral strategies: 1) selective referral for HIV testing of those with increased HIV risk, 2) routine referral of patients in the nine highest HIV prevalence states with selective referral elsewhere (current standard), and 3) routine referral of all patients for HIV testing. TB-related data were from the World Health Organization. HIV prevalence among TB patients was 9.0% in the highest prevalence states, 2.9% in the other states, and 4.9% overall. The selective referral strategy, beginning from age 33.50 years, had a projected discounted life expectancy of 16.88 years and a mean lifetime HIV/TB treatment cost of US$100. The current standard increased mean life expectancy to 16.90 years with additional per-person cost of US$10; the incremental cost-effectiveness ratio was US$650/year of life saved (YLS) compared to selective referral. Routine referral of all patients for HIV testing increased life expectancy to 16.91 years, with an incremental cost-effectiveness ratio of US$730/YLS compared to the current standard. For HIV-infected patients cured of TB, receiving antiretroviral therapy increased survival from 4.71 to 13.87 years. Results were most sensitive to the HIV prevalence and the cost of second-line antiretroviral therapy. Conclusions Referral of all patients with active TB in India for HIV testing will be both effective and cost-effective. While effective implementation of this strategy would require investment, routine
Oviedo-Trespalacios, Oscar; Haque, Md Mazharul; King, Mark; Washington, Simon
This study investigated how situational characteristics typically encountered in the transport system influence drivers' perceived likelihood of engaging in mobile phone multitasking. The impacts of mobile phone tasks, perceived environmental complexity/risk, and drivers' individual differences were evaluated as relevant individual predictors within the behavioral adaptation framework. An innovative questionnaire, which includes randomized textual and visual scenarios, was administered to collect data from a sample of 447 drivers in South East Queensland-Australia (66% females; n = 296). The likelihood of engaging in a mobile phone task across various scenarios was modeled by a random parameters ordered probit model. Results indicated that drivers who are female, are frequent users of phones for texting/answering calls, have less favorable attitudes towards safety, and are highly disinhibited were more likely to report stronger intentions of engaging in mobile phone multitasking. However, more years with a valid driving license, self-efficacy toward self-regulation in demanding traffic conditions and police enforcement, texting tasks, and demanding traffic conditions were negatively related to self-reported likelihood of mobile phone multitasking. The unobserved heterogeneity warned of riskier groups among female drivers and participants who need a lot of convincing to believe that multitasking while driving is dangerous. This research concludes that behavioral adaptation theory is a robust framework explaining self-regulation of distracted drivers. © 2018 Society for Risk Analysis.
The Atomic Energy Act of 1954, which was amended in 1974 by the Energy Reorganization Act, established the requirement that individuals who had the responsibility of operating the reactors in nuclear power plants must be licensed. Section 107 of the act states ''the Commission shall (1) prescribe uniform conditions for licensing individuals; (2) determine the qualifications of such individuals; and (3) issue licenses to such individuals in such form as the Commission may prescribe.'' The article discusses the types of licenses, the selection and training of individuals, and the administration of the Nuclear Regulatory Commission licensing examinations
The Operator Licensing Examiner Standards provide policy and guidance to NRC examiners and establish the procedures and practices for examining and licensing of applicants for NRC operator licenses pursuant to Part 55 of Title 10 of the Code of Federal Regulations (10 CFR 55). They are intended to assist NRC examiners and facility licensees to understand the examination process better and to provide for equitable and consistent administration of examinations to all applicants by NRC examiners. These standards are not a substitute for the operator licensing regulations and are subject to revision or other internal operator examination licensing policy changes
Ferreira, Fernanda A.; Ferreira, Flávio
We study the effects of entry of two foreign firms on domestic welfare in the presence of licensing, when the incumbent is technologically superior to the entrants. We consider two different situations: (i) the cost-reducing innovation is licensed to both entrants; (ii) the cost-reducing innovation is licensed to just one of the entrants. We analyse three kind of license: (lump-sum) fixed-fee; (per-unit) royalty; and two-part tariff, that is a combination of a fixed-fee and a royalty. We prove that a two part tariff is never an optimal licensing scheme for the incumbent. Moreover, (i) when the technology is licensed to the two entrants, the optimal contract consists of a licensing with only output royalty; and (ii) when the technology is licensed to just one of the entrants, the optimal contract consists of a licensing with only a fixed-fee.
Less than 20% of the referral letters included information on previous psychiatric consultations, current psychotropic medication, the outcome of physical examinations, and results of special investigations. Only 17 (6%) referral letters indicated a preliminary diagnosis according to an officially recognised classification system ...
... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Continuing accuracy of license application; application for modification of license. 431.73 Section 431.73 Aeronautics and Space COMMERCIAL SPACE... Conditions § 431.73 Continuing accuracy of license application; application for modification of license. (a...
van Buuren Stef
Full Text Available Abstract Background To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these guidelines, comparing it with cut-off values mentioned by the WHO. Methods Three sets of referral rules were tested on the growth data of a random sample (n = 400 of all children born between 01-01-1985 and 31-12-1988, attending school doctors between 1998 and 2000 in Leiden and Alphen aan den Rijn (the Netherlands: the screening criteria mentioned in the Dutch Consensus Guideline (DCG, those of the UK Consensus Guideline (UKCG and the cut-off values mentioned in the WHO Global Database on Child growth and Malnutrition. Results Application of the DCG would lead to the referral of too many children (almost 80%. The largest part of the referrals is due to the deflection of height, followed by distance to target height and takes primarily place during the first 3 years. The deflection away from the parental height would also lead to too many referrals. In contrast, the UKCG only leads to 0.3% referrals and the WHO-criteria to approximately 10%. Conclusion The current Dutch consensus guideline leads to too many referrals, mainly due to the deflection of length during the first 3 years of life. The UKCG leads to far less referrals, but may be relatively insensitive to detect clinically relevant growth disorders like Turner syndrome. New guidelines for growth monitoring are needed, which combine a low percentage of false positive results with a good sensitivity.
de Carvalho, Heraclito Barbosa; Andreuccetti, Gabriel; Rezende, Marcelo Rosa; Bernini, Celso; Silva, Jorge Santos; Leyton, Vilma; D'Andréa Greve, Julia Maria
Earlier studies have already identified that a greater proportion of injured drivers are under the effects of illicit drugs than alcohol in Brazil, but the crash risk attributable to each substance is still unknown. Injured motorcycle drivers who were involved in traffic accidents in the West Zone of the city of Sao Paulo were recruited for a cross-sectional study based on crash culpability analysis. Alcohol and drug positivity among drivers was evaluated according to their responsibility for the crash. Culpability ratios were generated based on the proportion of drivers who were deemed culpable in relation to those considered not culpable according to the use of drugs and alcohol. Of the 273 drivers recruited, 10.6% tested positive for alcohol. Among those who were also tested for drugs (n=232), 20.3% had consumed either alcohol and/or other drugs, 15.5% of whom were positive only for drugs other than alcohol, specifically cannabis and cocaine. Drivers who tested positive for alcohol were significantly less likely to possess a valid driver's license and to report driving professionally, whereas those who had consumed only drugs were more likely to drive professionally. The culpability ratio estimated for alcohol-positive drivers was three times higher than that for alcohol-free drivers, showing a superior ratio than drivers who had consumed only drugs other than alcohol, who presented a 1.7 times higher culpability ratio than drug-free drivers. Substance use was overrepresented among culpable motorcycle drivers, with alcohol showing a greater contribution to crash culpability than other drugs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Martinussen, Laila Marianne; Møller, Mette; Prato, Carlo Giacomo
The Driver Behavior Questionnaire (DBQ) and the Driver Skill Inventory (DSI) are two of the most frequently used measures of self-reported driving style and driving skill. The motivation behind the present study was to test drivers’ consistency or judgment of their own self-reported driving ability...... based on a combined use of the DBQ and the DSI. Moreover, the joint use of the two instruments was applied to identify sub-groups of drivers that differ in their potential danger in traffic (as measured by frequency of aberrant driving behaviors and level of driving skills), as well as to test whether...... the sub-groups of drivers differed in characteristics such as age, gender, annual mileage and accident involvement. 3908 drivers aged 18–84 participated in the survey. The results suggested that the drivers are consistent in their reporting of driving ability, as the self-reported driving skill level...
In order to provide for the continuity of the current generation of nuclear power plant operating licenses and at the same time ensure the health and safety of the public, and the quality of the environment, the US Nuclear Regulatory Commission (NRC) established a goal of developing and issuing regulations and regulatory guidance for license renewal in the early 1990s. This paper will discuss some of those activities underway to achieve this goal. More specifically, this paper will discuss the Commission's regulatory philosophy for license renewal and the two major license renewal rule makings currently underway. The first is the development of a new Part 54 to address procedural and technical requirements for license renewal; the second is a revision to existing Part 51 to exclude environmental issues and impacts from consideration during the license renewal process. (author)
Horne-Thompson, Anne; Daveson, Barbara; Hogan, Bridgit
The purpose of this project is to analyze music therapy (MT) referral trends from palliative care team members across nine Australian inpatient and community-based palliative care settings. For each referral 6 items were collected: referral source, reason and type; time from Palliative Care Program (PCP) admission to MT referral; time from MT referral to death/discharge; and profile of referred patient. Participants (196 female, 158 male) were referred ranging in age from 4-98 years and most were diagnosed with cancer (91%, n = 323). Nurses (47%, n = 167) referred most frequently to music therapy. The mean average time in days for all referrals from PCP admission to MT referral was 11.47 and then 5.19 days to time of death. Differences in length of time to referral ranged from 8.19 days (allied health staff) to 43.75 days (families). Forty-eight percent of referrals (48.5%, n = 172) were completed when the patient was rated at an Eastern Cooperative Oncology Group Performance (ECOG) of three. Sixty-nine percent (n = 244) were living with others at the time of referral and most were Australian born. Thirty-six percent (36.7%, n = 130) were referred for symptom-based reasons, and 24.5% (n = 87) for support and coping. Implications for service delivery of music therapy practice, interdisciplinary care and benchmarking of music therapy services shall be discussed.
California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...
Objective: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. Design: A retrospective descriptive study covering the period January 2000 to December 2003. Setting: Moi Teaching and Referral Hospital, ...
City of Jackson, Mississippi — This data displays all business license information for the year of 2015. This information details license classifications and status. This information will updated...
Simonetti, Franco L; Tornador, Cristian; Nabau-Moretó, Nuria; Molina-Vila, Miguel A; Marino-Buslje, Cristina
Cubbin, S; Llewellyn-Jones, S; Donnelly, P
It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).
Williams, Allan F
One objective was to determine teenage licensing rates on a national basis, interest in early licensure, and reasons for delay. A second objective was to learn teenagers' opinions about licensing policies, important in states considering ways to upgrade their current licensing systems. One thousand three hundred eighty-three 15- to 18-year-olds completed an online survey in November 2010. They were drawn from a nationally representative panel of US households recruited using probability-based sampling. The panel included cell phone-only households, and Internet access was provided to those without it. Weighting procedures were applied so that the study population represented the national US population of 15- to 18-year-olds. Most teens said that they were interested in getting a license as soon as legally possible, but many had not started the process. At 16, teens were about equally divided among those who had not started, those in the learner stage, and those with a restricted or full license. At 18, 62 percent had full licenses; 22 percent had not started. For those old enough to start, lack of a car, costs, parent availability, ability to get around without a car, and being busy with other activities were leading reasons for delay. The majority of teens were not in favor of higher licensing ages. Forty-six percent thought the minimum learner age should be 16; 30 percent thought the full license age should be 18 or older. The majority approved of night (78%) and passenger (57%) restrictions, and 85 and 93 percent endorsed cell phone and texting bans, respectively. When these policies were packaged together in a single law that included an age 16 start, night, passenger, cell phone and texting bans, and a full license at age 18, 74 percent of teens were in favor. Teenagers are not as supportive of strong licensing policies as parents of teens, but there is evidence that they will support comprehensive policies likely to lead to further reductions in teen crash
Pattison, Natalie; Eastham, Elizabeth
To explore referrals to a critical care outreach team (CCOT), associated factors around patient management and survival to discharge, and the qualitative exploration of referral characteristics (identifying any areas for service improvement around CCOT). A single-centre mixed method study in a specialist hospital was undertaken, using an explanatory design: participant selection model. In this model, quantitative results (prospective and retrospective episode of care review, including modified early warning system (MEWS), time and delay of referral and patient outcomes for admission and survival) are further explained by qualitative (interview) data with doctors and nurses referring to outreach. Quantitative data were analysed using SPSS +17 and 19, and qualitative data were analysed using grounded theory principles. A large proportion of referrals (124/407 = 30·5%) were made by medical staff. For 97 (97/407 = 23·8%) referrals, there was a delay between the point at which patients deteriorated (as verified by retrospective record review and MEWS score triggers) and the time at when patients were referred. The average delay was 2·96 h (95% CI 1·97-3·95; SD 9·56). Timely referrals were associated with improved outcomes; however, no causal attribution can be made from the circumstances around CCOT referral. Qualitative themes included indications for referral, facilitating factors for referral, barriers to referral and consequences of referral, with an overarching core theory of reassurance. Outreach was seen as back-up and this core theory demonstrates the important, and somewhat less tangible, role outreach has in supporting ward staff to care for at-risk patients. Mapping outreach episodes of care and patient outcomes can help highlight areas for improvement. This study outlines reasons for referral and how outreach can facilitate patient pathways in critical illness. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care
history, may not be elements that non-psychiatrist phy- sicians routinely collect during their examinations and, therefore, one would not expect such information to be available to be included in referral letters. Conclusion. Deficits in communication or information transfer through referral letters to the psychiatrist are common.
Result: A majority (>80%) of the referral letters had no information on the current medication list, relevant psychosocial history, outline of management to date, results of investigations to date, and known allergies. Conclusion: Deficits in communication or information transfer through referral letters to the psychiatrist are ...
Recent health service legislation, and especially the loss of crown immunity has once again focussed attention on the arrangements for licensing of radiopharmaceuticals. The aim of the article is to describe in general terms the UK licensing system and in particular to provide guidance to those responsible for the supply of radiopharmaceuticals in hospitals. (author)
Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas
Objective To create and validate an objective and reliable score to assess referral quality in gastroenterology. Design An observational multicentre study. Setting and participants 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Main outcome measure Correlation between the TPS and a visual analogue scale (VAS) for referral quality. Results The 327 referrals had an average TPS of 13.2 (range 1–25) and an average VAS of 4.7 (range 0.2–9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. Conclusions The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. PMID:27855107
Buckley, Lisa; Chapman, Rebekah L; Sheehan, Mary
Adolescent drivers are overrepresented in distraction-related motor vehicle crashes. A number of potential reasons for such an elevated risk include driving inexperience, high adoption of communication technology, increased peer involvement, and tendency to take risks, which render young drivers particularly vulnerable. Major legislative efforts in Graduated Licensing Systems that include passenger restrictions have shown positive effects. Restrictions on cell phone use are also being introduced; however, it is challenging to enforce such regulations. This article argues that such contextual, legislative interventions are an essential prevention strategy, but there is an unfilled need to introduce behavior change programs that may target adolescents, parents, and friends. A theoretical framework is applied in which risk and protective factors are identified from research within the contexts of community and jurisdiction. In the literature on distraction, social context and normative influences are key elements used to inform program design for adolescent drivers, with parental monitoring informing interventions targeting parents. Following from this assessment of the message content assessment, the design of strategies to deliver the messages is reviewed. In the current literature, school-based programs, simulations, and Web-delivered programs have been evaluated with supplementary strategies delivered by physicians and parents. Such developments are still at an early stage of development, and ultimately will need controlled implementation and evaluation studies. Of course, there is no likely single approach to prevent adolescent driver distraction. Complementary approaches such as the further development of technological interventions to manage phone use are needed. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Small Business Administration — Starting a business? Confused about whether you need a business license or permit? Virtually every business needs some form of license or permit to operate legally....
Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne
INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmar...
The Operator Licensing Examiner Standards provide policy and guidance to NRC examiners and establish the procedures and practices for examining and licensing of applicants for NRC operator licenses pursuant to Part 55 of Title 10 of the Code of Federal Regulations (10 CFR 55). They are intended to assist NRC examiners and facility licensees to understand the examination process better and to provide for equitable and consistent administration of examinations to all applicants by NRC examiners. These standards are not a substitute for the operator licensing regulations and are subject to revision or other internal operator examination licensing policy changes. As appropriate, these standards will be revised periodically to accommodate comments and reflect new information or experience
Snell, V. G.; Takats, F.; Szivos, K.
The SLOWPOKE Energy System (SES-10) is a 10 MW heating reactor that has been developed in Canada. It will be capable of running without a licensed operator in continuous attendance, and will be sited in urban areas. It has forgiving safety characteristics, including transient time-scales of the order of hours. A process called `up-front` licensing has been evolved in Canada to identify, and resolve, regulatory concerns early in the process. Because of the potential market in Hungary for nuclear district heating, a licensing plan has been developed that incorporates Canadian licensing experience, identifies specific Hungarian requirements, and reduces the risk of licensing delays by seeking agreement of all parties at an early stage in the program.
Huntelaar, Mark; Vos, Renate de; Roobol, Lars
Full text: A new license under the nuclear power act is applied for at the Dutch Government for the building of a High Active Repackaging Unit (HAVA-VU in Dutch) at NRG in Petten, The Netherlands. This new building is necessary to comply with our nuclear license to dispose of high active nuclear waste at Petten to the intermediate storage facility (COVRA). In the first part of this paper attention is given to the formal procedure followed by the Government, what type of documents are to be submitted, what time frames are followed, how citizen participation is organized, and as final result a new license. In the second part more detailed information is given about the present license renewal needed for the High Active Repackaging Unit
Alonderis, A.; Barbee, F.; Bonsignore, M.
Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulati......Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license...... sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries...... it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea...
... Justice. 11.17 Section 11.17 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Referral to Department of Justice. When Department of Justice approval or consultation is required under § 11.16, the referral or request shall be transmitted to the Department of Justice by the Chief Counsel...
Smits, M; Rutten, M; Schepers, L; Giesen, P
There is a trend for General Practitioner Cooperatives (GPCs) to co-locate with emergency departments (EDs) of hospitals at Emergency Care Access Points (ECAPs), where the GPCs generally conduct triage and treat a large part of self-referrals who would have gone to the ED by themselves in the past. We have examined patient and care characteristics of self-referrals at ECAPs where triage was conducted by GPCs, also to determine the percentage of self-referrals being referred to the ED. Retrospective cross-sectional observational study. Descriptive analyses of routine registration data from self-referrals of five ECAPs (n = 20.451). Patient age, gender, arrival time, urgency, diagnosis and referral were analysed. Of the self-referrals, 57.9% was male and the mean age was 32.7 years. The number of self-referrals per hour was highest during weekends, particularly between 11 a.m. and 5 p.m. On weekdays, there was a peak between 5 and 9 p.m. Self-referrals were mostly assigned a low-urgency grade (35.7% - U4 or U5) or a mid-urgency grade (49% - U3). Almost half of the self-referrals had trauma of the locomotor system (28%) or the skin (27.3%). In total, 23% of the patients was referred to the ED. Self-referred patients at GPCs are typically young, male and have low- to mid-urgency trauma-related problems. Many self-referrals present themselves on weekend days or early weekday evenings. Over three quarters of these patients can be treated by the GPCs, without referral to the ED. This reduces the workload at the ED.
Spencer, K.M.; Zeighami, E.A.
This report presents the results of a six-year project that reviewed material licenses that had been terminated during the period from inception of licensing until approximately late-1994. The material licenses covered in the review project were Part 30, byproduct material licenses; Part 40, source material licenses; and Part 70, special nuclear material licenses. This report describes the methodology developed for the project, summarizes the findings of the license file inventory process, and describes the findings of the reviews or evaluations of the license files. The evaluation identified nuclear material use sites that need review of the licensing material or more direct follow-up of some type. The review process also identified licenses authorized to possess sealed sources for which there was incomplete or missing documentation of the fate of the sources
BACKGROUND: Cork University Hospital (CUH) provides a tertiary service for all neurophysiology referrals in the Southern Health Board region. AIM: To ascertain the number, source, symptoms and diagnosis of neurophysiology referrals at CUH. METHODS: We did a prospective audit of the referral patterns to the neurophysiology department over a 12 -week period. RESULTS: Of 635 referrals, 254 had electromyograms (EMG), 359 had electro-encephalograms (EEG), 18 had visual evoked potentials (VEP), three had somato-sensory evoked potentials (SSEP) and one had multiple sleep latency tests (MSLT). We analysed the demographic pattern, reason for referrals, the average waiting time for neurophysiology tests and the patterns of diagnosis in this audit. CONCLUSIONS: Patients from County Cork are making more use of the neurophysiology services than patients from other counties within the Southern Health Board. The average waiting time for an EEG was 32 days and for an EMG was 74 days. However, more than 35% of those patients waiting for an EEG or an EMG had their tests done within four weeks of referral. The appointments of EEG and EMG were assigned on the basis of clinical need.
Martinussen, Laila Marianne; Møller, Mette; Prato, Carlo Giacomo
The Driver Behavior Questionnaire (DBQ) and the Driver Skill Inventory (DSI) are two of the most frequently used measures of driving style and driving skill. The motivation behind the present study was to test drivers’ insight into their own driving ability based on a combined use of the DBQ......, annual mileage and accident involvement. 3908 drivers aged 18–84 participated in the survey. The results suggested that the drivers have good insight into their own driving ability, as the driving skill level mirrored the frequency of aberrant driving behaviors. K-means cluster analysis revealed four...... distinct clusters that differed in the frequency of aberrant driving behavior and driving skills, as well as individual characteristics and driving related factors such as annual mileage, accident frequency and number of tickets and fines. Thus, two sub-groups were identified as more unsafe than the two...
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice is...
... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to the Attorney General... Referral to the Attorney General. If the results of a complaint investigation or a compliance review... appropriate cases shall recommend that the General Counsel refer the case to the Attorney General of the...
Zvika Neeman; Gerhard O. Orosel
We analyze a model of repeated franchise bidding for natural monopoly with contestable licensing - a franchisee halds an (exclusive) license to operate a franchise until another rm offers to pay more for it. In a world where quality is observable but not veri able, the simple regulatory scheme we describe combines market-like incentives with regulatory oversight to generate efficient outcomes.
Wallace, David J; Mohan, Deepika; Angus, Derek C; Driessen, Julia R; Seymour, Christopher M; Yealy, Donald M; Roberts, Mark M; Kurland, Kristen S; Kahn, Jeremy M
Regional, coordinated care for time-sensitive and high-risk medical conditions is a priority in the United States. A necessary precursor to coordinated regional care is regions that are actionable from clinical and policy standpoints. The Dartmouth Atlas of Health Care, the major health care referral construct in the United States, uses regions that cross state and county boundaries, limiting fiscal or political ownership by key governmental stakeholders in positions to create incentive and regulate regional care coordination. Our objective is to develop and evaluate referral regions that define care patterns for patients with acute myocardial infraction, acute stroke, or trauma, yet also preserve essential political boundaries. We developed a novel set of acute care referral regions using Medicare data in the United States from 2011. For acute myocardial infraction, acute stroke, or trauma, we iteratively aggregated counties according to patient home location and treating hospital address, using a spatial algorithm. We evaluated referral political boundary preservation and spatial accuracy for each set of referral regions. The new set of referral regions, the Pittsburgh Atlas, had 326 distinct regions. These referral regions did not cross any county or state borders, whereas 43.1% and 98.1% of all Dartmouth Atlas hospital referral regions crossed county and state borders. The Pittsburgh Atlas was comparable to the Dartmouth Atlas in measures of spatial accuracy and identified larger at-risk populations for all 3 conditions. A novel and straightforward spatial algorithm generated referral regions that were politically actionable and accountable for time-sensitive medical emergencies. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Narendra, P L; Hegde, Harihar V; Khan, Maroof Ahmad; Talikoti, Dayanand G; Nallamilli, Samson
Anesthetists come in contact with more than two-third of hospital patients. Timely referral to anesthetists is vital in perioperative and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation, perioperative complications, and poor outcome. The self administered paper survey to delegates attending anesthesia conferences. Questions were asked on how high-risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and presence of rapid response teams. The response rate was 43.8%. Sixty percent (55.3-64.8, P - 0.001) reported high-risk elective cases were referred after admission. Sixty-eight percent (63.42-72.45, P - 0.001) opined preoperative resting echocardiographs were useful. Six percent (4.16-8.98, P - 0.001) reported emergency room referral before arrival of the patient. Twenty-five percent (20.92-29.42, P - 0.001) indicated high-risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more commonly than residents (32% vs. 22%) ( P - 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40% vs. 28%) ( P - 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) ( P = 0.002). Remote site patients were commonly referred to residents after sedation attempts (32% vs. 20%) ( P = 0.036). Only 34.8 said hosptals where tbey practiced had dedicated cardiac arrest team in place. Anesthetic departments must periodically assess whether subgroups of patients are being referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits must be encouraged.
... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section 3.21... and Compromise of Claims § 3.21 Referrals of Debts to Justice. An agency shall promptly refer to Justice for litigation debts on which aggressive collection activity has been taken in accordance with...
... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice is...
Full Text Available Abstract Background A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. Methods A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Results Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY. When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %. Conclusions Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both
Villa, Guillermo; Sánchez-Álvarez, Emilio; Cuervo, Jesús; Fernández-Ortiz, Lucía; Rebollo, Pablo; Ortega, Francisco
A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %). Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients' survival rates and health-related quality of life at an
Full Text Available Fetene Netsanet,1 Ayalew Dessie21IMA World Health SuddHealth Multi Donor Trust Fund-Basic Package of Health Services Project, Juba, South Sudan; 2United States Agency for International Development, Private Health Sector Program, Abt Associates Inc, Addis Ababa, EthiopiaBackground: Human immunodeficiency virus (HIV-positive individuals who do not disclose their HIV status to their partners are more likely to present late for HIV and acquired immune deficiency syndrome (AIDS care than those who have disclosed their HIV status to their partners. A major area of challenge with regards to HIV counseling for clients is disclosure of their HIV status to their partners. The main methods of partner notification are patient referral, provider referral, contract referral, and outreach assistance. The emphasis on a plausible and comprehensive partner referral strategy for widespread positive case detection in resource-limited countries needs to be thought out and developed.Methods: A qualitative study was conducted among newly HIV-positive clients to identify partners for notification and acceptance of referral by their partners. Health service providers working in HIV testing and counseling clinics were also provided with semistructured questionnaires in order to assess their view towards partner notification strategies for clients testing positive for HIV.Results: Fifteen newly diagnosed HIV-positive clients were counseled to provide referral slips to their partners. All clients agreed and took the referral card. However, only eight were willing and actually provided the card to their partners. Five of the eight partners of clients who tested HIV-positive and who were provided with referral cards responded to the referral and were tested for HIV. Three were positive and two were negative. Nine of 11 counselors did not agree to requesting partner locator information from HIV-positive clients for contractual referral and/or outreach assistance. The findings
and compares the school transport driver performance with that of general motorists. Despite concerns that ... To compare Safe Travel to School Programme driver safety perfor- .... The SA government has recognised the challenges faced with.
Full Text Available Introduction: Today, all kinds of people need vehicles for performing their daily activities. The need for use of these vehicles for transportation frequently leads to a high rate of road accidents and it seems that certain people do not have enough ability to use these vehicles. Dangerous behaviors lead to financial and life risking irreparable damages. Methods: The aim of the study was to examine the relationship between psychological characteristics (mental health, aggression, type A characteristic and driving habits. The researchers chose 110 injured men drivers and asked them to complete the Manchester Driving Behavior, Type A Characteristic, Ahvaz Aggressive and Mental Health questionnaires. The data was analyzed by Pearson's Correlation and Regression Analysis. Results: The findings showed that there is a significant relation between psychological characteristics (mental health, aggression, type A characteristic and driving habits. The regression analysis also foresees the aggressive and mental health of testers’ dangerous driving behavior. Meanwhile, Type A characteristic is not able to foresee driving behaviors. Conclusion: Risky driving is a phenomenon that leads to many irreparable damages for the society and individual. Present study suggests that in order to reduce dangers and probable damages, procurement of driving license procedures should be prolonged and drivers should be regularly assessed psychologically (personal or public. Risky drivers or the attackers who need education or consultation should attend education-consultation programs.
Bieri, R.; Meier, W.
Parametric studies to optimize heavy-ion driver designs are described and an optimized 5 MJ driver design is described. Parametric studies are done on driver parameters including driver energy, number of beams, type of superconductor used in focusing magnets, maximum magnetic field allowed at the superconducting windings, axial quadrupole field packing fraction, ion mass, and ion charge state. All modeled drivers use the maximum beam currents allowed by the Maschke limits; driver scaling is described in a companion paper. The optimized driver described is conservative and cost effective. The base driver direct costs are only $120/Joule, and the base driver uses no recirculation, beam combination, or beam separation. The low driver cost achieved is due, in part, to the use of compact Nb 3 Sn quadrupole arrays, but results primarily from optimization over the large, multi-dimensional, parameter space available for heavy-ion drivers
Lal, Sham; Ndyomugenyi, Richard; Magnussen, Pascal
Malaria-endemic countries have implemented community health worker (CHW) programs to provide malaria diagnosis and treatment to populations living beyond the reach of health systems. However, there is limited evidence describing the referral practices of CHWs. We examined the impact of malaria...... rapid diagnostic tests (mRDTs) on CHW referral in two cluster-randomized trials, one conducted in a moderate-to-high malaria transmission setting and one in a low-transmission setting in Uganda, between January 2010 and July 2012. All CHWs were trained to prescribe artemisinin-based combination therapy...... (ACT) for malaria and recognize signs and symptoms for referral to health centers. CHWs in the control arm used a presumptive diagnosis for malaria based on clinical symptoms, whereas intervention arm CHWs used mRDTs. CHWs recorded ACT prescriptions, mRDT results, and referral inpatient registers...
Gazda, P.A.; Bhatt, P.C.
During the next 10 years, nuclear plant license renewal is expected to become a significant issue. Recent Electric Power Research Institute (EPRI) studies have shown license renewal to be technically and economically feasible. Filing an application for license renewal with the Nuclear Regulatory Commission (NRC) entails verifying that the systems, structures, and components essential for safety will continue to perform their safety functions throughout the license renewal period. This paper discusses the current proposed requirements for this verification and the current industry knowledge regarding age-related degradation of structures. Elements of a license renewal program incorporating NRC requirements and industry knowledge including a schedule are presented. Degradation mechanisms for structural components, their significance to nuclear plant structures, and industry-suggested age-related degradation management options are also reviewed
Full Text Available Background. Clinical neurophysiologists observe a large number of examinees referred to a electromyographic (EMG laboratory without clinical symptoms or signs of the peripheral nervous system lesion. Such referrals do not improve management of patients, but only unnecessarily burden examinees and laboratory personnel. The aim of the present study was to check appropriateness of referrals to electrodiagnostic examination, look for reasons for problems and suggest possible improvements.Methods. From the database of the Institute of Clinical Neurophysiology in Ljubljana all examinees evaluated by the author in a »general« EMG laboratory in the first 4 months of 2002 were included. From data about examinees, referral doctors, referral diagnoses, clinical symptoms and signs and electrophysiological findings, predictive values for neurological referral diagnoses and electrodiagnostic abnormalities were calculated using descriptive and multivariate statistical analyses.Results. Three hundred examinees (42% men were included. Neurological diagnosis was provided in 55% of referrals. Electrodiagnostic abnormalities were found in 45% of examinees (carpal tunnel syndrome 50%, radiculopathy 25%, other mononeuropathies 15%, polineuropathy 9%. In 9% of examinees only clinical, and in 47% neither clinical nor electrodiagnostic abnormalities were demonstrated. Using a multivariate analysis positive effect of referral with neurological diagnosis, of paraesthesiae and findings of weakness and sensory loss, and negative effect of pain and referral diagnosis cervicobrachialgia or lumboischialgia on pathological electrodiagnostic findings were found. Isolated pain and paraesthesiae (with carpal tunnel syndrome excluded were particularly poor predictors of abnormal electrodiagnostic findings (9% and 16%, respectively. With exception of 20 patients with carpal tunnel syndrome, none with normal clinical neurological examination had abnormal electrodiagnostic findings
physicians' mode of referral of patients for physiotherapy in Nigeria. A total of 1192 physicians .... The Influence of Medical School of Graduation. Table 1 shows the .... This must have also been responsible for the high rate of referral observed.
... 29 Labor 4 2010-07-01 2010-07-01 false Referral to the Attorney General. 1601.29 Section 1601.29... of Civil Actions § 1601.29 Referral to the Attorney General. If the Commission is unable to obtain... shall inform the Attorney General of the appropriate facts in the case with recommendations for the...
... 10 Energy 3 2010-01-01 2010-01-01 false Referral to the Attorney General. 430.54 Section 430.54... Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for exemption under this subpart shall be transmitted to the Attorney General by the Secretary and shall contain (a) a...
Soderholm, K., E-mail: firstname.lastname@example.org [Fortum Power, Espoo (Finland)
This paper aims to increase the understanding of high level Nuclear Power Plant (NPP) licensing processes in Finland, France, the UK, Canada and the USA. These countries have been selected for this study because of their different licensing processes and recent actions in new NPP construction. After discussing their similarities and differences, suitable features for Small Modular Reactor licensing can be emphasized and suggested. Some of the studied licensing processes have elements that are already quite well suited for application to SMRs, but all of these different national processes can benefit from studying and implementing lessons learned from SMR specific licensing needs. The main SMR features to take into account in licensing are standardization of the design, modularity, mass production and serial construction. Modularity can be divided into two different categories: the first category is simply a single unit facility constructed of independently engineered modules (e.g., construction process for Westinghouse AP-1000 NPP) and the second is a facility structure composed of many reactor modules where modules are manufactured in factories and installed into the facility as needed (e.g., NuScale Power SMR design). Short construction schedules will not be fully benefited from if the long licensing process prolongs the commissioning and approach to full-power operation. The focus area of this study is to better understand the possibility of SMR deployment in small nuclear countries, such as Finland, which currently has four operating NPPs. The licensing process needs to be simple and clear to make SMR deployment feasible from an economical point of view. This paper uses public information and interviews with experts to establish the overview of the different licensing processes and their main steps. A high-level comparison of the licensing steps has been carried out. Certain aspects of the aviation industry licensing process have also been studied and certain
... ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM LIST GOVERNMENTS SANCTIONS REGULATIONS General Definitions § 596.306 License. Except as otherwise specified, the term license means any license or...
Kotecha, A; Brookes, J; Foster, P J
PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.
Kennedy, I.; Jones, N.; Sharpley, J.; Greenberg, N.
Background The UK military runs a comprehensive mental health service ordinarily accessed via primary care referrals. Aims To evaluate the feasibility of self-referral to mental health services within a military environment. Methods Three pilot sites were identified; one from each service (Royal Navy, Army, Air Force). Socio-demographic information included age, rank, service and career duration. Clinical data included prior contact with general practitioner (GP), provisional diagnosis and assessment outcome. Results Of the 57 self-referrals, 69% (n = 39) had not previously accessed primary care for their current difficulties. After their mental health assessment, 47 (82%) were found to have a formal mental health problem and 41 (72%) were offered a further mental health clinician appointment. The data compared favourably with a large military mental health department that reported 87% of primary care referrals had a formal mental health condition. Conclusions The majority of self-referrals had formal mental health conditions for which they had not previously sought help from primary care; most were offered further clinical input. This supports the view that self-referral may be a useful option to encourage military personnel to seek professional care over and above the usual route of accessing care through their GP. PMID:27121634
Cabaleiro, Goretti; Moreira, Solon; Reichstein, Toke
The potential for rent dissipation has been argued to be the main cause of firms? licensing out behavior being stifled.However, this aspect has been scarcely studied empirically. We draw on rent dissipation arguments, and hypothesize that firms suffering from the not-invented-here (NIH) syndrome......, firms in competitive product markets, and firms that have incurred substantial sunk cost are associated with lower rates of technology out-licensing. We also posit that sunk costs negatively moderate the relationship between competition in the licensor?s product market, and licensing rate. We test our...
The judicial aspects of nuclear stations licensing are presented. The licensing systems of the United States, Spain, France and Federal Republic of Germany are focused. The decree n 0 60.824 from July 7 sup(th), 1967 and the following legislation which define the systematic and area of competence in nuclear stations licensing are analysed [pt
... 10 Energy 4 2010-01-01 2010-01-01 false Referral to the Attorney General. 820.72 Section 820.72... Referral to the Attorney General. If there is reason to believe a criminal violation of the Act or the DOE Nuclear Safety Requirements has occurred, DOE may refer the matter to the Attorney General of the United...
Carter, Marion W; Robbins, Cheryl L; Gavin, Loretta; Moskosky, Susan
Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning. We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices. In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62). Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care.
Matloob, Samir A; Hyam, Jonathan A; Thorne, Lewis; Bradford, Robert
Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them. During a 14-day period, number of bleeps, missed bleeps, calls discussing new referrals and previously processed referrals were recorded. Whether new referrals were appropriately documented and referrers received a written response was also recorded. A commercially provided secure cloud-based data archiving telecommunications and database platform for referrals was subsequently introduced within the Trust and the questionnaire repeated during another 14-day period 1 year after implementation. Missed bleeps per day reduced from 16% (SD ± 6.4%) to 9% (SD ± 4.8%; df = 13, paired t-tests p = 0.007) and mean calls per day clarifying previous referrals reduced from 10 (SD ± 4) to 5 (SD ± 3.5; df = 13, p = 0.003). Documentation of new referrals increased from 43% (74/174) to 85% (181/210), and responses to referrals increased from 74% to 98%. The use of a secure cloud-based data archiving telecommunications and database platform significantly increased the documentation of new referrals. This led to fewer missed bleeps and fewer calls about old referrals for the on call registrar. This system of documenting referrals results in improved continuity of care for neurosurgical patients, a significant reduction in risk for Trusts and a more efficient use of Registrar time.
Wang, Jen-Pang; Wu, Chia-Yi; Chiu, Chih-Chiang; Yang, Tsu-Hui; Liu, Tzong-Hsien; Chou, Pesus
The police are the frontline workers in crisis situations involving patients with severe mental illness and act as a primary referral source for psychiatric emergency services (PES) in the community. The aims of this study were to investigate the distribution and characteristics of police referral among psychiatric patients in Taiwan. The study cohort consisted of patients who visited the PES of Taipei City Psychiatric Center from January 2009 to December 2010. The associations between the factors of demographics, clinical characteristics, and psychiatric service utilization and police referral were evaluated. Among the 7656 psychiatric emergency visits, 3029 (39.6%) were referred by the police. These patients referred by police were more likely to be male and aged between 30 to 49 years. Clinical factors related to police referrals including a higher triage assessment level, chief problems included violence, disturbance, substance use, less anxiety, and a diagnosis of unspecified psychosis. The triage assessment level and chief problems assessed by nurses were major predictors. These patients tended to be referred from the catchment area and during the nighttime shift, were discharged during the daytime shift, and stayed longer in the PES. Disposition arrangements such as discharge against medical advice and involuntary admission were also associated with police referrals. Patients referred by the police to the PES were those with more severe psychiatric problems and illnesses assessed by psychiatric nurses and psychiatrists. They tended to have more complex service utilization at the PES. © 2015 Wiley Publishing Asia Pty Ltd.
Klauer, Sheila G; Simons-Morton, Bruce; Lee, Suzanne E; Ouimet, Marie Claude; Howard, E Henry; Dingus, Thomas A
Though there is ample research indicating that nighttime, teen passengers, and speeding increase the risk of crash involvement, there is little research about teen drivers' exposure to these known risk factors. Three research questions were assessed in this article: (1) Does exposure to known risk factors change over time? (2) Do teenage drivers experience higher rates of exposure to known risk factors than adult drivers? (3) Do teenage drivers who own a vehicle experience higher rates of exposure to risk factors than those who share a family vehicle? Forty-one newly licensed teenage drivers and at least one parent (adult) were recruited at licensure. Driving data were recorded for 18 months. Average vehicle miles traveled (VMT) or average nighttime VMT for teens did not increase over time. Teenagers consistently drove 24 percent of VMT at night, compared with 18 percent for adults. Teenagers drove 62 percent of VMT with no passengers, 29 percent of VMT with one passenger, and less than 10 percent of VMT with multiple passengers. Driving with no passengers increased with driving experience for these teens. Teenage drivers who owned their vehicles, relative to those who shared a vehicle, sped 4 times more frequently overall and more frequently at night and with multiple teen passengers. These findings are among the first objective data documenting the nature of teenage driving exposure to known risk factors. The findings provide evidence that vehicle access is related to risk and suggest the potential safety benefit of parental management of novice teenage driving exposure.
Klauer, Sheila G.; Simons-Morton, Bruce; Lee, Suzanne E.; Ouimet, Marie Claude; Howard, E. Henry; Dingus, Thomas A.
Objective Though there is ample research indicating that nighttime, teen passengers, and speeding increase the risk of crash involvement, there is little research about teen drivers' exposure to these known risk factors. Three research questions were assessed in this article: (1) Does exposure to known risk factors change over time? (2) Do teenage drivers experience higher rates of exposure to known risk factors than adult drivers? (3) Do teenage drivers who own a vehicle experience higher rates of exposure to risk factors than those who share a family vehicle? Methods Forty-one newly licensed teenage drivers and at least one parent (adult) were recruited at licensure. Driving data were recorded for 18 months. Results Average vehicle miles traveled (VMT) or average nighttime VMT for teens did not increase over time. Teenagers consistently drove 24 percent of VMT at night, compared with 18 percent for adults. Teenagers drove 62 percent of VMT with no passengers, 29 percent of VMT with one passenger, and less than 10 percent of VMT with multiple passengers. Driving with no passengers increased with driving experience for these teens. Teenage drivers who owned their vehicles, relative to those who shared a vehicle, sped 4 times more frequently overall and more frequently at night and with multiple teen passengers. Conclusion These findings are among the first objective data documenting the nature of teenage driving exposure to known risk factors. The findings provide evidence that vehicle access is related to risk and suggest the potential safety benefit of parental management of novice teenage driving exposure. PMID:21469023
Full Text Available The behavioral and cognitive characteristics of dangerous drivers differ significantly from those of safe drivers. However, differences in emotional information processing have seldom been investigated. Previous studies have revealed that drivers with higher anger/anxiety trait scores are more likely to be involved in crashes and that individuals with higher anger traits exhibit stronger negativity biases when processing emotions compared with control groups. However, researchers have not explored the relationship between emotional information processing and driving behavior. In this study, we examined the emotional information processing differences between dangerous drivers and safe drivers. Thirty-eight non-professional drivers were divided into two groups according to the penalty points that they had accrued for traffic violations: 15 drivers with 6 or more points were included in the dangerous driver group, and 23 drivers with 3 or fewer points were included in the safe driver group. The emotional Stroop task was used to measure negativity biases, and both behavioral and electroencephalograph data were recorded. The behavioral results revealed stronger negativity biases in the dangerous drivers than in the safe drivers. The bias score was correlated with self-reported dangerous driving behavior. Drivers with strong negativity biases reported having been involved in mores crashes compared with the less-biased drivers. The event-related potentials (ERPs revealed that the dangerous drivers exhibited reduced P3 components when responding to negative stimuli, suggesting decreased inhibitory control of information that is task-irrelevant but emotionally salient. The influence of negativity bias provides one possible explanation of the effects of individual differences on dangerous driving behavior and traffic crashes.
With nearly 2,000 free and open source software (FLOSS) licenses, software license proliferation¿ can be a major headache for software development organizations trying to speed development through software component reuse, as well as companies redistributing software packages as components of their products. Scope is one problem: from the Free Beer license to the GPL family of licenses to platform-specific licenses such as Apache and Eclipse, the number and variety of licenses make it difficu...
Full Text Available The characteristics of the driver are manifested in his/her behaviour. For safe driving one must have a driver's knowledge. The contents of educational material are determined by law, and are both theoretical and practical, yet frequently they do not suffice to meet the requirements of safe driving. In this paper, the author suggests that, in the training of drivers, more educational elements should be included, such a would have an effective influence on the driver's moti ves and attitudes. The driver's motives - which may result in incorrect driving are diverse: most often, the default is overspeeding, even though the drivers always over-estimate the potential time gain. In fact, over-fast driving is a way of satisfying other, different needs; and, above all, it is a form of compensation for unsettled life problems, and at the same time an indication of the driver's personal inability to cope with stress.
Full Text Available South Africa has one of the highest incidences of road accidents in the world. Most accidents are avoidable and are caused by driver behaviour and errors. The purpose of this article was to identify the riskiest driver behaviours in commercial fleets in South Africa, to determine the business impact of such behaviour, to establish a framework for the management of risky driver behaviour and to test the framework by applying a leading commercial driver behaviour management system as a case study. The case study comprised three South African commercial fleets. Using data from these fleets, critical incident triangles were used to determine the ratio data of risky driver behaviour to near-collisions and collisions. Based on managing the riskiest driver behaviours as causes of more serious incidents and accidents, the results indicated that through the implementation of an effective driver risk management system, risky incidents were significantly reduced.
Wang, Yuandi; Roijakkers, N.; Vanhaverbeke, W.
This paper explores how interfirm variations in their in-licensed technology portfolios influence subsequent innovation performance. Existing studies mainly assume licensed technologies are homogeneously accessible to firms, and a prevailing explanation as to why firms vary in their innovation pe...
Ebbers, Hans C; Langedijk, Joris; Bouvy, Jacoline C
the frequency of licensing failure prior to CMDh referrals. RESULTS: During the study period, 10392 MRP/DCP procedures were finalized. Three hundred seventy-seven (3.6%) resulted in a referral procedure, of which 70 (19%) resulted in licensing failure, defined as refusal or withdrawal of the application...
Shen, Sijun; Neyens, David M
With the increase in automated driver support systems, drivers are shifting from operating their vehicles to supervising their automation. As a result, it is important to understand how drivers interact with these automated systems and evaluate their effect on driver responses to safety critical events. This study aimed to identify how drivers responded when experiencing a safety critical event in automated vehicles while also engaged in non-driving tasks. In total 48 participants were included in this driving simulator study with two levels of automated driving: (a) driving with no automation and (b) driving with adaptive cruise control (ACC) and lane keeping (LK) systems engaged; and also two levels of a non-driving task (a) watching a movie or (b) no non-driving task. In addition to driving performance measures, non-driving task performance and the mean glance duration for the non-driving task were compared between the two levels of automated driving. Drivers using the automated systems responded worse than those manually driving in terms of reaction time, lane departure duration, and maximum steering wheel angle to an induced lane departure event. These results also found that non-driving tasks further impaired driver responses to a safety critical event in the automated system condition. In the automated driving condition, driver responses to the safety critical events were slower, especially when engaged in a non-driving task. Traditional driver performance variables may not necessarily effectively and accurately evaluate driver responses to events when supervising autonomous vehicle systems. Thus, it is important to develop and use appropriate variables to quantify drivers' performance under these conditions. Copyright © 2017 Elsevier Ltd and National Safety Council. All rights reserved.
Bottino, Clement J; Rhodes, Erinn T; Kreatsoulas, Catherine; Cox, Joanne E; Fleegler, Eric W
To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0). In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
The Operator Licensing Examiner Standards provide policy and guidance to NRC examiners and establish the procedures and practices for examining licensees and applicants for reactor operator and senior reactor operator licenses at power reactor facilities pursuant to Part 55 of Title 10 of the Code of Federal Regulations (10 CFR 55). The Examiner Standards are intended to assist NRC examiners and facility licensees to better understand the initial and requalification examination processes and to ensure the equitable and consistent administration of examinations to all applicants. These standards are not a substitute for the operator licensing regulations and are subject to revision or other internal operator licensing policy changes
Full Text Available The case is presented for a more flexible approach to licensing online library resources. Today's distributed education environment creates pressure for UK higher and further education institutions (HEI/FEIs to form partnerships and to develop educational products and roll them out across the globe. Online library resources are a key component of distributed education and yet existing licensing agreements struggle to keep pace with the increasing range of users and purposes for which they are required. This article describes the process of developing a flexible approach to licensing and proposes a new model licence for online library resources which has the adaptability needed in this new global educational landscape. These ideas have been presented and discussed at various workshops across Eduserv's and JISC Collections' higher education and publisher communities, and further consultation is ongoing.
Portman, M; Penttilä, A; Haukka, J; Rajalin, S; Eriksson, C J P; Gunnar, T; Koskimaa, H; Kuoppasalmi, K
The aim of the present study was to define the profile of a drunk driver and to determine risk factors for drunk driving by analyzing data on both sober and drunk drivers. Systematic roadside surveys have been carried out in Southern Finland for over 18 years, with 20,000-30,000 drivers breath tested annually. During the study period, 1241 drunk drivers were caught (legal blood alcohol limit 0.50‰). The comparison material consisted of 3407 sober drivers. The surveys were designed to further investigate demographic features and driving habits of drivers. The prevalence of drunk driving has been 0.2% over the time period, with only random variations. According to the data, a typical drunk driver is a man aged 40-49 who has a valid driving license and drives his own car, usually alone, with a blood alcohol concentration (BAC) of 1.0‰. He has a job and is married or cohabiting. The profile remained consistent throughout the study period. The risk of drunk driving was found to be five times higher for men than for women. Divorcees and widow(er)s had a substantially higher risk factor for being caught drunk driving than married drivers. Drunk drivers are most likely to be caught by roadside testing on Saturday mornings. During the study period the blood alcohol limit for aggravated drunk driving was lowered in 1994 from 1.5 to 1.2‰. In 2004 the taxation of alcohol beverages was reduced by 30%. Neither of these measures affected the prevalence of drunk driving or the mean BAC of drunk drivers (p=0.63). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Dalton, N W [Council for Nuclear Safety, Hennopsmeer, Pretoria (South Africa)
The development of nuclear safety and licensing is briefly reviewed in four stages namely: The Formative Period (1946-1959), The Expansive Period (1960-1969), The Mature Period (1970-1979) and the Apprehensive Period (1980-1989). Particular safety issues in the respective periods are highlighted to indicate the changing emphasis of nuclear licensing over the past thirty years or so. Against this background, nuclear licensing. (author)
The development of nuclear safety and licensing is briefly reviewed in four stages namely: The Formative Period (1946-1959), The Expansive Period (1960-1969), The Mature Period (1970-1979) and the Apprehensive Period (1980-1989). Particular safety issues in the respective periods are highlighted to indicate the changing emphasis of nuclear licensing over the past thirty years or so. Against this background, nuclear licensing. (author)
Fishman, Laurie; Rappaport, Leonard; Schonwald, Alison; Nurko, Samuel
To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes. A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes. In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for >3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years. Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome.
Kennedy, I; Whybrow, D; Jones, N; Sharpley, J; Greenberg, N
The UK military runs a comprehensive mental health service ordinarily accessed via primary care referrals. To evaluate the feasibility of self-referral to mental health services within a military environment. Three pilot sites were identified; one from each service (Royal Navy, Army, Air Force). Socio-demographic information included age, rank, service and career duration. Clinical data included prior contact with general practitioner (GP), provisional diagnosis and assessment outcome. Of the 57 self-referrals, 69% (n = 39) had not previously accessed primary care for their current difficulties. After their mental health assessment, 47 (82%) were found to have a formal mental health problem and 41 (72%) were offered a further mental health clinician appointment. The data compared favourably with a large military mental health department that reported 87% of primary care referrals had a formal mental health condition. The majority of self-referrals had formal mental health conditions for which they had not previously sought help from primary care; most were offered further clinical input. This supports the view that self-referral may be a useful option to encourage military personnel to seek professional care over and above the usual route of accessing care through their GP. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: email@example.com.
Kurata, Yoshinori; Wada, Takahiro; Kamiji, Norimasa; Doi, Shun'ichi
Disturbances decrease vehicle stability and increase driver's mental and physical workload. Especially unexpected disturbances such as lateral winds have severe effect on vehicle stability and driver's workload. This study aims at building a driver model of steering operations in lateral wind toward developing effective driver assistance system. First, the relationship between the driver's lateral motion and its reactive quick steering behavior is investigated using driving simulator with lateral 1dof motion. In the experiments, four different wind patterns are displayed by the simulator. As the results, strong correlation was found between the driver's head lateral jerk by the lateral disturbance and the angular acceleration of the steering wheel. Then, we build a mathematical model of driver's steering model from lateral disturbance input to steering torque of the reactive quick feed-forward steering based on the experimental results. Finally, validity of the proposed model is shown by comparing the steering torque of experimental results and that of simulation results.
Referral criteria for school-based hearing screening in South Africa: Considerations for resource-limited contexts. ... Diagnostic audiometry confirmed that almost half (47%) of the referred children had a hearing loss. Conclusion: A screening intensity of 25 dB HL andimmediate rescreen reduces the referral rate significantly ...
Suguitan, G A; Cabanayan-Casasola, C B; Danguilan, R A; Jaro, J M A
The Human Organ Preservation Effort is a government organ procurement organization that pioneered the Deceased Organ Donation Program in the Philippines. Deceased organ donation comprises only 20% of kidney transplantation in the Philippines in the last 3 years. Various measures were implemented to improve deceased organ donor referrals and organ retrieval. To compare outcome of deceased organ donor referrals from 2002 to 2008 and 2009 to 2012 in the Philippines. This retrospective study reviewed the deceased organ donor referrals from 2002 to 2008 and 2009 to 2012. There were 437 referrals for potential deceased organ donors from 2009 to 2012, compared to 434 referrals from 2002 to 2008. Referrals were mainly trauma victims (76%) followed by those with cerebrovascular accidents (12%). In the recent cohort, 81% were approached and 60% consented for donation, but only 23% were retrieved and transplanted. Among those not retrieved, the majority (19%) were medically unsuitable and 6% retracted their consent. Although there was an increasing trend of organ donation referrals in the last 4 years, only 25% were procured. The reasons for nonprocurement should be addressed. Copyright © 2014 Elsevier Inc. All rights reserved.
Dozier, J.; Lee, S.; Kuo, P.T.
The staff of the NRC has been developing three regulatory guidance documents for license renewal: the Generic Aging Lessons Learned (GALL) report, Standard Review Plan for License Renewal (SRP-LR), and Regulatory Guide (RG) for Standard Format and Content for Applications to Renew Nuclear Power Plant Operating Licenses. These documents are designed to streamline the license renewal review process by providing clear guidance for license renewal applicants and the NRC staff in preparing and reviewing license renewal applications. The GALL report systematically catalogs aging effects on structures and components; identifies the relevant existing plant programs; and evaluates the existing programs against the attributes considered necessary for an aging management program to be acceptable for license renewal. The GALL report also provides guidance for the augmentation of existing plant programs for license renewal. The revised SRP-LR allows an applicant to reference the GALL report to preclude further NRC staff evaluation if the plant's existing programs meet the criteria described in the GALL report. During the review process, the NRC staff will focus primarily on existing programs that should be augmented or new programs developed specifically for license renewal. The Regulatory Guide is expected to endorse the Nuclear Energy Institute (NEI) guideline, NEI 95-10, Revision 2, entitled 'Industry Guideline for Implementing the Requirements of 10 CFR Part 54 - The License Renewal Rule', which provides guidance for preparing a license renewal application. This paper will provide an introduction to the GALL report, SRP-LR, Regulatory Guide, and NEI 95-10 to show how these documents are interrelated and how they will be used to streamline the license renewal review process. This topic will be of interest to domestic power utilities considering license renewal and international ICONE participants seeking state-of-the-art information about license renewal in the United States
Clauss, J.M.; Harrison, D.L.; Pickens, T.A.
Today, 111 nuclear power plants provide over 20 percent of the electrical energy generated in the United States. The operating license of the oldest operating plant will expire in 2003, one-third of the existing operating licenses will expire by 2010 and the newest plant's operating license will expire in 2033. The National Energy Strategy (NES) prepared by the Department of Energy (DOE) assumes that 70 percent of the current operating plants will continue to operate beyond their current license expiration. Power from current operating plants can assist in ensuring an adequate, diverse, and environmentally acceptable energy supply for economic growth and improved U.S. competitiveness. In order to preserve this energy resource, three major tasks must be successfully completed: (1) establishment of regulations, technical standards, and procedures for the preparation and review of License Renewal Applications (LRAs); (2) development of technical criteria and bases for monitoring, refurbishing or replacing plant equipment; and (3) demonstration of the regulatory process by a plant obtaining a renewed license. Since 1986, the DOE has been working with the nuclear industry and the Nuclear Regulatory Commission (NRC) to establish and demonstrate the option to extend the life of a nuclear power plant by renewing the operating license. The Monticello Lead Plant demonstration project was initiated in September 1988, following the Pilot Plant studies. This paper is primarily focused on the status and insights gained from the Northern States Power Company (NSP) Monticello Lead Plant demonstration project. The following information is included: (1) Current Status - Monticello License Renewal Application; (2) Economic Analysis; (3) License Renewal Regulatory Uncertainty Issues; (4) Key Decisions; (5) Management Structure; (6) Technical and Licensing Perspective; (7) NRC Interactions; (8) Summary
Full Text Available Background: The maternal mortality ratio in India is high. An effective emergency obstetric care (EmOC strategy has been identified as a priority to reduce maternal deaths. Since the capacity of different levels of public health facilities to provide EmOC is varied, an effective referral system is crucial. However, few studies have evaluated the functioning and quality of referral systems in India. A systematic monitoring of referrals helps to identify current gaps in the provision of essential obstetric care. Objective: This study was conducted to identify the medical and logistic reasons for emergency obstetric referrals from a subdistrict hospital (SDH. Methods: An audit of emergency referrals during the period January 2015–December 2015 was carried out. Records of all obstetric patients referred from the maternity ward during the study period were reviewed. Results: The referral rate was found to be 31.7%. Preterm labor (30.6%, pregnancy-induced hypertension (17%, and fetal distress (10.6% were the main reasons for referral. Deficiencies were found in critical determinants of functionality, that is, nonavailability of emergency cesarean, neonatal care unit, and blood bank. Conclusions: The referral rate at the SDH was high. Lack of workforce and infrastructural facilities led to referrals of women who ought to have been managed at this level of the hospital.
... referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.953 Minimum amount of referrals to the Department of Justice. (a) Except as otherwise provided in paragraphs...
Conclusions: Patient referral systems in Liberia are relatively unsystematic. While formal and informal mechanisms for referrals exist at both rural and urban health facilities, establishing guidelines for referral care practices and transportation strategies tailored to each of these settings will help to strengthen the healthcare system as a whole.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referrals to the Department of Justice. 213.37... Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS cross... of Justice's Nationwide Central Intake Facility as required by the Claims Collection Litigation...
Background: Healthcare workers at primary healthcare (PHC) clinics are frustrated by the fact that they do not receive replies to their referral letters to doctors. Referral letters act as permission slips to allow patients easy access to treatment by specialists at secondary and tertiary service levels and communicate reasons for ...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Referral of non-JS-related complaints. 658... ADMINISTRATIVE PROVISIONS GOVERNING THE JOB SERVICE SYSTEM Job Service Complaint System State Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the operation of the...
Introduction: This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference…
Emmanuel Osaigbovo Ighodaro
Full Text Available Introduction: The demand for radiological examination has increased tremendously despite paucity of referring clinicians' knowledge on radiation protection. Reasons to justify these referrals vary. Consequently, the aim of this study is to evaluate the relationship between clinicians' knowledge of radiological imaging dosage to their referral justification and guideline. Materials and Methods: Structured questionnaires were developed with four sections (Section 1, sociodemographic data; Section 2, justification for imaging referral; Section 3, knowledge of radiation dose to patients; Section 4, effect of irradiation. The questionnaires were administered at a previous Nigerian Medical Association National Conference, which took place at Lagos in 2013. Sections 3 and 4 were scored and rated. Results: The respondents gave plausible reasons to refer patients for radiological evaluation despite the observation that majority of them were unaware of the existence of referral guidelines and had poor knowledge on radiation. Only 16 (12.2% of the respondents had a fair score on knowledge about radiation dose to patients while 110 (84.0% had poor score. Five (3.8% of the respondents had good score. Similarly, on identifying effect of radiation, 10 (7.6% had good score, 4 (3.1% fair score, and 117 (89.3% poor score. Conclusion: Most of the referrals of patients for radiological evaluation by the respondents were not based on the standard guidelines. Therefore, it is pertinent that referral guidelines should be developed and implemented and clinicians should be educated and trained on radiation protection.
Ibrahim, Nader; Virk, Jagdeep; George, Jason; Elmiyeh, Behrad; Singh, Arvind
A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost.
The Atomic Energy Act and the implementing regulations of the US Nuclear Regulatory Commission (NRC) permit the renewal of nuclear plant operating licenses upon expiration of their 40-year license term. However, the regulatory process by which license renewal may be accomplished and the requirements for the scope and content of renewal applications are yet to be established. On August 29, 1988, the NRC published an Advanced Notice of Proposed Rulemaking regarding the subject of license renewal. This Advanced Notice and the NUREG which it references, NUREG-1317, Regulatory Options for Nuclear Plant License Renewal, provide the most recent regulatory thought on this issue. The basic issue addressed by NUREG-1317 is the definition of an adequate licensing basis for the renewal of a plant license. The report contemplates three alternatives in this regard. This paper discusses each of these three proposals. The NUMARC NUPLEX Working Group endorses a license renewal process based on a plant's current licensing basis along with an evaluation of the pertinent components, systems, and structures affected by age-related degradation. The NUMARC NUPLEX Working group believes that an appropriate scope for NRC review of the license renewal application should focus on those safety-significant structures systems, and components subject to significant age-related degradation that are not subject to existing recognized effective replacement, refurbishment, or inspection programs. The paper also briefly discusses NUMARC's view of the role of the Backfit Rule in the license renewal process
Full Text Available Abstract Background Home Based Management of fever (HBM was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile children Methods A case-series study was performed during 20 weeks in a West-Ugandan sub-county with an under-five population of 3,600. Community drug distributors (DDs were visited fortnightly and recording forms collected. Referred children were located and primary caretaker interviewed in the household. Referral health facility records were studied for those stating having completed referral. Results Overall referral rate was 8% (117/1454. Fever was the main reason for mothers to seek DD care and for DDs to refer. Twenty-six of the 28 (93% "urgent referrals" accessed referral care but 8 (31% delayed >24 hours. Waiting for antimalarial drugs to finish caused most delays. Of 32 possible pneumonias only 16 (50% were urgently referred; most delayed ≥ 2 days before accessing referral care. Conclusion The HBM has high referral compliance and extends primary health care to the communities by maintaining linkages with formal health services. Referral non-completion was not a major issue but failure to recognise pneumonia symptoms and delays in referral care access for respiratory illnesses may pose hazards for children with acute respiratory infections. Extending HBM to also include pneumonia may increase prompt and effective care of the sick child in sub-Saharan Africa.
The high growth rate of vehicle ownership and many novel drivers in China determine the special features of Chinese driver behavior. This thesis introduces a comparative study on driver behavior by the analysis of saturation flow at urban intersections, Driver Behavior Questionnaire surveys, focus
Lewinter, Christian; Bland, John M; Crouch, Simon
BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI......% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion...... (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003. CONCLUSIONS: CR referral was associated with improved survival in 2003...
Full Text Available Studies have shown large variation of referral probabilities in different countries, and many influencing factors have been described. This variation is most likely explained by different healthcare systems, particularly to which extent primary care physicians (PCPs act as gatekeepers. In Switzerland no mandatory gatekeeping system exists, however insurance companies offer voluntary managed care plans with reduced insurance premiums. We aimed at investigating the role of managed care plans as a potential referral determinant in a non-gatekeeping healthcare system. We conducted a cross-sectional study with 90 PCPs collecting data on consultations and referrals in 2012/2013. During each consultation up to six reasons for encounters (RFE were documented. For each RFE PCPs indicated whether a referral was initiated. Determinants for referrals were analyzed by hierarchical logistic regression, taking the potential cluster effect of the PCP into account. To further investigate the independent association of the managed care plan with the referral probability, a hierarchical multivariate logistic regression model was applied, taking into account all available data potentially affecting the referring decision. PCPs collected data on 24'774 patients with 42'890 RFE, of which 2427 led to a referral. 37.5% of patients were insured in managed health care plans. Univariate analysis showed significant higher referral rates of patients with managed care plans (10.7% vs. 8.5%. The difference in referral probability remained significant after controlling for other confounders in the hierarchical multivariate regression model (OR 1.355. Patients in managed care plans were more likely to be referred than patients without such a model. These data contradict the argument that patients in managed care plans have limited healthcare access, but underline the central role of PCPs as coordinator of care.
Full Text Available Introduction: Patients with chronic conditions can improve their health through participation in self-care programs. However, awareness of and enrollment in these programs are generally low. Objective: We sought to identify factors influencing patients’ receptiveness to a referral for programs and services supporting chronic disease management. Methods: We analyzed data from 541 high-risk diabetic patients who completed an assessment between 2010 and 2013 from a computer-based, nurse-led Navigator referral program within a large primary care clinic. We compared patients who accepted a referral to those who declined. Results: A total of 318 patients (75% accepted 583 referrals, of which 52% were for self-care programs. Patients who accepted a referral had more primary care visits in the previous year, were more likely to be enrolled in another program, expressed more interest in using the phone and family or friends for support, and were more likely to report recent pain than those who declined a referral. Discussion: Understanding what factors influence patients’ decisions to consider and participate in self-care programs has important implications for program design and development of strategies to connect patients to programs. This work informs outreach efforts to identify and engage patients who are likely to benefit from self-care activities.
Bibby, Anna C; Williams, Katie; Smith, Sarah; Bhatt, Nidhi; Maskell, Nick A
returned within 2 weeks of referral. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Kadak, Andrew C.
The license by test approach to licensing is a novel method of licensing reactors. It provides an opportunity to deal with innovative non-water reactors in a direct way on a time scale that could permit early certification based on tests of a demonstration reactor. The uncertainties in the design and significant contributors to risk would be identified in the PRA during the design. Deterministic analysis computer codes could be tested on a real reactor. Scaling effects and associated uncertainties would be minimized. License by test is an approach that has sufficient merit to be developed and tested
... 10 Energy 4 2010-01-01 2010-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive of...
... referral, a point of contact by name, a telephone number (commercial and DSN), and an e-mail address (if... record any FOIA request for investigative, intelligence, or any other type of records that are on loan to.... However, if for investigative or intelligence purposes, the outside agency desires anonymity, a DON...
... Licensing and Corporate Governance § 96.30 State licensing. (a) The agency or person is properly licensed or... person follows applicable State licensing and regulatory requirements in all jurisdictions in which it provides adoption services. (c) If it provides adoption services in a State in which it is not itself...
... 49 Transportation 8 2010-10-01 2010-10-01 false Referral to the Department of Justice. 1018.72... Claim § 1018.72 Referral to the Department of Justice. (a) Claims for which the gross original amount is... Justice, Washington, DC 20530. Claims for which the gross original amount is $500,000 or less must be...
The operating reactors licensing actions summary is designed to provide the management of the Nuclear Regulatory Commission (NRC) with an overview of licensing actions dealing with operating power and nonpower reactors. These reports utilize data collected from the Division of Licensing in the Office of Nuclear Reactor Regulation and are prepared by the Office of Management and Program Analysis. This summary report is published primarily for internal NRC use in managing the operating reactors licensing actions program. Its content will change based on NRC management informational requirements
The operating reactors licensing actions summary is designed to provide the management of the Nuclear Regulatory Commission (NRC) with an overview of licensing actions dealing with operating power and nonpower reactors. These reports utilize data collected from the Division of Licensing in the Office of Nuclear Reactor Regulation and are prepared by the Office of Management and Program Analysis. This summary report is published primarily for internal NRC use in managing the operating reactors licensing actions program. Its content will change based on NRC management informational requirements
The operating reactors licensing actions summary is designed to provide the management of the Nuclear Regulatory Commission (NRC) with an overview of licensing actions dealing with operating power and nonpower reactors. These reports utilize data collected from the Division of Licensing in the Office of Nuclear Reactor Regulation and are prepared by the Office of Management and Program Analysis. This summary report is published primarily for internal NRC use in managing the operating reactors licensing actions program. Its content will change based on NRC management informational requirements
Houwing, Sjoerd; Hagenzieker, Marjan; Mathijssen, René
DRUID (Driving under the Influence of Drugs, Alcohol and Medicines) aimed to combat the problem of driving under the influence of psychoactive substances by providing a solid scientific base for European policy makers. It brought together experienced organisations in Europe to assemble...... of offenders and withdrawal of driving licenses (www.druid-project.eu). The main objective of WP2 of DRUID was to assess the situation in Europe regarding the prevalence and risk of the use of illicit drugs, alcohol and psychoactive medicinal drugs by drivers. The main aim of this study was to obtain more...
Wang, T. G.; Rudnick, I.; Elleman, D. D.; Stoneburner, J. D.
Report discusses acoustic levitation in rectangular chamber using one driver mounted at corner. Placement of driver at corner enables it to couple effectively to acoustic modes along all three axes. Use of single driver reduces cost, complexity and weight of levitation system below those of three driver system.
The Operator Licensing Examiner Standards provide policy and guidance to NRC examiners and establish the procedures and practices for examining licensees and applicants for reactor operator and senior reactor operator licenses at power reactor facilities pursuant to Part 55 of Title 10 of the Code of Federal Regulations (10 CFR 55). The Examiner Standards are intended to assist NRC examiners and facility licensees to better understand the initial and requalification examination processes and to ensure the equitable and consistent administration of examinations to all applicants. These standards are not a substitute for the operator licensing regulations and are subject to revision or other internal operator licensing policy changes. Revision 7 was published in January 1993 and became effective in August 1993. Supplement 1 is being issued primarily to implement administrative changes to the requalification examination program resulting from the amendment to 10 CFR 55 that eliminated the requirement for every licensed operator to pass an NRC-conducted requalification examination as a condition for license renewal. The supplement does not substantially alter either the initial or requalification examination processes and will become effective 30 days after its publication is noticed in the Federal Register. The corporate notification letters issued after the effective date will provide facility licensees with at least 90 days notice that the examinations will be administered in accordance with the revised procedures
Dossett, Lesly A; Kauffmann, Rondi M; Lee, Jay S; Singh, Harkamal; Lee, M Catherine; Morris, Arden M; Jagsi, Reshma; Quinn, Gwendolyn P; Dimick, Justin B
Our objective was to determine specialist physicians' attitudes and practices regarding disclosure of pre-referral errors. Physicians are encouraged to disclose their own errors to patients. However, no clear professional norms exist regarding disclosure when physicians discover errors in diagnosis or treatment that occurred at other institutions before referral. We conducted semistructured interviews of cancer specialists from 2 National Cancer Institute-designated Cancer Centers. We purposively sampled specialists by discipline, sex, and experience-level who self-described a >50% reliance on external referrals (n = 30). Thematic analysis of verbatim interview transcripts was performed to determine physician attitudes regarding disclosure of pre-referral medical errors; whether and how physicians disclose these errors; and barriers to providing full disclosure. Participants described their experiences identifying different types of pre-referral errors including errors of diagnosis, staging and treatment resulting in adverse events ranging from decreased quality of life to premature death. The majority of specialists expressed the belief that disclosure provided no benefit to patients, and might unnecessarily add to their anxiety about their diagnoses or prognoses. Specialists had varying practices of disclosure including none, non-verbal, partial, event-dependent, and full disclosure. They identified a number of barriers to disclosure, including medicolegal implications and damage to referral relationships, the profession's reputation, and to patient-physician relationships. Specialist physicians identify pre-referral errors but struggle with whether and how to provide disclosure, even when clinical circumstances force disclosure. Education- or communication-based interventions that overcome barriers to disclosing pre-referral errors warrant development.
Full Text Available David Price,1,2 Leif Bjermer,3 David A Bergin,4 Rafael Martinez5 1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 2Observational and Pragmatic Research Institute, Singapore; 3Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden; 4Novartis Ireland Limited, Dublin, Ireland; 5Novartis Pharma AG, Basel, Switzerland Abstract: Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient’s health status. Hurdles in implementing these recommendations include lack of their dissemination among health care providers and nonadherence to these guidelines; these hurdles considerably limit the implementation of specialist referrals, eventually affecting the rate of referrals. In this review, recommendations for specialist referrals from several key international and national asthma guidelines and other relevant published literature are evaluated. Furthermore, we highlight why referrals are not happening, how this can be improved, and ultimately, what should be done in the specialist setting, based on existing evidence in published literature. Keywords: asthma, disease management, specialization, primary care physicians, referral
Santiago, Leonardo; Martinelli, Marcela; Elói-Santos, Daniel T.
to develop our approach, which we illustrate with an in-depth assessment of 50 technologies. We conclude by discussing the pros and cons of our approach and its potential generalization to other companies and considering how it can be used to indicate value drivers for R&D strategy.......Companies invest in R&D to create and exploit new opportunities. In recent years, leading innovative companies have attempted to establish a market for technologies and create leveraging opportunities through such markets. In this paper, we consider the question of how a firm can evaluate its...... patent portfolio for licensing purposes. To this end, we propose an approach that enables large corporations to scrutinize their portfolio of (patented) technologies and to subsequently set up royalty rate values to support the negotiation process of a particular technology. We use case-based research...
Lohr, Robert H; West, Colin P; Beliveau, Margaret; Daniels, Paul R; Nyman, Mark A; Mundell, William C; Schwenk, Nina M; Mandrekar, Jayawant N; Naessens, James M; Beckman, Thomas J
To compare the quality of referrals of patients with complex medical problems from nurse practitioners (NPs), physician assistants (PAs), and physicians to general internists. We conducted a retrospective comparison study involving regional referrals to an academic medical center from January 1, 2009, through December 31, 2010. All 160 patients referred by NPs and PAs combined and a random sample of 160 patients referred by physicians were studied. Five experienced physicians blinded to the source of referral used a 7-item instrument to assess the quality of referrals. Internal consistency, interrater reliability, and dimensionality of item scores were determined. Differences between item scores for patients referred by physicians and those for patients referred by NPs and PAs combined were analyzed by using multivariate ordinal logistical regression adjusted for patient age, sex, distance of the referral source from Mayo Clinic, and Charlson Index. Factor analysis revealed a 1-dimensional measure of the quality of patient referrals. Interrater reliability (intraclass correlation coefficient for individual items: range, 0.77-0.93; overall, 0.92) and internal consistency for items combined (Cronbach α=0.75) were excellent. Referrals from physicians were scored higher (percentage of agree/strongly agree responses) than were referrals from NPs and PAs for each of the following items: referral question clearly articulated (86.3% vs 76.0%; P=.0007), clinical information provided (72.6% vs 54.1%; P=.003), documented understanding of the patient's pathophysiology (51.0% vs 30.3%; P<.0001), appropriate evaluation performed locally (60.3% vs 39.0%; P<.0001), appropriate management performed locally (53.5% vs 24.1%; P<.0001), and confidence returning patient to referring health care professional (67.8% vs 41.4%; P<.0001). Referrals from physicians were also less likely to be evaluated as having been unnecessary (30.1% vs 56.2%; P<.0001). The quality of referrals to an
Ferreira, Fernanda A.
We study the effects of entry of a foreign firm on domestic welfare in the presence of licensing, when the entrant is technologically superior to the incumbent. We show that foreign entry increases domestic welfare for sufficiently large technological differences between the firms under both fixed-fee licensing and royalty licensing.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false License. 120.20 Section 120.20 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.20 License. License means a document bearing the word “license” issued by the Directorate of Defense Trade...
... Software and Computer Software Documentation 227.7203-4 License rights. (a) Grant of license. The... license, under an irrevocable license granted or obtained by the contractor which developed the software... granted to the Government. The scope of a computer software license is generally determined by the source...
... Administrative Law Judge to conduct such hearings as may be necessary to decide the disputed matters. A copy of... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Chief Administrative Law Judge. 6.41 Section 6... Substantial Interest Proceedings § 6.41 Referral to Chief Administrative Law Judge. (a) Upon timely receipt of...
Inglis, Tom; Armour, Paul; Inglis, Grahame; Hooper, Gary
The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA). Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB. Patients were triaged by two consultant surgeons on the basis of their referral letter and radiological imaging into one of five categories: accepted for FSA, insufficient information, no capacity, low priority or direct entry to waiting list (if already seen by a specialist). Those not accepted for an FSA were returned to general practitioner (GP) care. During the study period there were 1,733 referrals (838 hip related referrals and 895 knee related referrals) to the orthopaedic department with a request for FSA. All patients had failed conservative management. Of these referrals 43% of hip and 54% of knee related referrals could not be offered an FSA and were returned, following triage, to general practitioner care unseen. Only 8% and 9% respectively were declined for insufficient information in the referral letter or lack of need. This study details the implementation of a triage system for elective hip and knee referrals to the CDHB and with accurate data we have been able to determine the large number of patients unable to access a specialist opinion. These patients represent the unmet need within our community and highlights the degree of rationing taking place within the public hospital.
Kim, J. Y.; Cho, J. S.; Min, Y. S.; Nam, J. M.; Jeon, G. P.; Park, S. S.; Jo, J. H.; Song, I. T.
Since 2010 August, PEFP(Proton Engineering Frontier Project)'s Proton Accelerator Research Center has been under construction so far. Generally, in advance of construction startup, many kinds of licenses should be acquired along with the types of construction works. To acquire a license in time, each item should meet the standard by the related regulation, including not only procedural but also content aspect. In the advent of internet era, electronic government system has been adopted in many governmental functions: So is the national construction license acquisition system. Owing to the system, both approval and documentation functions in licensing are integrated in online computer network which provide us simplification in process and easy accessibility to license data. However, aside from these construction licenses, other types of licenses still remain separately managed: Machinery, electric facilities, and so on. Moreover, all the licenses have the priority order and take legal term in processing. So, to avoid any time delay in license acquisition, we organized license hierarchy and found out the priority among them. Thereafter, according to their legal term in approval and acquisition, whole license acquisition schedule was arranged and we completed all the necessary licenses acquisition in time In this study, we summarize the current status of license acquisition on Proton Accelerator Research Center Construction, and manifest how they have been and will be managed systematically
Kim, J. Y.; Cho, J. S.; Min, Y. S.; Nam, J. M.; Jeon, G. P.; Park, S. S.; Jo, J. H.; Song, I. T. [KAERI, Daejeon (Korea, Republic of)
Since 2010 August, PEFP(Proton Engineering Frontier Project)'s Proton Accelerator Research Center has been under construction so far. Generally, in advance of construction startup, many kinds of licenses should be acquired along with the types of construction works. To acquire a license in time, each item should meet the standard by the related regulation, including not only procedural but also content aspect. In the advent of internet era, electronic government system has been adopted in many governmental functions: So is the national construction license acquisition system. Owing to the system, both approval and documentation functions in licensing are integrated in online computer network which provide us simplification in process and easy accessibility to license data. However, aside from these construction licenses, other types of licenses still remain separately managed: Machinery, electric facilities, and so on. Moreover, all the licenses have the priority order and take legal term in processing. So, to avoid any time delay in license acquisition, we organized license hierarchy and found out the priority among them. Thereafter, according to their legal term in approval and acquisition, whole license acquisition schedule was arranged and we completed all the necessary licenses acquisition in time In this study, we summarize the current status of license acquisition on Proton Accelerator Research Center Construction, and manifest how they have been and will be managed systematically.
acquisition. The findings indicate that technology licensing is positively related to the number of inventions produced by the licensee in the years subsequent to the licensing deal. Subsequently, I investigate the moderating effect that organizational slack and myopia have on this main relationship....... The findings also suggest that high levels of Organizational Slack (available financial resources) strengthen the positive effect of licensing on innovation. However, higher levels of Organizational Myopia (the extent to which a firm draws on its own knowledge) can decrease the main effect of licensing....
Mustafa, Rozina; Hashmi, Haleema; Mustafa, Rubina
In Pakistan 90% of births are conducted by TBA's. In most cases, TBA's are unable to diagnose the complications and are often unable to take decisions on timely referral. The objective of this study was to determine the prevalence, nature and outcome of life threatening obstetrical conditions in referrals by Traditional Birth Attendants (TBAs). This Observational, Descriptive study was conducted from January to December 2007, in the obstetrical unit of Fatima Hospital, Baqai Medical University, a tertiary care community based hospital. The study included patients referred by TBA's who developed life threatening obstetric conditions (LTOCs). Total 64 patients were referred by TBA's. The prevalence was 7.8%. Out of them, 53 (82.8%) patients admitted with life threatening obstetric conditions. The near-miss morbidities and mortalities were 45 (84.9%) and 8 (15%) respectively. Maternal mortality to Near-miss morbidity ratio was 1:6. Obstructed labour caused near-miss morbidity in 32 (60.3%) patients with no mortality. Postpartum haemorrhage as life threatening condition developed in 16 (30.1%) patients with 10 (18.8%) near-miss morbidities and 6 (11.3%) mortalities. Puerperal sepsis accounted for 1 (1.88%) near-miss morbidity and 2 (3.76%) mortalities. The mortality index for puerperal sepsis is (66.6%) almost double of postpartum haemorrhage (37.5%). Mortality to near miss morbidity ratio is high. Misidentification and late referrals of complicated cases by TBA's were responsible for near-miss morbidities and mortalities.
... FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM LIST GOVERNMENTS SANCTIONS REGULATIONS General Definitions § 596.309 Specific license. The term specific license means any license or...
Martinussen, Laila Marianne; Møller, Mette; Prato, Carlo Giacomo
The Driver Behavior Questionnaire and the Driver Skill Inventory are two of the most frequently used measures of self-reported driving style and driving skill. The motivation behind the present study was to identify sub-groups of drivers that potentially act dangerously in traffic (as measured...... self-reported driving skills and whether the reported skill level was reflected in the reported aberrant driving behaviors. 3908 drivers aged 18–84 participated in the survey. K-means cluster analysis revealed four distinct sub-groups that differed in driving skills and frequency of aberrant driving...... by frequency of aberrant driving behaviors and level of driving skills), as well as to test whether the sub-groups differ in characteristics such as age, gender, annual mileage and accident involvement. Furthermore, the joint analysis of the two instruments was used to test drivers’ assessment of their own...
Bieri, R.; Monsler, M.; Meier, W.; Stewart, L.
Parametric models for scaling heavy-ion driver designs are described. Scaling of target performance and driver cost is done for driver parameters including driver energy, number of beams, type of superconductor used in focusing magnets, maximum magnetic field allowed at the superconducting windings, linear quadrupole array packing fraction mass, and ion charge state. The cumulative accelerator voltage and beam currents are determined from the Maschke limits on beam current for each choice of driver energy and post-acceleration pulse duration. The heavy-ion driver is optimized over the large available driver parameter space. Parametric studies and the choice of a base driver model are described in a companion paper
Hughes, Danny R; Sunshine, Jonathan H; Bhargavan, Mythreyi; Forman, Howard
As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship between self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. Using Medicare's 5% Research Identifiable Files for 2004 to 2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and total episode cost, episode imaging cost, and episode nonimaging cost. Analyses were controlled for patient characteristics (eg, age and general health status), the condition's severity, and treating physician specialty. Self-referral in imaging was significantly (P nonimaging costs were much more often significantly higher (in 24 combinations) with self-referral than being lower (in 4 combinations). We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs.
For reasons of public acceptance the basis of a licensing system should be laid down in a law, details can be fixed in regulations below the law-level. The competence for licensing nuclear installations should be attributed to one body, which is not a the same time charged with the promotion of nuclear energy. The licensing authority has to be provided with sufficient technical advice, given by experts organized in advisory bodies. Normally a licensing procedure is split into several steps (site approval, construction permit, operation licence), each step can be subdivided. Some general aspects of licensing conditions (personal, technical and financial) as well as of the licensing procedure are outlined. The participation of the public is of particular importance but also involves most intricate problems. The paper concludes with some critical remarks on the role of administrative courts with respect to the licensing of nuclear power plants. (orig.) [de
... FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM LIST GOVERNMENTS SANCTIONS REGULATIONS General Definitions § 596.305 General license. The term general license means any license or authorization...
Harley, David A.
Relatively little empirical research has been done on the supervisory referral of employees to employee assistance programs (EAPs). Inclusion of constructive confrontation (supervisory referral) into program standards and its continued promotion as a "central strategy" of program theory and operation calls for critical investigation of…
Mustard, C.A.; McClarty, B.M.; MacEwan, D.W. [Manitoba Univ., Winnipeg, MB (Canada)
The influence of referral protocols on the utilization of magnetic resonance imaging (MRI) services was studied. Three neuroradiologists and one radiologist reviewed the indications for MRI for 198 referrals to a facility in Winnipeg, selected at random from patients seen in 1991 for suspected disorders of the brain or the spine. Out-of-province referrals had not been subject to referral protocols, whereas those from within Manitoba had been subject to such protocols. At least three of the four radiologists agreed on whether an examination was appropriate in 88.4 % of the cases. Out-of-province referrals were significantly more likely to be considered inappropriate for MRI (24 %) than referrals from within Manitoba (10 %). It was estimated that the combined effect of instituting protocols and reviewing each referral before the examination could result in a 16 % to 31 % reduction in the demand for MRI services without compromising diagnostic information. 18 refs., 3 tabs.
Full Text Available Abstract Background Allergy is a serious and apparently increasing public health problem yet relatively little is known about the types of allergy seen in routine tertiary practice, including their spatial distribution, co-occurrence or referral patterns. This study reviewed referrals over an eleven year period to a regional allergy clinic that had a well defined geographical boundary. For those patients confirmed as having an allergy we explored: (i differences over time and by demographics, (ii types of allergy, (iii co-occurrence, and (iv spatial distributions. Methods Data were extracted from consultant letters to GPs, from September 1998 to September 2009, for patients confirmed as having an allergy. Other data included referral statistics and population data by postcode. Simple descriptive analysis was used to describe types of allergy. We calculated 11 year standardised morbidity ratios for postcode districts and checked for spatial clustering. We present maps showing 11 year rates by postcode, and 'difference' maps which try to separate referral effect from possible environmental effect. Results Of 5778 referrals, 961 patients were diagnosed with an allergy. These were referred by a total of 672 different GPs. There were marked differences in referral patterns between GP practices and also individual GPs. The mean age of patients was 35 and there were considerably more females (65% than males. Airborne allergies were the most frequent (623, and there were very high rates of co-occurrence of pollen, house dust mite, and animal hair allergies. Less than half (410 patients had a food allergy, with nuts, fruit, and seafood being the most common allergens. Fifteen percent (142 had both a food and a non-food allergy. Certain food allergies were more likely to co-occur, for example, patients allergic to dairy products were more likely to be allergic to egg. There were age differences by types of allergy; people referred with food allergies were
Silverman, D.J.; Bauser, M.A.; Baird, R.D.
This report provides a detailed set of proposed criteria and guidance for the preparation of a license application for an assured isolation facility (AIF). The report is intended to provide a detailed planning basis upon which a prospective applicant may begin pre-licensing discussions with the Nuclear Regulatory Commission and initiate development of a license application. The report may also be useful to the NRC or to state regulatory agencies that may be asked to review such an application. Volume 1 of this report provides background information, and describes the licensing approach and methodology. Volume 2 identifies specific information that is recommended for inclusion in a license application
Nasa Zata Dina
Full Text Available The number of vehicles on the road has increased drastically in recent years. The license plate is an identity card for a vehicle. It can map to the owner and further information about vehicle. License plate information is useful to help traffic management systems. For example, traffic management systems can check for vehicles moving at speeds not permitted by law and can also be installed in parking areas to se-cure the entrance or exit way for vehicles. License plate recognition algorithms have been proposed by many researchers. License plate recognition requires license plate detection, segmentation, and charac-ters recognition. The algorithm detects the position of a license plate and extracts the characters. Various license plate recognition algorithms have been implemented, and each algorithm has its strengths and weaknesses. In this research, I implement three algorithms for detecting license plates, three algorithms for segmenting license plates, and two algorithms for recognizing license plate characters. I evaluate each of these algorithms on the same two datasets, one from Greece and one from Thailand. For detecting li-cense plates, the best result is obtained by a Haar cascade algorithm. After the best result of license plate detection is obtained, for the segmentation part a Laplacian based method has the highest accuracy. Last, the license plate recognition experiment shows that a neural network has better accuracy than other algo-rithm. I summarize and analyze the overall performance of each method for comparison.
Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R.
Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through “referral-based crowdsourcing”: the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530
José Juvenal Linhares
Full Text Available Objective: To describe the appropriateness of referrals of high-risk pregnancies in the basic healthcare network of Sobral, in Ceará, Brazil. Methods: A descriptive quantitative study. The medical files of 173 pregnant patients referred to the high-risk outpatient clinic of Centro de Especialidades Médicas of Sobral, during the period from July 2006 to April 2007, were analyzed. Variables analyzed were correctness of the referrals, professionals who made them, causes and origins of the referrals, and age bracket of the patients referred. The referrals were divided into “appropriate” and “inappropriate”, according to the classification of risk established by the technical manual of the Ministry of Health. Rresults: Of the 173 cases, 102 (59% were considered appropriate/correct, and 71 (41% referrals were considered inappropriate/incorrect. The referrals were divided according to the professional class of the referring individuals: physicians or nurses. Of the 173 referrals, 49 (28.3% were made by physicians, and 124 (71.7% by nurses. Of the 49 patients referred by physicians, 39 (79.6% were considered correct. Of the 124 referrals made by nurses, 63 (50.8% were considered incorrect, revealing a significant difference between the groups (p < 0.00001. The most common causes of referrals of pregnant patients were hypertensive syndromes (23.6%, physiological modifications of pregnancy (22.6%, prolonged pregnancy (15.1%, and diabetes (12.3%. Cconclusions: There was a low rate of appropriate/correct referrals. There is a need for training in the basic healthcare network for quality prenatal care, with special emphasis on referring nurses.
The operating reactors licensing actions summary is designed to provide the management of the Nuclear Regulatory Commission (NRC) with an overview of licensing actions dealing with operating power and nonpower reactors. These reports utilize data collected from the Division of Licensing in the Office of Nuclear Reactor Regulation and are prepared by the Office of Management and Program Analysis
Nunkoosing, Karl; Haydon-Laurelut, Mark
The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…
Larsson, Laura S; Kuster, Emilie
The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.
Cuccia, Valeria; Sacramento, Arivaldo M.; Aleixo, Bruna L.; Ferreira, Vinicius V.M.
The licensing process of a waste disposal facility is a complex and demanding undertaking. It proceeds in phases, starting with the site selection and ending many decades later, when the radionuclides decayed and no longer offer possible hazard. That is one of the reasons why the licensing process for the Brazilian repository for low and intermediate level radioactive waste (RBMN Project) is a challenge for all the technicians involved. Besides that, the only national experience associated to this subject arose after a radiological accident in the State of Goias, in 1987. Two different institutions are involved in this licensing process: IBAMA, for environmental licensing, and CNEN, for nuclear licensing. Both of them will evaluate the possible impacts caused by the waste disposal, so it is essential to avoid conflicts and duplications of activities. The RBMN project has different teams for each main activity, and one of them is the Licensing group. This team has been planning the licensing activities for the repository, studying the legal framework and estimating costs and execution time for each step. This paper presents the status of the licensing activities regarding to the RBMN project done by the CNEN staff. (author)
Arora, Ashish; Rønde, Thomas; Fosfuri, Andrea
the technology makes licensing decisions—to centralized licensing. The business unit has superior information about licensing opportunities but may not have the appropriate incentives because its rewards depend upon product market performance. If licensing is decentralized, the business unit forgoes valuable...... licensing opportunities since the rewards for licensing are (optimally) weaker than those for product market profits. This distortion is stronger when production-based incentives are more powerful, making centralization more attractive. Growth of technology markets favors centralization and drives higher...
The Department of Energy (DOE) is authorized by the Nuclear Waste Policy Act of 1982 (Act) to site, design, construct, and operate mined geologic repositories for high-level radioactive wastes and is required to obtain licenses from the Nuclear Regulatory Commission (NRC) to achieve that mandate. To this end the DOE has developed a licensing approach which defines program strategies and which will facilitate and ease the licensing process. This paper will discuss the regulatory framework within which the repository program is conducted, the DOE licensing strategy, and the interactions between DOE and NRC in implementing the strategy. A licensing strategy is made necessary by the unique technical nature of the repository. Such a facility has never before been licensed; furthermore, the duration of isolation of waste demanded by the proposed EPA standard will require a degree of reliance on probabilistic performance assessment as proof of compliance that is a first of a kind for any industry. The licensing strategy is also made necessary by the complex interrelationships among the many involved governmental agencies and even within DOE itself, and because these relationships will change with time. Program activities which recognize these relationships are essential for implementing the Act. The guiding principle in this strategy is an overriding commitment to safeguarding public health and safety and to protecting the environment
Roane, Brandy Michelle; Valleley, Rachel J.; Allen, Keith D.
The American Academy of Pediatrics has recommended an algorithm for identifying children with potential developmental delays. It includes a recommendation that positive screening should result in referral for additional evaluation or intervention. Yet, it is not known whether positive screens do, in fact, influence physician referrals. The primary…
Grote, F.K.; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Dekker, F.W.; Dommelen, P. van; Buuren, S. van; Lodder-van der Kooij, A.M.; Verkerk, P.H.; Wit, J.M.
Background. To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these
Grant, S D [Atomic Energy of Canada Ltd., Saskatoon, SK (Canada); Snell, V G [Atomic Energy of Canada Ltd., Mississauga, ON (Canada)
AECL has been pioneering `up-front` licensing of new reactor designs. The CANDU 3 design has been formally reviewed by AECB staff for a number of years. The CANDU 9 design has just started the up-front licensing process. The process gives designers, regulators and potential customers early confidence in the licensability of future plants. (author). 4 refs., 2 tabs.
Grant, S.D.; Snell, V.G.
AECL has been pioneering 'up-front' licensing of new reactor designs. The CANDU 3 design has been formally reviewed by AECB staff for a number of years. The CANDU 9 design has just started the up-front licensing process. The process gives designers, regulators and potential customers early confidence in the licensability of future plants. (author). 4 refs., 2 tabs
The US Nuclear Regulatory Commission (NRC) has developed a series of licensing guidance documents based on the regulatory requirements in Part 60 of Title 10 of the Code of Federal Regulations (10 CFR Part 60). This regulatory systems-based approach to licensing guidance documentation relies on the definition of the high-level waste repository in 10 CFR Part 60. A document which is important for the frame-work it gives to other programmatic licensing guidance is the Draft Regulatory Guide open-quotes Format and Content for the License Application for the High-Level Waste Repositoryclose quotes (FCRG). The FCRG describes a format and content acceptable to NRC for a high-level waste repository license application pursuant to the requirements of 10 CFR Part 60. Other licensing guidance documents will be compatible with the FCRG
Full text: Nuclear plants in the United States are licensed for 40 years, a length specified in the Atomic Energy Act of 1954, which laid out much of the regulatory basis for the commercial nuclear industry. The Act, however, made provision for license renewal. The original 40-year license period was chosen arbitrarily by the U.S. Congress because it was the typical period over which utilities recovered their investment in electricity generating plants. Nuclear plants, however, are subject to a rigorous program of Nuclear Regulatory Commission oversight, maintenance and equipment replacement. In effect, they must be in the same operating condition on the last day of their licenses as they were on the first. As the industry matured, it became apparent that there was no physical limitation on the continued operation of nuclear plants past 40 years. The industry turned its attention toward license renewal. When the issue was first raised, the NRC considered stringent process equivalent to seeking a new operating license for each plant. The complexity, length and cost of the process made it unlikely that many nuclear plants would seek license renewal. The nuclear industry worked successfully with NRC on the application of generic principles to license renewal, however, and in 1995, the NRC issued an efficient, tightly-focused rule that made license renewal a safe, viable option. To extend the operating license for a reactor, a company must demonstrate to the NRC that aging effects will be adequately managed during the renewal terms, thus ensuring equipment functionality. The rule allows licensees to apply for extensions of up to 20 years. The first license renewal application was filed in 1998 by the owner of the two-unit Calvert Cliffs plant. Shortly thereafter, an application was filed for the three-unit Oconee Nuclear Station. The NRC renewed the licenses for all five units in 2000, and since then, five more licenses have been renewed. The NRC has received 37
Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K
We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.
Appropriateness of Referrals for Upper Gastrointestinal Endoscopy. ... Accra between January and December, 2008 were interviewed and evaluated for this study. ... Presentations with bleeding and suspicion of malignancy showed statistical ...
Young, D W; Reichman, W R; Levy, M F
Potential factors underlying sex differences in the referral of problem-drinking subordinates to employee assistance programs (EAPs) were explored in interviews with 120 supervisors in four organizations. Analyses of data obtained in these interviews assessed the relative ability of eight variables to predict supervisor's actual identification and referral of female and male problem drinkers. In addition to numbers of employees supervised, the supervisors' judgment of the EAP's effectiveness was the best predictor of referral and identification, regardless of the sex of the referred subordinate. Knowledge and training in the EAP was a secondary contributor to referral of men, but played no role in female referrals. When controlling for all other variables, the extent to which supervisors held an egalitarian attitude toward women's rights and roles was found to be marginally positively related to identification of female drinkers. Similarly, a less stigmatized, stereotyped view of women's use and abuse of alcohol was marginally associated with a greater likelihood of referral of a female drinker to the EAP. Neither of these attitudinal variables was related to identification or referral of male problem drinkers.
Künkele, Annette; Wilm, Josephine; Holdt, Markus; Lohmann, Dietmar; Bornfeld, Norbert; Eggert, Angelika; Temming, Petra; Schulte, Johannes H
Retinoblastoma can extend beyond the structures of the eye, where cells can enter the bloodstream and cause metastases. Various types of protocols for adjuvant treatment risk-adapted according to histopathological risk factors are used worldwide. Between 1997 and 2009, 420 children were diagnosed with retinoblastoma at the German Retinoblastoma Referral Centre and risk factors were assessed. Patients with post-laminar optic nerve infiltration or choroid or minor scleral invasion received six courses of adjuvant chemotherapy using vincristine, etoposide, carboplatin and cyclophosphamide (group 1). Patients with microscopic extension beyond the sclera to the resection margin of the optic nerve or potential spread due to vitrectomy received chemotherapy plus orbital radiotherapy (group 2). Neoadjuvant chemotherapy was performed in patients with local extraocular invasion detected on MRI. Following this protocol, 42 of the 420 patients and 21 referred from other centres showed high-risk histopathological factors qualifying for adjuvant therapy (57 in group 1 and 6 in group 2). Seven of the 63 patients received neoadjuvant and adjuvant treatment. During a mean follow-up of 5.8 (range 0.4-15.4) years, one of six patients in group 2 developed metastases and died. No patients died from toxicity. The 5-year overall survival was 100% for group 1 and 80% for group 2. This retrospective single-site study reveals a 10% incidence of high-risk features in children with retinoblastoma diagnosed at the German Retinoblastoma Referral Centre. Overall survival rates of 98.3% underline the safety of this adjuvant chemotherapy protocol and its efficiency in preventing metastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Hanley, Judy; Adams, Jane
This article describes the initial development and subsequent evolution of a simple referral assessment tool for stoma care. The first author's personal experience identified that there was widespread inconsistency in perceptions of local multidisciplinary teams as to when it was appropriate to refer to specific specialist nursing teams. This resulted in both inappropriate and delayed referrals. A 'Think Specialist Nurse' initiative was developed across the author's trust, building on the traffic light template from the 'ThinkGlucose' tool, to facilitate referrals to clinical nurse specialists. The stoma-care specific tool, 'Think Stoma Nurse', has subsequently evolved beyond its initial audience, and has been adapted into materials aimed at patients and carers.
Kortuem, Karsten; Fasler, Katrin; Charnley, Amanda; Khambati, Hussain; Fasolo, Sandro; Katz, Menachem; Balaskas, Konstantinos; Rajendram, Ranjan; Hamilton, Robin; Keane, Pearse A; Sim, Dawn A
The increasing incidence of medical retinal diseases has created capacity issues across UK. In this study, we describe the implementation and outcomes of virtual medical retina clinics (VMRCs) at Moorfields Eye Hospital, South Division, London. It represents a promising solution to ensure that patients are seen and treated in a timely fashion METHODS: First attendances in the VMRC (September 2016-May 2017) were included. It was open to non-urgent external referrals and to existing patients in a face-to-face clinic (F2FC). All patients received visual acuity testing, dilated fundus photography and optical coherence tomography scans. Grading was performed by consultants, fellows and allied healthcare professionals. Outcomes of these virtual consultations and reasons for F2FC referrals were assessed. A total number of 1729 patients were included (1543 were internal and 186 external referrals). The majority were diagnosed with diabetic retinopathy (75.1% of internal and 46.8% of external referrals). Of the internal referrals, 14.6% were discharged, 54.5% continued in VMRC and 30.9% were brought to a F2FC. Of the external referrals, 45.5% were discharged, 37.1% continued in VMRC and 17.4% were brought to a F2FC. The main reason for F2FC referrals was image quality (34.7%), followed by detection of potentially treatable disease (20.2%). VMRC can be implemented successfully using existing resources within a hospital eye service. It may also serve as a first-line rapid-access clinic for low-risk referrals. This would enable medical retinal services to cope with increasing demand and efficiently allocate resources to those who require treatment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 1403.17... PROCEDURES § 1403.17 Referral of debts to Department of Justice. Debts which cannot be collected in accordance with these regulations may be referred to the Department of Justice for collection action. ...
Aim: To study the presentation of herpes zoster (shingles) in self-referral urban primary care setting. Patients and method: During nearly 20 years, patients of Igbo ethnic group presented with herpes zoster, on a self-referral basis, to my urban, week day evening, out patient clinic. The recorded epidemiological parameters ...
Susilowati, Indri H; Yasukouchi, Akira
Some causes of accidents among older drivers are: not paying attention to traffic signals; missing stop lines; and having to deal with and misjudging emergency situations. These causes of accidents reveal problems with attention and cognition. Such incidents are also related to driver perception and stress-coping mechanisms. It is important to examine the relation of stress reactions to attention and cognition as a factor influencing the causes of accidents commonly involving older drivers. Subjects were 10 young drivers (23.3 ± 3.33 years) and 25 older drivers divided into two groups (older1 [60 to 65 years] and older2 [> 65 years]). This study revealed the correlation within driver stress inventory and driver coping questionnaires parameters was observed only in older drivers. They also needed a longer response time for Trail Making Test A and B. The factors affected the attention and cognition of older drivers by age but not driving experience itself, and coping parameters such as emotion focus, reappraisal, and avoidance were not included as stress inventory parameters. Being prone to fatigue was less for younger drivers than older drivers. Because they have shorter distances, shorter drive times, and no need for expressways, older drivers also had a significantly lower risk of thrill-seeking behaviour and more patience. The intervention addressing their attention skills, aggressive feelings, and emotion focus should be considered. The technological improvements in cars will make older drivers feel safer and make driving easier which might lower the attention paid to the road, and regular driving training might be needed to assess and enhance their safety.
Josyula, Srirama; Taylor, Kathryn K; Murphy, Blair M; Rodas, Dairamise; Kamath-Rayne, Beena D
referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes. we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care. ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses. our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas. Copyright © 2015 Elsevier Ltd. All rights reserved.
Storage of spent fuel at Away-From-Reactor (AFR) installations will allow reactors to continue to operate until reprocessing or other fuel disposal means are available. AFR installations must be licensed by the Nuclear Regulatory Commission (NRC). Although wide experience in licensing reactors exists, the licensing of an AFR installation is a relatively new activity. Only one has been licensed to date. This paper delineates the requirements for licensing an AFR installation and projects a licensing schedule. Because the NRC is developing specific AFR requirements, this schedule is based primarily on draft NRC documents. The major documents needed for an AFR license application are similar to those for a reactor. They include: a Safety Analysis Report (SAR), and Environmental Report (ER), safeguards and security plans, decommissioning plans, proposed technical specifications, and others. However, the licensing effort has one major difference in that for AFR installations it will be a one-step effort, with follow-up, rather than the two-step process used for reactors. The projected licensing schedule shows that the elapsed time between filing an application and issuance of a license will be about 32 months, assuming intervention. The legal procedural steps will determine the time schedule and will override considerations of technical complexity. A license could be issued in about 14 months in the absence of intervention
Day, Marianne R; Thompson, Andrew R; Poulter, Damian R; Stride, Christopher B; Rowe, Richard
Drivers are at high crash risk when they begin independent driving, with liability decreasing steeply over the first three months. Their behavioural development, and other changes underlying improved safety are not well understood. We adopted an innovative longitudinal qualitative design, with thirteen newly qualified drivers completing a total of 36 semi-structured interviews, one, two and three months after acquiring a full UK driving license. The interviews probed high-risk factors for new drivers, as well as allowing space for generating novel road safety issues. Analysis adopted a dual deductive and inductive interpretative thematic approach, identifying three super-ordinate themes: (1) Improvements in car control skills and situation awareness; (2) A reduction in the thrill of taking risks when driving against a background of generally increasing driving speed; (3) Early concerns about their social status in the eyes of other road users during the early stages of driving, which may put pressure on them to drive faster than they felt comfortable with. The study provides important new leads towards understanding how novice driving becomes safer over the first few months of driving, including how well-studied concepts of driving skill and style may change during development of independent driving, and bringing the less rigorously studied concept of social status into focus. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.
In southern Tanzania, few high-risk pregnancies are channeled through antenatal care to the referral level. We studied the influences that make pregnant women heed or reject referral advice. Semi-structured interviews with sixty mothers-to-be, twenty-six health workers and six key-informants to identify barriers to use of ...
Iarussi, Melanie M.; Shaw, Brian M.
The need to refer students to off-campus mental health providers is common in college counseling. Such referrals can be challenging for college counselors who strive to meet students' counseling needs while adhering to ethical and center policy guidelines. In this article, the authors explore the nature and challenges of referral in college…
McCartt, Anne T; Teoh, Eric R
Given teenagers' elevated crash rates, it is especially important that their vehicles have key safety features and good crash protection. A profile of vehicles driven by teenagers killed in crashes was developed. Data on vehicles of drivers ages 15-17 and ages 35-50 who died in crashes during 2008-2012 were obtained from the Fatality Analysis Reporting System. Using vehicle identification numbers, the vehicle make, model and model year were identified. 29% of fatally injured teenagers were driving mini or small cars, 82% were driving vehicles at least 6 years old, and 48% were driving vehicles at least 11 years old. Compared with middle-aged drivers, teenagers' vehicles more often were small or mini cars or older vehicles. Few teenagers' vehicles had electronic stability control or side airbags as standard features. Parents should consider safety when choosing vehicles for their teenagers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
This article explores the history and describes the main features of free software licenses and other free licenses in an attempt to shed light on the reasons for their success in promoting individual behaviors converging towards the collective construction of digital commons.
Arora, Ashish; Fosfuri, Andrea; Rønde, Thomas
, we find that interdependency across business units may result in more, not less, decentralization. Furthermore, even though centralization results in less information, centralized licensing deals are larger. Our model conforms to the existing evidence that reports heterogeneity across firms in both......Technology licensing is an important means for companies to extract more value from their intellectual assets. We build a model that helps understand how licensing activity should be organized within large corporations. More specifically, we compare decentralization—where the business unit using...... the technology makes licensing decisions—to centralized licensing. The business unit has superior information about licensing opportunities but may not have the appropriate incentives because its rewards depend on product market performance. If licensing is decentralized, the business unit forgoes valuable...
Cruz, Mario; Cruz, Patricia B; Weirich, Christine; McGorty, Ryan; McColgan, Maria D
To describe the referral patterns and utilization of on-site intimate partner violence (IPV) services in both inpatient and outpatient settings at a large urban children's hospital. Retrospective review of case records from IPV victims referred to an on-site IPV counselor between September 2005 and February 2010. Descriptive statistics were used to examine IPV victim demographics, number of referrals per hospital department, referral source (type of staff member), time spent by IPV counselor for initial consultation, and services provided to IPV victims. A total of 453 unique referrals were made to the IPV counselor: 81% were identified by universal screening and 19% by risk-based screening. Thirty-six percent of IPV victims were referred from primary care clinics; 26% from inpatient units; 13% from outpatient subspecialty clinics; 12.5% from the emergency department; 5% from the Child Protection Program; and 4% were employee self-referrals. Social workers generated the most referrals (55%), followed by attending physicians (17%), residents (13%), nurses (7%), and other individuals (self-referrals) (4%). The median initial IPV intervention required 42 minutes. Supportive counseling and safety planning were the services most often utilized by IPV victims. IPV screening can be successfully integrated in both inpatient and outpatient settings by a multidisciplinary group of hospital staff. Most referrals were generated by universal screening outside of the primary care setting. IPV victims generally desired supportive counseling and safety planning over immediate housing relocation. Many IPV screening opportunities were missed by using verbal screening alone. Copyright © 2013 Elsevier Ltd. All rights reserved.
... 0720-AB36 TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech... referrals of beneficiaries to the Military Health System for physical therapy, occupational therapy, and... practitioners will be allowed to issue referrals to patients for physical therapy, occupational therapy, and...
Conclusions Three iterations of the model correctly predicted at least 75% of the approved referrals in the validation set. A correct prediction of whether or not a referral will be approved can be made in three out of four cases.
Full Text Available Background and purpose: Although, economically, referral systems make utilization of health facilities at different levels sound, in many countries caretakers often bypass primary care facilities that are regularly costlier for caretakers and health care systems. The main objective of the current study was to assess the utilization of hospital services with more emphasis on economic point of view. Materials and methods: The present study was a facility-based cross-sectional study. A researcher developed questionnaire was used to collect the data. The samples were randomly selected and interviewed on their consent. SPSS Software was also used to analyze the collected data through Chi-2, correlation, and t-test. Results: Just 29.4 percent of the attendees to the hospital were carrying out a referral slip from their family medicine. Five variables including type of care, type of attending, appointment arrangement, satisfaction with family medicine, and vising family medicine were statistically analyzed and found significantly related to carrying referral slip. Conclusion: Because of dysfunction of referral system, Iran’s health care system was found to be far from achieving economic advantages of a referral based DHS. It is actually an inappropriate use of limited health resources in a country like Iran that seriously suffers from shortage of financial and health system resources. This is likely due to deficiencies in the components of its referral system, therefore, a full revision of current reforms and appropriate remedies for deficiencies in the components of referral system was found to be in top priority in Iran.
Susilowati Indri H
Full Text Available Abstract Background Some causes of accidents among older drivers are: not paying attention to traffic signals; missing stop lines; and having to deal with and misjudging emergency situations. These causes of accidents reveal problems with attention and cognition. Such incidents are also related to driver perception and stress-coping mechanisms. It is important to examine the relation of stress reactions to attention and cognition as a factor influencing the causes of accidents commonly involving older drivers. Finding Subjects were 10 young drivers (23.3 ± 3.33 years and 25 older drivers divided into two groups (older1 [60 to 65 years] and older2 [> 65 years]. This study revealed the correlation within driver stress inventory and driver coping questionnaires parameters was observed only in older drivers. They also needed a longer response time for Trail Making Test A and B. The factors affected the attention and cognition of older drivers by age but not driving experience itself, and coping parameters such as emotion focus, reappraisal, and avoidance were not included as stress inventory parameters. Being prone to fatigue was less for younger drivers than older drivers. Because they have shorter distances, shorter drive times, and no need for expressways, older drivers also had a significantly lower risk of thrill-seeking behaviour and more patience. Conclusion The intervention addressing their attention skills, aggressive feelings, and emotion focus should be considered. The technological improvements in cars will make older drivers feel safer and make driving easier which might lower the attention paid to the road, and regular driving training might be needed to assess and enhance their safety.
... Licensing Authority will transfer to such other person the historical, nonhistorical or designated license... escrow with the sole condition for return of escrow being that the Licensing Authority determines that... to whom the historical licenses were issued during the quota year in which the sale or conveyance...
Blanchette, M. A.; Rivard, M.; Dionne, C. E.
, and the percentage of patients referred to other health care providers were associated with a higher number of MD referrals to DCs. The percentage of patients with somatovisceral conditions, using a particular chiropractic technique (hole in one and Thompson), taking his/her own radiographs, being the client...
Full Text Available This article explores the history and describes the main features of free software licenses and other free licenses in an attempt to shed light on the reasons for their success in promoting individual behaviors converging towards the collective construction of digital commons.
Van Gijssel, A.
This thesis investigates the potential of a fail-safe approach to driver distraction through novel interface concepts for integrated Advanced Driver Assistance Systems (ADAS). Traffic accidents are a negative side effect of the universal and economical desire for mobility. The year 2009 saw the
... 7 Agriculture 7 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 792.18... § 792.18 Referral of debts to Department of Justice. (a) Debts that exceed $100,000.00 exclusive of... referred to the Department of Justice before they can be discharged. (b) Debts which cannot be compromised...
Roman, Gabriela D; Poulter, Damian; Barker, Edward; McKenna, Frank P; Rowe, Richard
Identifying the changes in driving behavior that underlie the decrease in crash risk over the first few months of driving is key to efforts to reduce injury and fatality risk in novice drivers. This study represented a secondary data analysis of 1148 drivers who participated in the UK Cohort II study. The Driver Behavior Questionnaire was completed at 6 months and 1, 2 and 3 years after licensure. Linear latent growth models indicated significant increases across development in all four dimensions of aberrant driving behavior under scrutiny: aggressive violations, ordinary violations, errors and slips. Unconditional and conditional latent growth class analyses showed that the observed heterogeneity in individual trajectories was explained by the presence of multiple homogeneous groups of drivers, each exhibiting specific trajectories of aberrant driver behavior. Initial levels of aberrant driver behavior were important in identifying sub-groups of drivers. All classes showed positive slopes; there was no evidence of a group of drivers whose aberrant behavior decreased over time that might explain the decrease in crash involvement observed over this period. Male gender and younger age predicted membership of trajectories with higher levels of aberrant behavior. These findings highlight the importance of early intervention for improving road safety. We discuss the implications of our findings for understanding the behavioral underpinnings of the decrease in crash involvement observed in the early months of driving. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Full Text Available Abstract Background Uganda’s under-five mortality is high, currently estimated at 66/1000 live births. Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve referral and uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics. Methods/Design A cluster randomized design will be applied to test the intervention in Mukono District, central Uganda. A sample of study clusters will implement the intervention. The intervention will consist of three components: i raising awareness in the community: village health teams will discuss the importance of referral and encourage households to save money, ii training and supervision of providers in the private sector to diagnose, treat and refer sick children, iii regular meetings between the public and private providers (convened by the district health team to discuss the referral system. Twenty clusters will be included in the study, randomized in the ratio of 1:1. A minimum of 319 sick children per cluster and the total number of sick children to be recruited from all clusters will be 8910; adjusting for a 10 % loss to follow up and possible withdrawal of private outlets. Discussion The immediate sustainable impact will be appropriate treatment of sick children. The intervention is likely to impact on private sector practices since the scope of the services they provide will have expanded. The proposed study is also likely to have an impact on families as; i they may appreciate the importance of timely referral on child illness management, ii the cost savings related to reduced morbidity will be used by household to access other social services. The linkage between the private and public sectors will create a potential avenue for delivery of other public health interventions and improved working relations in the two sectors. Further, improved quality of
The licensing of teachers should be modeled against professions similar to teaching rather than professions like medicine and architecture that are vastly different. Applying similar licensing practices can raise the status of teaching. Ignoring these licensing practices will prevent teachers from functioning as professionals. (MD)
Medina Gironzini, E.
In Peru, the Regulation for Ionizing Radiation Sources is applied, which establishes the norms and procedures to follow in the nuclear and radioactive installations of the country in order to assure their correct operation as concerns to the nuclear safety and radiological protection, allowing the emission of the respective licenses. As for the nuclear facilities, this authorization includes the Previous License, the Construction License and the Operation License (provisional and definitive) and for radioactive facilities and equipment generating ionizing radiations: the Construction License and the Operation License. The personnel also require a license that can be an operator license (as for nuclear reactors) or a supervisor license (for nuclear and radioactive facilities). In spite of the above mentioned regulation and its long enforcement period, less than 10% of radioactive facilities in this country are licensed, due to different problems which will be solved in the medium term. (Author)
van Dijk, Christel E; de Jong, Judith D; Verheij, Robert A; Jansen, Tessa; Korevaar, Joke C; de Bakker, Dinny H
In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it. Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance. In 86.6% of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply. About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.
Locatelli, Giorgio; Mancini, Mauro; Sainati, Tristano; Sallinen, Liisa
The paper deals with the licensing nuclear power plants; it focuses primarily on the licensing process implications into the international nuclear market. Nowadays there are twenty-six countries that are planning to build new nuclear facilities, and thirty-seven where nuclear reactors are proposed; on the other hand, there are mainly ten international reactor vendors. At international level, there are few vendors that have sufficient resources, capabilities and experience to carry out the design and delivering of a nuclear power plant in the international market; On the other hand, the licensing processes are strictly dependent on national law frameworks, and on the nuclear policies. The paper proposes a comparison of six licensing processes (the ones established in Finland, France, Italy, South Korea, USA and UK), and analyzes its main features and implications; the IAEA licensing process is taken as reference point. The objective of the paper is to propose a systemic approach for considering the licensing procedures. The framework proposed enables facilitating the licensing management and inferring the main features of licensing contexts. The paper concludes with a forecast of the nuclear licensing context, especially with respect to the fourth generation of nuclear reactors. (author)
Laursen, Keld; Reichstein, Toke; Trombini, Giulia
between technology and market forces: if partners are market distant, the likelihood of technology license contractual partnership decreases with partners’ technological distance. Using data on the formation of license partnerships in the global biopharmaceutical industry over the period 1994......This paper investigates the matching of firms on the market for technology. The paper forwards two dimensions along which license formation occurs: technology and product-market. Both sides of the market search for a partner representing potential for high technology synergies to maximize licensing...
This paper deals with the problems of an overseas regulatory agency in licensing a Canadian-supplied nuclear plant which is referenced to a plant in Canada. Firstly, the general problems associated with the use of a reference plant are discussed. This is followed by a discussion of specific problems which arise from the licensing practices in Canada. The paper concludes with recommendations to simplify the task of demonstrating the licensability of an overseas CANDU plant
... 7 Agriculture 1 2010-01-01 2010-01-01 false Globalization of licenses. 6.32 Section 6.32 Agriculture Office of the Secretary of Agriculture IMPORT QUOTAS AND FEES Dairy Tariff-Rate Import Quota Licensing § 6.32 Globalization of licenses. If the Licensing Authority determines that entries of an article...
... Licensing Nursing Home Administrators § 431.710 Provisional licenses. To fill a position of nursing home... 42 Public Health 4 2010-10-01 2010-10-01 false Provisional licenses. 431.710 Section 431.710 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...
Manard, William T; Syberg, Kevin; Behera, Anit; Salas, Joanne; Schneider, F David; Armbrecht, Eric; Hooks-Anderson, Denise; Crannage, Erica; Scherrer, Jeffrey
The medical home model has been gaining attention from the health care community as a strategy for improved outcomes for management of chronic disease, including diabetes. The purpose of this study was to compare referrals for diabetes education among patients receiving care from a medical home model versus a traditional practice. Data were obtained from a large, university-affiliated primary care patient data registry. All patients (age 18-96 years) with a diagnosis of prediabetes or diabetes and seen by a physician at least twice during 2011 to 2013 were selected for inclusion. Multivariate regression models measuring the association between medical home status and referral to diabetes education were computed before and after adjusting for covariates. A significantly (P patients in a medical home than without a medical home (23.9% vs 13.5%) received a referral for diabetes education. After adjusting for covariates, medical home patients were 2.7 times more likely to receive a referral for diabetes education (odds ratio, 2.70; 95% confidence interval, 1.69-4.35). Patients in a medical home model were more likely to receive referrals for diabetes education than patients in a standard university-affiliated family medicine practice. Future longitudinal designs that match characteristics of patients with a medical home with those of patients without one will provide strong evidence to determine whether referral to diabetes education is a result of the medical home model of care independent of confounding factors. © Copyright 2016 by the American Board of Family Medicine.
The goal of this project is to organize and centralize the data about software tools available to CERN employees, as well as provide a system that would simplify the license management process by providing information about the available licenses and their expiry dates. The project development process is consisted of two steps: modeling the products (software tools), product licenses, legal agreements and other data related to these entities in a relational database and developing the front-end user interface so that the user can interact with the database. The result is an ASP.NET MVC web application with interactive views for displaying and managing the data in the underlying database.
The Uranium Mill Tailings Remedial Action (UMTRA) Project Office developed a plan to define UMTRA Project licensing program objectives and establish a process enabling the DOE to document completion of remedial actions in compliance with 40 CFR 1 92 and the requirements of the NRC general license. This document supersedes the January 1987 Project Licensing Plan (DOE, 1987). The plan summarizes the legislative and regulatory basis for licensing, identifies participating agencies and their roles and responsibilities, defines key activities and milestones in the licensing process, and details the coordination of these activities. This plan provides an overview of the UMTRA Project from the end of remedial actions through the NRC's acceptance of a disposal site under the general license. The licensing process integrates large phases of the UMTRA Project. Other programmatic UMTRA Project documents listed in Section 6.0 provide supporting information
Carvalho, A.J.M. de.
The need for the adoption of a legal and normative system, defining objectives, pescriptions and the process of nuclear licensing and building of nuclear power plants in Brazil is enphasized. General rules for the development of this system are presented. The Brazilian rules on the matter are discussed. A general view of the German legal system for nuclear power plant licensing and the IAEA recommendations on the subject are finally presented. (A.L.S.L.) [pt
Simons‐Morton, B; Ouimet, M C
Motor vehicle crashes remain elevated among novice teen drivers for at least several years after licensure. Licensing policies and driver education are the two primary countermeasures employed to decrease young driver crash risks. Graduated driver licensing policies have proved to be effective in reducing crash rates where evaluated. Driver education is an essential part of teaching teens the rules of the road and operating a vehicle, but requires few hours of professional driver training, re...
Full Text Available In this paper the authors examine statutes that regulate, license, and enforce investigative functions in each US state. After identification and review of Private Investigator licensing requirements, the authors find that very few state statutes explicitly differentiate between Private Investigators and Digital Examiners. After contacting all state agencies the authors present a distinct grouping organizing state approaches to professional Digital Examiner licensing. The authors conclude that states must differentiate between Private Investigator and Digital Examiner licensing requirements and oversight.
Hendrickson, Chase D; Saini, Saumya; Pothuloori, Avin; Mecchella, John N
Outpatient specialty consultations rely on the timeliness and completeness of referral information to facilitate a valuable patient-specialist interaction. This project aimed to increase essential diagnostic information availability at the initial consultation for patients referred for common endocrine conditions frequently lacking such data-diabetes mellitus, thyroid nodule, thyrotoxicosis, and hypercalcemia. At an endocrinology clinic at an academic medical center in rural New England, providers see several thousand new patients annually, the majority of whom are referred by providers external to the clinic's healthcare system. Through consensus, endocrinology clinic providers agreed on the two or three data elements essential for a meaningful initial consultation for each. A quality improvement team employed a planned series of interventions based on previously published methods and an innovative approach: dissemination of a referral guideline, an assessment of referral adequacy in the endocrinology clinic workflow, coupled with focused requests for missing items, and a pre-visit lab appointment. Between April 2015 and March 2016, 762 referrals were reviewed. At baseline for the four conditions, referrals contained all essential elements only 27.5% (22 of 80) of the time. Over a 7-month period, the team implemented the interventions, with subsequent referrals containing all essential elements increasing to 75.5% (P<.0001), largely attributable to the pre-visit lab appointment. Incoming referrals that lack essential information are a significant problem in specialty care and may adversely affect patient experience, provider satisfaction, and clinic efficiency. Improvement may require innovative approaches, such as the potentially transferable and generalizable ones employed here. DHMC = Dartmouth-Hitchcock Medical Center EHR = electronic health record PDSA = Plan-Do-Study-Act.
"The little squealer" or "the virtual guardian angel"? Young drivers' and their parents' perspective on using a driver monitoring technology and its implications for parent-young driver communication.
Guttman, Nurit; Gesser-Edelsburg, Anat
In-vehicle driving monitoring technologies have the potential to enable young drivers to learn from self-assessment. However, their use is largely dependent on parental involvement. A total of 79 interviews were conducted with young drivers and parents regarding this technology and its use. Most had the experience of having an in-vehicle data recorder installed in the vehicle driven by the young drivers. Parents and the young drivers expressed both appreciation as well as reservations about its potential as a means to enhance the driving safety of young drivers. A surprising finding was that some parents did not check the feedback and said they relied on the young driver to do so. Main concerns related to privacy, parent-young driver relationship, self-esteem and confidence, constructive use of the feedback data, and the limitations of the documentation that can be done by the technology. Providing parents and young drivers with a support system and tools to discuss and utilize the feedback are underscored. Challenges include addressing the invasion of young drivers' privacy and gender differences, and using the monitoring-capacity of the technology to enhance safe driving practices. Implications for programs to enhance communication and a dialogical approach between parents and young drivers are discussed. Copyright © 2010 Elsevier Ltd. All rights reserved.
The Operating Reactors Licensing Actions Summary is designed to provide the management of the Nuclear Regulatory Commission (NRC) with an overview of licensing actions dealing with operating power and nonpower reactors
... DEPARTMENT OF DEFENSE Department of the Army Notice of Intent to License Government-Owned Inventions; Intent to License on a Partially-Exclusive Basis AGENCY: Department of the Army, DoD. ACTION... by the Secretary of the Army. The US Army Edgewood Chemical Biological Center intends to license...
Selhorst, Mitchell; Fischer, Anastasia; Graft, Kristine; Ravindran, Reno; Peters, Eric; Rodenberg, Richard; Welder, Eric; MacDonald, James
The purposes of this study were (1) to determine whether the duration of rest before referral to physical therapy (PT) affects the time to make a full return to activity for patients with an acute spondylolysis, (2) to assess the safety of an early referral to PT in patients with an acute spondylolysis. Retrospective chart review. Hospital-based sports medicine clinic. The medical charts of 196 adolescent athletes (mean age = 14.3 ± 1.8 years) with an acute spondylolytic injury met the inclusion criteria and were reviewed. Patients were subgrouped based on physician referral to PT. An aggressive referral group (10 weeks). Duration of rest before clearance to a full return to activity and the frequency of adverse reactions during the course of treatment. Safety was assessed by calculating the risk of experiencing an adverse reaction in each group. Median days to a full return to activity for aggressive referral group (115.5 days, interquartile range 98-150 days) and conservative referral group (140.0 days, interquartile range 114.5-168 days) were significantly different (P = 0.002). Eleven patients had adverse reactions during the course of treatment. The risk of adverse reaction was not statistically significant between groups (P = 0.509). Patients with acute spondylolysis in the aggressive referral group were able to make a full return activity almost 25 days sooner. No differences in the risk of adverse reactions were noted between aggressive and conservative referral groups.
Rawlins, Matthew D M; Raby, Edward; Sanfilippo, Frank M; Douglass, Rae; Chambers, Jonathan; McLellan, Duncan; Dyer, John R
To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds). Retrospective, single-centre observational study between March 2015 and February 2016. A new quaternary referral centre. Adults referred for antimicrobial rounds outside of the intensive care and haematology units. Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system. The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam. Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased. The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.
Mikolaitchouk, H.; Bogdan, L.; Steinberg, N.
In the former USSR, unlike most countries, radioactive waste management activities including waste disposal needed no license. But after the USSR breakdown the Ukrainian Parliament -- Verkhovna Rada -- invoked the revised Law on Business activities. According to Article 4 of the Law, in order to treat or to dispose radioactive waste every enterprise has to get a special permission or license. In compliance with the Law, the Cabinet of Ministers by its Ordinance of January 13, 1993, authorized the Ukrainian State Committee for Nuclear and Radiation Safety (UkrSCNRS) to issue special permissions or licenses for waste treatment and disposal. And that requirement was valid not only for future activities but also for existing facilities in operation. Taking into account the undergoing legislative process, SCNRS began to develop its licensing process without waiting for the special nuclear laws to be passed. On the basis of the legislation already in effect, first of all the Law on Enterprises (full responsibility of enterprises for their activities) and Law on Business activities (requirement to have a license for special types of activities), the newly formed national regulatory body had to identify all the enterprises that needed to be licensed, to establish relevant procedures, to develop related regulatory documents, to implement these procedures and documents at operating enterprises, and for each case to make a decision concerning feasibility of issuing a license, period of validity and license conditions
An analysis of referrals received by a psychiatric unit in a general hospital part 1: the need for and research design adopted to study referrals received by a psychiatric unit in a general hospital: research. M. Dor, V.J. Ehlers, M.M. Van der Merwe ...
Almberg, Maria; Selander, Helena; Falkmer, Marita; Vaz, Sharmila; Ciccarelli, Marina; Falkmer, Torbjörn
Little is known about whether individuals with autism spectrum disorder (ASD) or attention deficit hyperactive disorder (ADHD) experience any specific facilitators or barriers to driving education. To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learner's permit, from the perspective of the learner drivers and their driving instructors. Data were collected from 33 participants with ASD or ADHD, and nine of their driving instructors. Participants with ASD required twice as many driving lessons and more on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to "unfamiliar" driving situations to be the greatest challenges. Obtaining a driving license was associated with stressful training experience.
Driver, J M; Nelson, T G; Simpson, R; Wall, C
There are currently over 9000 British soldiers serving in Afghanistan. The Defence Medical Services provide primary health care to soldiers at forward locations using Regimental Medical Officers (RMOs) and General Duties Medical Officers (GDMOs). If required, GDMOs can refer patients to senior colleagues. Currently, little is known about the reasons for referrals by GDMOs. This study aims to identify the main factors affecting why GDMOs refer from forward locations. Nine GDMOs, who deployed on Operation HERRICK 13, were invited to join the study. They maintained a log of their referrals for two 14 day periods, one in each half of their tour. In addition, a semi-structured interview was performed with each GDMO in order to elicit the common themes surrounding referrals. The mean referral rate was 0.9 referrals/GDMO/week. The main reasons for referral were dental problems, musculoskeletal injuries, abdominal pain of unknown cause, and ano-genital problems. Factors that influenced referrals included availability of forwardly projected services (dentist and physiotherapist), manpower availability at the locations, the availability of flights (affected by weather, enemy action, and schedule of routine flights), and the timing of the tour in relation to leave. Referrals from GDMOs were due to doctor inexperience in the treatment of a particular condition, lack of access to investigations and the potential for deterioration in a location without adequate support. The referral decision process was affected by the patient's importance with regards to the mission, the weather and access to safe transportation. The introduction of clinical guidelines for common conditions in conjunction with minor alterations to GDMO training could help reduce referrals from Role 1, preserving manpower, reducing costs, and minimising risk to evacuation aircraft.
Aragam, Krishna G; Dai, Dadi; Neely, Megan L; Bhatt, Deepak L; Roe, Matthew T; Rumsfeld, John S; Gurm, Hitinder S
Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients. This study sought to determine the prevalence of and factors associated with referral to cardiac rehabilitation in a national PCI cohort, and to assess the association between insurance status and referral patterns. Consecutive patients who underwent PCI and survived to hospital discharge in the National Cardiovascular Data Registry between July 1, 2009 and March 31, 2012 were analyzed. Cardiac rehabilitation referral rates, and patient and institutional factors associated with referral were evaluated for the total study population and for a subset of Medicare patients presenting with acute myocardial infarction. Patients who underwent PCI (n = 1,432,399) at 1,310 participating hospitals were assessed. Cardiac rehabilitation referral rates were 59.2% and 66.0% for the overall population and the AMI/Medicare subgroup, respectively. In multivariable analyses, presentation with ST-segment elevation myocardial infarction (odds ratio 2.99; 95% confidence interval: 2.92 to 3.06) and non-ST-segment elevation myocardial infarction (odds ratio: 1.99; 95% confidence interval: 1.94 to 2.03) were associated with increased odds of referral to cardiac rehabilitation. Models adjusted for insurance status showed significant site-specific variability in referral rates, with more than one-quarter of all hospitals referring rehabilitation. Site-specific variation in referral rates is significant and is unexplained by insurance coverage. These findings highlight the potential need for hospital-level interventions to improve cardiac rehabilitation referral rates after PCI. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Craig, John W.; Kuo, P.T.
In preparation for license renewal reviews, the Nuclear Regulatory Commission has recently published for public review and comment a proposed rule for license renewal and a draft Standard Review Plan as well as a draft Regulatory Guide relating to the implementation of the proposed rule. In support of future license renewal applications, the nuclear industry has also submitted 11 industry reports for NRC review and approval. This paper briefly describe how these parallel regulatory and industry activities will be factored into the NRC review process for license renewal. (author)
In The Netherlands, young novice drivers (18-24 years of age) show a crash rate that is five times higher than that of experienced drivers (30-59 years of age). The rate of young males is even seven times as high. The main reasons are lack of driving experience and hazardous behaviour typical of
... corporate structure of which licensee is a part, if any. However, the license shall not be assignable or... license upon the policies of the United States Government; (3) The effect of the license upon domestic and... extent of U.S. Government contribution to the development of the invention; (iv) The degree of...
... certified mail, return receipt requested, advising the licensee that if payment is not mailed in accordance.... Where the license at issue is a historical license, this will result, pursuant to § 6.23(b), in the person's loss of historical eligibility for such license. (d) Licensees may elect not to accept certain...
Berg, Shipra; Berg, Erlend
To investigate whether the youngest children in each school cohort are overrepresented as users of specialist mental health services. Dates of birth were obtained for all 9,157 children and adolescents referred to specialist mental health services in 3 London boroughs from 2008 to 2011. The actual frequency of referrals by month of birth is compared to the expected frequency of referrals as determined by birth statistics for the relevant age group. August-born children, who are the youngest in their cohorts in England, represent 9.38% of referrals but only 8.59% of the population in the relevant age segment. Hence, August-born children are overrepresented in referrals to specialist mental health services (P value = .007). September- and October-born children, who are the oldest in their cohorts, are underrepresented: September-born children represent 8.62% of the population but 7.99% of referrals to mental health services (P value = .032), and October-born children are 8.56% of the population but 7.86% of referrals (P value = .016). Being among the youngest in a school cohort is associated with a higher risk of referral to mental health services, while being among the oldest is a protective factor. © Copyright 2014 Physicians Postgraduate Press, Inc.
Scott, John R; Wong, Eric; Sowerby, Leigh J
No literature exists which examines referral preferences to, or the consultation process with, Otolaryngology. In a recent Canadian Medical Association nation-wide survey of General Practitioners and Family Physicians, Otolaryngology was listed as the second-most problematic specialty for referrals. The purpose of this study was to learn about and improve upon the referral process between primary care physicians (PCPs) and Otolaryngology at an academic centre in Southwestern Ontario. PCPs who actively refer patients to Otolaryngology within the catchment area of Western University were asked to complete a short paper-based questionnaire. Data was analyzed using descriptive statistics. A total of 50 PCPs were surveyed. Subspecialty influenced 90.0% of the referrals made. Specialist wait times altered 58.0% of referrals. All PCPs preferred to communicate via fax. Half of those surveyed wanted clinical notes from every encounter. Seventy-four percent of respondents wanted inappropriate referrals forwarded to the proper specialist automatically. Twenty-two percent of those surveyed were satisfied with current wait times. A central referral system was favored by 74% of PCPs. Improvements could help streamline the referral and consultation practices with Otolaryngology in Southwestern Ontario. A central referral system and reduction in the frequency of consultative reports can be considered.
Referral letters act as permission slips to allow patients easy access to ... Methods: A qualitative study method was used, as the purpose of this study was to .... The total list of topics ..... Research design: qualitative and quantitative approaches.
Styles, David; O'Brien, Kieran; Jones, Michael B
This paper presents an innovative, quantitative assessment of pollution avoidance attributable to environmental regulation enforced through integrated licensing, using Ireland's pharmaceutical-manufacturing sector as a case study. Emissions data reported by pharmaceutical installations were aggregated into a pollution trend using an Environmental Emissions Index (EEI) based on Lifecycle Assessment methodologies. Complete sectoral emissions data from 2001 to 2007 were extrapolated back to 1995, based on available data. Production volume data were used to derive a sectoral production index, and determine 'no-improvement' emission trends, whilst questionnaire responses from 20 industry representatives were used to quantify the contribution of integrated licensing to emission avoidance relative to these trends. Between 2001 and 2007, there was a 40% absolute reduction in direct pollution from 27 core installations, and 45% pollution avoidance relative to hypothetical 'no-improvement' pollution. It was estimated that environmental regulation avoided 20% of 'no-improvement' pollution, in addition to 25% avoidance under business-as-usual. For specific emissions, avoidance ranged from 14% and 30 kt a(-1) for CO(2) to 88% and 598 t a(-1) for SO(x). Between 1995 and 2007, there was a 59% absolute reduction in direct pollution, and 76% pollution avoidance. Pollution avoidance was dominated by reductions in emissions of VOCs, SO(x) and NO(x) to air, and emissions of heavy metals to water. Pollution avoidance of 35% was attributed to integrated licensing, ranging from between 8% and 2.9 t a(-1) for phosphorus emissions to water to 49% and 3143 t a(-1) for SO(x) emissions to air. Environmental regulation enforced through integrated licensing has been the major driver of substantial pollution avoidance achieved by Ireland's pharmaceutical sector - through emission limit values associated with Best Available Techniques, emissions monitoring and reporting requirements, and
Eensoo, Diva; Paaver, Marika; Harro, Jaanus
Road traffic collisions caused by drunk driving pose a significant public health problem all over the world. Therefore additional preventive activities against drunk driving should be worked out. The aim of the study was to assess drunk driving in novice drivers after a psychological intervention taking into account also impulsivity, law obedience, and alcohol-related measures. An intervention study was started with 1889 car driver's license attempters during their driving school studies. Subjects were classified as intervention group (n=1083, mean age 23.1 (SD=7.4) years), control group (n=517, mean age 22.8 (SD=7.1) years) and "lost" group (n=289, mean age 23.0 (SD=6.9) years). "Lost" group subjects had been assigned into the intervention group, but they did not participate in the intervention. Subjects of the intervention group participated in a psychological intervention on the dangers of impulsive behavior in traffic. After a three year follow-up period it appeared that in the control group and in the lost group there was a significantly higher proportion of drunk drivers than in the intervention group, 3.3% (n=17), 3.5% (n=10) and 1.5% (n=10) (p=0.026), respectively. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving (p=0.015), and the impact of the intervention was persistent also in the case of higher scores in Mild social deviance. In subjects with higher scores in impulsivity measures and alcohol-related problems the impact of short psychological intervention was not sufficient for preventing drunk driving. It can be concluded that psychological intervention used during the driving school studies is an effective primary prevention activity against drunk driving. However, for drivers with high scores in impulsivity measures and alcohol-related problems, the short psychological intervention is not sufficient in reducing drunk driving behavior.
... 25 Indians 1 2010-04-01 2010-04-01 false Marriage licenses. 11.601 Section 11.601 Indians BUREAU... ORDER CODE Domestic Relations § 11.601 Marriage licenses. A marriage license shall be issued by the clerk of the court in the absence of any showing that the proposed marriage would be invalid under any...
Wu, Jianqing; Xu, Hao
Understanding driver behavior is important for traffic safety and operation, especially at intersections where different traffic movements conflict. While most driver-behavior studies are based on simulation, this paper documents the analysis of driver-behavior at signalized intersections with the SHRP 2 Naturalistic Driving Study (NDS) data. This study analyzes the different influencing factors on the operation (speed control) and observation of right-turn drivers. A total of 300 NDS trips at six signalized intersections were used, including the NDS time-series sensor data, the forward videos and driver face videos. Different factors of drivers, vehicles, roads and environments were studied for their influence on driver behavior. An influencing index function was developed and the index was calculated for each influencing factor to quantitatively describe its influencing level. The influencing index was applied to prioritize the factors, which facilitates development and selection of safety countermeasures to improve intersection safety. Drivers' speed control was analyzed under different conditions with consideration of the prioritized influencing factors. Vehicle type, traffic signal status, conflicting traffic, conflicting pedestrian and driver age group were identified as the five major influencing factors on driver observation. This research revealed that drivers have high acceleration and low observation frequency under Right-Turn-On-Red (RTOR), which constituted potential danger for other roadway users, especially for pedestrians. As speed has a direct influence on crash rates and severities, the revealed speed patterns of the different situations also benefit selection of safety countermeasures at signalized intersections. Published by Elsevier Ltd.
The supply used in servo systems tends to have a high voltage in order to reduce loss and improve the response of motor drives. We propose a new boost motor driver that comprises EDLCs. The proposed driver has a simple structure, wherein the EDLCs are connected in series to the supply, and comprises a charge circuit to charge the EDLCs. The proposed driver has three advantages over conventional boost drivers. The first advantage is that the driver can easily attain the stable boost voltage. The second advantage is that the driver can reduce input power peaks. In a servo system, the input power peaks become greater than the rated power in order to accelerate the motor rapidly. This implies that the equipments that supply power to servo systems must have sufficient power capacity to satisfy the power peaks. The proposed driver can suppress the increase of the power capacity of supply facilities. The third advantage is that the driver can store almost all of the regenerative energy. Conventional drivers have a braking resistor to suppress the increase in the DC link voltage. This causes a considerable reduction in the efficiency. The proposed driver is more efficient than conventional drivers. In this study, the experimental results confirmed the effectiveness of the proposed driver and showed that the drive performance of the proposed driver is the same as that of a conventional driver. Furthermore, it was confirmed that the results of the simulation of a model of the EDLC module, whose capacitance is dependent on the frequency, correspond well with the experimental results.
Hassan EL Rashidy, R.A.
The current practice for assessing driver competence performance is in-cab riding by driver managers. However, this paper investigates whether real-world driving data extracted from on-train monitoring recorders data (OTMR) can be used to assess the driver performance. A number of indicators were used to evaluate the drivers’ performance. These include: their use of the emergency bypass switch, the driver's reminder appliance as well as the driver’s reaction time. A study case illustrated the applicability of OTMR data to estimate the proposed indicators, which suggests that the indicators can be useful in the driver management system in addition to the current indicators. Furthermore, the proposed indicators could be used to tailor the driver training schemes up to their individual needs and evaluate their effectiveness. They could even be used for improving driver competence performance and reducing crash involvement by revealing potentially detrimental driving performance. (Author)
Hong, Xianpei; Yang, Lijun; Zhang, Huaige; Zhao, Dan
This paper extends the work of Wang (2002) by considering a differentiated Stackelberg model, when the leader firm is an inside innovator and licenses its new technology by three options, that is, fixed-fee licensing, royalty licensing, and two-part tariff licensing. The main contributions and conclusions of this paper are threefold. First of all, this paper derives a very different result from Wang (2002). We show that, with a nondrastic innovation, royalty licensing is always better than fixed-fee licensing for the innovator; with a drastic innovation, royalty licensing is superior to fixed-fee licensing for small values of substitution coefficient d; however when d becomes closer to 1, neither fee nor royalty licensing will occur. Secondly, this paper shows that the innovator is always better off in case of two-part tariff licensing than fixed-fee licensing no matter what the innovation size is. Thirdly, the innovator always prefers to license its nondrastic innovation by means of a two-part tariff instead of licensing by means of a royalty; however, with a drastic innovation, the optimal licensing strategy can be either a two-part tariff or a royalty, depending upon the differentiation of the goods.
Full Text Available Objectives. The national Department of Health strongly advocates the strengthening of primary health care systems, and recommendations for appropriate level of care referrals exist. Very few published data on the scope of current ambulatory specialised psychiatric hospital services in South Africa are currently available, making it difficult to assess whether these recommendations are being followed. As a starting point, an audit was conducted to obtain a profile of new non-urgent general adult patients seen at Stikland Hospital with a view to evaluating system needs and demands. Methods. The folders of 103 consecutively seen patients were selected for retrospective review. Patient demographic, referral and assessment information was entered into a single database. Descriptive statistics were compiled with reference to the above variables using SPSS. Results. Overall 58.3% of referrals were from the private sector. More than a third (36.7% of referral letters stated no clear reason for referral and 41.7% no psychiatric diagnosis, and 29.1% of patients were referred without psychotropic medication being started. On assessment 62.1% of patients were found to have a single Axis I diagnosis. Despite virtually no referral letters making any mention of them, substance use disorders (30.1%, personality traits/disorders (35.9% and co-morbid medical illness (36.7% were commonly found on assessment. Conclusions. A significant portion of the patients in our sample could have been managed at primary care level and were referred prematurely. The overall quality of referral letters was poor, and they lacked vital information required for appropriate pre-assessment decision making. Undergraduate training focusing on these skills should be intensified, and consideration should be given to incorporating aspects of our findings into primary health care updates.
Wu, Qiong; Zhang, Guohui; Ci, Yusheng; Wu, Lina; Tarefder, Rafiqul A; Alcántara, Adélamar Dely
Teenage drivers are more likely to be involved in severely incapacitating and fatal crashes compared to adult drivers. Moreover, because two thirds of urban vehicle miles traveled are on signal-controlled roadways, significant research efforts are needed to investigate intersection-related teenage driver injury severities and their contributing factors in terms of driver behavior, vehicle-infrastructure interactions, environmental characteristics, roadway geometric features, and traffic compositions. Therefore, this study aims to explore the characteristic differences between teenage and adult drivers in intersection-related crashes, identify the significant contributing attributes, and analyze their impacts on driver injury severities. Using crash data collected in New Mexico from 2010 to 2011, 2 multinomial logit regression models were developed to analyze injury severities for teenage and adult drivers, respectively. Elasticity analyses and transferability tests were conducted to better understand the quantitative impacts of these factors and the teenage driver injury severity model's generality. The results showed that although many of the same contributing factors were found to be significant in the both teenage and adult driver models, certain different attributes must be distinguished to specifically develop effective safety solutions for the 2 driver groups. The research findings are helpful to better understand teenage crash uniqueness and develop cost-effective solutions to reduce intersection-related teenage injury severities and facilitate driver injury mitigation research.
AIM: To analyse inpatient consultation referrals to the Dermatology Department and to identify the educational needs of junior\\/trainee doctors. METHODS: Consultation data of inpatients referred to the Dermatology Department between 2001 and 2006 was reviewed. RESULTS: There were 703 referrals identified. Patients were referred from all wards in the hospital. There were a total of 113 different dermatological diagnoses in the group. One-fifth (22%) consultations were for skin infections, 12% had atopic dermatitis, 8% had psoriasis and 8% had clear or suspected drug cause for their rash. In 391 cases, the Consultant Dermatologist\\'s diagnosis was different to the inpatient referral diagnosis on the consultation referral form. CONCLUSIONS: Our results emphasise the need for junior dermatology trainees to undertake extra training in both the dermatologic conditions. This data supports the need for expansion of service provision of dermatology in the region.
Gonçalves, M; Peralta, A R; Monteiro Ferreira, J; Guilleminault, Christian
Sleepiness is considered to be a leading cause of crashes. Despite the huge amount of information collected in questionnaire studies, only some are based on representative samples of the population. Specifics of the populations studied hinder the generalization of these previous findings. For the Portuguese population, data from sleep-related car crashes/near misses and sleepiness while driving are missing. The objective of this study is to determine the prevalence of near-miss and nonfatal motor vehicle crashes related to sleepiness in a representative sample of Portuguese drivers. Structured phone interviews regarding sleepiness and sleep-related crashes and near misses, driving habits, demographic data, and sleep quality were conducted using the Pittsburgh Sleep Quality Index and sleep apnea risk using the Berlin questionnaire. A multivariate regression analysis was used to determine the associations with sleepy driving (feeling sleepy or falling asleep while driving) and sleep-related near misses and crashes. Nine hundred subjects, representing the Portuguese population of drivers, were included; 3.1% acknowledged falling asleep while driving during the previous year and 0.67% recalled sleepiness-related crashes. Higher education, driving more than 15,000 km/year, driving more frequently between 12:00 a.m. and 6 a.m., fewer years of having a driver's license, less total sleep time per night, and higher scores on the Epworth Sleepiness Scale (ESS) were all independently associated with sleepy driving. Sleepiness-related crashes and near misses were associated only with falling asleep at the wheel in the previous year. Sleep-related crashes occurred more frequently in drivers who had also had sleep-related near misses. Portugal has lower self-reported sleepiness at the wheel and sleep-related near misses than most other countries where epidemiological data are available. Different population characteristics and cultural, social, and road safety specificities may
Research has demonstrated that older drivers pose a higher risk of involvement in fatal crashes at intersections than : younger drivers. Age-triggered restrictions are problematic as research shows that the majority of older people : have unimpaired ...
Zuchowski, Jessica L; Rose, Danielle E; Hamilton, Alison B; Stockdale, Susan E; Meredith, Lisa S; Yano, Elizabeth M; Rubenstein, Lisa V; Cordasco, Kristina M
Poor communication between primary care providers (PCPs) and specialists is a significant problem and a detriment to effective care coordination. Inconsistency in the quality of primary-specialty communication persists even in environments with integrated delivery systems and electronic medical records (EMRs), such as the Veterans Health Administration (VHA). The purpose of this study was to measure ease of communication and to characterize communication challenges perceived by PCPs and primary care personnel in the VHA, with a particular focus on challenges associated with referral communication. The study utilized a convergent mixed-methods design: online cross-sectional survey measuring PCP-reported ease of communication with specialists, and semi-structured interviews characterizing primary-specialty communication challenges. 191 VHA PCPs from one regional network were surveyed (54% response rate), and 41 VHA PCPs and primary care staff were interviewed. PCP-reported ease of communication mean score (survey) and recurring themes in participant descriptions of primary-specialty referral communication (interviews) were analyzed. Among PCPs, ease-of-communication ratings were highest for women's health and mental health (mean score of 2.3 on a scale of 1-3 in both), and lowest for cardiothoracic surgery and neurology (mean scores of 1.3 and 1.6, respectively). Primary care personnel experienced challenges communicating with specialists via the EMR system, including difficulty in communicating special requests for appointments within a certain time frame and frequent rejection of referral requests due to rigid informational requirements. When faced with these challenges, PCPs reported using strategies such as telephone and e-mail contact with specialists with whom they had established relationships, as well as the use of an EMR-based referral innovation called "eConsults" as an alternative to a traditional referral. Primary-specialty communication is a continuing
healthcare systems in certain regions of SA. ... Care Unit owing to incorrect use of referral pathways or during ... Due to budget constraints, limited resources .... Hospital. Home. Primary care clinic. Fig. 2. Origin of referral for each SD for 2011.
Macdonald, S; Albert, W; Maynard, M; French, P
This study examined characteristics of referrals to employee assistance programs (EAP) associated with subsequent termination of employment. As well, relationships between characteristics of the referrals and program characteristics were explored. Longitudinal data were collected at several time periods for 163 referrals to EAPs from five organizations. Survival analysis was conducted to determine which variables were associated with termination of employment. Females, cohabitating couples, and employees who worked for the organization for 5 or more years were most likely to remain employed. One interesting finding was that people with alcohol problems were significantly more likely to be formal referrals.
Muen, Wisam J; Hewick, Simon A
Objectives To evaluate the quality of referrals to a neovascular age-related macular degeneration clinic from optometrists using the standard Rapid Access Referral Form (RARF) from the Royal College of Ophthalmologists. Design A prospective study. Prospective data were gathered from all optometry referrals using the RARF, between the periods of December 2006 to August 2009. These were assessed for accuracy of history, clinical signs and final diagnosis as compared to a macula expert. Setting ...
Pembe, Andrea B; Mbekenga, Columba K; Olsson, Pia; Darj, Elisabeth
In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice. To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community. Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe and create meanings out of the decision-making process. In all interviews, not following the referral advice was greatly influenced by close family members. Three main traits of how referral advice was understood emerged: convinced referral is not necessary, accepting referral advice but delayed by others, and passive and moving with the wind. The main reasons given for declining the referral advice included discrediting midwives' advice, citing previous successful deliveries despite referral advice; being afraid of undergoing surgery; lack of support for care of siblings at home; and high costs incurred during referral. Declining maternal referral advice centred around the pregnant women's position and their dependence on the family members around them, with a decreased ability to show autonomy. If they were socially and economically empowered, women could positively influence decision making during maternal referrals.
Van Lerberghe Wim
Full Text Available Abstract Background For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. Methods Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants – patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. Results Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. Conclusions Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns.
Skandalis, Dean A.
MPEG LA, LLC offers a joint patent license for the AVC (a/k/a H.264) Standard (ISO/IEC IS 14496-10:2004). Like MPEG LA's other licenses, the AVC Patent Portfolio License is offered for the convenience of the marketplace as an alternative enabling users to access essential intellectual property owned by many patent holders under a single license rather than negotiating licenses with each of them individually. The AVC Patent Portfolio License includes essential patents owned by DAEWOO Electronics Corporation; Electronics and Telecommunications Research Institute (ETRI); France Telecom, societe anonyme; Fujitsu Limited; Hitachi, Ltd.; Koninklijke Philips Electronics N.V.; LG Electronics Inc.; Matsushita Electric Industrial Co., Ltd.; Microsoft Corporation; Mitsubishi Electric Corporation; Robert Bosch GmbH; Samsung Electronics Co., Ltd.; Sedna Patent Services, LLC; Sharp Kabushiki Kaisha; Siemens AG; Sony Corporation; The Trustees of Columbia University in the City of New York; Toshiba Corporation; UB Video Inc.; and Victor Company of Japan, Limited. Another is expected also to join as of August 1, 2006. MPEG LA's objective is to provide worldwide access to as much AVC essential intellectual property as possible for the benefit of AVC users. Therefore, any party that believes it has essential patents is welcome to submit them for evaluation of their essentiality and inclusion in the License if found essential.
Maria Helena Lenardt
Full Text Available Objective: to investigate the association between the condition of physical pre-frailty in elderly people and the final results of the driver license test for motor vehicles. Methods: cross-sectional study carried out with 347 elderly who underwent driver license tests. A questionnaire and tests were applied, and information on the result of the driver license test was collected. A descriptive statistical analysis and a non-parametric test were performed. Results: 163 (47.0% were found to be pre-frail, 71 (43.6% had reduced hand grip strength, 65 (39.9% had reduced level of physical activity and 62 (38.0%, reduced gait speed. The result of the driver test indicated 115 (70.6% pre-frail elderly to be able to drive with restriction. Pre-frailty was not associated with the results of the driver license test (p=0.744. Conclusion: although the pre-frail condition was frequent, there was no significant association with the result of the driver test.
Full Text Available This paper extends the work of Wang (2002 by considering a differentiated Stackelberg model, when the leader firm is an inside innovator and licenses its new technology by three options, that is, fixed-fee licensing, royalty licensing, and two-part tariff licensing. The main contributions and conclusions of this paper are threefold. First of all, this paper derives a very different result from Wang (2002. We show that, with a nondrastic innovation, royalty licensing is always better than fixed-fee licensing for the innovator; with a drastic innovation, royalty licensing is superior to fixed-fee licensing for small values of substitution coefficient d; however when d becomes closer to 1, neither fee nor royalty licensing will occur. Secondly, this paper shows that the innovator is always better off in case of two-part tariff licensing than fixed-fee licensing no matter what the innovation size is. Thirdly, the innovator always prefers to license its nondrastic innovation by means of a two-part tariff instead of licensing by means of a royalty; however, with a drastic innovation, the optimal licensing strategy can be either a two-part tariff or a royalty, depending upon the differentiation of the goods.