scholarly journals The effects of stress on the driving abilities of paramedic students: a pilot, simulator-based study

2019 ◽  
Author(s):  
Trevor Hines Duncliffe ◽  
Brittany D’Angelo ◽  
Michael Brock ◽  
Cal Fraser ◽  
Jake Lamarra ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Negative Impact ◽  
Clinical Performance ◽  
Significant Risk ◽  
List Type ◽  
Clinical Scenario ◽  
Clinical Scenarios ◽  
Stress Levels ◽  
Before And After ◽  
Effects Of Stress

AbstractBackgroundPrevious research has suggested that stress may have a negative effect on the clinical performance of paramedics. In addition, stress has been demonstrated to have a negative impact the driving abilities of the general population, increasing the number of driving errors. However, to date no studies have explored stress and its potential impact on non-clinical performance of paramedics, particularly their driving abilities.MethodsParamedic students underwent emergency driving assessment in a driving simulator before and after exposure to a stressful medical scenario. Number and type of errors were documented before and after by both driving simulator software and observation by two observers from the research team. The NASA Task Load Index (TLX) was utilised to record self-reported stress levels.Results36 students participated in the study. Following exposure to a stressful medical scenario, paramedic students demonstrated no increase in overall error rate, but demonstrated an increase in three critical driving errors, namely failure to wear a seatbelt (3 baseline v 10 post stress), failing to stop for red lights or stop signs (7 v 35), and losing control of the vehicle (2 v 11). Self-reported stress levels also increased after the clinical scenario, particularly in the area of mental (cognitive) demand.ConclusionParamedics are routinely exposed to acute stress in their everyday work, and this stress could affect their non-clinical performance. The critical errors committed by participants in this study closely matched those considered to be contributory factors in many ambulance collisions. These results stimulate the need for further research into the effects of stress on non-clinical performance in general, and highlight the potential need to consider additional driver training and stress management education in order to mitigate the frequency and severity of driving errors.Key pointsParamedics are exposed to stressful clinical scenarios during the course of their workMany critical and serious clinical calls require transport to hospitalAmbulance crashes occur regularly and pose a significant risk to the safety and wellbeing of both patients and paramedicsThis simulated clinical scenario followed by a simulated driving scenario has highlighted that stress appears to affect driving abilities in paramedic studentsThe findings of this study, although conducted in paramedic students in simulated environments, highlight the need to further investigate the effects of stress on driving abilities among paramedics

Examining the effects of stress on the driving abilities of paramedic students

2019 ◽  
Vol 9 (4) ◽  
pp. 76-83
Author(s):  
Trevor Hines Duncliffe ◽  
Brittany D'Angelo ◽  
Michael Brock ◽  
Cal Fraser ◽  
Jake Lamarra ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Acute Stress ◽  
Clinical Performance ◽  
Seat Belt ◽  
Task Load ◽  
Stress Levels ◽  
Before And After ◽  
Negative Effect ◽  
Effects Of Stress ◽  
Nasa Task Load Index

Background: Research has suggested that stress may have a negative effect on paramedics' clinical performance. Stress has also been demonstrated to negatively affect the driving abilities of the general population, increasing the number of driving errors. However, no studies have explored stress and its potential impact on the non-clinical performance of paramedics, particularly their driving abilities. Methods: Paramedic students underwent emergency driving assessment in a driving simulator before and after exposure to a stressful medical scenario. The number and type of errors were documented before and after through the use of both driving simulator software and observation by two members of the research team. The NASA Task Load Index (TLX) was used to record self-reported stress levels. Results: Thirty-six students participated in the study. Following exposure to a stressful medical scenario, paramedic students had no rise in overall error rate, but demonstrated increases in three critical driving errors: namely, failure to wear a seat belt (three baseline versus 10 after stress); failing to stop for red lights or stop signs (seven versus 35); and losing control of the vehicle (two versus 11). Self-reported stress levels also increased after the clinical scenario, particularly in the area of mental (cognitive) demand. Conclusion: Paramedics are routinely exposed to acute stress in their everyday work, and this stress could affect their non-clinical performance. The critical errors committed by participants in the present study closely matched those considered to be contributory factors in many ambulance collisions. These results illustrate the need for further research into the effects of stress on non-clinical performance in general, and highlight the potential need to consider additional driver training and stress management education to mitigate the frequency and severity of driving errors among paramedics.

scholarly journals Driving me crazy: the effects of stress on the driving abilities of paramedic students

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Trevor Hines Duncliffe ◽  
Brittany D'Angelo ◽  
Michael Brock ◽  
Cal Fraser ◽  
Nick Austin ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Acute Stress ◽  
Management Education ◽  
Negative Impact ◽  
Driving Ability ◽  
Driver Training ◽  
Before And After ◽  
Effects Of Stress ◽  
Working Day ◽  
Post Stress

<p><strong>Background</strong></p><p>Previous research has demonstrated that stress has a negative impact on the performance of paramedics while performing medical related tasks. Acute stress has also been shown to negatively impact the driving abilities of the general population increasing the number of critical driving errors performed. No literature was discovered that discussed the effects of stress on the driving abilities of paramedics.</p><p><strong>Methods</strong></p><p>Paramedic students underwent a driving ability assessment in a driving simulator. We then exposed them to a stress inducing medical scenario. Another driving assessment was then conducted. The numbers, and types of errors were documented before and after the scenario.</p><p><strong>Results</strong></p><p>36 students participated in the study. Paramedic students demonstrated no increase in overall error rate after a stressful scenario, but demonstrated an increase in three critical driving errors; failure to wear a seatbelt (3 baseline v 10 post stress, p= 0.0087), failing to stop for red lights or stop signs (7 v 35, p= &lt;0.0001), and losing controlling of the vehicle (2 v 11, p= 0.0052).</p><p><strong>Conclusion</strong></p><p>Paramedic students demonstrated an increase in critical driving errors after a stressful simulated clinical scenario. Paramedics are routinely exposed to acute stress during the course of their working day. This stress could increase the number of critical driving errors that occur. These results reinforce the need for further research, and highlight the potential need for increased driver training and stress management education in order to mitigate the frequency and severity of driving errors made by paramedics.</p>

Migration Patterns and Labor Market Outcomes

2018 ◽  
Author(s):  
Anda David ◽  
Mohamed Ali Marouani
Keyword(s):  
Labor Market ◽  
Negative Impact ◽  
Labor Market Outcomes ◽  
Wealth Index ◽  
Transition Matrices ◽  
Market Outcomes ◽  
Migration Patterns ◽  
Depth Analysis ◽  
Before And After ◽  
Spatial Composition

This chapter focuses on the external effects of emigration on non-migrants, and particularly on the interactions with labor market outcomes in Tunisia before and after the revolution. Using the new Tunisia Labor Market Panel Survey (TLMPS), we conduct an in-depth analysis of the structure and dynamics of migration, including the profile of migrants and their origin households, mainly in terms of skills and spatial composition. We investigate transition matrices, employment status, income for current migrants and returnees, and the evolution of remittances. Our analysis confirms the role of emigration as a safety valve for the Tunisian labor market. Moreover, origin households of migrants have a significantly higher wealth index. Our analysis also tends to confirm the effects of remittances on labor supply of non-migrants, which can have a negative impact on Tunisia’s unemployment rate when a crisis in destination countries affects the remittance rate negatively.

scholarly journals Potential advantages and limitations of using information fusion in media forensics—a discussion on the example of detecting face morphing attacks

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Christian Kraetzer ◽  
Andrey Makrushin ◽  
Jana Dittmann ◽  
Mario Hildebrandt
Keyword(s):  
Information Fusion ◽  
Classification Accuracy ◽  
Negative Impact ◽  
Field Application ◽  
Attack Detection ◽  
Majority Voting ◽  
Forensic Sciences ◽  
List Type ◽  
Media Forensics ◽  
Shafer Theory

AbstractInformation fusion, i.e., the combination of expert systems, has a huge potential to improve the accuracy of pattern recognition systems. During the last decades, various application fields started to use different fusion concepts extensively. The forensic sciences are still hesitant if it comes to blindly applying information fusion. Here, a potentially negative impact on the classification accuracy, if wrongly used or parameterized, as well as the increased complexity (and the inherently higher costs for plausibility validation) of fusion is in conflict with the fundamental requirements for forensics.The goals of this paper are to explain the reasons for this reluctance to accept such a potentially very beneficial technique and to illustrate the practical issues arising when applying fusion. For those practical discussions the exemplary application scenario of morphing attack detection (MAD) is selected with the goal to facilitate the understanding between the media forensics community and forensic practitioners.As general contributions, it is illustrated why the naive assumption that fusion would make the detection more reliable can fail in practice, i.e., why fusion behaves in a field application sometimes differently than in the lab. As a result, the constraints and limitations of the application of fusion are discussed and its impact to (media) forensics is reflected upon.As technical contributions, the current state of the art of MAD is expanded by: The introduction of the likelihood-based fusion and an fusion ensemble composition experiment to extend the set of methods (majority voting, sum-rule, and Dempster-Shafer Theory of evidence) used previously The direct comparison of the two evaluation scenarios “MAD in document issuing” and “MAD in identity verification” using a realistic and some less restrictive evaluation setups A thorough analysis and discussion of the detection performance issues and the reasons why fusion in a majority of the test cases discussed here leads to worse classification accuracy than the best individual classifier

Simulation of Cerebrospinal Fluid Leak Repair Using a 3-Dimensional Printed Model

2021 ◽  
pp. 194589242110035
Author(s):  
Muhamed A. Masalha ◽  
Kyle K. VanKoevering ◽  
Omar S. Latif ◽  
Allison R. Powell ◽  
Ashley Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Great Part ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Clinical Environment ◽  
Training Tool ◽  
3 Dimensional ◽  
Clinical Scenarios ◽  
Before And After ◽  
3D Printed

Background Acquiring proficiency for the repair of a cerebrospinal fluid (CSF) leak is challenging in great part due to its relative rarity, which offers a finite number of training opportunities. Objective The purpose of this study was to evaluates the use of a 3-dimensional (3D) printed, anatomically accurate model to simulate CSF leak closure. Methods Volunteer participants completed two simulation sessions. Questionnaires to assess their professional qualifications and a standardized 5-point Likert scale to estimate the level of confidence, were completed before and after each session. Participants were also queried on the overall educational utility of the simulation. Results Thirteen otolaryngologists and 11 neurosurgeons, met the inclusion criteria. A successful repair of the CSF leak was achieved by 20/24 (83.33%), and 24/24 (100%) during the first and second simulation sessions respectively (average time 04:04 ± 1.39 and 02:10 ± 01:11). Time-to-close-the-CSF-leak during the second session was significantly shorter than the first (p < 0.001). Confidence scores increased across the training sessions (3.3 ± 1.0, before the simulation, 3.7 ± 0.6 after the first simulation, and 4.2 ± 0.4 after the second simulation; p < 0.001). All participants reported an increase in confidence and believed that the model represented a valuable training tool. Conclusions Despite significant differences with varying clinical scenarios, 3D printed models for cerebrospinal leak repair offer a feasible simulation for the training of residents and novice surgeons outside the constrictions of a clinical environment.

scholarly journals Cooperation & Liaison between Universities & Editors (CLUE): recommendations on best practice

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Elizabeth Wager ◽  
◽  
Sabine Kleinert
Keyword(s):  
Peer Review ◽  
Best Practice ◽  
Research Integrity ◽  
Decision Makers ◽  
Publication Ethics ◽  
List Type ◽  
Research Institutions ◽  
Academic Journals ◽  
Before And After ◽  
Published Research

Abstract Background Inaccurate, false or incomplete research publications may mislead readers including researchers and decision-makers. It is therefore important that such problems are identified and rectified promptly. This usually involves collaboration between the research institutions and academic journals involved, but these interactions can be problematic. Methods These recommendations were developed following discussions at World Conferences on Research Integrity in 2013 and 2017, and at a specially convened 3-day workshop in 2016 involving participants from 7 countries with expertise in publication ethics and research integrity. The recommendations aim to address issues surrounding cooperation and liaison between institutions (e.g. universities) and journals about possible and actual problems with the integrity of reported research arising before and after publication. Results The main recommendations are that research institutions should: develop mechanisms for assessing the integrity of reported research (if concerns are raised) that are distinct from processes to determine whether individual researchers have committed misconduct; release relevant sections of reports of research integrity or misconduct investigations to all journals that have published research that was investigated; take responsibility for research performed under their auspices regardless of whether the researcher still works at that institution or how long ago the work was done; work with funders to ensure essential research data is retained for at least 10 years. Journals should: respond to institutions about research integrity cases in a timely manner; have criteria for determining whether, and what type of, information and evidence relating to the integrity of research reports should be passed on to institutions; pass on research integrity concerns to institutions, regardless of whether they intend to accept the work for publication; retain peer review records for at least 10 years to enable the investigation of peer review manipulation or other inappropriate behaviour by authors or reviewers. Conclusions Various difficulties can prevent effective cooperation between academic journals and research institutions about research integrity concerns and hinder the correction of the research record if problems are discovered. While the issues and their solutions may vary across different settings, we encourage research institutions, journals and funders to consider how they might improve future collaboration and cooperation on research integrity cases.

Impact of Dividend Tax Change on the Payout Policy of Indian Companies

2019 ◽  
Vol 20 (5) ◽  
pp. 1282-1291
Author(s):  
Sanjay Dhamija ◽  
Ravinder Kumar Arora
Keyword(s):  
Negative Impact ◽  
Payout Policy ◽  
Tax Law ◽  
Dividend Payout ◽  
Inside Ownership ◽  
Regulatory Changes ◽  
Before And After ◽  
The Government ◽  
The Impact ◽  
Dividend Tax

The article examines the impact of regulatory changes in the tax on dividends on the payout policy of Indian companies. The tax law was recently amended to levy tax on dividends received by large shareholders. As the promoters group is the largest shareholder, this is expected to have a negative impact on the payout policy of companies. Furthermore, companies with larger promoter holdings have a higher motivation to reduce their payout. The study covers 370 companies present in the BSE 500 Index and compares the dividend payout of the companies before and after the introduction of tax levy. The study finds that the newly introduced tax indeed caused a shift in the dividend policy of companies, particularly those companies which have high levels of inside ownership. The findings have significant implications for companies, investors and the government.

Spouse Caregivers' Perceptions of Influence of Dementia on Marriage

2002 ◽  
Vol 14 (1) ◽  
pp. 47-58 ◽  
Author(s):  
Ulla Eloniemi-Sulkava ◽  
Irma-Leena Notkola ◽  
Kaija Hämäläinen ◽  
Terhi Rahkonen ◽  
Petteri Viramo ◽  
...  
Keyword(s):  
Behavioral Change ◽  
Intervention Study ◽  
Negative Impact ◽  
Behavioral Changes ◽  
Telephone Interviews ◽  
Before And After ◽  
Spouse Caregivers ◽  
Dementing Illness ◽  
Male Patients ◽  
Patients Experience

Objectives: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. Design: Semistructured telephone interviews of spouse caregivers of demented patients. Setting: Community-living demented patients and their spouse caregivers in eastern Finland. Participants: The spouse caregivers of 42 demented patients recruited from a previous intervention study. Measures: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. Results: A statistically significant decline had occured in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). Conclusions: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.

Abstract 2605: Hypoglycemia Does Not Increase Long-term Mortality Or Morbidity In Diabetic Patients With Myocardial Infarction. A Report From The Digami 2 Trial.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Linda G Mellbin ◽  
Klas Malmberg ◽  
Anders Waldenstrom ◽  
Hans Wedel ◽  
Lars Ryden
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Negative Impact ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Diabetic Patients ◽  
Type 2 Dm ◽  
Hazard Ratios

Aims Tight, insulin-based glucose control is recommended to diabetic patients (DM pat) with acute myocardial infarction (AMI). A potential draw-back would be if insulin induced hypoglycaemia (HG) had a negative impact of future prognosis. Methods 1253 pat (mean age 68 years; 67% males) with type 2 DM and suspect AMI were followed for a median of 2.1 years. 947 were randomised to insulin infusion during at least 24 hours while 306 were treated routinely. HG (blood glucose<3.0 mmol/L with or without symptoms) was recorded during hospitalisation. Unadjusted and adjusted (age, sex, smoking, previous MI and heart failure, renal function, duration of DM, coronary interventions, blood glucose at randomisation) Hazard Ratios (HR) and 95% Confidence Intervals (CI) for cardiovascular events (CVE = death, MI or stroke) during follow up were calculated. Results 153 pat (12.2%) experienced HG. During the first 24 hours 111 (11.7%) insulin-treated pat experienced HG (symptomatic 23.4%) compared with 3 (1.0%) pat on routine treatment (symptomatic 33.3%). As outlined in the figure HG was not an independent predictor of subsequent CVE. Conclusion Insulin induced HG was not a significant risk factor for subsequent CVE in AMI-pat with type 2 DM. Hypoglycaemic seem to identify patients at high risk for other reasons.

Safety Impact of Weaving Distance on Freeway Facilities with Managed Lanes using Both Microscopic Traffic and Driving Simulations

2018 ◽  
Vol 2672 (39) ◽  
pp. 130-141 ◽  
Author(s):  
Qing Cai ◽  
Moatz Saad ◽  
Mohamed Abdel-Aty ◽  
Jinghui Yuan ◽  
Jaeyoung Lee
Keyword(s):  
Traffic Safety ◽  
Traffic Congestion ◽  
Driving Simulator ◽  
Negative Impact ◽  
Control Strategies ◽  
General Purpose ◽  
Valuable Insight ◽  
Lane Change ◽  
Simulation Studies ◽  
Managed Lanes

With the challenges of increasing traffic congestion, the concept of managed lanes (MLs) has been gaining popularity recently as a means to effectively improve traffic mobility. MLs are usually designed to be left-lane concurrent with an at-grade access/exit. Such a design forms weaving segments since it requires vehicles to change multiple general purpose lanes (GPLs) to enter or exit the ML. The weaving segments could have a negative impact on traffic safety in the GPLs. This study provides a comprehensive investigation of the safety impact of different lengths for each lane change maneuver on GPL weaving segments close to the ingress and egress of MLs through two simulation approaches: VISSIM microsimulation and driving simulator. The two simulation studies are developed based on traffic data collected from freeway I-95 in Miami, Florida. The results from the two simulation studies support each other. Based on the two simulation studies, it is recommended that 1,000 feet be used as the optimal length for per lane change at the GPLs weaving segments with MLs. The safety impact of traffic volume, variable speed limit control strategies, and drivers’ gender and age characteristics are also explored. This study can provide valuable insight for evaluating the traffic performance of freeway weaving segments with the presence of concurrent GPLs and MLs in a highway safety context. It also provides guidelines for future conversion of freeways to include MLs.

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