Evidence of reduced mobility was evident during GARU admission amongst older people assessed as malnourished. Considering the results, a larger study concerning nutritional status, functionality and falls in the hospitalized population is warranted. The influence of nutritional status upon a person's physical functioning should be considered more broadly in falls research.

Ambulance crashes are a significant risk to prehospital care providers, the patients they are carrying, persons in other vehicles, and pedestrians. No uniform national transportation or medical database captures all ambulance crashes in the United States. A website captures many significant ambulance crashes by collecting reports in the popular media (the website is mentioned in the introduction). This report summaries findings from ambulance crashes for the time period of May 1, 2007 to April 30, 2009. Of the 466 crashes examined, 358 resulted in injuries to prehospital personnel, other vehicle occupants, patients being transported in the ambulance, or pedestrians. A total of 982 persons were injured as a result of ambulance crashes during the time period. Prehospital personnel were the most likely to be injured. Provider safety can and should be improved by ambulance vehicle redesign and the development of improved occupant safety restraints. Seventy-nine (79) crashes resulted in fatalities to some member of the same groups listed above. A total of 99 persons were killed in ambulance crashes during the time period. Persons in other vehicles involved in collisions with ambulances were the most likely to die as a result of crashes. In the urban environment, intersections are a particularly dangerous place for ambulances.

No abstract

Background: Driving is a complex everyday activity that requires the use and integration of different cognitive and psychomotor functions, many of which are known to be affected when under the influence of cannabis (CNB). Given legal implications of drugged-driving and rapidly increasing use of CNB nationwide, there is an urgent need to better understand the effects of CNB on such functions in the context of driving. This longitudinal, double-blind placebo-controlled study investigated the effects of CNB on driving brain-behavior relationships in a controlled simulated environment using functional MRI (fMRI). Methods: N=26 frequent cannabis users were administered 0.5 grams of 13% THC or placebo flower cannabis via a Stortz+Bickel ‘Volcano’ vaporizer using paced inhalation, on separate days at least 1 week apart. On each study day, participants drove a virtual driving simulator (steering wheel, brake, gas pedal) inside an MRI scanner approximately 40 minutes post-dosing. Each fMRI driving session presented a naturalistic simulated environment that unobtrusively engaged drivers with scenarios that tested specific driving skills and response. There were three, approximately 10 min epochs where drivers engaged in task of lane keeping/weaving (LK), lead car following (CF), and safe overtaking (OT). fMRI data were prepared for analyses using the Human Connectome Project pipeline, then subjected to group independent component analysis (ICA) to isolate 50 spatially independent networks. 40 ICA networks were deemed valid and non-noisy. Network regions in these components were identified using 387 parcel locations, incorporating a cortical parcellation atlas (Glasser et al 2016) and detailed subcortical labels. A placebo minus high difference connectivity map was generated for each subject. A similar placebo minus high behavioral score was generated for each subject and then subjected to a principal component analysis (PCA) to reduce it to 8 orthogonal behavioral factors. Of the 8 driving behavior factors, two represented CF events (F1 and F5), three LK (F3, F4, and F8), and three OT (F2, F6, and F7). Driving behavior factors were evaluated for linear association with connectivity maps via FSL’s randomize (p<0.01 FWE-corrected significance). Results:Across all components examined, we found connectivity differences between placebo v high THC within right motion-sensitive visual cortex (parcel FST) (visual) and right superior temporal gyrus (social cognition) to positively correlate with LK driving performance. The strongest brain-behavior relationships were found for OT-related behavioral factors. Connectivity in left dorsolateral parcel a9-46v (cognitive flexibility) and right motor cortex parcel 3b (somatosensory) correlated negatively with F6 (OT). A left superior frontal parcel (higher order cognition/working memory) correlated negatively with F7 (OT) and finally R inferior frontal gyrus (response inhibition and reward deduction) correlated positively with F7 (OT). Conclusion: Our preliminary analyses yield a complex yet informative picture of key brain areas sensitive to acute CNB exposure on different driving behaviors using a simulated environment, further underscoring the impact of substance use on driving as a potential public safety issue.

Background: Driving is a complex day-to-day activity that employs a variety of cognitive and psychomotor functions in harmony, many of which are known to be affected acutely by CNB intoxication which could in turn pose a significant public health risk. The recent legalization of both recreational and/or medicinal marijuana in several states has thus created an urgent need to better understand the effects of CNB on such functions in the context of driving. The present study employs a longitudinal, double-blind, placebo- 2 active dose study to investigate the effects of CNB on a variety of driving-related behaviors in a controlled, naturalistic simulated environment. Methods: The current study employed N=37 subjects (N=25 male, frequent cannabis users, mean age 24.25+7.01), each exposed to a placebo, low and high dose of CNB on three separate days. On each day, following a single acute inhaled 0.5 g dose of either 0%, 3% or 5-7% of THC via a desktop vaporizer, subjects drove a virtual driving simulator (RTI SimVehicle platform) three times inside an MRI scanner and once out of scanner, randomized, and dispersed throughout an eight hour daily period. During each driving session three distinct real time behavioral tasks corresponding to lane-keeping following simulated wind gusts (operational), lead car following (tactical) and safe overtaking (strategic) were assessed and corresponding behavioral data were computed using custom Matlab scripts. Data were analyzed using a mixed model framework in SPSS v24 which included dose, session, instrument (desktop v MRI), dose*session, dose*instrument and session*instrument as primary factors, covarying for age and sex. Results: Intoxicated subjects made significantly fewer gas pedal corrections (p<0.02) during the car following task and similarly fewer corrections to the steering reversal rate (p<0.02) during the lane weaving task, suggesting reduced awareness under the influence of cannabis. In addition we found that several variables showed significant differences in terms of estimates captured throughout the day suggesting that overall risk taking lessened as the day progressed and CNB effects wore off. Also, data trends suggested that under the high dose subjects took longer to return to baseline from their ‘impaired’ driving patterns. Key metrics that showed such significant daily effects included mean headway (p<0.001) and time to collision (p=0.02) from the car following task, deviation of lane position (p=0.03) from the lane weaving task, median gap (p=0.02) and overtaking speed (p=0.02) from the overtaking task. Although many driving measurements differed depending on whether driving was done in MRI or at a desktop setting, these differences had no relationship to different drug dose levels. Conclusion: In summary, key driving functions affected under higher doses of CNB largely agreed current cross sectional literature. Generally, largest impairments in driving behavior seemed to occur within 1-4 hours after drug exposure, which might have important implications for real life driving situations. Our preliminary analyses yield numerous metrics that changed throughout the day, suggesting broad-based impairment on many metrics commonly used to quantify driving performance and risk.