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Vaginal misoprostol before elective cesarean section for preventing neonatal respiratory distress: a randomized controlled trial
Get PDFObjective: The current study aims to evaluate the efficacy of vaginal misoprostol before elective cesarean section (ECS) for preventing the occurrence of neonatal respiratory distress (RD).
Materials and Methods: A randomized controlled trial (NCT03239327) was carried out in a tertiary-care university-affiliated hospital between June 2016 and August 2017. All eligible pregnant women scheduled for ECS were randomly allocated in a 1:1 ratio to two groups. One group, the Misoprostol group, received a misoprostol 50 mcg vaginal tablet 60 minutes before ECS while the other, the Control group, received no drugs before ECS. The primary outcome was the rate of neonatal RD among the study groups.
Results: The study included 146 women in each arm, with no significant difference between the baseline characteristics of members in each group. Primary outcomes resulted in 22 (15.1%) newborns in the misoprostol group having RD at birth versus 44 (30.1%) newborns with RD in the control (P =0.02). No differences were found between the groups regarding the need for neonatal intensive care unit (NICU) admission (P =0.61), duration of NICU stay (P =0.08) and neonatal mortality rate (P =0.73).
Conclusion: Prophylactic vaginal misoprostol at a dose of 50 mcg administered 60 minutes before ECS could reduce the rate of neonatal RD and improve the neonatal respiratory outcomes
Real-Time Effects of Age-Related Cognitive Dysfunction on Driver Vehicle Control
Get PDFThis study tackles the need to understand how driver behavior deteriorates in advancing age, with the direct goal of improving real-world assessments of age-related cognitive dysfunction and safety in older drivers. Older drivers are at-risk for cognitive dysfunction, which may lead to dementia and elevates the risk of errors that may lead to crashes. Prior research on older drivers is critically limited by studying behavior in laboratory and controlled settings. To advance the field and overcome these limitations, we combine sensor-based technologies for continuous, real-world monitoring of driver behavior with comprehensive assessments of older drivers’ cognitive function. We assess patterns of vehicle control across each driver’s personal profile of cognitive function and link age-related cognitive dysfunction to changes in safety-relevant vehicle control. We find that age-related cognitive dysfunction effects braking and accelerating behaviors, but not steering behaviors, across wide-spread driving environments. Older drivers with worse cognitive function drove less yet did not reduce exposure to specific environments that may carry greater risk. Exposure patterns suggest potential maladaptive compensatory behavioral tradeoffs that lessen older driver mobility without sufficiently mitigating safety risks. Results demonstrate that older driver behavior is highly context dependent, suggesting specific targets for interventions to improve safety while preserving mobility and quality of life, and underscore the value of using the vehicle for sensing and monitoring driver functional capacity and subsequent risk for age-related cognitive dysfunction
Driving Simulator Performance in the Acute Post-Injury Phase Following a Mild Traumatic Brain Injury Among Young Drivers
Get PDFWhile mild traumatic brain injury (mTBI) can lead to cognitive and functional impairments, little is known about how mTBI may affect driving, especially among young drivers who are at an increased risk of mTBI and motor vehicle collisions compared to other age groups. The objective of this multisite, pilot study was to examine the feasibility of assessing driving performance acutely post-injury (i.e., mTBI sustained \u3c 2 weeks at assessment) among young drivers with and without mTBIs (N=42; nmTBI= 21; ncontrol=21) using high-fidelity driving simulators. Driving performance was hypothesized to be significantly degraded, especially under conditions of high cognitive load, among drivers with mTBI compared to matched controls. Neurocognitive measures used in clinical assessment of mTBI (i.e., Cogstate Brief Battery) were hypothesized to correlate with driving simulator performance metrics. Risk management protocols were successful (i.e., no participants withdrew due to simulator sickness) and no significant increase in post-concussion symptoms was found from pre-assessment to immediately following driving assessment. Group differences on key driving variables did not emerge; however, drivers with mTBI showed a differential pattern of driving under high cognitive load. Neurocognitive correlates of simulated driving performance suggested processing speed, attention, and working memory are important functions for driving. Implications and future directions discussed
What You See is What You Get? Correspondence of Video and Interview Data on Secondary Task Engagement While Driving-A Naturalistic Driving Study
Get PDFNumerous studies use questionnaires or interviews to investigate the prevalence of secondary task engagement while driving. This data may be subject to memory distortion. This study aims at investigating the extent to which interviews are valid instruments to assess secondary tasks. Therefore, we evaluated interviews and video data allowing the observation of secondary task engagement from a Naturalistic Driving Study. We equipped the vehicles of 94 subjects with cameras filming the driver\u27s vehicle cabin. Video and interview data were collected twice within the study period of 3 days. We then determined hit rate, misses, false alarms, correct rejections, sensitivity, as well as specificity for 15 secondary tasks. We found 594 secondary tasks in the videos. In 10% of all comparisons (Nall=2.187 for 15 tasks) the interview correctly identified task engagement (hit). In 17% of the comparisons drivers missed to report a task. In 9% of the comparisons there was a false alarm and in 64% we found correct rejections. More conscious and longlasting tasks (hands-free phoning, smoking) were remembered best. The interview method seems to be a valuable and valid tool to assess rather consciously conducted and legally prohibited secondary tasks while driving