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Parkinson's disease (PD) negatively affects driver fitness. Few studies document the benefits of in-vehicle information systems (IVIS) and advanced-driver assistance systems (ADAS), the focus of this study, for drivers with PD. This study quantified the impact of IVIS and ADAS on the number of on-road driving errors. Drivers with PD (N = 107) drove a vehicle equipped with IVIS and ADAS in traffic. The activation of IVIS and ADAS resulted in fewer driver errors. Specifically, adaptive cruise control reduced the number of speeding errors on the highway. Bradykinesia correlated with driving errors with deactivated systems. Memory impairments correlated with the total number of driving errors with activated systems. Impairments in executive function and visuospatial ability were associated with more errors during system deactivation. IVIS and ADAS reduced the total number of driving errors for PD drivers; ameliorated effects of individual variations; but memory declines posed a challenge while using these technologies.

A randomized controlled trial study of self-driving in-vehicle technologies on driver fitness for people with Parkinson's diseaseThis study investigated the effects of in-vehicle information systems (IVIS) and advanced driver-assistance systems (ADAS) on the driver fitness of individuals with Parkinson's disease (PD). Notably, 107 drivers with PD drove a vehicle equipped with IVIS and ADAS. The results showed that activating these systems led to fewer speeding errors on the highway. The study identified correlations between bradykinesia, executive function, visuospatial ability, and increased errors with deactivated systems, where memory impairments correlated with increased driving errors during system activation. Although IVIS and ADAS had a positive overall effect, challenges related to memory decline existed when these technologies were in use.

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Introduction: PD is a progressive neurodegenerative disorder that affects, according to the ICF, body systems (cognitive, visual, and motor), and functions (e.g., decreased executive functions, decreased visual acuity, impaired contrast sensitivity, decreased coordination)-all which impact driving performance, an instrumental activity of daily living in the domain of "Activity" and "Participation" according to the ICF. Although there is strong evidence of impaired driving performance in PD, few studies have explored the real-world benefits of in-vehicle automation technologies, such as in-vehicle information systems (IVIS) and advanced driver assistance systems (ADAS), for drivers with PD. These technologies hold potential to alleviate driving impairments, reduce errors, and improve overall performance, allowing individuals with PD to maintain their mobility and independence more safely and for longer periods. This preliminary study aimed to fill the gap in the literature by examining the impact of IVIS and ADAS on driving safety, as indicated by the number of driving errors made by people with PD in an on-road study. Methods: Forty-five adults with diagnosed PD drove a 2019 Toyota Camry equipped with IVIS and ADAS features (Toyota Safety Sense 2.0) on a route containing highway and suburban roads. Participants drove half of the route with the IVIS and ADAS systems activated and the other half with the systems deactivated. Results: The results suggest that systems that assume control of the driving task, such as adaptive cruise control, were most effective in reducing driving errors. Furthermore, individual differences in cognitive abilities, particularly memory, were significantly correlated with the total number of driving errors when the systems were deactivated, but no significant correlations were present when the systems were activated. Physical capability factors, such as rigidity and bradykinesia, were not significantly correlated with driving error. Discussion: Taken together, these results show that in-vehicle driver automation systems can benefit drivers with PD and diminish the impact of individual differences in driver cognitive ability.

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The prevalence of phone use has become a major concern for pedestrian safety. Using smartphones while walking reduces pedestrians' ability to perceive the environment by increasing their cognitive, manual, and visual demands. The purpose of this study was to investigate the effect of common phone tasks (i.e., reading, tapping, gaming) on walking behaviors during outdoor walking. Nineteen young adults were instructed to complete four walking conditions (walking only, walking-reading, walking-tapping, and walking-gaming) along an open corridor. Results showed that all three phone tasks increased participants' neck flexion (i.e., neck kyphosis) during walking. Meanwhile, the reading task showed a greater influence on the temporal aspect during the early phases of a gait cycle. The tapping task lowered the flexion angles of the middle and lower back (i.e., torso lordosis) and induced a longer terminal double support. And the gaming task resulted in a decrease in middle back flexion, a shorter stride length, and a longer terminal double support while walking. Findings from the study confirmed our hypothesis that phone tasks changed pedestrians' physical responses to smartphone distraction while walking. To avoid potential risks caused by the observed posture and gait adaptations, safety precautions (e.g., roadside/electronic warning signals) might be imposed depending on the workload expected by different phone tasks.

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BACKGROUND: Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information. OBJECTIVE: This study aims to examine how individuals interact with two different types of health insurance decision aids (guided VBCs that mimic conversations with a real HR counselor and self-directed HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions. METHODS: In total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined. RESULTS: Both the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate. CONCLUSIONS: This study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats.

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BACKGROUND: Health insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision. OBJECTIVE: This study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source. METHODS: An introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: demographics, sources of information, health insurance literacy, and technology acceptance. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents. RESULTS: In terms of demographics, most of the respondents were women (103/126, 81.7%), represented a small household (1-2 persons; 87/126, 69%), and used their insurance 3-12 times a year (52/126, 41.3%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were Official employer or state websites and Official Human Resources Virtual Benefits Counselor Alex. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased. CONCLUSIONS: In this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies.

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INTRODUCTION: Timely transfer of patients among facilities within a regionalized critical-care system remains a large obstacle to effective patient care. For medical transport systems where dispatchers are responsible for planning these interfacility transfers, accurate estimates of interfacility transfer times play a large role in planning and resource-allocation decisions. However, the impact of adverse weather conditions on transfer times is not well understood. HYPOTHESIS/PROBLEM: Precipitation negatively impacts driving conditions and can decrease free-flow speeds and increase travel times. The objective of this research was to quantify and model the effects of different precipitation types on land travel times for interfacility patient transfers. It was hypothesized that the effects of precipitation would accumulate as the distance of the transfer increased, and they would differ based on the type of precipitation. METHODS: Urgent and emergent interfacility transfers carried out by the medical transport system in Ontario from 2005 through 2011 were linked to Environment Canada's (Gatineau, Quebec, Canada) climate data. Two linear models were built to estimate travel times based on precipitation type and driving distance: one for transfers between cities (intercity) and another for transfers within a city (intracity). RESULTS: Precipitation affected both transfer types. For intercity transfers, the magnitude of the delays increased as driving distance increased. For median-distance intercity transfers (48 km), snow produced delays of approximately 9.1% (3.1 minutes), while rain produced delays of 8.4% (2.9 minutes). For intracity transfers, the magnitude of delays attributed to precipitation did not depend on distance driven. Transfers in rain were 8.6% longer (1.7 minutes) compared to no precipitation, whereas only statistically marginal effects were observed for snow. CONCLUSION: Precipitation increases the duration of interfacility land ambulance travel times by eight percent to ten percent. For transfers between cities, snow is associated with the longest delays (versus rain), but for transfers within a single city, rain is associated with the longest delays.

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