A Survey of Activation Importance of Individual Secondary Controls in Modified Vehicles

The results of a new survey of members of the Society of Automotive Engineers Adaptive Devices Standards Committee are presented. These findings identify priorities for secondary controls when adapting vehicle controls for drivers who are physically disabled. Previous surveys conducted in this area are cited in conjunction with the results from the current survey. The results identify the secondary controls that should be considered to have the greatest and least importance when designing the driver's compartment. A summary of additional comments made by those surveyed is also presented.     

Riding a Bus While Seated in a Wheelchair: A Pilot Study of Attitudes and Behavior Regarding Safety Practices

A total of 283 wheelchair-seated bus riders responded to a 35-item Web-based survey investigating their experiences on public, fixed-route buses. The survey addressed the use of wheelchair tiedowns and occupant restraint systems (WTORS), the attitudes and behaviors of wheelchair users toward the use of this equipment, and the transit experience. Results indicate that consistent use of four-point tiedown and occupant restraint systems is fairly low. Only 33.2% of the participants reported always securing their wheelchair, and 62.2% reported using occupant restraints consistently. A preference for fixed-route over paratransit was related to larger city size. Implementation of transit agency policy regarding WTORS was found to be inconsistent. Easier-to-use WTORS and improved operator training in larger transit agencies would likely increase the correct use of safety equipment and improve wheelchair users' bus-riding experiences.     

新型驱动基因融合阳性非小细胞肺癌脑转移的研究进展北大核心

肺癌是我国最常见且死亡率最高的恶性肿瘤之一,随着表皮生长因子受体(EGFR)、间变性淋巴瘤激酶(ALK)及活性氧1(ROS1)等驱动基因及其相应分子靶向药物的出现,晚期非小细胞肺癌的治疗和预后发生了革命性变化。此外,一些少见新型驱动基因融合,包括神经调节蛋白1(NRG1)、神经营养酪氨酸受体激酶(NTRK)和转染重排因子(RET),正逐渐发展成为全身性治疗选择。然而,这些罕见新型融合驱动基因在NSCLC脑转移中的作用机制,以及优化控制和预防脑转移的意义人们所知甚少。因此,本文就近几年罕见驱动基因融合在NSCLC脑转移中的研究进行综述。     

Ramps remain a barrier to safe wheelchair user transit bus ingress/egress

Abstract

Background: Wheelchair users (WCUs) often rely on ramps for access to transit buses. Previous studies indicate WCUs have difficulty using ramps for bus ingress/egress and many transportation-related incidents occur on ramps. However, experiences of WCU ramp usage during ingress/egress have not been fully described.

Methods: Cross-sectional, internet-based survey of WCUs who ride transit buses was conducted. The participants were queried on frequency of bus usage, difficulty and incidents involving ramps, and factors contributing to difficulty and incidents. Wheelchair characteristics, primary condition, and whether participants received travel training were also captured. Chi-square was used to describe relationships between wheelchair type and frequency of difficulties and incidents, and odd ratios were used to determine likelihood of the incidents.

Results: The majority (55.7%) of 384 participants reported using public transportation ≥ 1 per week. Seventy-eight percent of WCUs had ≥ 1 ramp incident over the past 3?years, with an increased likelihood of incidents occurring during ingress (OR = 1.53; CI 1.21–1.86). Of those who had an incident, 22% were injured or had damage to their wheelchair. Over 60% of those who had an incident identified steep ramp slope as being the contributing factor. Steep ramp slope, exterior ramp thresholds and wet surfaces were the most common contributing factors to difficulty using ramps.

Conclusion: This is the first large-scale US study enabling WCUs to describe their experiences using transit bus ramps. Despite ADA guidelines, steep ramps remain the primary factor contributing to incidents and difficulty when using ramps to access transit buses.

• Implications for rehabilitation

• The discrepancy between ADA maximum allowable ramp slopes for the built environment and transit buses may require an increased level of effort that is a barrier to transportation accessibility for some wheelchair users.

• Wheelchair users who access transit buses should be made aware of, and trained, to navigate ramp configurations found in the environment.

• We suggest rehabilitation therapists provide skills training specific to navigating transit bus ramp slopes that may be steeper and narrower than building ramps.

     

公交驾驶员职业倦怠与心理健康状况的关系研究

目的 揭示公交驾驶员职业倦怠和心理健康现状,探索二者之间的关系,为减少公交驾驶员职业倦怠、提高其心理健康水平提供参考。方法 对成都市3个公交公司的995名公交驾驶员采用Maslach职业倦怠量表普适版（MBI-GS）及一般健康问卷（GHQ-12）进行调查。结果 成都市995名公交驾驶员在职业倦怠总分及情绪衰竭、玩世不恭、成就感低落维度上的中位数和四分位数间距分别为2.33(1.58)分、2.40(3.00)分、0.75(2.00)分及2.17(3.00)分,一般心理健康总分的中位数和四分位数间距为11.00(5.00)分。不同学历、锻炼情况驾驶员倦怠总分差异有统计学意义（P＜0.05）,心理健康总分在性别、驾龄及锻炼情况上差异有统计学意义（P＜0.05）。因子分析共提取了自我否定、自我肯定、严重情绪反应3个因子。职业倦怠总分及各维度与一般心理健康总分及各因子间均呈正相关（P＜0.05）,自我否定和严重情绪反应因子对职业倦怠有较好的预测作用。结论 公交驾驶员职业倦怠现象较为严重且存在一定的心理健康问题。心理健康水平可以预测驾驶员的职业倦怠。     

Cardiovascular reaction to job stress in middle-aged train drivers

In this study, cardiovascular (CV) response to a standard laboratory challenge was compared to 24-hr noninvasive monitoring of heart rate (HR) and blood pressure (BP) in 30 healthy middle-aged train drivers. Laboratory stress test consisted of the orthostatic test, the cold pressor test, the Valsalva maneuver, the Stroop test, and the numerical square. In addition, the participants completed an extensive questionnaire on their health state and family health history, lifestyle, job stress, social and family support, personality characteristics, and health risk behaviors. In waking activities (leisure time, traveling to work, preparations for driving, and an uneventful driving) HR and systolic Wood pressure (SBP), but not diastolic Wood pressure (DBP), were normal (e.g., mean HR = 78.3, SBP = 128.6. and DBP= 92.3 during driving). In occasional stressful work situations, most participants reacted with a considerable rise in SBP and DBP (maximum values 201 for SBP and 126 for DBP). Interindividual differences in maximum BP reactions to emergency stress were predicted reliably by several psychological characteristics and by the CV reactions to the laboratory psychological challenge. The frequency, intensity, and persistence of psychological and physiological reactions to urgent situations appear to be more relevant measures of the health impact of psychological job stress than are the shift average values of physiological stress markers.     

The effect of an irregular shift system on sleepiness at work in train drivers and railway traffic controllers

Sleepiness and fatigue are frequent problems in railway transportation with occasional monotony and irregular shift schedules. This study aimed at (1) studying the prevalence of severe sleepiness in shifts and (2) examining which shift and sleep-related factors were associated with the occurrence of severe sleepiness in an irregular shift system. A total of 126 randomly selected male train drivers (Tdrs) and 104 railway traffic controllers (Tcos) were investigated using questionnaires and sleep-wake diaries. A sleep diary was used to collect information on sleepiness at work and sleeping times during the 21 consecutive days of the study. The prevalence of severe sleepiness at work (i.e. Karolinska Sleepiness Scale 7 or higher) was modelled by a logistic regression analysis for repeated measurements (GEE) using different shift schedule related factors and sleep length as explanatory variables. Severe sleepiness was reported in 49% (Tdrs) and 50% (Tcos) of the night shifts and in 20% (Tdrs) and 15% (Tcos) of the morning shifts. The odds ratios showed that the risk for severe sleepiness was 6-14 times higher in the night shift and about twice as high in the morning shift compared with the day shift. Age affected the two occupational samples differently: with Tdrs increased age was associated with an additional 8% reduction of risk for severe sleepiness for each year of age, while the Tcos did not show any age dependency. Shift length increased the risk by 15% for each hour of the shift and main sleep period decreased the risk by 15% for each hour of the main sleep. The risk of severe sleepiness was not consistently related to the time-off period before the shifts. The results indicate that adjustments for shift timing, length and off-duty time, in addition to actions aiming at extending the main sleep period, would probably decrease severe sleepiness in railway transportation.     

公交车驾驶员冲动性与心理健康的相关性研究

目的：调查公交公司驾驶员的冲动性水平及心理健康水平,并分析二者之间的关系。方法：采用自编人口学调查表、Barratt冲动性量表第11版（BIS-11）、症状自评量表（SCL-90）为研究工具,对266名公交公司驾驶员进行问卷调查。结果：公交车驾驶员的冲动性总分为（53.50±7.54）,注意冲动性（12.39±2.27）,运动冲动性（18.51±3.40）,无计划冲动性（22.62±4.29）。SCL-90中除敌对因子外,均显著高于全国常模（P<0.01）;BIS-11量表的冲动性各因子分和总分分别与SCL-90各因子得分进行相关分析,结果显示除无计划冲动性因子与SCL-90中的强迫、人际关系、偏执、精神病性及其他因子无关外,其余均呈显著正相关。逐步多元回归分析结果显示,注意力冲动性（b=7.748,P=0.000）、运动冲动性（b=2.686, P=0.022）为心理健康的影响因素,并具有正性预测作用。结论：公交车驾驶员心理健康水平低于常人,高冲动性公交公司驾驶员的心理健康水平更低,应及时进行心理干预。     

Genomic alterations and molecular subtypes of gastric cancers in Asians

Gastric cancer (GC) is a highly heterogenic disease, and it is the second leading cause of cancer death in the world. Common chemotherapies are not very effective for GC, which often presents as an advanced or metastatic disease at diagnosis. Treatment options are limited, and the prognosis for advanced GCs is poor. The landscape of genomic alterations in GCs has recently been characterized by several international cancer genome programs, including stud-ies that focused exclusively on GCs in Asians. These studies identiifed major recurrent driver mutations and provided new insights into the mutational heterogeneity and genetic proifles of GCs. An analysis of gene expression data by the Asian Cancer Research Group (ACRG) further uncovered four distinct molecular subtypes with well-deifned clini-cal features and their intersections with actionable genetic alterations to which targeted therapeutic agents are either already available or under clinical development. In this article, we review the ACRG GC project. We also discuss the implications of the genetic and molecular ifndings from various GC genomic studies with respect to developing more precise diagnoses and treatment approaches for GCs.