Impact of Texting Laws on Motor Vehicular Fatalities in the United States

Using a panel study design, we examined the effects of different types of texting bans on motor vehicular fatalities.We used the Fatality Analysis Reporting System and a difference-in-differences approach to examine the incidence of fatal crashes in 2000 through 2010 in 48 US states with and without texting bans. Age cohorts were constructed to examine the impact of these bans on age-specific traffic fatalities.Primarily enforced laws banning all drivers from texting were significantly associated with a 3% reduction in traffic fatalities in all age groups, and those banning only young drivers from texting had the greatest impact on reducing deaths among those aged 15 to 21 years. Secondarily enforced restrictions were not associated with traffic fatality reductions in any of our analyses.Motor vehicle safety has been described as one of the 10 great public health achievements in the United States in the past decade,1 with car manufacturers and highway engineers making significant improvements to car and roadway safety features.2 Despite these improvements, traffic fatalities remain one of the leading causes of death in the United States,3 with an estimated 32 788 such deaths in 2010.4 Thus, road traffic fatalities continue to be a significant public health concern,5,6 garnering much attention from state lawmakers.In an effort to reduce motor vehicle fatalities, states have enacted restrictions on drunk driving, implemented graduated driver’s license programs, and mandated seatbelt use and special licensing procedures for older adults. Most recently, states have focused on restricting texting while driving.7–9 Generally, states define texting as reading, manual composition, or sending of electronic communications—text messages, instant messages, or e-mails—via a portable electronic device. Portable electronic devices include mobile (i.e., cellular) phones, personal digital assistants, and laptop computers. Texting while driving is a serious threat to road safety,10–13 given that research has shown that mobile phone use is associated with impaired following distance,14 improper lane position,11,15 longer reaction times,11,14,16 and crashes,11,17 which can all lead to significant adverse public health outcomes, including death.18 Unlike talking on a mobile phone while driving, texting poses a unique threat in that it requires drivers to take their eyes off the road for several seconds at a time.14Our current understanding of the impact of texting laws on driving outcomes is limited. To our knowledge, 2 studies have empirically examined the impact of texting laws on adverse motor vehicle outcomes. The first was published by the Highway Loss Data Institute.19 It examined the relationship of collision claim frequency and texting bans in just 4 states (CA, LA, MN, and WA). The authors found that texting bans were associated with increased collision claims. They speculated that this increase might be due to drivers hiding their phones from view to avoid fines and, in so doing, taking their eyes off the road more than they did before the bans. More recently, Abouk and Adams20 published the first national-level study of texting bans’ impacts on traffic fatalities. They examined the impact of texting-while-driving bans on the occurrence of only single-vehicle, single-occupant accidents between 2007 and 2010. Their findings indicated that stronger bans that are applied to all drivers were associated with decreases in single-vehicle, single-occupant accidents.The purpose of this study is to add to the knowledge base concerning the effectiveness of texting laws, particularly by considering the varying stringency levels of these laws. Texting bans can be secondarily enforced (i.e., an officer must have another reason to stop a vehicle before citing a driver for texting while driving) or primarily enforced (i.e., an officer does not have to have another reason for stopping a vehicle). Furthermore, some states ban texting among learner’s permit holders, and some ban texting among all those aged 18 years, 21 years, or younger, and still other states ban all drivers from texting. Some states have no texting laws at all. We consider the impact of each of these policy nuances on traffic fatalities in 48 states over an 11-year period. Moreover, given that younger individuals are more likely to text while driving,21 we examine the impact of texting laws on age-specific traffic fatalities. Overall, this study will be of interest to policymakers, law enforcement personnel, and other stakeholders interested in improving roadway safety and, by extension, public health.     

The efficacy and safety of cyclosporine reduction in de novo renal allograft patients receiving sirolimus and corticosteroids: results from an open‐label comparative study

This study evaluated the safety and efficacy of a sirolimus, corticosteroid, and cyclosporine reduction regimen in an open‐label, 12‐month trial of 420 de novo renal allograft recipients at 49 European transplant centers. One month post‐transplantation, 357 patients were randomized to receive standard‐dose cyclosporine (sCsA, n = 179) or reduced‐dose cyclosporine (rCsA, n = 178). All patients also received sirolimus and corticosteroids. The primary end points were the rate of biopsy‐confirmed acute rejection (BCAR) and renal function, as measured by serum creatinine. Baseline demographic and donor characteristics were similar between groups. BCAR rates at 12 months were not significantly different: 11.2% for rCsA patients and 16.2% for sCsA patients. Mean serum creatinine (±SEM) was significantly lower (1.75 ± 0.10 vs. 1.97 ± 0.07 mg/dl, P < 0.001), and creatinine clearance (±SEM; Nankivell method) was significantly higher (57.8 ± 1.78 vs. 49.5 ± 2.46 ml/min, P < 0.001) in patients receiving rCsA versus sCsA at 1 year, respectively. Patient and graft survival exceeded 98% in both groups. No significant differences in infection or malignancy were noted between groups. The rCsA with sirolimus and corticosteroid regimen resulted in excellent 12‐month patient and graft survival, a low incidence of BCAR, and improved renal function in renal allograft recipients. Sirolimus administered with rCsA and corticosteroids provided adequate immunosuppression while reducing the potential for the nephrotoxic effects of cyclosporine. These findings may help to improve long‐term renal allograft outcomes.     

Spielen. Aber szenisch-kreativ!

Zeitschrift für Psychodrama und Soziometrie - In diesem Beitrag in der Zeitschrift für Psychodrama und Soziometrie wird gezeigt, dass sich grundlegende Bestimmungen des Spiels, die...     

Radical operations for carcinoma of the gallbladder: Present status in Germany

Despite the overall poor prognosis of gallbladder carcinoma, it appears that, in resectable lesions, an aggressive surgical approach promises improvement in survival rates. Radical treatment of gallbladder carcinoma is based on a detailed knowledge of the lymphatic, venous, direct, and intraductal modes of spread of gallbladder carcinoma. Customized therapy of gallbladder carcinoma takes staging into consideration: if one is dealing with gallbladder carcinoma with macroscopic liver infiltration (T3 or T4), or with a pre- or intraoperatively diagnosed gallbladder carcinoma with an unknown depth of infiltration, an en bloc resection of the gallbladder with adjacent liver segments IVb and V, perhaps including VI, as well as a dissection of the hepatoduodenal ligament should be performed. If the carcinoma is missed intraoperatively at the time of cholecystectomy for other indications, in the presence of a T2 gallbladder carcinoma in proximity to the liver bed, reoperation with dissection of the hepatoduodenal ligament and resection of liver segments IVb and V should be performed. In the presence of T1 gallbladder carcinoma, simple cholecystectomy is adequate.This concept is based on our experience with 113 patients with gallbladder carcinoma who underwent treatment in our department from January, 1970 to June, 1989. Sixty-seven percent of the gallbladder carcinomas were resected, 30% for cure and 37% palliatively. In 33%, the operation was limited to an exploratory laparotomy or a palliative operation, or no operation was performed. Of the curatively resected carcinomas (n=34), 7 were Stage I, 7 Stage II, 9 Stage III, and 11 Stage IV.The average follow-up or survival time following curative resection at first operation (n=21) was 48.1 months; survival in patients who underwent curative resection at reoperation, in the presence of distant metastases, if there was tumor spillage, and in the presence of synchronous tumor was 14.0 months; survival following palliative resection was 5.8 months, and after exploratory laparotomy, palliative operation, or no operation was 3.6 months.Compared to palliative resection, customized therapy of gallbladder carcinoma for cure at the time of initial operation leads to a significant improvement in prognosis.

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Resumen A pesar del pobre pronóstico general del carcinoma de la vesícula biliar, es aparente que en las lesiones resecables un aproche quirúrgico radical promete mejores tasas de sobrevida. El tratamiento radical del carcinoma de la vesícula biliar se fundamenta en un conocimiento detallado de las modalidades de extensión linfática, venosa, directa, e intraductal del carcinoma de la vesícula biliar. La terapia es individualizada de acuerdo al estadio: si se trata de un carcinoma con infiltración macroscópica del hígado (T3 o T4), o de un carcinoma diagnosticado pre- o intraoperatoriamente con grado de infiltración no determinado, se debe proceder con una resección en bloque de la vesícula biliar y los segmentos hepáticos adyacentes IVb, y V, tal vez incluyendo VI, junto con disección del ligamento hepatoduodenal. Si el carcinoma no es detectado intraoperatoriamente en el momento de una colecistectomía realizada por otra indicación, en presencia de un carcinoma T2 en proximidad al lecho hepático, se debe emprender la reoperación con disección del ligamento hepatoduodenal y resección de los segmentos hepáticos IVb y V. En presencia de un carcinoma T1, la simple colecistectomía constituye tratamiento adecuado.Este concepto se fundamenta en nuestra experiencia con 113 pacientes con carcinoma de la vesícula biliar que fueron sometidos a tratamiento en nuestro departamento entre enero de 1970 y junio de 1989. Sesenta y siete por ciento de los carcinomas fueron resecados, 30% en forma curativa y en 37% en forma paliativa. En 33% la operación estuvo limitada a una laparotomía exploratoria o una intervención paliativa, o no se realizó operación. De los carcinomas resecados en forma curativa (n= 34), 7 fueron Estado I, 7 Estado II, 9 Estado III, y 11 Estado IV.El seguimiento promedio o tiempo de sobrevida después de una resección curativa en la primera intervención (n=21) fue 48.1 meses; después de una resección curativa en reoperación, en presencia de metástasis distantes, o si hubo desgarre del tumor o en presencia de tumor sincrónico, fue 14.0 meses; después de resección paliativa 5.8 meses y después de laparotomía exploratoria, operación paliativa o no operación, 3.6 meses.En comparación con la resección paliativa, la terapia indiviudalizada del carcinoma de la vesícula biliar con intención de curación realizada, en el momento de la primera operación, da lugar a una mejoría significativa del prónostico.

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Résumé Bien que le pronostic de cancer de la vésicule biliaire soit généralement mauvais, il semble que pour les lésions qu'on peut réséquer, l'approche chirurgicale agressive permette d'améliorer les taux de survie. Le traitement radical de la vésicule biliaire repose sur la connaissance parfaite de la dissémination à distance à partir de la vésicule dans les voies lymphatiques, veineuses, directes et biliaires. Le traitement courant du cancer de la vésicule biliaire tient compte du stade; si on traite un cancer de la vésicule biliaire avec une infiltration macroscopique du foie (T3 ou T4), ou un cancer de la vésicule biliaire diagnostiqué avant ou pendant l'intervention et dont on ne connaît pas l'étendue de l'envahissement, on doit faire une résection en bloc de la vésicule biliaire et des segments adjacents du foie IVb et V, peut-être même VI, ainsi que du ligament hépatoduodénal (petit épiploon). Si le cancer est passé inaperçu lors d'une cholécystectomie pratiquée pour d'autres diagnostics, devant un cancer T2 de la vésicule biliaire près du lit du foie, on doit faire une nouvelle intervention avec lymphadénectomie du ligament hépatoduodénal et une résection des segments IVb et V du foie. Pour un cancer T1 de la vésicule biliaire, la simple cholécystectomie suffit.Cette théorie se fonde sur notre expérience de 113 patients ayant un cancer de la vésicule biliaire et ayant eu un traitement dans notre service de janvier 1970 à juin 1989. Dans 67% des cas de cancers de la vésicule biliaire, on a fait une résection, à visée curative chez 30% des patients et à visée palliative chez 37%, Chez 33% des patients, l'intervention a été limitée à la laparotomie exploratrice ou à une intervention palliative, ou bien aucune intervention n'a été pratiquée. Pour les résections à visée curative (n=34), 7 cancers étaient de Stade I, 7 de Stade II, 9 de Stade III, et 11 de Stade IV.Le temps moyen de survie après résection à visée curative en première intervention (n=21) était de 48.1 mois; après résection à visée curative en seconde intention, avec métastases à distance, s'il y a eu effraction de la capsule tumorale et avec tumeur synchrone, 14.0 mois; après résection à visée palliative, 5.8 months et après laparotomie exploratrice, intervention à visée palliative ou pas d'opération, 3.6 mois.Comparé à la résection à visée palliative, le traitement courant du cancer de la vésicule biliaire au moment de la première intervention améliore le pronostic de façon significative.