Assessment Of Drivers Research Articles

Effects of Auditory Display Types and Acoustic Variables on Subjective Driver Assessment in a Rail Crossing Context

Highway-rail grade crossings (HRGCs) present multiple collision risks for motorists, suggesting the need for additional countermeasures to increase driver compliance. The use of in-vehicle auditory alerts (IVAAs) at HRGCs has been increasing, but there are limited standards or guidelines on how such alerts should be implemented. In the current study, we sought to investigate the effect of different auditory display variables, such as display type and acoustics, on subjective user assessments. We recruited 24 participants and asked them to rate 36 different IVAAs belonging to one of three display types (earcons—short synthetic tones, speech alerts, and hybrid alerts consisting of an earcon and speech) along 11 subjective ratings. Results showed that a hybrid alert led to better overall ratings for acceptance, safety, and semantic understanding when compared with earcon or speech alerts. Additional analyses revealed that semantic variables, such as speech order and gender, should be accounted for when designing IVAAs in an HRGC context. Hybrid IVAAs with spatial audio showed lower Urgency and Hazard level ratings. Findings of the current study can help inform the design of IVAAs for HRGCs.

Hazard Perception, Presence, and Simulation Sickness-A Comparison of Desktop and Head-Mounted Display for Driving Simulation.

Driving simulators are becoming increasingly common in driver training and assessment. Since virtual reality is generally regarded as an appropriate environment for measuring risk behavior, simulators are also used to assess hazard perception, which is considered to be one of the most important skills for safe driving. Simulators, which offer challenges that are indeed comparable to driving in real traffic, but at a very low risk of physical injury, have the potential to complement theoretical and practical driver trainings and tests. Although configurations and fidelity differ considerably between driving simulators, studies comparing the impact of their distinct features on driving performance and test validity remain rare. In this context, prior research demonstrated that a wider field of view (three monitors compared to a single monitor) led to earlier speed adjustments in response to potential hazards—especially for experienced drivers. The wider field of view was assumed to cause the drivers to be more present in the virtual world, which in turn provoked more natural scanning of the road and therefore, earlier hazard detection in experienced drivers. Research on spatial presence in other contexts support this assumption. The present experiment investigated whether this effect could be enhanced by an even more immersive presentation technique for driving simulation: a head-mounted display (HMD). Moreover, we studied the interplay between display mode, sense of presence and simulation sickness. Eighty experienced and less experienced drivers completed six simulation-based hazard perception scenarios, which were displayed either via a triple-monitor set-up or an HMD. Results indicate that the experienced drivers showed very similar driving and risk behavior as the inexperienced drivers in both experimental conditions. However, there were significant differences between the two display conditions. The use of an HMD resulted in a clearer and more abrupt speed reduction, more virtual presence, and a higher degree of simulation sickness. However, the interrelation between these three variables could not be conclusively clarified in the present study and thus represents a research aim that could be addressed in future studies.

Occupational risk assessment of passenger bus drivers

The aim of this work is improving the procedure for professional risk assessment of passenger bus drivers, taking into account ergonomic, psychosocial, individual, and hygienic factors.
 To develop the methodology for assessing the professional risk of drivers the theory of analysis was used, which allows to establish alternative solutions of the problem by determining an integrated criterion that depends on a number of individual indicators characterized by ergonomic, psychosocial, individual, and hygienic factors influencing the working conditions of the passenger bus driver.
 A checklist has been developed to quickly assess the occupational risk of passenger bus drivers, which takes into account the impact of several harmful production factors that contribute to the creation of unfavorable conditions for the occurrence of occupational diseases. A feature of this approach is the ability to distinguish the level of risk for each harmful production factor and determine the overall level of occupational risk. It is recommended to reduce the effect of occupational risk on the driver of a passenger bus to improve the system of medical examinations, the system of admission to the vehicles driving in the implementation of passenger traffic and strengthen control over the technical condition of vehicles.
 The relationship between the integrated criterion of occupational risk of the driver and indicators that are characterized by ergonomic, psychosocial, individual, and hygienic factors, which are formed by the working conditions of the driver in the carriage of passengers.
 As a result, a new approach (checklist) is proposed, which can be used in trucking companies without any additional equipment after training in testing.

Chemical Mixture Calculator - A novel tool for mixture risk assessment

Humans are continuously exposed to complex chemical mixtures from foods and the environment. Experimental models in vivo and in vitro have increased our knowledge on how we can predict mixture effects. To accommodate a need for tools for efficient mixture risk assessment across different chemical classes and exposure sources, we have developed fit-for-purpose criteria for grouping of chemicals and a web-based tool for mixture risk assessment. The Chemical Mixture Calculator (available at www.chemicalmixturecalculator.dk) can be used for mixture risk assessment or identification of main drivers of risk. The underlying database includes hazard and exposure estimates for more than 200 chemicals in foods and environment.We present a range of cumulative assessment groups for effects on haematological system, kidney, liver, nervous system, developmental and reproductive system, and thyroid. These cumulative assessment groups are useful for grouping of chemicals at several levels of refinement depending on the question addressed. We present a mixture risk assessment case for phthalates, evaluated with and without contributions from other chemicals with similar effects. This case study shows the usefulness of the tool as a starting point for mixture risk assessment by the risk assessor, and emphasizes that solid scientific insight regarding underlying assumptions and uncertainties is crucial for result interpretation.

Investigating feasibility and preliminary efficacy of a simulator-based driving intervention for people with acquired brain injury: A randomised controlled pilot study

Objective: To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury. Design: Pilot randomised controlled trial. Setting: Occupational therapy driver assessment and rehabilitation service. Subjects: Individuals post-acquired brain injury aiming to return to driving. Intervention: Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only. Main measures: Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale – Daytime, assessed at baseline and five weeks post-randomisation. Results: Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group (n = 12 Simulator, n = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group (P = 0.373). On average, the Simulator group reported a positive change in confidence ratings (M = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change (M = −6.97, SD = 8.47), P = 0.034. The Simulator group (M = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group (M = −0.83, SD = 1.83, P = 0.325). Conclusions: With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.

Why Is Energy Access Not Enough for Choosing Clean Cooking Fuels? Sustainable Development Goals and Beyond

The transition to sustainable energy requires an assessment of drivers of the use of clean and dirty fuels for cooking. Literature highlights the importance of access to modern fuel for switching from dirty fuels. Though access to cleaner fuels such as electricity promotes clean fuel use, it does not necessarily lead to a complete transition to the use of modern fuels. Households continue using traditional fuels in addition to modern fuels. We explain the choice of dirty cooking fuels even when access to electricity is provided. We use nationally representative household survey data to study the household energy use decisions in three middle-income countries, India, Kazakhstan, and the Kyrgyz Republic. We discuss the role of access to natural gas, free fuel, convenience or multi-use of fuels determined by the heating system installed, built-in environment, and other socioeconomic factors in household fuel choice for cooking. The results show that access to natural gas increases the likelihood of opting for natural gas, while the availability of free fuel in rural areas and the coal-based heating system promote the use of solid fuels.

A cross-sectional study to evaluate the validity of a novel patient-reported outcome measure of medication adherence in Type 2 Diabetes

Abstract Introduction The average medication adherence (MA) among patients in developed countries living with a chronic disease is estimated to be roughly 50%.(1) Non-adherence is multi-factorial, owing to socio-economic and clinical factors, as well as arguably the most important factor, patients’ health beliefs and experiences. Patient Reported Outcome Measures (PROMs) are often uni-dimensional in their assessment of drivers of MA. This study has evaluated a novel PROM as part of a wider international research initiative focused on Type 2 Diabetes (T2D) which assesses four key factors of MA referred to as Social (S), Psychological (P), Usage (U) and Rationale (R), in short SPUR®. Aim To compare the validity of SPUR® against previously validated PROMs in patients with T2D. Methods This South London cross-sectional study surveyed adult participants with a confirmed diagnosis of T2D prescribed a minimum of one anti-hyperglycaemic medicine. Surveys were administered face-to-face by community pharmacists using a convenience sampling method based on interactions with pharmacy patients. The survey consisted of questions relating to socio-demographic and clinical data, the SPUR® tool and three previously validated PROMs (BeMQ-General®, MARS-10® and BeMQ-Specific®) as comparators to evaluate factors P, U and R respectively. The Medication Possession Ratio (MPR), a measure of a patient’s pill count in a given time period, was used as an objective comparator of adherence. Pearson’s correlation coefficients (r) were calculated to determine the strength of association between the validated PROMs and SPUR®, with T tests used as a measure of significance (p=<0.05) as an evaluation of validity for SPUR®. Results The survey response rate was 21.6% (n=149/690). The modal age range for participants was 60–69 years of age (40.1%, n=60). Participants were predominantly educated to degree level (29.5%, n=44), White (48.3%, n=72) and retired (28.9%, n=43). Overall, 47.6% (n=71) of participants identified as female. Body Mass Index (BMI) data were available for 88.6% (n=132) of the sample with 42.4% (n=56/132) reporting a BMI >30. In ascending order, moderate to strong positive correlations were observed between SPUR® and the comparative PROMs for factors P (r=0.464, p=<0.0001), U (r=0.595, p=<0.0001) and R (r=0.719, p=<0.0001), indicating SPUR® to be a reliable measure of those MA factors. When assessing MA objectively, SPUR® demonstrated the strongest correlation (r=0.281, p=<0.0001) to MPR compared with the validated tools, with MARS-10® as the closest comparator (r=0.266, p=0.001). Despite this, SPUR® did not overestimate MA, 83.8% (n=125) of the sample was identified as adherent based on MPR compared to 53% (n=79) with SPUR®. The latter more closely reflecting HbA1c data which identified 55.4% (n=31/56) as adherent. Conclusion Study strengths include the implementation of validated PROMs and two objective MA measures; however, the study sample size was limited. SPUR® has demonstrated its validity against validated PROMs whilst predicting adherence levels without exaggeration, which is often attributed to crude objective measures such as MPR.(2) SPUR® may therefore holistically identify the multiple factors linked to non-adherence, thus supporting the design of individualised interventions.. Such interventions are deemed by the World Health Organisation as potentially more impactful than developing new treatments.(1)

Visual assessment of commercial drivers in the South West Region of Cameroon

BackgroundDriving is a visually intensive task. In Cameroon, where the burden of road traffic deaths is high, visual assessment is not universally performed before the issuance of driver licenses. This study aims to assess the visual status of commercial drivers (CDs) in the southwestern region of Cameroon, and to find its relation to road traffic crashes (RTCs).MethodsThis work was a cross-sectional community-based study on CDs in Limbe and Buea. Questionnaires were used to assess sociodemographic parameters, the incidence of RTCs, and self-reported visual status. Visual acuity (VA) was measured using a standard Snellen chart at 6 m. Statistical analysis was performed using descriptive methods: frequencies, the paired Student’s t-test, and the chi-square test.ResultsTwo hundred seven CDs were enrolled in this study, all of which were male, with a mean age of 41.8 ± 12.1 years. A total of 15.0% had undergone an eye exam prior to licensure, and 3.4% had undergone an eye exam within the past 10 years. The VA in the better-seeing eye of participants was less than 6/9 and 6/12 in 14.1 and 10.6% of CDs, respectively. Seventy-five percent of CDs with self-reported poor vision and 95% of CDs with VA < 0.5 had a history of RTCs compared to 55.8% of CDs with self-reported good vision and 55.7% of CDs with VA ≥ 0.5 (p < 0.05). Injuries from RTCs were more common in CDs with self-reported poor vision (81.1%) and in those with VA < 0.5 (90.5%) compared to CDs who self-reported good vision (55.8%) and those with VA ≥ 0.5 (55.7%) (p < 0.05).ConclusionsA large proportion of CDs did not undergo a visual assessment before the issuance or renewal of their driver licenses. A substantial number of CDs had poor vision in their better-seeing eye and suffered from RTCs and related injuries, which suggests that the visual status of CDs in Cameroon is related to the gruesome number of road traffic crashes and deaths in the country. Therefore, concerned authorities should consider making vision tests a necessary requirement for the obtention of driver licenses.

Zoonotic Tuberculosis – The Changing Landscape

Despite slow reductions in the annual burden of active human tuberculosis (TB) cases, zoonotic TB (zTB) remains a poorly monitored and an important unaddressed global problem. There is a higher incidence in some regions and countries, especially where close association exists between growing numbers of cattle (the major source of Mycobacterium bovis) and people, many suffering from poverty, and where dairy products are consumed unpasteurised. More attention needs to be focused on possible increased zTB incidence resulting from growth in dairy production globally and increased demand in low income countries in particular. Evidence of new zoonotic mycobacterial strains in South Asia and Africa (e.g. M. orygis), warrants urgent assessment of prevalence, potential drivers and risk in order to develop appropriate interventions. Control of M. bovis infection in cattle through detect and cull policies remain the mainstay of reducing zTB risk, whilst in certain circumstances animal vaccination is proving beneficial. New point of care diagnostics will help to detect animal infections and human cases. Given the high burden of human tuberculosis (caused by M. tuberculosis) in endemic areas, animals are affected by reverse zoonosis, including multi-drug resistant strains. This, may create drug resistant reservoirs of infection in animals. Like COVID-19, zTB is evolving in an ever-changing global landscape.

On High-Resolution Pressure Amplitude and Phase Measurements Comparing Fast-Response Pressure Transducers and Unsteady Pressure-Sensitive Paint

AbstractThis paper presents the simultaneous application of fast-response pressure transducers and unsteady pressure-sensitive paint (unsteady PSP) for the precise determination of pressure amplitudes and phases up to 3000 Hz. These experiments have been carried out on a low-pressure turbine blade cascade under engine-relevant conditions (Re, Ma, and Tu) in the high-speed cascade wind tunnel. Periodic blade/vane interactions were simulated at the inlet to the cascade using a wake generator operating at a constant perturbation frequency of 500 Hz. The main goal of this paper is the detailed comparison of amplitude and phase distributions between both flow sensing techniques at least up to the second harmonic of the wake generator’s fundamental perturbation frequency (i.e., 1000 Hz). Therefore, a careful assessment of the key drivers for relative deviations between measurement results as well as a detailed discussion of the data processing is presented for both measurement techniques. This discussion outlines the mandatory steps which were essential to achieve the quality as presented down to pressure amplitudes of several Pascal even under challenging experimental conditions. Apart from the remarkable consistency of the results, this paper reveals the potential of (unsteady) PSP as a future key flow sensing technique in turbomachinery research, especially for cascade testing. The results demonstrate that PSP was able to successfully sense pressure dynamics with very low fluctuation amplitudes down to 8 Pa.

The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach.

Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice. A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors. Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants' views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%. The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.

Local and regional drivers of macrophyte beta diversity in tropical coastal rivers

Studies on beta diversity across different spatial scales can yield insight into the ecological factors that shape communities and the mechanisms of maintenance and loss of diversity. The coastal rivers in southeast Brazil have different lengths and salinity gradients because of variation in coastal plain width and slope. These differences in environmental characteristics promote natural gradients and patterns of macrophyte assemblage variation within and among rivers. To investigate the drivers of macrophyte beta diversity, we recorded the occurrence of species and life forms and collected limnological variables at 100 sampling sites over 8 unconnected rivers that run directly to the sea. We estimated macrophyte beta diversity, and its nestedness and turnover components, within (local scale) and among (regional scale) coastal rivers using traditional metrics (Jaccard dissimilarity matrix) and a metric that accounts for sampling effect (permutational analysis of multivariate dispersions). At each sampling site, we collected variables from water (nutrients, dissolved oxygen, and pH), sediment (nutrients, salinity, and grain type), and channel (width, littoral declivity, distance from river’s mouth, and coastline). For assessment of regional-scale drivers of macrophyte beta diversity, we measured river length and calculated salinity gradient. We evaluated the potential of environmental variables to explain local and regional beta diversity using distance-based redundancy analysis and multiple linear regression. As expected, at the local scale, high species turnover and life-form nestedness were predominantly explained by the rivers’ longitudinal gradients (mainly salinity, P, and channel width). At the regional scale, we found that river length explained life-form nestedness among rivers (small rivers are subsets of the largest rivers); however, neither river length nor salinity gradient explained the high species turnover among rivers. We suggest that dispersal limitation among rivers and historical colonization shaped the species pool in each river resulting in almost completely distinct assemblage compositions. This high turnover at the regional scale suggests that conservation strategies for macrophytes must consider multiple rivers and not only the largest ones. Overall, our results suggest that environmental variation strongly influences macrophyte beta diversity within and among coastal tropical rivers.

To decarbonize industry, we must decarbonize heat

Summary Industry is often termed “hard to decarbonize” because a vast, inhomogeneous array of processes comprise the sector. But developing new, decarbonized process heating technologies represents a single, broadly applicable pathway to eliminating a large portion of sectoral emissions—and approximately one-fifth of global CO2 emissions, overall. We begin this perspective with a brief review of the demand for and cost of industrial heat. Then, we highlight key challenges and R&D needs in developing zero-carbon industrial heating technologies. Technologies in four pathways are discussed: (1) zero-carbon fuels, (2) zero-carbon heat sources, (3) electrification of heat, and (4) better heat management. Finally, we identify cross-cutting challenges to the development and adoption of zero-carbon industrial heat technologies, the solution to any of which would constitute a significant breakthrough on the path to industrial decarbonization.

Are ambulance drivers exposed to loud siren noise within their ambulances? Identifying the risks involved.

Objective To identify the risk to the ambulance drivers from the siren systems of their rescue vehicles.&#x0D; Study design This was a cross sectional study.&#x0D; Place duration This study was carried out at two rescue centres, namely, Gulberg and Johar Town areas of Lahore, where the ambulances were parked.&#x0D; Methodology A sound pressure meter was used to measure the sound intensity inside and in the vicinity of the ambulance in use. This was done in two centers in Lahore in 10 vehicles.&#x0D; Result It was evident that the ambulance drivers are constantly exposed to unsuitable and noxious levels of noise which can over time damage their hearing. A recommendation is contributed regarding hearing assessment for ambulance drivers and their compulsory periodical hearing assessment.&#x0D; Conclusion&#x0D; The sirens in the Pakistani ambulances have almost the same sound intensity levels as the ones abroad which can have a damaging effect on the inner ear. Pakistani ambulance drivers should wear ear protection while in their vehicles to protect against ear damage.

Assessment of bus driver's mental workload by Persian Driving Activity Load Index

Assessment of driver's mental workload by valid and easy to use instruments is an important issue. Accordingly, this study aims to assess mental workload by the Persian Driving Activity Load Index (DALI) and investigates psychometric properties of this index. The present study was descriptive and of psychometric studies' type. A total of 100 bus drivers were selected by available sampling method and answered to DALI and NASA-TLX questionnaires. For data analysis, factor analysis method, Cronbach's alpha coefficient and Pearson correlation were used by software SPSS version 22 and AMOS version 21. Factor analysis result showed that this questionnaire has good fitness indexes. Significant positive relationships between DALI and NASA-TLX questionnaires (r = 0.30 and p≤0.01) were obtained. Cronbach's alpha was 0.67 for DALI questionnaire, which was acceptable. Findings of the research showed that Persian version of the DALI questionnaire have good psychometric characteristic and it can be used as a valid instrument in this area of studies.

Assessment of bus driver's mental workload by Persian Driving Activity Load Index

Assessment of driver's mental workload by valid and easy to use instruments is an important issue. Accordingly, this study aims to assess mental workload by the Persian Driving Activity Load Index (DALI) and investigates psychometric properties of this index. The present study was descriptive and of psychometric studies' type. A total of 100 bus drivers were selected by available sampling method and answered to DALI and NASA-TLX questionnaires. For data analysis, factor analysis method, Cronbach's alpha coefficient and Pearson correlation were used by software SPSS version 22 and AMOS version 21. Factor analysis result showed that this questionnaire has good fitness indexes. Significant positive relationships between DALI and NASA-TLX questionnaires (r = 0.30 and p≤0.01) were obtained. Cronbach's alpha was 0.67 for DALI questionnaire, which was acceptable. Findings of the research showed that Persian version of the DALI questionnaire have good psychometric characteristic and it can be used as a valid instrument in this area of studies.

Assessment and analysis of road transport driver’s behavior in terms of eco-driving

Eco driving courses are one of the methods to gain cost savings in transport companies. Road transport drivers equipped with appropriate knowledge of Eco- driving and defensive driving can reduce the costs of fuel consumption even by one third as compared to those involved in their previous driving style. This is the knowledge of a vehicle operation and ability to use driving techniques that leads to fuel consumption reduction. Based on the conducted tests, an analysis of behavior change of drivers who use Eco- driving in road transport systems has been performed. A comparison of the number of drivers’ reactions to road situations allows to determine percentage change in their behavior which leads to fuel-efficient and ecological driving.

On the Assessment of Fitness to Drive: Steering and Brake Operative Forces

The Directive (EU) 2015/653 aimed at facilitating that the maximum force that any disabled driver could make on the vehicle’s primary controls could be adjusted to their needs. The technical adjustment in the vehicle’s design requires a measurement of the operational forces applied by the driver on the steering and brake controls, in order to determine its functional capacity during the execution of driving manoeuvres. The objective of this paper is to define the steering and braking operative forces used for driving current-market M1 motor vehicles for the fitness to drive assessment of drivers with physical disabilities. A total of 200 trials were performed with 17 different vehicles and 26 drivers. The results obtained help to define a new threshold’s criteria for operative forces onto the steering and braking systems for adapting motor vehicles to disabled drivers. The main contribution of this paper consist on a new technical recommendations about the use of code 20.07 -braking- and 40.01 -steering- to be used in the fitness to drive assessment of driver with disabilities according to Directive (EU) 2015/653 requirements.

1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings

BackgroundAntimicrobial prescribing rates vary across ambulatory settings and provider types. We sought to identify and compare non-clinical drivers of antimicrobial prescribing for children across diverse outpatient settings.MethodsWe recruited physicians and advanced practice providers (APPs) working in primary care, urgent care (walk-in and pediatric after-hours clinics), and retail health clinics affiliated with Vanderbilt University Medical Center (Table 1). We conducted in-person or telephone interviews using an interview guide created through an iterative process of literature review and sequential pilot testing with residents and administrators from included settings. All interviews were recorded and transcribed verbatim. Analysis is ongoing using inductive methods. The study was IRB approved with a waiver of consent.Table 1:Characteristics of interviewed providersResultsAmong the 38 providers interviewed to date, 22 (58%) were APPs. Twenty-eight (74%) interviews were conducted by telephone. In a closed-ended question, most providers (82%) identified “guideline recommended” as the primary factor informing their prescribing decisions. Providers perceived that guideline concordant care was determined by a complex interaction of patient, provider, and setting factors (Figure). A major theme identified by providers was that standardized antibiotic prescribing practices within each clinic setting and the larger community was perceived to inform parental expectations. Additionally, shaping parental expectations in a way that aligns with guidelines is a process that happens over time rather than being a one-time event. (Figure, Table 2)FigureDiagram of relationship between major categories and select themesTable 2:Select themes and sample quotesConclusionIn all outpatient settings, providers caring for children cited clinical guidelines as the most important factor influencing antibiotic prescribing. Providers felt that adherence to guidelines had downstream benefits including standardization of prescribing practices which may shape parental expectations in a way that aligns with guidelines, thus facilitating guideline-concordant care in future encounters. These findings can inform design of outpatient stewardship interventions. Additional provider recruitment and analysis by provider and setting type is ongoing.DisclosuresHillary Spencer, MD, MPH, NIH (T32 grant support) (Grant/Research Support)

Use of a Driving Simulator to Facilitate Older People to Return to Driving

Driving simulators are a relatively underutilized therapy tool that provide an opportunity for older drivers with a range of health-related problems to participate in simulated driving scenarios in a low cost and safe environment. The aim of this paper is to (i) describe the use of a Forum 8 driving simulator prior to a driver assessment, (ii) detail the story-boarding technique used to develop and grade driving scenes to enable older drivers to increase confidence, practice using vehicle modifications such as a spinner knob (e.g. for one-handed driving following stroke), and train specific skills including visual scanning and attention, and (iii) present five case studies to identify the strengths and limitations of incorporating the simulator into therapy programs with older drivers. of simulator use. The establishment and use of a driving simulator in a rehabilitation unit highlights both the challenges and benefits of using this kind of technology in practice. Part of a symposium sponsored by Transportation and Aging Interest Group.