Multimodal In-Vehicle Hypoglycemia Warning for Drivers With Type 1 Diabetes: Design and Evaluation in Simulated and Real-World Driving

BACKGROUND

Hypoglycemia threatens cognitive function and driving safety. Previous research investigated in-vehicle voice assistants as hypoglycemia warnings. However, they could startle drivers. To address this, we combine voice warnings with ambient LEDs.

OBJECTIVE

The study assesses the effect of in-vehicle multimodal warning on emotional reaction and technology acceptance among drivers with type 1 diabetes.

METHODS

Two studies were conducted, one in simulated driving and the other in real-world driving. A quasi-experimental design included 2 independent variables (blood glucose phase and warning modality) and 1 main dependent variable (emotional reaction). Blood glucose was manipulated via intravenous catheters, and warning modality was manipulated by combining a tablet voice warning app and LEDs. Emotional reaction was measured physiologically via skin conductance response and subjectively with the Affective Slider and tested with a mixed-effect linear model. Secondary outcomes included self-reported technology acceptance. Participants were recruited from Bern University Hospital, Switzerland.

RESULTS

The simulated and real-world driving studies involved 9 and 10 participants with type 1 diabetes, respectively. Both studies showed significant results in self-reported emotional reactions (P<.001). In simulated driving, neither warning modality nor blood glucose phase significantly affected self-reported arousal, but in real-world driving, both did (F2,68=4.3; P<.05 and F2,76=4.1; P=.03). Warning modality affected self-reported valence in simulated driving (F2,68=3.9; P<.05), while blood glucose phase affected it in real-world driving (F2,76=9.3; P<.001). Skin conductance response did not yield significant results neither in the simulated driving study (modality: F2,68=2.46; P=.09, blood glucose phase: F2,68=0.3; P=.74), nor in the real-world driving study (modality: F2,76=0.8; P=.47, blood glucose phase: F2,76=0.7; P=.5). In both simulated and real-world driving studies, the voice+LED warning modality was the most effective (simulated: mean 3.38, SD 1.06 and real-world: mean 3.5, SD 0.71) and urgent (simulated: mean 3.12, SD 0.64 and real-world: mean 3.6, SD 0.52). Annoyance varied across settings. The standard warning modality was the least effective (simulated: mean 2.25, SD 1.16 and real-world: mean 3.3, SD 1.06) and urgent (simulated: mean 1.88, SD 1.55 and real-world: mean 2.6, SD 1.26) and the most annoying (simulated: mean 2.25, SD 1.16 and real-world: mean 1.7, SD 0.95). In terms of preference, the voice warning modality outperformed the standard warning modality. In simulated driving, the voice+LED warning modality (mean rank 1.5, SD rank 0.82) was preferred over the voice (mean rank 2.2, SD rank 0.6) and standard (mean rank 2.4, SD rank 0.81) warning modalities, while in real-world driving, the voice+LED and voice warning modalities were equally preferred (mean rank 1.8, SD rank 0.79) to the standard warning modality (mean rank 2.4, SD rank 0.84).

CONCLUSIONS

Despite the mixed results, this paper highlights the potential of implementing voice assistant-based health warnings in cars and advocates for multimodal alerts to enhance hypoglycemia management while driving.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05183191; https://classic.clinicaltrials.gov/ct2/show/NCT05183191, ClinicalTrials.gov NCT05308095; https://classic.clinicaltrials.gov/ct2/show/NCT05308095.

Using EpiCore to Enable Rapid Verification of Potential Health Threats: Illustrated Use Cases and Summary Statistics

BACKGROUND

The proliferation of digital disease-detection systems has led to an increase in earlier warning signals, which subsequently have resulted in swifter responses to emerging threats. Such highly sensitive systems can also produce weak signals needing additional information for action. The delays in the response to a genuine health threat are often due to the time it takes to verify a health event. It was the delay in outbreak verification that was the main impetus for creating EpiCore.

OBJECTIVE

This paper describes the potential of crowdsourcing information through EpiCore, a network of voluntary human, animal, and environmental health professionals supporting the verification of early warning signals of potential outbreaks and informing risk assessments by monitoring ongoing threats.

METHODS

This paper uses summary statistics to assess whether EpiCore is meeting its goal to accelerate the time to verification of identified potential health events for epidemic and pandemic intelligence purposes from around the world. Data from the EpiCore platform from January 2018 to December 2022 were analyzed to capture request for information response rates and verification rates. Illustrated use cases are provided to describe how EpiCore members provide information to facilitate the verification of early warning signals of potential outbreaks and for the monitoring and risk assessment of ongoing threats through EpiCore and its utilities.

RESULTS

Since its launch in 2016, EpiCore network membership grew to over 3300 individuals during the first 2 years, consisting of professionals in human, animal, and environmental health, spanning 161 countries. The overall EpiCore response rate to requests for information increased by year between 2018 and 2022 from 65.4% to 68.8% with an initial response typically received within 24 hours (in 2022, 94% of responded requests received a first contribution within 24 h). Five illustrated use cases highlight the various uses of EpiCore.

CONCLUSIONS

As the global demand for data to facilitate disease prevention and control continues to grow, it will be crucial for traditional and nontraditional methods of disease surveillance to work together to ensure health threats are captured earlier. EpiCore is an innovative approach that can support health authorities in decision-making when used complementarily with official early detection and verification systems. EpiCore can shorten the time to verification by confirming early detection signals, informing risk-assessment activities, and monitoring ongoing events.

Visual and steering behaviours during lane departures: a longitudinal study of interactions between lane departure warning system, driving task and driving experience

Lane Departure Warning Systems (LDWS) generate a warning in case of imminent lane departure. LDWS have proven to be effective and associated human-machine cooperation modelled. In this study, LDWS acceptance and its impact on visual and steering behaviour have been investigated over 6 weeks for novice and experienced drivers. Unprovoked lane departures were analysed along three driving tasks gradually more demanding. These observations were compared to a baseline condition without automation. The number of lane departures and their duration were dramatically reduced by LDWS, and a narrower visual spread of search during lane departure events was recorded. The findings confirmed LDWS effectiveness and suggested that these benefits are supported by visuo-attentional guidance. No specific influence of driving experience on LDWS was found, suggesting that similar cognitive processes are engaged with or without driving experience. Drivers' acceptance of LDWS lowered after automation use, but LDWS effectiveness remained stable during prolonged use.Practitioner summary: Lane Departure Warning Systems (LDWS) have been designed to prevent lane departure crashes. Here, LDWS assessment over a 6-week period showed a major drop in the number of lane departure events increasing over time. LDWS effectiveness is supported by the guidance of drivers' visual attention during lane departure events.

Early Warning and Prediction of Scarlet Fever in China Using the Baidu Search Index and Autoregressive Integrated Moving Average With Explanatory Variable (ARIMAX) Model: Time Series Analysis

BACKGROUND

Internet-derived data and the autoregressive integrated moving average (ARIMA) and ARIMA with explanatory variable (ARIMAX) models are extensively used for infectious disease surveillance. However, the effectiveness of the Baidu search index (BSI) in predicting the incidence of scarlet fever remains uncertain.

OBJECTIVE

Our objective was to investigate whether a low-cost BSI monitoring system could potentially function as a valuable complement to traditional scarlet fever surveillance in China.

METHODS

ARIMA and ARIMAX models were developed to predict the incidence of scarlet fever in China using data from the National Health Commission of the People's Republic of China between January 2011 and August 2022. The procedures included establishing a keyword database, keyword selection and filtering through Spearman rank correlation and cross-correlation analyses, construction of the scarlet fever comprehensive search index (CSI), modeling with the training sets, predicting with the testing sets, and comparing the prediction performances.

RESULTS

The average monthly incidence of scarlet fever was 4462.17 (SD 3011.75) cases, and annual incidence exhibited an upward trend until 2019. The keyword database contained 52 keywords, but only 6 highly relevant ones were selected for modeling. A high Spearman rank correlation was observed between the scarlet fever reported cases and the scarlet fever CSI (rs=0.881). We developed the ARIMA(4,0,0)(0,1,2)(12) model, and the ARIMA(4,0,0)(0,1,2)(12) + CSI (Lag=0) and ARIMAX(1,0,2)(2,0,0)(12) models were combined with the BSI. The 3 models had a good fit and passed the residuals Ljung-Box test. The ARIMA(4,0,0)(0,1,2)(12), ARIMA(4,0,0)(0,1,2)(12) + CSI (Lag=0), and ARIMAX(1,0,2)(2,0,0)(12) models demonstrated favorable predictive capabilities, with mean absolute errors of 1692.16 (95% CI 584.88-2799.44), 1067.89 (95% CI 402.02-1733.76), and 639.75 (95% CI 188.12-1091.38), respectively; root mean squared errors of 2036.92 (95% CI 929.64-3144.20), 1224.92 (95% CI 559.04-1890.79), and 830.80 (95% CI 379.17-1282.43), respectively; and mean absolute percentage errors of 4.33% (95% CI 0.54%-8.13%), 3.36% (95% CI -0.24% to 6.96%), and 2.16% (95% CI -0.69% to 5.00%), respectively. The ARIMAX models outperformed the ARIMA models and had better prediction performances with smaller values.

CONCLUSIONS

This study demonstrated that the BSI can be used for the early warning and prediction of scarlet fever, serving as a valuable supplement to traditional surveillance systems.

Comparison of Experienced and Novice Drivers' Visual and Driving Behaviors during Warned or Unwarned Near-Forward Collisions

Forward collision warning systems (FCWSs) monitor the road ahead and warn drivers when the time to collision reaches a certain threshold. Using a driving simulator, this study compared the effects of FCWSs between novice drivers (unlicensed drivers) and experienced drivers (holding a driving license for at least four years) on near-collision events, as well as visual and driving behaviors. The experimental drives lasted about six hours spread over six consecutive weeks. Visual behaviors (e.g., mean number of fixations) and driving behaviors (e.g., braking reaction times) were collected during unprovoked near-collision events occurring during a car-following task, with (FCWS group) or without FCWS (No Automation group). FCWS presence reduced the number of near-collision events drastically and enhanced visual behaviors during those events. Unexpectedly, brake reaction times were observed to be significantly longer with FCWS, suggesting a cognitive cost associated with the warning process. Still, the FCWS showed a slight safety benefit for novice drivers attributed to the assistance provided for the situation analysis. Outside the warning events, FCWS presence also impacted car-following behaviors. Drivers took an extra safety margin, possibly to prevent incidental triggering of warnings. The data enlighten the nature of the cognitive processes associated with FCWSs. Altogether, the findings support the general efficiency of FCWSs observed through a massive reduction in the number of near-collision events and point toward the need for further investigations.

PANDEMIC--Nature's wrath and warning

This poem points out the misdeeds of human in their journey to overpower the nature and Mother Earth through science and technology and how the greed has led to the nature growing wild and deadly against human race by this COVID-19 pandemic.

Microseismic Dynamic Response and Multi-Source Warning during Rockburst Monitoring Based on Weight Decision Analysis

To prevent rockburst disasters and improve the accuracy of warnings for rockburst, based on the microseismic data of the 1366 working face of Hengda Coal Mine collected by the microseismic monitoring system, Fourier transform, wavelet packet transform, and Hilbert-Huang transform analysis methods are used for time-frequency domain joint analysis. The time-frequency differences of the main frequency, amplitude, frequency band percentage, and instantaneous energy of the high-energy microseismic event and the events before high-energy microseismic event are obtained. The analysis shows that the high-energy event has obvious low frequency characteristics, and when the high-energy event occurs, the instantaneous energy shows an obvious "inverted V" trend. At the same time, it is found that the acoustoelectric indexes show a trend of "rising" or "inverted V" when the high-energy event occurs. On this basis, the unascertained measure comprehensive evaluation model of rock burst hazard is established by analytic hierarchy process (AHP). Based on the analysis of microseismic data and the acoustoelectric index of the 1366 working face in Hengda coal mine, it is of great significance to determine the warning indicators for rockburst, improve the accuracy of uncertainty quantitative analysis for rockburst, and improve the discrimination accuracy of rockburst risk.

A Gas Pressure Prediction Model of the Excavation Face Based on Gas Emission

Gas pressure is one of the important factors related to the occurrence of coal and gas outburst disasters. The accurate gas pressure forecasting is of significance for the prevention and control of a gas disaster. In this work, a gas pressure prediction model based on the sources of gas emissions was established. The verified results show that the predicted gas pressure was roughly consistent with the actual situation. This model could meet the needs of engineering projects. Coal and gas outburst dynamic phenomenon are successfully predicted in an engineering application using the model. Overall, the prediction of coal and gas outburst using the gas pressure model achieves a continuous and dynamic effect. The model can overcome both the static and sampling shortcomings of traditional methods and solve the difficulty of coal and gas outburst prediction at the excavation face. With its broad applicability and potential prospects, the model is of great importance for guiding gas drainage, and the prevention of coal and gas outburst disasters.

Evaluating cost benefits from a heat health warning system in Adelaide, South Australia

OBJECTIVE

To examine the cost benefits of a heat health warning system (HHWS) in South Australia.

METHODS

Information from key agencies was used to estimate the costs associated with the South Australian HHWS, including for three targeted public health interventions. Health cost savings were estimated based on previously reported HHWS-attributable reductions in hospital and emergency department (ED) admissions and ambulance callouts.

RESULTS

The estimated cost for a one-week activation of the HHWS was AU$593,000. Activation costs compare favourably with the potential costs averted through HHWS-attributable reductions in hospital admissions and ambulance callouts with an estimated benefit-cost ratio of 2.0-3.3.

CONCLUSIONS

On the basis of estimated cost benefit, the South Australian HHWS is a no-regret public health response to heatwaves. Implications for public health: As global temperatures rise there are likely to be significant health impacts from more frequent and intense heatwaves. This study indicates that HHWSs incorporating targeted supports for vulnerable groups are likely to be cost-effective public health interventions.

Country Participation in the WHO Framework Convention on Tobacco Control Health Warnings Database

Background

The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) Health Warnings Database is an online, publicly available resource created for countries to upload and share pictorial health warnings for tobacco packaging. The purpose of this study was to evaluate the extent to which the database is used by countries for the sharing of pictorial warnings.

Methods

The study’s sample included parties to the FCTC who required graphic health warning labels on cigarette packaging from. Those countries were categorized as having a low, middle, and high Socio-Demographic Index (SDI). The Health Warnings Database was then analyzed for those countries’ unique pictorial images, as well as the number of pictorials that were shared between countries.

Results

Of the 110 countries that required pictorial warnings on cigarette packaging, only 53 (48%) voluntarily contributed pictorials to the database, with most of those (53%) being high SDI-level countries. There were 342 unique pictorials on the database, with 62 images posted by seven countries that were used by 13 other countries.

Conclusion

While sharing was evident from the database, there remains a need for more countries to upload the pictorials to the database. There is also a need to expand the database to include alternative tobacco products, such as waterpipe tobacco and e-cigarettes.

Quitline Information Included on Cigarette Packaging: An Assessment of Country Adherence to WHO FCTC Guidelines, 2007 to 2018

The purpose of this study is to evaluate country adherence to the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) guidelines in terms of including quitline information on cigarette packaging. Data were gathered from the WHO's Global Health Observatory database. The study included countries that were signatories to the FCTC, had a toll-free quitline, and required health warnings on cigarette packaging. Countries were then classified by income level according to the World Bank. From 2007 to 2018, the number of countries that established a quitline increased from 34 to 60. During the same timeframe among those countries, the number of countries that included information about the quitline on cigarette packaging increased from 5 to 37, with a larger proportion (79%) of high-income countries promoting their quitlines on cigarette packaging compared to middle-income (45%) countries. Although there was an increase in adherence to the WHO FCTC guidelines, there is still a need for several countries to include quitline information on cigarette packaging.

Evidence of the Effectiveness of Pictorial Health Warnings on Cigarette Packaging in Nepal

BACKGROUND

Tobacco Control Act of 2010 mandates government to implement at least 75% pictorial health warnings (PHWs) on tobacco packaging that was enforced in 2013. The purpose of the study was to assess the effectiveness of PHWs and its impact to the policy change.

METHODS

A cross-sectional study was conducted in 9 cities between September 2014 and March 2015. Direct interviews were made among 2250 randomly selected individuals. The effectiveness of PHWs were measured as perceived: i) scariness; ii) quit motivation iii) convincing youth not to start smoking; iv) encouraging ex-smokers to remain as quitters; v) building public awareness. Logistic regression analysis was used to determine the factors associated with the effectiveness of PHWs.

RESULTS

Of the 2250 participants, 29.8% (670) were current smokers, 8.6% (193) were ex-smokers and 97.6% believed that smoking was addictive. PHWs made 83% of the participants scared. Participants believed that PHWs would be effective in motivating smokers to quit (80.2%), in convincing youth not to start smoking (86.8%), in encouraging ex-smokers to remain as quitters (89.1%) and in building public awareness on the dangers of smoking (94%). PHWs made 58% of the current smokers intended to quit smoking and reduced their daily intake of cigarettes from 11 to 5 on average.  Current smokers preferred to purchase loose cigarettes rather than a pack. The covariates significantly associated with the effectiveness of PHWs were current smokers, ex-smokers and addiction.

CONCLUSION

PHWs were found important to motivate smokers to quit smoking, to reduce consumption of cigarettes and to prevent relapse in ex-smokers. Evidence from the study had triggered policy changes which included enlargement of the size of PHW to 90% and the release of a notification to ban selling of loose cigarettes. Thus, the warning messages with pictures are required to be improved and rotated.

Professional discrepancies of doctors and lawyers in episodic memory: Modulations of professional morality and warning

Past investigations have consistently demonstrated the robust stereotype-consistent effect in the circumstance of source memory but not always in item memory, including the case of professional stereotype. However, it remains unclear whether the effect still occurs in professional stereotype when considering the attributes of negative (or bad) or positive (or good); besides, it has not been concerned about how does warning work in remembering the professional stereotypical stimuli. The current experiments aimed to address these issues by adopting descriptive sentences as stimuli, which were related or unrelated to doctors and lawyers, and with different professional moral valences (negative, neutral, or positive). Item memory and source memory were tested successively. Experiment 1 without the explicit warning confirmed the reliable stereotype-consistent effect solely in source memory; the modulation of professional morality on memory behaved differently between doctor and lawyer, that is, negativity bias versus positivity bias. When giving an explicit warning (Experiment 2), the stereotype-consistent effect attenuated in the lawyer case, and the occurrence of negativity bias was sensitive to the memory task. Thus, our findings further reinforce the dual-process model; both professional morality and warning work in memory of professional stereotype, depending upon the nature of the profession, the concerned memory task, and also the presence of warning. Implications are made for future research to consider more perspectives.

Awareness of risk factors and warning signs of stroke among nursing students: Results from questionnaire

Background

It is important to inform nursing students about stroke and improve their role in the clinic.

Aims

We aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students. Therefore, we aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students.

Materials and Methods

The descriptive and cross-sectional study was carried out between December 2017 and March 2018 with intern students at the faculty of nursing of a university. The sample consisted of 173 students. The data were collected by researchers using "Student Information Form" and "Information Form about Stroke". The ethical and institutional permission were obtained to conduct the research.

Results

Hypertension (96.5%) for risk factors, weakness (98.8%) for warning signs, blood pressure control (96.5%) for prevention measures were the most commonly identified factors. Approximately half of the students had a good level of awareness/knowledge of risk factors (53.2%) and warning signs (53.8%) for stroke. The majority of students (84.4%) had a good level of awareness/knowledge of prevention measures. Ninety-five percent of the students stated that calling an ambulance would be the first appropriate action.

Conclusion

Students had a good knowledge of some of the warning signs and risk factors about stroke. Therefore, it is recommended that this subject should be emphasized more in course contents.

Factors that influence occupational physicians' decision to issue an employer warning in Japan

Objectives

To elucidate the factors that influence occupational physicians’ decision to issue an employer warning.

Methods

The interview was conducted with 10 Japan Society for Occupational Health certified occupational physicians (COPs) and certified senior occupational physicians (CSOPs) to create nine fictive scenarios in which an occupational physician may need to consider issuing a warning. Sixteen CSOPs assessed the seriousness of the problem in each of nine scenarios where they may need to consider issuing an employer warning. Next, using a survey questionnaire, 597 COPs and CSOPs were asked to rate how likely they were to issue a warning in each of the nine scenarios, and answer items on their characteristics and number of previously issued warnings. A multilevel logistic regression analysis nested for various scenarios was used to assess the odds ratio (OR) of being likely to issue a warning.

Results

Valid questionnaires were obtained from 117 participants (19.6%). The ORs and 95% confidence intervals (CIs) were as follows: mean score of seriousness of the problem, 5.90 (4.50‐7.75); years of experience as occupational physician, 1.04 (1.02‐1.06); women, 1.75 (1.20‐2.54); being a part‐time occupational physician without in‐house experience, 2.08 (1.31‐3.29); and having previously issued two or more times warnings, 1.99 (1.29‐3.06), compared with those who had never issued a warning.

Conclusions

Occupational physicians’ likelihood to issue a warning was associated with the seriousness of the problem as assessed in various scenarios, years of experience as occupational physician, gender, employment type, experience as in‐house occupational physician, and number of past warnings.

An Investigation of Situational and Dispositional Antecedents of Faking Intentions in Selection Interviews

Applicants use faking in selection interviews to create a favorable impression and to increase their chances for a job offer. Theoretical models assume that such a behavior is influenced by situational and dispositional variables. However, previous research has mainly focused on dispositional variables whereas research about situational variables is sparse. To address this gap, we conducted three studies in which we examined how competition for a job and warning interviewees that information from their answers will be verified can influence faking intentions. Furthermore, we wanted to know whether these situational variables are able to explain additional variance in faking intentions beyond dispositional variables and whether there are interactions between situational and dispositional variables. In Study 1, we only found that high competition led to slightly higher faking intentions than low competition in a student sample. In Study 2, only a warning about the verification of applicants’ answers led to slightly lower faking intentions compared to no warning concerning verification in a working sample. Furthermore, faking intentions were lower in Study 2 than in the student sample in Study 1. In Study 3, we found no impact of our situational variables in a combined sample of students and non-students. We only found slightly higher honest impression management intentions in the high competition and the verification warning condition. We also found hardly any support for interaction effects between the situational and dispositional variables. Furthermore, the situational variables did not explain additional variance beyond the dispositional variables in any of the three studies. Possible reasons for the non-significant or small effect sizes for the situational variables can be found in a qualitative analysis of answers to an open-ended question in Study 3. However, we found that Honesty-humility und all facets of the Dark Triad were related to faking intentions. These results indicate that dispositional variables in particular have an impact on faking intentions.

Do We Really Need More Stages? Comparing the Effects of Likelihood Alarm Systems and Binary Alarm Systems

OBJECTIVE

This research investigates the potential behavioral and performance benefits of a four-stage likelihood alarm system (4-LAS) contrasting a 3-LAS, a binary alarm system with a liberal threshold (lib-BAS), and a BAS with a conservative threshold (con-BAS).

BACKGROUND

Prior research has shown performance benefits of 3-LASs over conventional lib-BASs due to more distinct response strategies and better discriminating true from false alerts. This effect might be further enhanced using 4-LASs. However, the increase in stages could cause users to reduce cognitive complexity by responding in the same way to the two lower and the two higher stages, thus treating the 4-LAS like a con-BAS.

METHOD

All systems were compared using a dual-task paradigm. Response strategies, number of joint human machine (JHM) false alarms (FAs), misses, and sensitivity were regarded.

RESULTS

Compared with the lib-BAS, JHM sensitivity only improved with the 4-LAS and the con-BAS. However, the number of JHM misses was lowest for the con-BAS compared with all other systems.

CONCLUSION

JHM sensitivity improvements can be achieved by using a 4-LAS, as well as a con-BAS. However, only the latter one may also reduce the number of JHM misses, which is remarkable considering that BASs with conservative thresholds a priori commit more inbuilt misses than other systems.

APPLICATION

Results suggest implementing conservative BASs in multi-task working environments to improve JHM sensitivity and reduce the number of JHM misses. When refraining from designing systems which are miss prone, 4-LASs represent a suitable compromise.

Labels to prevent the detrimental effects of media on body image: A systematic review and meta-analysis

OBJECTIVE

Most advertisements contain thin-ideal imagery enhanced by digital modification. The deleterious effects on body image and eating disorder risk of exposure to such images have been well documented. One of the proposed macro-level solutions to mitigate these effects has been the use of labels on images, primarily disclaimer labels. A growing number of studies have explored the usefulness of such labels in protecting body image against the detrimental effects of media exposure; however, findings have been divergent.

METHODS

The current study aimed to conduct a systematic review and meta-analysis of the existing literature investigating the effects of including labels on media images on body image.

RESULTS

The systematic review identified n = 22 studies that were included in a narrative review, n = 18 were included in the meta-analysis. Overall, findings provided little support for the use of disclaimer or warning labels as a means of protecting against the detrimental effects of media exposure on body image. Furthermore, findings suggested that such labels might increase state appearance comparison when exposed to media images.

DISCUSSION

These findings are especially concerning in light of recent legislative efforts to mitigate media effects through the use of labels on imagery, as well as industry initiatives based on image labeling. Additional research examining alternative strategies for universal prevention of body image and eating concerns is warranted.

Awareness and perceptions regarding taxation and health warnings related to sugar-sweetened beverages and the factors associated with these among visitors of a general out-patient clinic in Bhopal, India

INTRODUCTION

Although increased taxation on sugar-sweetened beverages (SSBs) and warning labels on their packaging have been successful in other countries, India has not implemented these. It is imperative to understand the user perspectives before implementation, regarding which almost no information exists.

OBJECTIVES

To assess the awareness and perceptions of people regarding taxation and health warnings on SSB packaging, and to determine the factors associated with these.

METHODOLOGY

This cross-sectional study was conducted in the general out-patient clinic of a public tertiary care hospital in Bhopal, India, between April and November 2018. Patients and accompanying persons ≥15 years of age and attending the clinic were included. Severely ill patients were excluded. Exit interviews were conducted after the clinical consultation using a pre-tested semi-structured interview schedule. Data were analyzed using IBM SPSS version 21.

RESULTS

Out of the 503 participants interviewed, three-fourths had never heard of taxes on SSBs and had never seen any health warning on SSB packaging. Most participants (96.6%) wanted some health warning to be present on the packaging. Majority of them (69.3%) wanted both textual and pictorial warnings. Close to half of those who wanted a pictorial warning to be present opined that it should occupy <25% of the surface area of the packaging. Multivariable analysis showed that participants aged <25 years and females were not in favor of tax increment.

CONCLUSION

Government policies should also focus on user perspectives and preferences before deciding to increase tax on SSBs or introducing mandatory health warnings on SSBs.

The study on the early warning period of varicella outbreaks based on logistic differential equation model

Chickenpox is a common acute and highly contagious disease in childhood; moreover, there is currently no targeted treatment. Carrying out an early warning on chickenpox plays an important role in taking targeted measures in advance as well as preventing the outbreak of the disease. In recent years, the infectious disease dynamic model has been widely used in the research of various infectious diseases. The logistic differential equation model can well demonstrate the epidemic characteristics of epidemic outbreaks, gives the point at which the early epidemic rate changes from slow to fast. Therefore, our study aims to use the logistic differential equation model to explore the epidemic characteristics and early-warning time of varicella. Meanwhile, the data of varicella cases were collected from first week of 2008 to 52nd week of 2017 in Changsha. Finally, our study found that the logistic model can be well fitted with varicella data, besides the model illustrated that there are two peaks of varicella at each year in Changsha City. One is the peak in summer–autumn corresponding to the 8th–38th week; the other is in winter–spring corresponding to the time from the 38th to the seventh week next year. The ‘epidemic acceleration week’ average value of summer–autumn and winter–spring are about the 16th week (ranging from the 15th to 17th week) and 45th week (ranging from the 44th to 47th week), respectively. What is more, taking warning measures during the acceleration week, the preventive effect will be delayed; thus, we recommend intervene during recommended warning weeks which are the 15th and 44th weeks instead.

[Effectiveness of cigarette-pack warning labels in capturing the attention of smokers and nonsmokersEficácia das tarjas de advertência em maços de cigarro para atrair a atenção de fumantes e não fumantes]

Objective

To determine the ability of cigarette-pack warning labels, of the minimum size required by the World Health Organization, to capture the attention of smokers and nonsmokers.

Methods

In this study, 30 smokers and 30 nonsmokers completed a dot-probe task in which they simultaneously observed images of cigarette packs split in two: the top contained the cigarette brand and the bottom contained the warning label. During the task, brain activity was recorded through two event-related potentials of the negative-polarity type--the potential that occurs in the posterior-contralateral zone approximately 200 ms after a stimulus (N2pc) and the sustained posterior contralateral negativity (SPCN) response--which are indicators of early and sustained attention.

Results

In both groups, a greater amplitude of N2pc and SPCN potentials was found for the part of the pack containing the cigarette brand. However, during the dot-probe task, reaction times were shorter for the warning label.

Conclusions

These results suggest that, initially, attention is focused on the cigarette brand, and only then on the warning label. The inability of warning labels to capture early-phase attention decreases their effectiveness, especially in smokers. We suggest that warning labels be enlarged to facilitate increased attention response.

Eyeing the storm: How residents of coastal Florida see hurricane forecasts and warnings

This paper examines the societal dimensions of warning decisions during extreme weather events in one of the most hurricane-prone areas in the U.S., Miami-Dade County, Florida. With the aim of informing improvements in the hurricane forecast and warning system, and better understanding warning decisions in extreme weather events, we explore how members of the public obtain and use hurricane forecasts and warnings in decision making. Results from in depth mental models interviews with members of the public (N=28) and survey data from three counties in Florida (N=460) show that a large majority of respondents have some hurricane experience, which influences their thinking about storm impacts, individual actions to mitigate the hazard, and vulnerability to the hazard. Comparison with results from previous research with warning system professionals (National Weather Service forecasters, media broadcasters, and public officials) indicates several gaps between professionals and laypeople including different perceptions of hurricane risks overall and related to flooding from storm surge. The findings suggest several areas for improvements in the hurricane forecast and warning system.

[Assistance Dogs for epileptics]

Three dogs trained to detect seizures, to warn their master, to alert those around him and to assist in the return to consciousness, were given to recipients with epilepsy. This is part of the Handi'Chiens initiative, a first in France.

Placing Health Warnings on E-Cigarettes: A Standardized Protocol

Health warnings for e-cigarettes are a promising and novel tobacco control intervention for reducing e-cigarette use. We developed a new protocol for evaluating e-cigarette warnings by placing them on users' own devices to reflect real-world exposure. Study 1 participants were a national convenience sample of 606 U.S. adult e-cigarette users surveyed online in March 2017. Most Study 1 participants were willing to have their e-cigarette devices (87%) and refills (83%) labeled. Study 2 participants were a convenience sample of 22 adult e-cigarette users recruited in California, United States in April 2017. We applied the U.S. Food and Drug Administration's proposed e-cigarette warning to users' own devices and refills. Most Study 2 participants (81%) reported using e-cigarette devices with our warning labels at least 90% of the time during the study. Nearly all (95%) said they would participate in the study again, and 100% would recommend the study to a friend. Conversations about e-cigarette harms, conversations about quitting e-cigarettes, and intentions to quit using e-cigarettes increased during the study (all p < 0.05). These studies show that our naturalistic labeling protocol was feasible, acceptable to participants, and had high retention over three weeks. Using the protocol can yield important evidence on the impact of e-cigarette warnings to inform tobacco warning policies.

Pharmacogenomic information in the Warning section of drug labels: A comparison between labels in the United States and those in five other countries/regions

WHAT IS KNOWN AND OBJECTIVE

Clinically validated pharmacogenomic information useful for patient selection and/or dose adjustment is included in drug labels. However, the label information may differ among countries. This commentary summarizes the pharmacogenomic information on drug labels in different countries.

COMMENT

We selected six drugs, namely, clopidogrel, atomoxetine, irinotecan, mercaptopurine, abacavir and carbamazepine and compared the pharmacogenomic information in the "Warning" section of these drug labels in the United States and 5 other countries/regions.

WHAT IS NEW AND CONCLUSION

The pharmacogenomic information in drug labels is not well harmonized across countries/regions, possibly due to differences in population characteristics such as relevant allele frequencies, variable genetic test availability and differences in insurance coverage. Further and periodical investigations of this issue would be useful.

FDA Boxed Warning for Immediate-Release Opioids

On March 22, 2016, the Food and Drug Administration (FDA) announced enhanced warnings for immediate-release opioid pain medications related to risks of misuse, abuse, addiction, overdose, and death. The new safety warnings also added to all prescription opioid medications to inform prescribers and patients of additional risks related to opioid use.

Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review

The current study sought to examine the impact of strengthening cigarette pack warnings on attention, message processing, and perceived effectiveness, through a systematic review of longitudinal observational studies. The review included 22 studies (N = 81,824 participants). Strengthened warnings increased attention to warnings, recall of warnings, and thinking about the health risks of smoking. Strengthened warnings also increased several perceived effectiveness outcomes, including perceptions that warnings reduce smoking and motivate quitting. Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act. Strengthening warning policies should be a priority for tobacco control globally.

Changes in Asthma Maintenance Therapy Prescribing Patterns Following the 2006 Long-acting β-Agonist FDA Drug Warning

PURPOSE

The US Food and Drug Administration issued a boxed warning on all products containing a long-acting β-agonist (LABA) in March 2006, after the findings from a trial suggested an increased risk for death in patients treated with salmeterol monotherapy. Almost nothing is known about the impact of this warning on LABA prescribing patterns or on clinicians' approaches to asthma maintenance therapy.

METHODS

A cohort of asthmatic adults on LABA therapy was retrospectively identified from a Baltimore-area Medicaid data warehouse. Pharmacy claims were used for determining the utilization rates of all asthma maintenance medications. Rates from the 6-month period before the warning (September 1, 2005, to February 28, 2006) were compared with rates from a similar 6-month period 1 year afterward (September 1, 2006, to February 28, 2007). The demographic characteristics of patients who continued LABA use were compared with those of discontinuers. In LABA discontinuers, utilization of alternative maintenance drugs was assessed.

FINDINGS

In this cohort of 455 asthmatic patients, LABAs were prescribed only in combination with inhaled corticosteroids. Following the warning, 53% of patients discontinued LABA use, and the mean number of LABA prescription fills per patient decreased from 2.6 to 1.8 (P < 0.0001). Concurrently, the use of inhaled corticosteroids increased from 0.3 to 0.8 fills per patient (P < 0.0001). LABA continuers were younger (P = 0.0005), more likely to be black (P = 0.0079), and more consistent with LABA fills prewarning (P < 0.0001). Of the 243 LABA discontinuers, 155 were placed on no alternative maintenance therapy.

IMPLICATIONS

The management of asthma changed significantly after the LABA warning. The use of LABAs combined with inhaled corticosteroids plummeted, while the use of inhaled corticosteroid monotherapy increased. More than half of patients who discontinued LABAs were not placed on alternative maintenance therapy.

"Know What to Do If You Encounter a Flash Flood": Mental Models Analysis for Improving Flash Flood Risk Communication and Public Decision Making

Understanding how people view flash flood risks can help improve risk communication, ultimately improving outcomes. This article analyzes data from 26 mental models interviews about flash floods with members of the public in Boulder, Colorado, to understand their perspectives on flash flood risks and mitigation. The analysis includes a comparison between public and professional perspectives by referencing a companion mental models study of Boulder-area professionals. A mental models approach can help to diagnose what people already know about flash flood risks and responses, as well as any critical gaps in their knowledge that might be addressed through improved risk communication. A few public interviewees mentioned most of the key concepts discussed by professionals as important for flash flood warning decision making. However, most interviewees exhibited some incomplete understandings and misconceptions about aspects of flash flood development and exposure, effects, or mitigation that may lead to ineffective warning decisions when a flash flood threatens. These include important misunderstandings about the rapid evolution of flash floods, the speed of water in flash floods, the locations and times that pose the greatest flash flood risk in Boulder, the value of situational awareness and environmental cues, and the most appropriate responses when a flash flood threatens. The findings point to recommendations for ways to improve risk communication, over the long term and when an event threatens, to help people quickly recognize and understand threats, obtain needed information, and make informed decisions in complex, rapidly evolving extreme weather events such as flash floods.

A cross-hazard analysis of terse message retransmission on Twitter

For decades, public warning messages have been relayed via broadcast information channels, including radio and television; more recently, risk communication channels have expanded to include social media sites, where messages can be easily amplified by user retransmission. This research examines the factors that predict the extent of retransmission for official hazard communications disseminated via Twitter. Using data from events involving five different hazards, we identity three types of attributes--local network properties, message content, and message style--that jointly amplify and/or attenuate the retransmission of official communications under imminent threat. We find that the use of an agreed-upon hashtag and the number of users following an official account positively influence message retransmission, as does message content describing hazard impacts or emphasizing cohesion among users. By contrast, messages directed at individuals, expressing gratitude, or including a URL were less widely disseminated than similar messages without these features. Our findings suggest that some measures commonly taken to convey additional information to the public (e.g., URL inclusion) may come at a cost in terms of message amplification; on the other hand, some types of content not traditionally emphasized in guidance on hazard communication may enhance retransmission rates.

Flash Flood Risks and Warning Decisions: A Mental Models Study of Forecasters, Public Officials, and Media Broadcasters in Boulder, Colorado

Timely warning communication and decision making are critical for reducing harm from flash flooding. To help understand and improve extreme weather risk communication and management, this study uses a mental models research approach to investigate the flash flood warning system and its risk decision context. Data were collected in the Boulder, Colorado area from mental models interviews with forecasters, public officials, and media broadcasters, who each make important interacting decisions in the warning system, and from a group modeling session with forecasters. Analysis of the data informed development of a decision-focused model of the flash flood warning system that integrates the professionals' perspectives. Comparative analysis of individual and group data with this model characterizes how these professionals conceptualize flash flood risks and associated uncertainty; create and disseminate flash flood warning information; and perceive how warning information is (and should be) used in their own and others' decisions. The analysis indicates that warning system functioning would benefit from professionals developing a clearer, shared understanding of flash flood risks and the warning system, across their areas of expertise and job roles. Given the challenges in risk communication and decision making for complex, rapidly evolving hazards such as flash floods, another priority is development of improved warning content to help members of the public protect themselves when needed. Also important is professional communication with members of the public about allocation of responsibilities for managing flash flood risks, as well as improved system-wide management of uncertainty in decisions.

Warning dreams preceding the diagnosis of breast cancer: a survey of the most important characteristics

BACKGROUND

There are rare reports of warning dreams about breast cancer in the dream literature and even fewer in the medical literature. Anxiety about breast cancer is increasing due to uncertainty about conflicting guidelines regarding mammography screening.

OBJECTIVE

The purpose of the study was to survey women with breast cancer who had warning dreams prior to diagnosis to determine the most common and important characteristics of these dreams.

METHODS

Eighteen women with a known diagnosis of breast cancer completed a survey of 19 Yes or No questions about their warning dreams and submitted dream narratives.

RESULTS

The five most common characteristics of warning dreams in descending order of frequency reported in the survey were: a sense of conviction about the importance in 94%; the dreams were more vivid, real or intense than ordinary in 83%; an emotional sense of threat, menace or dread in 72%; the use of the specific words breast cancer/tumor in 44%; and the sense of physical contact with the breast in 39%.

CONCLUSION

Warning dreams of breast cancer were often reported to be life changing experiences that prompted medical attention leading directly to diagnosis. Further research needs to be done to determine the frequency of such dreams in women without known breast cancer in order to assess the predictive value of a warning dream. These preliminary results suggest that keeping a dream diary might be a useful adjunct to routine self-examination as part of a breast self-care program, particularly for women in a high-risk category.

[Towards informed tobacco consumption in Mexico: effect of pictorial warning labels in smokers]

OBJECTIVE

Evaluate the effect of the first pictorial warning labels on cigarette packs in Mexican smokers.

MATERIALS AND METHODS

A population-based representative cohort of smokers from seven Mexican cities was surveyed before (2010) and after (2011) the implementation of pictorial warning labels. To determine the change variables representing the cognitive and behavioral impact of pictorial warnings, bivariate and adjusted generalized estimating equations were estimated. Data from the second survey (2011) were analyzed to determine the factors associated with aided recall of specific pictorial warnings, as well as the factors associated with self-report of the impact that these warnings had.

RESULTS

From 2010 to 2011, significant increases were found in smoker's knowledge about smoking risks, the toxic components of tobacco, and the quitline number for receiving cessation assistance. Recall and impact of specific pictorial warnings was generally broad and equally distributed across the smoker population. In comparison with recent ex-smokers interviewed in 2010, more recent ex-smokers in 2011 reported that pack warnings had influenced their decision to quit (RM=2.44, 95% IC 1.27-4.72).

CONCLUSION

The first pictorial warning labels on cigarette packages in Mexico have had a significant impact on knowledge and behavior.

Proactive inhibitory control of response as the default state of executive control

Refraining from reacting does not only involve reactive inhibitory mechanisms. It was recently found that inhibitory control also relies strongly on proactive mechanisms. However, since most available studies have focused on reactive stopping, little is known about how proactive inhibition of response is implemented. Two behavioral experiments were conducted to identify the temporal dynamics of this executive function. They manipulated respectively the time during which inhibitory control must be sustained until a stimulus occurs, and the time limit allowed to set up inhibition before a stimulus occurs. The results show that inhibitory control is not set up after but before instruction, and is not transient and sporadic but sustained across time. Consistent with our previous neuroimaging findings, these results suggest that proactive inhibition of response is the default mode of executive control. This implies that top-down control of sensorimotor reactivity would consist of a temporary release (up to several seconds), when appropriate (when the environment becomes predictable), of the default locking state. This conclusion is discussed with regard to current anatomo-functional models of inhibitory control, and to methodological features of studies of attention and sensorimotor control.

Core ethical questions: what do you do when your obligations as a psychiatrist conflict with ethics?

Psychiatrists face many difficult ethical decisions in which they must exercise their discretion. In the most difficult decisions they confront, there are significant "harms," regardless of what they choose. The best they can do in these instance is to be as acutely aware of the most important pros and cons as they can. This article will discuss such pros and cons in regard to, particularly, informing patients when they may be dangerous to themselves or others, have dementia, and have genetic illness. This article will also discuss giving moral weight to the psychiatrist's own interests when making these ethical decisions.

An evaluation of advance notice to increase compliance among preschoolers

Advance notice of an upcoming instruction was evaluated to increase compliance among 3 children (4 to 5 years old) who exhibited noncompliance. Results show that the procedure was ineffective for all 3 participants. Advance notice plus physical guidance or physical guidance alone was necessary to increase compliance.

Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay and Mexico

OBJECTIVE

To assess the impact of different health warning labels (HWL).

MATERIAL AND METHODS

Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact.

RESULTS

HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment.

CONCLUSIONS

This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking.

Systems and Sensors for Debris-flow Monitoring and Warning

Debris flows are a type of mass movement that occurs in mountain torrents. They consist of a high concentration of solid material in water that flows as a wave with a steep front. Debris flows can be considered a phenomenon intermediate between landslides and water floods. They are amongst the most hazardous natural processes in mountainous regions and may occur under different climatic conditions. Their destructiveness is due to different factors: their capability of transporting and depositing huge amounts of solid materials, which may also reach large sizes (boulders of several cubic meters are commonly transported by debris flows), their steep fronts, which may reach several meters of height and also their high velocities. The implementation of both structural and non-structural control measures is often required when debris flows endanger routes, urban areas and other infrastructures. Sensor networks for debris-flow monitoring and warning play an important role amongst non-structural measures intended to reduce debris-flow risk. In particular, debris flow warning systems can be subdivided into two main classes: advance warning and event warning systems. These two classes employ different types of sensors. Advance warning systems are based on monitoring causative hydrometeorological processes (typically rainfall) and aim to issue a warning before a possible debris flow is triggered. Event warning systems are based on detecting debris flows when these processes are in progress. They have a much smaller lead time than advance warning ones but are also less prone to false alarms. Advance warning for debris flows employs sensors and techniques typical of meteorology and hydrology, including measuring rainfall by means of rain gauges and weather radar and monitoring water discharge in headwater streams. Event warning systems use different types of sensors, encompassing ultrasonic or radar gauges, ground vibration sensors, videocameras, avalanche pendulums, photocells, trip wires etc. Event warning systems for debris flows have a strong linkage with debris-flow monitoring that is carried out for research purposes: the same sensors are often used for both monitoring and warning, although warning systems have higher requirements of robustness than monitoring systems. The paper presents a description of the sensors employed for debris-flow monitoring and event warning systems, with attention given to advantages and drawbacks of different types of sensors.