title: Driving with Attention-Deficit/ Hyperactivity Disorder: Influences of Demand and Arousal in Real Traffic

authors: Randell, Nastassia Jane Saviah

subjects: Driving

abstract: Previous research has indicated a critical role of task demand in determining driving outcomes amongst individuals with attention-deficit/ hyperactivity disorder (ADHD). These findings are derived predominantly from laboratory simulations. The objective of the present study therefore was to investigate the relationship between factors influencing demand and arousal in real traffic, and the performance of drivers medicated (n = 15) and unmedicated for ADHD (n = 12), compared to a control group (n = 17). Self-reported data relating to risky driving behaviours and driving history, and symptoms of ADHD in adulthood were collected. To determine the influence of demand on driving performance and errors, participants navigated a route incorporating rural, urban, residential, and highway environments. Relative to controls, unmedicated ADHD drivers employed fewer safe driving skills (p < .05), committed more inattentive (p < .05), and impatient driving errors (p < .01), and reported engaging in more frequent aggressive violations (p < .05). ADHD was associated with higher rates of crashes (p < .01) and multiple crashes (p = .05). Attesting to the efficacy of stimulant treatment, medicated ADHD driver performance in the present study was comparable to, if not better than controls. While unmedicated drivers undervalued the risk related to driving behaviours predictive of poor outcomes, medicated ADHD drivers largely overestimated the severity of their risky driving (p < .01). Demand was found to significantly impact the performance of unmedicated ADHD drivers particularly. Attention was best during high demand, urban driving. As environmental demand declined, more frequent attentional lapses occasioned increased impairment to performance (p < .01). Relative to drivers of automatic vehicles, high demand manual driving was linked with better hazard detection (p < .05) and overall performance (p < .05) amongst medicated drivers, and safer following distances amongst unmedicated ADHD drivers (p < .05). Apparently distinct driving styles were also revealed between ADHD subtypes. This is the first study to document the impact of factors influencing task demand on ADHD driver performance in real traffic. Further exploration of the present findings could prove fundamental for future strategies of behavioural intervention.

text: Driving with Attention-Deficit/ Hyperactivity Disorder: Influences of Demand and Arousal in Real Traffic Previous research has indicated a critical role of task demand in determining driving outcomes amongst individuals with attention-deficit/ hyperactivity disorder (ADHD). These findings are derived predominantly from laboratory simulations. The objective of the present study therefore was to investigate the relationship between factors influencing demand and arousal in real traffic, and the performance of drivers medicated (n = 15) and unmedicated for ADHD (n = 12), compared to a control group (n = 17). Self-reported data relating to risky driving behaviours and driving history, and symptoms of ADHD in adulthood were collected. To determine the influence of demand on driving performance and errors, participants navigated a route incorporating rural, urban, residential, and highway environments. Relative to controls, unmedicated ADHD drivers employed fewer safe driving skills (p < .05), committed more inattentive (p < .05), and impatient driving errors (p < .01), and reported engaging in more frequent aggressive violations (p < .05). ADHD was associated with higher rates of crashes (p < .01) and multiple crashes (p = .05). Attesting to the efficacy of stimulant treatment, medicated ADHD driver performance in the present study was comparable to, if not better than controls. While unmedicated drivers undervalued the risk related to driving behaviours predictive of poor outcomes, medicated ADHD drivers largely overestimated the severity of their risky driving (p < .01). Demand was found to significantly impact the performance of unmedicated ADHD drivers particularly. Attention was best during high demand, urban driving. As environmental demand declined, more frequent attentional lapses occasioned increased impairment to performance (p < .01). Relative to drivers of automatic vehicles, high demand manual driving was linked with better hazard detection (p < .05) and overall performance (p < .05) amongst medicated drivers, and safer following distances amongst unmedicated ADHD drivers (p < .05). Apparently distinct driving styles were also revealed between ADHD subtypes. This is the first study to document the impact of factors influencing task demand on ADHD driver performance in real traffic. Further exploration of the present findings could prove fundamental for future strategies of behavioural intervention.

year: 2015

title: Testing times: New Zealand’s clinical laboratories under the 1990s health sector reforms

authors: France, Necia

abstract: This thesis examines New Zealand’s clinical laboratory services during the 1990s, a recent period of major neo-liberally driven health sector change in New Zealand. Internationally, although estimates of expenditure on laboratory services vary, the importance attributed to their pivotal role in health decision-making and expenditure is consistent. Consequently, changes impacting on the clinical laboratory system have the potential to resound throughout a national health service in unexpected ways. 

The 1990s New Zealand health reforms were characterised by a downplaying of the role of technical, scientific and clinical expertise in management decision making, a reduced role in management and planning for central government, and moves towards the creation of a ‘health market’ composed of consumers, rather than citizens. The transfer of occupational control from pathologists to managers in the clinical laboratory sector, and other attempts to contain state expenditure on clinical laboratories are monitored in the body of this thesis using both qualitative and quantitative data. 

Pre-reform weaknesses already present in the clinical laboratory service, particularly the dual systems for laboratory remuneration that hinge on specimen origin, were thrown into strong relief by the 1990s reforms. Furthermore, evidence gathered in this study suggests the reforms became counter-productive, even in their own terms. Thus, the change towards market controls not only destroyed strengths of the existing centrally controlled laboratory system, but also, by fostering a focus on outputs, greatly increased volume-driven state expenditure on laboratory testing. This occurred largely without improvement in disease ‘pick-up’ rates, avoidable hospitalisations, or cost-efficiencies. The internal market compromise proved powerless to avoid laboratory services monopoly development by foreign investor owned companies. As a consequence it neither indicated the most efficient test prices, nor engendered the physical laboratory amalgamations that have occurred overseas in the interests of cost-efficiency. 

The thesis concludes that the kind of structural reform introduced into the New Zealand health sector in the 1990s was a poor instrument for achieving cost effectiveness. Specific technological changes in laboratory practice, along with globalisation in health service provision, are identified as examples of design influences that will strongly re-shape the supply-side of New Zealand laboratory services. Their considered incorporation into a revived central, evidence-based, laboratory services redesign plan is strongly recommended. Unfortunately, the partially decentralised governance structure introduced by the Labour-led coalition in 2001 appears to have the potential to frustrate that recommendation.

text: Testing times: New Zealand’s clinical laboratories under the 1990s health sector reforms This thesis examines New Zealand’s clinical laboratory services during the 1990s, a recent period of major neo-liberally driven health sector change in New Zealand. Internationally, although estimates of expenditure on laboratory services vary, the importance attributed to their pivotal role in health decision-making and expenditure is consistent. Consequently, changes impacting on the clinical laboratory system have the potential to resound throughout a national health service in unexpected ways. 

The 1990s New Zealand health reforms were characterised by a downplaying of the role of technical, scientific and clinical expertise in management decision making, a reduced role in management and planning for central government, and moves towards the creation of a ‘health market’ composed of consumers, rather than citizens. The transfer of occupational control from pathologists to managers in the clinical laboratory sector, and other attempts to contain state expenditure on clinical laboratories are monitored in the body of this thesis using both qualitative and quantitative data. 

Pre-reform weaknesses already present in the clinical laboratory service, particularly the dual systems for laboratory remuneration that hinge on specimen origin, were thrown into strong relief by the 1990s reforms. Furthermore, evidence gathered in this study suggests the reforms became counter-productive, even in their own terms. Thus, the change towards market controls not only destroyed strengths of the existing centrally controlled laboratory system, but also, by fostering a focus on outputs, greatly increased volume-driven state expenditure on laboratory testing. This occurred largely without improvement in disease ‘pick-up’ rates, avoidable hospitalisations, or cost-efficiencies. The internal market compromise proved powerless to avoid laboratory services monopoly development by foreign investor owned companies. As a consequence it neither indicated the most efficient test prices, nor engendered the physical laboratory amalgamations that have occurred overseas in the interests of cost-efficiency. 

The thesis concludes that the kind of structural reform introduced into the New Zealand health sector in the 1990s was a poor instrument for achieving cost effectiveness. Specific technological changes in laboratory practice, along with globalisation in health service provision, are identified as examples of design influences that will strongly re-shape the supply-side of New Zealand laboratory services. Their considered incorporation into a revived central, evidence-based, laboratory services redesign plan is strongly recommended. Unfortunately, the partially decentralised governance structure introduced by the Labour-led coalition in 2001 appears to have the potential to frustrate that recommendation.

year: 2001

title: Unorthodox assistance: Novalis, Māori, scientism, and an uncertain approach to 'Whakapapa'

authors: Mika, Carl Te Hira

abstract: The reductionism of Western science is well noted among several Maori academics, who describe in various ways its methodical tendency to dissemble an organism and isolate its parts. The reductionist nature of the method of science then informs the practice, so that the manifestations of science - its latest innovations, evidenced in biotechnology, cloning, stem cell therapy and so on - become an overriding concern for these academics. Rightly, the effects of those innovations on Maori spiritual and phYSical realms are addressed, to the extent that they may constitute extensive submissions to governmental bodies. How effective these submissions are is open to considerable speculation, particularly when it is acknowledged by many of these same writers that those ministerial and judicial bodies are incapable of understanding the dilemmas posed by the effects of reductionist scientific practice on the Maori world. The Maori world, in the main, is left to wait until it is confronted with yet another scientific advancement or technology, and the rush to counter its modus operandi begins again.

text: Unorthodox assistance: Novalis, Māori, scientism, and an uncertain approach to 'Whakapapa' The reductionism of Western science is well noted among several Maori academics, who describe in various ways its methodical tendency to dissemble an organism and isolate its parts. The reductionist nature of the method of science then informs the practice, so that the manifestations of science - its latest innovations, evidenced in biotechnology, cloning, stem cell therapy and so on - become an overriding concern for these academics. Rightly, the effects of those innovations on Maori spiritual and phYSical realms are addressed, to the extent that they may constitute extensive submissions to governmental bodies. How effective these submissions are is open to considerable speculation, particularly when it is acknowledged by many of these same writers that those ministerial and judicial bodies are incapable of understanding the dilemmas posed by the effects of reductionist scientific practice on the Maori world. The Maori world, in the main, is left to wait until it is confronted with yet another scientific advancement or technology, and the rush to counter its modus operandi begins again.

year: 2011