scholarly journals Comparison of the effect of lemborexant and other insomnia treatments on driving performance: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Heather McElroy ◽  
Beth O’Leary ◽  
Michael Adena ◽  
Renee Campbell ◽  
Amir Abbas Tahami Monfared ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Meta Analysis ◽  
Blood Alcohol Concentration ◽  
Lateral Position ◽  
Driving Performance ◽  
Alcohol Concentration ◽  
Driving Under The Influence ◽  
Clinical Trial Registries ◽  
Clinically Significant ◽  
The Impact

Abstract Study Objectives This systematic literature review and meta-analysis explored the impact of lemborexant and other insomnia treatments on next-day driving performance. Methods Searches were conducted in MEDLINE ® and Embase ® on 16 May 2019, supplemented by clinical trial registries. Randomized controlled trials in healthy volunteers or people with insomnia were included if they reported a standardized on-road driving test, were published in English and included ≥1 group receiving a recommended dose of flunitrazepam, estazolam, triazolam, temazepam, brotizolam, etizolam, alprazolam, lorazepam, zolpidem, eszopiclone, zaleplon, zopiclone, trazodone, ramelteon, lemborexant, or suvorexant. Pairwise random-effects meta-analyses used the difference between each active treatment and placebo in standard deviation of lateral position (ΔSDLP). ΔSDLP of +2.4 cm, established as equivalent to a blood alcohol concentration of 0.05%, was considered clinically significant. Results Fourteen studies were included. Clinically significant differences in ΔSDLP were shown in healthy volunteers for zopiclone (10/10 studies) and ramelteon (1/1 study), and in people with insomnia for flunitrazepam (2/3 studies). Premature test termination was reported most frequently for zopiclone (5/10 studies) and was reported in two subjects for suvorexant (1/2 studies), one for flunitrazepam (1/3 studies) and one for placebo (1/12 studies). Lemborexant had no statistically or clinically significant ΔSDLP, and no premature driving test terminations. Conclusions Zopiclone, flunitrazepam and ramelteon were associated with impaired driving performance, similar to driving under the influence of alcohol. Premature test termination was reported most frequently for zopiclone, and also for suvorexant, flunitrazepam and placebo. Lemborexant had no statistically or clinically significant effect on driving performance.

Driving Under the Influence: The Impact of Legislative Reform on Court Sentencing Practices

1988 ◽  
Vol 34 (1) ◽  
pp. 3-27 ◽  
Author(s):  
Rodney Kingsnorth ◽  
Michael Jungsten
Keyword(s):  
Criminal Liability ◽  
Blood Alcohol Concentration ◽  
Plea Bargaining ◽  
Alcohol Concentration ◽  
Driving Under The Influence ◽  
Bargaining Process ◽  
Legislative Reform ◽  
The Impact ◽  
The Relationship ◽  
Reckless Driving

In 1982, California introduced a number of revisions into its Vehicle Code sections dealing with the prosecution and sentencing of defendants charged with driving under the influence of alcohol. These revisions included redefining the relationship between blood alcohol concentration and criminal liability, constraints upon the plea-bargaining process, and an increase in the severity of penalties. An assessment is offered, based upon a random sample of 2,091 cases from one California county, of the impact of legislative reform on court sentencing practices. While the new law succeeded in eliminating “prior conviction” bargaining, the “reduction to reckless driving” form of bargaining, though initially substantially reduced, quickly rose again to prereform levels. Contrary to expectations, trial rates increased and rates of conviction at trial decreased. Problems of court congestion were exacerbated rather than relieved. The impact of increased penalties has been substantial for some offenders and for others negligible.

scholarly journals The effect of acute ingestion of alcohol at 0.05% and 0.10% blood respiratory alcohol concentration on heterophoria

2016 ◽  
Vol 75 (1) ◽  
Author(s):  
Alvin J. Munsamy ◽  
Ryan S. Hamilton-Hoskins ◽  
Talent Bero ◽  
Philiswe P. Ximba ◽  
Daina Govender ◽  
...  
Keyword(s):  
Red Wine ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Alcohol Ingestion ◽  
Driving Under The Influence ◽  
Experimental Phase ◽  
Before And After ◽  
Acute Ingestion ◽  
Quasi Experimental ◽  
Clinically Significant

Introduction: Alcohol ingestion has a significant effect on speech, vision and coordination. The legal limit for driving under the influence in South Africa is 0.05% blood alcohol concentration (BAC), whilst intoxication is considered to occur at 0.10% BAC. The aim of our study was to investigate the effect of acute alcohol ingestion of 0.05% and 0.10% blood respiratory alcohol concentration (BrAC) on heterophoria.Methodology: The effect of alcohol ingestion on the oculomotor systems of 31 subjects was the basis of this quasi-experimental quantitative study. Various parameters were compared before and after the ingestion of 10% alc red wine. The Alcoscan ALP-1 breathalyser test was used as an indicator of BrAC. Heterophoric, fusional vergence and near point of convergence (NPC) measurements were measured during an experimental phase at 0.05% and 0.10% BrAC levels and a control phase at a 0% BrAC.Results: Mean changes in heterophoria for distance showed an increase of 1.13∆ ± 1.34∆ and 2.19∆ ± 1.70∆ towards esophoria at a BrAC of 0.05% and 0.10% respectively. At near, the results showed a mean increase of 0.84∆ ± 1.75∆ and 0.97∆ ± 1.70∆ towards exophoria at a BrAC of 0.05% and 0.10% respectively. There was a further mean decrease in the positive and negative fusional vergences as well as receded NPC break and recovery measurements at 0.05% and 0.10% BAC.Conclusion: It can be concluded that a BrAC of 0.05% has a minimal effect on heterophoria. However, at a BrAC of 0.1% there is a significant effect on heterophoria, fusional vergences and the NPC. This may or may not be clinically significant.

scholarly journals Reduced phagocytosis, ROS production and enhanced apoptosis of leukocytes upon alcohol drinking in healthy volunteers

2021 ◽  
Author(s):  
Florian Haag ◽  
Andrea Janicova ◽  
Baolin Xu ◽  
Maciej Powerski ◽  
Melanie Fachet ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Alcohol Drinking ◽  
Alcohol Misuse ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Cellular Functions ◽  
Intracellular Ros ◽  
Late Apoptosis ◽  
Leukocyte Counts ◽  
The Impact

Abstract Background Alcohol drinking is associated with a serious risk of developing health problems as well as with a large number of traumatic injuries. Although chronic alcohol misuse is known to contribute to severe inflammatory complications, the effects of an acute alcohol misuse are still unclear. Here, the impact of acute alcohol drinking on leukocyte counts and their cellular functions were studied. Methods Twenty-two healthy volunteers (12 female, 10 male) received a predefined amount of a whiskey-cola mixed drink (40% v/v), at intervals of 20 min, over 4 h to achieve a blood alcohol concentration of 1‰. Blood samples were taken before drinking T0, 2 h (T2), 4 h (T4), 6 h (T6), 24 h (T24) and 48 h (T48) after starting drinking alcohol. Leukocytes, monocytes and granulocyte counts and their functions regarding the production of reactive oxidative species (ROS), phagocytosis and apoptosis were analyzed by flow cytometry. Results Total leukocyte counts significantly increased at T2 and T4, while granulocyte and monocyte counts decreased at T4 and T6 vs. T0. Monocytes increased significantly at T24 and T48 vs. T0. While the total number of ROS-producing leukocytes and notably granulocytes significantly increased, in parallel, the intracellular ROS intensity decreased at T2 and T6. The numbers of ROS-positive monocytes have shown a delayed modulation of ROS, with a significant reduction in the total number of ROS-producing cells at T48 and a significantly reduced intracellular ROS-intensity at T24. Phagocyting capacity of leukocytes significantly decreased at T4 and T6. In general leukocytes, and notably granulocytes demonstrated significantly increased early (T2), while monocyte exerted significantly increased late apoptosis (T24 and T48). Conclusions Alcohol drinking immediately impacts leukocyte functions, while the impact on monocytes occurs at even later time points. Thus, even in young healthy subjects, alcohol drinking induces immunological changes that are associated with diminished functions of innate immune cells that persist for days.

4. Are a Blood Alcohol Concentration of 256mg/dl and Minimal Signs of Impairment Reliable Indications of Alcohol Dependence?

1994 ◽  
Vol 34 (3) ◽  
pp. 265-270 ◽  
Author(s):  
A W Jones
Keyword(s):  
Expert Witness ◽  
Blood Alcohol Concentration ◽  
Drunk Driving ◽  
Alcohol Concentration ◽  
Driving Under The Influence ◽  
Blood Alcohol ◽  
Lower Court ◽  
Dna Profile ◽  
Court Of Appeals ◽  
Driving Scenario

This article describes a drink-driving scenario where a woman was apprehended for driving under the influence (DUI) with a blood alcohol concentration (BAC) of 256mg/dl1 The correctness of this result was vigorously challenged by a medical expert witness for the defence, who was actually a specialist in alcohol diseases. Despite reanalysis to confirm the BAC as well as a DNA profile to prove the identity of the blood specimen, the woman was acquitted of the charge of drunk driving by the lower court. However, she was subsequently found guilty in the High Court of Appeals with a unanimous decision and sentenced to four weeks imprisonment. This case report illustrates some of the problems surrounding the use of expert medical evidence by the defence to challenge the validity of the prosecution evidence based solely on a suspect's BAC. In situations such as these, an expert witness should be called by the prosecution to clarify and, if necessary, rebut medical and/or scientific opinions that might mislead the court and influence the outcome of the trial.

scholarly journals Racial/Ethnic Disparities in the Relationship of Alcohol-Related Injury and Perceived Driving Under the Influence from Hours of Exposure to High Blood Alcohol Concentration: Data From Four US National Alcohol Surveys (2000–2015)

2020 ◽  
Vol 55 (5) ◽  
pp. 564-570
Author(s):  
Cheryl J Cherpitel ◽  
Edwina Williams ◽  
Yu Ye ◽  
William C Kerr
Keyword(s):  
Blood Alcohol Concentration ◽  
Ethnic Disparities ◽  
Alcohol Concentration ◽  
Driving Under The Influence ◽  
Blood Alcohol ◽  
Concentration Data ◽  
Predicted Probability ◽  
Exposure Levels ◽  
Relationship Of ◽  
Racial Ethnic

Abstract Aims To analyze racial/ethnic disparities in risk of two alcohol-related events, alcohol-related injury and self-reported perceived driving under the influence (DUI) from hours of exposure to an elevated blood alcohol concentration (BAC). Methods Risk curves for the predicted probability of these two outcomes from the number of hours of exposure to a BAC ≥ 0.08 mg% in the past year were analyzed separately for whites, blacks and Hispanics in a merged sample of respondents from four US National Alcohol Surveys (2000–2015). Results Hours of exposure to a BAC ≥ 0.08 showed a stronger association with perceived DUI than with alcohol-related injury for all racial/ethnic groups. Greater risk was found for whites than blacks or Hispanics for outcomes at nearly all BAC exposure levels, and most marked at the highest level of exposure. Risk of both outcomes was significant for whites at all exposure levels, but small for alcohol-related injury. Little association was found for alcohol-related injury for blacks or Hispanics. For perceived DUI, risk for blacks was significantly elevated at lower levels of exposure, while risk for Hispanics was significantly elevated beginning at 30 h of exposure. Conclusions Findings showed racial/ethnic differences in risk of alcohol-related injury and perceived DUI from hours of exposure to elevated BAC. Risk increased at relatively low levels of exposure to a BAC ≥ 0.08, especially for whites, highlighting the importance of preventive efforts to reduce harmful outcomes for moderate drinkers.

scholarly journals Study of the Effects of Alcohol on Drivers and Driving Performance on Straight Road

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Xiaohua Zhao ◽  
Xingjian Zhang ◽  
Jian Rong
Keyword(s):  
Standard Deviation ◽  
Traffic Safety ◽  
Traffic Accidents ◽  
Linear Trend ◽  
Blood Alcohol Concentration ◽  
Driving Performance ◽  
Alcohol Concentration ◽  
Accident Rate ◽  
Significant Linear Trend ◽  
Lane Position

Drinking driving is responsible for a high proportion of traffic accidents. To study the effects of alcohol on drivers and driving performance, 25 drivers’ subjective feelings and driving performance data in different blood-alcohol concentration (BAC) levels were collected with simulated driving experiment. The investigation results revealed that alcohol affected drivers in many aspects, including attitude, judgment, vigilance, perception, reaction, and controlling. The analysis of accident rate showed that higher BAC level would lead to higher accident rate. The statistical analysis results of driving performance indicated that average speed, speed standard deviation, and lane position standard deviation were significantly higher under the influence of alcohol. They also had a statistically significant linear trend as the function of BAC level. The discrimination of drinking driving based on driving performance was performed with Fisher discrimination method. The results showed that drinking driving with higher BAC level was easier to discriminate from normal driving. Also, the results indicated that the three significant indicators on straight roadway could be used in the discrimination of drinking driving state. The conclusions can provide references for the study of drinking driving and the identification of driving state and then contribute to traffic safety.

Everything Is Bigger in Texas: Alcohol Impaired Driving in Houston (2014–2018)

2020 ◽  
Author(s):  
Corissa Rodgers ◽  
Melissa Lloyd ◽  
Peter Stout ◽  
Dayong Lee
Keyword(s):  
Public Safety ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Driving Under The Influence ◽  
Science Center ◽  
Impaired Driving ◽  
Blood Samples ◽  
Drug Concentrations ◽  
Populations At Risk ◽  
Alcohol Impaired Driving

Abstract Driving while intoxicated (DWI) or driving under the influence of drugs (DUID) poses a continued public safety risk in Texas, which has one of the highest alcohol impaired traffic fatality rates. This study aimed to identify alcohol and drug use trends seen in DWI/DUID cases in the city of Houston from 2014 to 2018 to better understand the populations at risk. Blood samples submitted to the Houston Forensic Science Center (HFSC) were evaluated for blood alcohol concentration (BAC), drug concentrations and demographics. During the 5-year period, 12,682 Houston driver blood samples had a mean (median) BAC of 0.151 g/dL (0.167 g/dL) and age of 36.3 (34) years. Fifty percent of samples were white males. Seventy-five percent of samples were individuals aged 21 to 44 years. Between 2014 and 2018, the number of cases submitted nearly doubled, from approximately 2,000 cases per year to over 3,700. In 2014, 23% of cases submitted required further analysis per HFSC testing policy (drug screen and confirmation for DWI/DUID cases when BAC < 0.100 g/dL), which rose to 27% by 2018. Of those, 36% were polydrug cases, requiring two or more confirmation tests. Cannabinoids was the most common drug class detected (34% of cases analyzed for drugs), followed by benzodiazepines (25%), phencyclidine (20%), cocaine/metabolites (15%) and opioids (12%). Phencyclidine rose from the fifth-most commonly detected drug in 2014 to the second-most drug in 2018. Only 3% of all cases (n = 408) were negative for both alcohol and drugs. Communication between law enforcement and laboratory management is recommended to address growing caseload more effectively. The study limitations (e.g., limited scope of analysis) suggest the present data underestimated the full extent of impaired driving in Houston, indicating even more urgent needs for increasing resources and efforts to reduce this serious threat to public safety.

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