Safest Placement for Crosswalks at Intersections

This research studied the relationship between crosswalk setback and intersection safety. The study included field-based and driving simulator experiments. Video data was collected at 10 crosswalks in Oregon to examine the frequency pedestrian-vehicle conflicts (measured using PET), including how these conflicts vary between corner and setback crosswalks. A total of 507 pedestrians and 47 conflicts with post-encroachment times of less than 5 seconds were observed. The 50 participants driving simulator experiment was used to determine how setback distances, curb radii, and presence of pedestrians affect driver stopping decision and position, speed choice, visual attention, and level of stress. Observations of drivers\u2019 speed in a similar scenario were taken from field and simulator data to enhance the evidence provided by each experiment. Stop line speeds were found to be consistent between experiments and turning speeds were found to be slightly higher in the driving simulator experiment. The study results suggest that curb radius should be smaller to control driver speed. Additionally, setback distance of the crosswalk of 20ft is a suitable upper bound when reconstructing intersections

Malaria elimination in Ghana:recommendations for reactive case detection strategy implementation in a low endemic area of Asutsuare, Ghana

Background: Progress toward malaria elimination is increasing as many countries near zero indigenous malaria cases. In settings nearing elimination, interventions will be most effective at interrupting transmission when targeted at the residual foci of transmission. These foci may be missed due to asymptomatic infections. To solve this problem, the World Health Organization recommends reactive case detection (RACD). This case study was conducted to identify individuals with asymptomatic malaria, their predisposing risk factors and recommend RACD in Asutsuare, Ghana based on literature review and a cross sectional study. Methods: The study involved a search on PubMed and Google Scholar of literature published between 1st January, 2009–14th August, 2023 using the search terms “malaria” in “Asutsuare”. Furthermore, structured questionnaires were administered to one hundred individuals without symptoms of malaria and screened using rapid diagnostic test (RDT) kits, microscopy and real-time polymerase chain reaction (rt-PCR). Malaria prevalence based on the three diagnostic techniques as well as potential malaria risk factors were assessed through questionnaires in a cross-sectional study. Results: Cumulatively, sixty-four (64) studies (Google Scholar, 57 and PubMed, 7) were reviewed and 22 studies included in the literature on malaria in Asutsuare, Ghana. Significant risk factors were occupation, distance from a house to a waterbody, age group and educational level. Out of the 100 samples, 3 (3%) were positive by RDT, 6 (6%) by microscopy and 9 (9%) by rt-PCR. Ages 5–14.9 years had the highest mean malaria parasite densities of 560 parasites/µl with Plasmodium falciparum as the dominant species in 4 participants. Moreover, in the age group ≥ 15, 2 participants (1 each) harboured P. falciparum and Plasmodium malariae parasites. RDT had a higher sensitivity (76.54%; CI95 66.82–85.54) than rt-PCR (33.33%; CI95 4.33–77.72), while both rt-PCR and RDT were observed to have a higher specificity (92.55; CI95 85.26–96.95) and (97.30; CI95 93.87–99.13), respectively in the diagnosis of malaria. Conclusion: In Asutsuare, Ghana, a low endemic area, the elimination of malaria may require finding individuals with asymptomatic infections. Given the low prevalence of asymptomatic individuals identified in this study and as repleted in the literature review, which favours RACD, Asutsuare is a possible setting receptive for RACD implementation.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Improving Bicycle Crossings at Unsignalized Intersections through Pavement Markings: Analysis of the City of Portland Innovative Strategy

The increasing trend in the number of bicycle crashes in the U.S since 2009 has been a major challenge to safety. In 2019, a total of 36,096 people were killed on U.S roadways. A total of 846 (2.3%) of these fatalities were bicyclists and around 75% of the bicycle fatalities occur in urban areas and intersections are common locations of crashes. Many bicycle enhancements such as bike boxes, bicycle signals, curb extensions have been installed to improve safety at signalized intersections. The City of Portland OR experimented with an innovative treatment to improve bicycle crossings at unsignalized crossings. This treatment, termed a high visibility cross-bike, was installed at crossings of neighborhood bicycle greenways with busy roadways. The marking is similar way to a continental pedestrian crosswalk but with green pavement markings rather than white. Although the cross-bike marking does not currently require motorists to yield for bicycles waiting to cross the roadway, it was hypothesized that the presence of the marking would alter motorists yielding behavior towards bicyclists and improve the crossing experience for persons on bicycles. This thesis analyzed empirical data to evaluate the modifications in the rate of motorists yielding behavior at three unsignalized intersections in Portland, Oregon. Three intersections (NE Going and NE 15th Ave, SE Salmon and SE 20th Ave, NE Holman and NE 33rd) were evaluated in before and after experiment. A total of 48 hours of video data was analyzed to produce a sample of 1,840 bicycle crossing events (897 before; 943 after) carried out by 2,219 bicyclists. (1,097 before; 1,122 after). The rates of motorists yielding to bicyclists improved after installing cross-bike markings. The yielding rates at NE Going and NE 15th Ave increased from 48% near side to 91% near side and 61% far side to 95% far side after the markings. SE Salmon and SE 20th Ave also realized a significant increase in motorists yielding rates from 21% to 40% near side and 11% to 33% far side. Trends were similar at NE Holman and NE 33rd with rates improving from 38% to 77% near side and 36% to 82% far side. The changes in driver yielding behavior were all statistically significant. A reduction in bicyclists\u27 wait times at the locations was also observed. Finally, it was noted that the cross-bike marking encouraged bicyclist to position themselves more consistently in the intersection as they waited to cross

Driver Yielding and Pedestrian Performance at Midblock Crossings on Three-Lane Roadways with Rectangular Rapid Flashing Beacons

Rectangular rapid flashing beacons (RRFBs) have proven to be a useful tool for improving driver yielding and pedestrians’ safety at midblock crossings. This study analyzed driver yielding at 23 RRFB-enhanced midblock crossings on three-lane roadways with and without median refuge islands in Oregon. The locations were chosen to represent a range of posted speed limits and average daily traffic that aligns with existing guidance for median and beacon installations. Sites were classified either as (a) no median refuge, RRFBs placed outside the roadway, (b) median refuge, RRFBs placed outside the roadway, (c) median refuge, RRFBs placed on the island and outside the roadway. Yielding was determined following protocols established in prior research. Two hundred seventy-six hours of video footage were analyzed, resulting in 3,065 crossing events (1,338 staged; 1,727 naturalistic) undertaken by 3,683 pedestrians. High yielding rates were observed—the average near side yielding rate was 97%, with the lowest site having a rate of 89.9%. Yielding rates were generally higher on the far side. Owing to sample size and consistently high yielding rates, it was not possible to make conclusive observations about the relationship between driver yielding and the presence of median or additional beacons for the volume and speed combinations. The results generally indicated that yielding rates increased with the addition of median beacons. The findings also suggested median refuge islands with a beacon increased yielding. The increase in yielding was statistically significant at sites with average daily traffic of 12,000 to 15,000. Over the last decade, many jurisdictions in the United States have installed pedestrian crossing enhancements (PCEs) to improve pedestrian safety and experience. These enhancements include continental markings, median refuge islands, curb bulb-outs, pedestrian-activated flashing beacons, overhead signs, advanced stop bars, and most recently, rectangular rapid flashing beacons (RRFBs). FHWA first issued Interim Approval (IA-11) for the use of RRFBs in 2008 (1), then rescinded it in December 2017 because of patent issues. However, on March 20, 2018, FHWA issued Interim Approval for the optional use of pedestrian-actuated rectangular rapid-flashing beacons at uncontrolled marked crosswalks (IA-21) after the patent issues were resolved. In recent years, several studies have been carried out to evaluate the effectiveness, measured by driver yielding rates, of RRFBs at midblock crossings (2–12). These studies have used either staged pedestrian crossings, naturalistic observations, or both to evaluate driver yielding behavior. A wide range of driver yielding rates have been observed, ranging from 19% to nearly 98%, though there are differences in how yielding is defined. Other studies have also evaluated the safety effectiveness of RRFBs and found crash modification factors of 0.53 and 0.71, indicating a significant reduction in pedestrian–motor vehicle crashes postinstallation (13, 14). Other features of enhanced crossings such as raised medians have been found to significantly lower pedestrian crash rates along multilane roadways at both marked and unmarked crosswalk locations (15). Other research has also demonstrated safety benefits for pedestrians from raised medians and refuge islands as individual enhancements (16–18). However, no studies have been found to evaluate the combined effect of median refuge islands and RRFBs. Since RRFBs are primarily used at midblock crossings, the first decision an agency often faces is whether to mark the crossing or not. Subsequent decisions for the agencies include the type of crossing enhancement to install and whether RRFBs are suitable for that location. The guidance set forth by FHWA presents the range of conditions for which RRFBs should be considered a treatment option. The guidance has number of lanes (two, three, four, or more), posted speed limit (≤30 mph, 35 mph, ≥40 mph) and vehicle volume (15,000 ADT) (19). This research aimed to explore driver yielding on three-lane roadways, with and without median refuge islands. This research observed driver yielding behavior in Oregon at 23 midblock crossings on three-lane roadways equipped with RRFBs with and without median refuge islands and beacons. Twelve hours of video footage was collected and coded at each site. Both staged pedestrian crossings and observations of naturalistic crossings were analyzed for pedestrian performance measures and drivers’ yielding behavior. The remainder of the paper is organized in the following manner. A description of data collection and coding is next, followed by the results and analysis, and finally, our conclusions

Knowledge, attitude and acceptability of COVID-19 vaccine among residents in rural communities in Ghana: a multi-regional study

Abstract Background The Coronavirus Infectious Disease 2019 (COVID-19) pandemic has continuously affected human life with several devastating effects. Currently, there are effective vaccines to protect people from COVID‐19 and the World Health Organization (WHO) has highlighted strategies to influence COVID-19 vaccine uptake in hard-to-reach communities in Ghana. However, prior studies on COVID-19 vaccine acceptability in Ghana are online surveys targeting the literates and those in urban areas, leaving residents in far-flung communities. We assessed knowledge, attitude and acceptability of COVID-19 vaccine among residents in rural communities in Ghana. Methods This study was a community-based cross-sectional study and was conducted at three selected regions in Ghana (Northern, Ashanti and Western North) from May to November, 2021. This study included residents 15–81 years, living in the selected rural communities for more than 1 year. Study participants were recruited and questionnaires administered to collect data on knowledge, attitude and acceptance of the COVID-19 vaccine. Statistical analyses were performed using Statistical Package for Social Science (SPSS) version 26.0 and GraphPad Prism Version 8.0 software. Results Of the 764 participants included in this study, more than half had inadequate knowledge (55.0%), poor attitudes (59.4%) and bad perception about COVID-19 vaccine (55.4%). The acceptability of COVID-19 vaccine in this study was 41.9%. The acceptability of COVID-19 vaccine in Ashanti, Northern and Western North regions were 32.5%, 26.2% and 29.6% respectively. In a multivariate logistic regression analysis, receiving recent or previous vaccine such as HBV vaccine [aOR = 1.57, 95% CI (1.23–3.29), p = 0.002], having good attitude towards COVID-19 vaccine [aOR = 61.47, 95% CI (29.55–127.86), p < 0.0001] and having good perception about the COVID-19 vaccine [aOR = 3.87, 95% CI (1.40–10.72), p < 0.0001] were independently associated with higher odds of accepting COVID-19 vaccine. Conclusion More than half of residents in Ghanaian rural communities have inadequate knowledge, poor attitudes and bad perception about COVID-19 vaccine. The acceptability of COVID-19 vaccine is generally low among rural residents in Ashanti, Northern and Western North regions of Ghana. Residents living in hard-to-reach communities must be educated about the benefits of COVID-19 vaccine to achieve effective vaccination program

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study

Background: Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods: Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results: A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions: With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances