Using a motorcycle rider behaviour questionnaire (MRBQ) to investigate the predictors of motorcyclists' crash risk

In 2005, there were over 23,000 motorcyclists (including moped riders) involved in injury road traffic crashes in Great Britain and 6,142 of these riders were killed or seriously injured (Department for Transport, 2006). In order to reduce the casualty rates it is necessary to understand why motorcycle crashes happen. The present study approached this issue by investigating the role of aberrant rider behaviour, using a Motorcycle Rider Behaviour Questionnaire (MRBQ) as a framework. The aims of the study were to test the reliability and discriminant validity of the MRBQ and to examine which MRBQ behaviours relate to crash risk. Following the Driver Behaviour Questionnaire (e.g., Reason et al., 1990), which classifies driver behaviour into a system of errors ('the failure of planned actions to achieve their intended consequences') and violations ('deliberate deviations from those practices necessary to maintain the safe operation of a potentially hazardous system'), the MRBQ measured errors and violations, but with regard to motorcycling rather than car driving (see Elliott, Baughan & Sexton, 2007). The questionnaire consisted of 43 items to measure the self-reported frequency of specific riding behaviours. The questionnaire was administered to a sample of motorcyclists via a postal survey (N = 8,666). Principal components analysis revealed a 5-factor solution (TRAFFIC ERRORS, CONTROL ERRORS, SPEED VIOLATIONS, performance of STUNTS, and use of SAFETY EQUIPMENT). Generalised linear modelling showed that, while controlling for the effects of age, experience and annual mileage, TRAFFIC ERRORS were the main predictors of crash risk. For crashes in which respondents accepted some degree of blame, CONTROL ERRORS and SPEED VIOLATIONS were also significant predictors of crash risk. Implications of the findings will be discussed in relation to deciding on which countermeasures may be most effective at reducing motorcycle casualty rates

Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis (New EPOC): long-term results of a multicentre, randomised, controlled, phase 3 trial.

BACKGROUND: The interim analysis of the multicentre New EPOC trial in patients with resectable colorectal liver metastasis showed a significant reduction in progression-free survival in patients allocated to cetuximab plus chemotherapy compared with those given chemotherapy alone. The focus of the present analysis was to assess the effect on overall survival. METHODS: New EPOC was a multicentre, open-label, randomised, controlled, phase 3 trial. Adult patients (aged ≥18 years) with KRAS wild-type (codons 12, 13, and 61) resectable or suboptimally resectable colorectal liver metastases and a WHO performance status of 0-2 were randomly assigned (1:1) to receive chemotherapy with or without cetuximab before and after liver resection. Randomisation was done centrally with minimisation factors of surgical centre, poor prognosis cancer, and previous adjuvant treatment with oxaliplatin. Chemotherapy consisted of oxaliplatin 85 mg/m2 administered intravenously over 2 h, l-folinic acid (175 mg flat dose administered intravenously over 2 h) or d,l-folinic acid (350 mg flat dose administered intravenously over 2 h), and fluorouracil bolus 400 mg/m2 administered intravenously over 5 min, followed by a 46 h infusion of fluorouracil 2400 mg/m2 repeated every 2 weeks (regimen one), or oxaliplatin 130 mg/m2 administered intravenously over 2 h and oral capecitabine 1000 mg/m2 twice daily on days 1-14 repeated every 3 weeks (regimen two). Patients who had received adjuvant oxaliplatin could receive irinotecan 180 mg/m2 intravenously over 30 min with fluorouracil instead of oxaliplatin (regimen three). Cetuximab was given intravenously, 500 mg/m2 every 2 weeks with regimen one and three or a loading dose of 400 mg/m2 followed by a weekly infusion of 250 mg/m2 with regimen two. The primary endpoint of progression-free survival was published previously. Secondary endpoints were overall survival, preoperative response, pathological resection status, and safety. Trial recruitment was halted prematurely on the advice of the Trial Steering Committee on Nov 1, 2012. All analyses (except safety) were done on the intention-to-treat population. Safety analyses included all randomly assigned patients. This trial is registered with ISRCTN, number 22944367. FINDINGS: Between Feb 26, 2007, and Oct 12, 2012, 257 eligible patients were randomly assigned to chemotherapy with cetuximab (n=129) or without cetuximab (n=128). This analysis was carried out 5 years after the last patient was recruited, as defined in the protocol, at a median follow-up of 66·7 months (IQR 58·0-77·5). Median progression-free survival was 22·2 months (95% CI 18·3-26·8) in the chemotherapy alone group and 15·5 months (13·8-19·0) in the chemotherapy plus cetuximab group (hazard ratio [HR] 1·17, 95% CI 0·87-1·56; p=0·304). Median overall survival was 81·0 months (59·6 to not reached) in the chemotherapy alone group and 55·4 months (43·5-71·5) in the chemotherapy plus cetuximab group (HR 1·45, 1·02-2·05; p=0·036). There was no significant difference in the secondary outcomes of preoperative response or pathological resection status between groups. Five deaths might have been treatment-related (one in the chemotherapy alone group and four in the chemotherapy plus cetuximab group). The most common grade 3-4 adverse events reported were: neutrophil count decreased (26 [19%] of 134 in the chemotherapy alone group vs 21 [15%] of 137 in the chemotherapy plus cetuximab group), diarrhoea (13 [10%] vs 14 [10%]), skin rash (one [1%] vs 22 [16%]), thromboembolic events (ten [7%] vs 11 [8%]), lethargy (ten [7%] vs nine [7%]), oral mucositis (three [2%] vs 14 [10%]), vomiting (seven [5%] vs seven [5%]), peripheral neuropathy (eight [6%] vs five [4%]), and pain (six [4%] vs six [4%]). INTERPRETATION: Although the addition of cetuximab to chemotherapy improves the overall survival in some studies in patients with advanced, inoperable metastatic disease, its use in the perioperative setting in patients with operable disease confers a significant disadvantage in terms of overall survival. Cetuximab should not be used in this setting. FUNDING: Cancer Research UK

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Developing a self-report method of investigating adolescent road user behaviour

The aim of the present study was to develop a self-report questionnaire to provide a classification of aberrant road user behaviour in adolescent children. An Adolescent Road user Behaviour Questionnaire (ARBQ) was developed, comprising 43 items requiring respondents to rate the frequency with which they engaged in specific examples of road-using behaviour. The questionnaire was completed by 2433 children aged 11-16. Factor analysis showed that responses to the 43 items were best fitted by a three-factor solution. Factor 1 comprised items relating to "unsafe road crossing behaviour", factor 2 comprised items related to "dangerous playing in the road", and factor 3 comprised items which as a group were termed "planned protective behaviour". A revised 21-item ARBQ was produced by selecting the items that loaded most strongly on the three factors. The 21-item instrument had good internal reliability. The effects of demographic variables on ARBQ scale scores were investigated. This study provided a tool that could be used in the future by researchers investigating adolescent road user safety. Possible avenues for future research include applying the ARBQ to the study of adolescents' road accident involvement, and the study of the psychological variables that predict the ARBQ scales

Drivers' Compliance with Speed Limits: An Application of the Theory of Planned Behavior

The theory of planned behavior (TPB; I. Ajzen, 1985) was applied to drivers' compliance with speed limits. Questionnaire data were collected for 598 drivers at 2 time points separated by 3 months. TPB variables,' demographic information, and self-reported prior behavior were measured at Time 1, and self-reported subsequent behavior was measured at Time 2. In line with the TPB, attitude, subjective norm, and perceived control were positively associated with behavioral intention, and intention and perceived control were positively associated with subsequent behavior. TPB variables mediated the effects of age and gender on behavior. Prior behavior was found to moderate the perceived control-intention and perceived control-subsequent behavior relationships. Practical implications of the findings for road safety and possible avenues for further research are discussed

Exploring the beliefs underpinning drivers' intentions to comply with speed limits

Using the theory of planned behaviour (TPB; [Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl, J. Beckmann (Eds.), Action control: From cognition to behavior (pp. 11-39). Berlin: Springer-Verlag.]) as a theoretical framework, the present study was designed to: (a) identify the beliefs underpinning drivers' intentions to comply with speed limits, and (b) test the expectancy-value theory held to underpin those beliefs. A sample of drivers (N = 598) completed questionnaires designed to measure TPB variables with respect to compliance with speed limits. The results of hierarchical multiple regression analyses provided support for the expectancy-value theory held to underpin each behavioural beliefs (outcome beliefs X outcome evaluations), normative beliefs (referent beliefs X motivation to comply), and control beliefs (control frequency beliefs X control power beliefs). Belief targets for road safety countermeasures that aim persuade drivers to comply with speed limits were also identified by selecting those beliefs that were the statistically significant predictors of direct TPB measures (attitudes, subjective norm, perceived control) and intention. Theoretical and practical implications of the results are discussed

Common variation near CDKN1A, POLD3 and SHROOM2 influences colorectal cancer risk

We performed a meta-analysis of five genome-wide association studies to identify common variants influencing colorectal cancer (CRC) risk comprising 8,682 cases and 9,649 controls. Replication analysis was performed in case-control sets totaling 21,096 cases and 19,555 controls. We identified three new CRC risk loci at 6p21 (rs1321311, near CDKN1A; P = 1.14 × 10 -10), 11q13.4 (rs3824999, intronic to POLD3; P = 3.65 × 10 -10) and Xp22.2 (rs5934683, near SHROOM2; P = 7.30 × 10 -10) This brings the number of independent loci associated with CRC risk to 20 and provides further insight into the genetic architecture of inherited susceptibility to CRC.</p