Road Safety Management at Work Zones : Final report

Accidents nearby work zones are a persistent road safety problem in many European countries. The Conference of European Directors of Roads (CEDR) has initiated and finances the IRIS project (Incursion Reduction to Increase Safety in road work zones) with the aim to collect and share information about best practices in temporary traffic management at road works. An analysis of work zone accidents and a review of best practices were made. Psychological issues to improve safety at work zones were studied by a literature review. Interviews with stakeholders were carried out in eight European countries to gather information on guidelines, standards and procedures in temporary traffic management. Best practice findings cover organizational/management issues, work zone safety reviews, establishment/de-establishment of a road work zone, informing/warning and guiding road users through work zone areas, speed management, protecting devices for road workers’ and road users’ safety and incursion warning systems

The effect of wind turbines alongside motorways on drivers’ behaviour

This paper presents the results of a first study aimed at investigating whether the presence of wind turbines in close proximity to motorways leads to behavioural adaptations among passing drivers. Empirical data from loop detectors and temporary video cameras were analysed in a study employing a before-and-after design at a site near Rotterdam, The Netherlands. Analyses of driving speed and standard deviation of speed (corrected for trend effects through the use of control sites) were performed as well as analyses of the lateral position and standard deviation of the lateral position and an observation of serious traffic conflicts. The results showed that constructing wind turbines alongside a motorway led to some clearly observable effects on drivers’ behaviour. The analyses of the speed data showed that the mean speed was lowered by 2.24km/h (corrected for trend effects) after the construction of the wind turbines while the standard deviation of the speed significantly increased. After the construction of the wind turbines, drivers took a lateral position somewhat more to the left-hand side in their driving lane. There was an indication close to the 0.05 significance level (p=0.057) that the standard deviation of the lateral position slightly increased when the rotor blades were in transversal position. In the before period as well as in the after period, no serious traffic conflicts were registered. The increase in standard deviation of speed and in lateral position are two factors that intrinsically can have an unfavourable effect on road safety. However, the observed order of magnitude of the change was shown to be quite limited. Earlier research suggests that negative effects on road safety are only expected for changes substantially greater than the ones that were observed in this study. On the other hand, there was a significant reduction in driving speed, which might have a favourable effect on the expected number and severity of crashes, although it could also be a compensatory mechanism that indirectly indicates a reduced driving performance. From these findings, it can be concluded that, based on the observed variables, no substantial negative effects for road safety were found in the present study. The authors recommend continuous monitoring and further research on the topic

A systematic cost-benefit analysis of 29 road safety measures

Economic evaluations of road safety measures are only rarely published in the scholarly literature. We collected and (re-)analyzed evidence in order to conduct cost-benefit analyses (CBAs) for 29 road safety measures. The information on crash costs was based on data from a survey in European countries. We applied a systematic procedure including corrections for inflation and Purchasing Power Parity in order to express all the monetary information in the same units (EUR, 2015). Cost-benefit analyses were done for measures with favorable estimated effects on road safety and for which relevant information on costs could be found. Results were assessed in terms of benefit-to-cost ratios and net present value. In order to account for some uncertainties, we carried out sensitivity analyses based on varying assumptions for costs of measures and measure effectiveness. Moreover we defined some combinations used as best case and worst case scenarios. In the best estimate scenario, 25 measures turn out to be cost-effective. 4 measures (road lighting, automatic barriers installation, area wide traffic calming and mandatory eyesight tests) are not cost-effective according to this scenario. In total, 14 measures remain cost-effective throughout all scenarios, whereas 10 other measures switch from cost-effective in the best case scenario to not cost-effective in the worst case scenario. For three measures insufficient information is available to calculate all scenarios. Two measures (automatic barriers installation and area wide traffic calming) even in the best case do not become cost-effective. Inherent uncertainties tend to be present in the underlying data on costs of measures, effects and target groups. Results of CBAs are not necessarily generally valid or directly transferable to other settings.acceptedVersio

Personalized bacteriophage therapy outcomes for 100 consecutive cases:a multicentre, multinational, retrospective observational study

In contrast to the many reports of successful real-world cases of personalized bacteriophage therapy (BT), randomized controlled trials of non-personalized bacteriophage products have not produced the expected results. Here we present the outcomes of a retrospective observational analysis of the first 100 consecutive cases of personalized BT of difficult-to-treat infections facilitated by a Belgian consortium in 35 hospitals, 29 cities and 12 countries during the period from 1 January 2008 to 30 April 2022. We assessed how often personalized BT produced a positive clinical outcome (general efficacy) and performed a regression analysis to identify functional relationships. The most common indications were lower respiratory tract, skin and soft tissue, and bone infections, and involved combinations of 26 bacteriophages and 6 defined bacteriophage cocktails, individually selected and sometimes pre-adapted to target the causative bacterial pathogens. Clinical improvement and eradication of the targeted bacteria were reported for 77.2% and 61.3% of infections, respectively. In our dataset of 100 cases, eradication was 70% less probable when no concomitant antibiotics were used (odds ratio = 0.3; 95% confidence interval = 0.127–0.749). In vivo selection of bacteriophage resistance and in vitro bacteriophage–antibiotic synergy were documented in 43.8% (7/16 patients) and 90% (9/10) of evaluated patients, respectively. We observed a combination of antibiotic re-sensitization and reduced virulence in bacteriophage-resistant bacterial isolates that emerged during BT. Bacteriophage immune neutralization was observed in 38.5% (5/13) of screened patients. Fifteen adverse events were reported, including seven non-serious adverse drug reactions suspected to be linked to BT. While our analysis is limited by the uncontrolled nature of these data, it indicates that BT can be effective in combination with antibiotics and can inform the design of future controlled clinical trials. BT100 study, ClinicalTrials.gov registration: NCT05498363.</p

Assessing changes in global fire regimes

PAGES, Past Global Changes, is funded by the Swiss Academy of Sciences and the Chinese Academy of Sciences and supported in kind by the University of Bern, Switzerland. Financial support was provided by the U.S. National Science Foundation award numbers 1916565, EAR-2011439, and EAR-2012123. Additional support was provided by the Utah Department of Natural Resources Watershed Restoration Initiative. SSS was supported by Brigham Young University Graduate Studies. MS was supported by National Science Centre, Poland (grant no. 2018/31/B/ST10/02498 and 2021/41/B/ST10/00060). JCA was supported by the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 101026211. PF contributed within the framework of the FCT-funded project no. UIDB/04033/2020. SGAF acknowledges support from Trond Mohn Stiftelse (TMS) and University of Bergen for the startup grant ‘TMS2022STG03’. JMP participation in this research was supported by the Forest Research Centre, a research unit funded by Fundação para a Ciência e a Tecnologia I.P. (FCT), Portugal (UIDB/00239/2020). A.-LD acknowledge PAGES, PICS CNRS 06484 project, CNRS-INSU, Région Nouvelle-Aquitaine, University of Bordeaux DRI and INQUA for workshop support.Background The global human footprint has fundamentally altered wildfire regimes, creating serious consequences for human health, biodiversity, and climate. However, it remains difficult to project how long-term interactions among land use, management, and climate change will affect fire behavior, representing a key knowledge gap for sustainable management. We used expert assessment to combine opinions about past and future fire regimes from 99 wildfire researchers. We asked for quantitative and qualitative assessments of the frequency, type, and implications of fire regime change from the beginning of the Holocene through the year 2300. Results Respondents indicated some direct human influence on wildfire since at least ~ 12,000 years BP, though natural climate variability remained the dominant driver of fire regime change until around 5,000 years BP, for most study regions. Responses suggested a ten-fold increase in the frequency of fire regime change during the last 250 years compared with the rest of the Holocene, corresponding first with the intensification and extensification of land use and later with anthropogenic climate change. Looking to the future, fire regimes were predicted to intensify, with increases in frequency, severity, and size in all biomes except grassland ecosystems. Fire regimes showed different climate sensitivities across biomes, but the likelihood of fire regime change increased with higher warming scenarios for all biomes. Biodiversity, carbon storage, and other ecosystem services were predicted to decrease for most biomes under higher emission scenarios. We present recommendations for adaptation and mitigation under emerging fire regimes, while recognizing that management options are constrained under higher emission scenarios. Conclusion The influence of humans on wildfire regimes has increased over the last two centuries. The perspective gained from past fires should be considered in land and fire management strategies, but novel fire behavior is likely given the unprecedented human disruption of plant communities, climate, and other factors. Future fire regimes are likely to degrade key ecosystem services, unless climate change is aggressively mitigated. Expert assessment complements empirical data and modeling, providing a broader perspective of fire science to inform decision making and future research priorities.Peer reviewe

Nutritional supplementation for hip fracture aftercare in older people

Background: Older people with hip fractures are often malnourished at the time of fracture, and subsequently have poor food intake. This is an update of a Cochrane review first published in 2000, and previously updated in 2010.  Objectives: To review the effects (benefits and harms) of nutritional interventions in older people recovering from hip fracture.  Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Embase, CAB Abstracts, CINAHL, trial registers and reference lists. The search was last run in November 2015.  Selection criteria: Randomised and quasi-randomised controlled trials of nutritional interventions for people aged over 65 years with hip fracture where the interventions were started within the first month after hip fracture.  Data collection and analysis: Two review authors independently selected trials, extracted data and assessed risk of bias. Where possible, we pooled data for primary outcomes which were: all cause mortality; morbidity; postoperative complications (e.g. wound infections, pressure sores, deep venous thromboses, respiratory and urinary infections, cardiovascular events); and ’unfavourable outcome’ defined as the number of trialparticipants who died plus the number of survivors with complications. We also pooled data for adverse events such as diarrhoea.  Main results: We included 41 trials involving 3881 participants. Outcome data were limited and risk of bias assessment showed that trials were often methodologically flawed, with less than half of trials at low risk of bias for allocation concealment, incomplete outcome data, or selective reporting of outcomes. The available evidence was judged of either low or very low quality indicating that we were uncertain or very uncertain about the estimates. Eighteen trials evaluated oral multinutrient feeds that provided non-protein energy, protein, vitamins and minerals. There was low-quality evidence that oral feeds had little effect on mortality (24/486 versus 31/481; risk ratio (RR) 0.81 favouring supplementation, 95% confidence interval (CI) 0.49 to 1.32; 15 trials). Thirteen trials evaluated the effect of oral multinutrient feeds on complications(e.g. pressure sore, infection, venous thrombosis, pulmonary embolism, confusion). There was low-quality evidence that the number of participants with complications may be reduced with oral multinutrient feeds (123/370 versus 157/367; RR 0.71, 95% CI 0.59 to 0.86; 11 trials). Based on very low-quality evidence from six studies (334 participants), oral supplements may result in lower numbers with ’unfavourable outcome’ (death or complications): RR 0.67, 95% CI 0.51 to 0.89. There was very low-quality evidence for six studies (442 participants) that oral supplementation did not result in an increased incidence of vomiting and diarrhoea (RR 0.99, 95% CI 0.47 to 2.05).Only very low-quality evidence was available from the four trials examining nasogastric multinutrient feeding. Pooled data from three heterogeneous trials showed no evidence of an effect of supplementation on mortality (14/142 versus 14/138; RR 0.99, 95%CI 0.50 to 1.97). One trial (18 participants) found no difference in complications. None reported on unfavourable outcome. Nasogastric feeding was poorly tolerated. One study reported no cases of aspiration pneumonia. There is very low-quality evidence from one trial (57 participants, mainly men) of no evidence for an effect of tube feeding followed by oral supplementation on mortality or complications. Tube feeding, however, was poorly tolerated.There is very low-quality evidence from one trial (80 participants) that a combination of intravenous feeding and oral supplements may not affect mortality but could reduce complications. However, this expensive intervention is usually reserved for people with non-functioning gastrointestinal tracts, which is unlikely in this trial.Four trials tested increasing protein intake in an oral feed. These provided low-quality evidence for no clear effect of increased protein intake on mortality (30/181 versus 21/180; RR 1.42, 95% CI 0.85 to 2.37; 4 trials) or number of participants with complications but very low-quality and contradictory evidence of a reduction in unfavourable outcomes (66/113 versus 82/110; RR 0.78, 95% CI 0.65 to 0.95; 2 trials). There was no evidence of an effect on adverse events such as diarrhoea.Trials testing intravenous vitamin B1 and other water soluble vitamins, oral 1-alpha-hydroxycholecalciferol (vitamin D), high dose bolus vitamin D, different oral doses or sources of vitamin D, intravenous or oral iron, ornithine alpha-ketoglutarate versus an isonitrogenous peptide supplement, taurine versus placebo, and a supplement with vitamins, minerals and amino acids, provided low- or very low-quality evidence of no clear effect on mortality or complications, where reported.Based on low-quality evidence, one trial evaluating the use of dietetic assistants to help with feeding indicated that this intervention may reduce mortality (19/145 versus 36/157; RR 0.57, 95% CI 0.34 to 0.95) but not the number of participants with complications (79/130 versus 84/125).  Authors’ conclusions: There is low-quality evidence that oral multinutrient supplements started before or soon after surgery may prevent complications within the first 12 months after hip fracture, but that they have no clear effect on mortality. There is very low-quality evidence that oral supplements may reduce ’unfavourable outcome’ (death or complications) and that they do not result in an increased incidenceof vomiting and diarrhoea. Adequately sized randomised trials with robust methodology are required. In particular, the role of dietetic assistants, and peripheral venous feeding or nasogastric feeding in very malnourished people require further evaluation

Safety Effects of Protected Left-Turn Phasing at Signalized Intersections: An Empirical Analysis

Left-turn crashes occur frequently at signalized intersections and often lead to severe injuries. This problem can be addressed through the implementation of protected left-turn signals. This gives left-turning vehicles the right to enter the intersection free from conflict with opposing drivers and pedestrians. The present study analyses the effect of this measure on crash occurrence. The study included 103 signalized intersections with left-turn signals in highways in Flanders, Belgium, of which 33 received only changes in the signal control and 70 also received additional changes. The effect on traffic safety is analyzed through an Empirical Bayesian before-and-after study on crashes, in which general trend effects and regression-to-the-mean are controlled. On the 33 intersections that received only changes in the signal control, the number of injury crashes decreased significantly (−46%, 95% CI (−36%; −55%)) during the after-period. This was mainly attributable to a decrease in left-turn crashes: −60%, 95% CI (−39%; −74%). The number of rear-end injury crashes did not change significantly after the implementation of a protected left-turn signal. A larger effect was identified for more severe crashes (involving serious injuries and fatalities) as compared with crashes resulting in lighter injuries: −66%, 95% CI (43%; −80%). Furthermore, the effect of left-turn phasing on the number of injured car occupants, cyclists, moped riders and motor cyclists was examined, and favorable effects were found for each of these groups