Exploring behavioral responses of motorists to risk-based charging mechanisms

This paper reports the behavioral response of motorists in Australia to a variable-rate charging scheme designed to encourage safer driving practices and reduce exposure to crash risk, specifically kilometers driven, nighttime driving, and speeding. The study involved a 5-week before period of Global Positioning System monitoring to establish how motorists drove normally, followed by a 5-week after period of Global Positioning System monitoring in which charges were levied and changes assessed. Incentives were paid to motorists for the difference in the charges between the two 5-week periods. Vehicle kilometers traveled (VKT) was reduced by 10%, although the sample was evenly split into motorists with increasing VKT and those with decreasing VKT. The proportion of distance speeding fell by 4.7%; this finding, when coupled with decreases in VKT, implied a net reduction of more than 40% in kilometers spent speeding. Three-fourths of the participants reduced their speeding. Exit interviews with a cross section of participants highlighted the practical difficulties of reducing kilometers but (more encouragingly) reinforced the potential to reduce speedin

A combined GPS/Stated Choice experiment to estimate values of crash-risk reduction

This paper details the development and application of a Stated Choice (SC) experiment designed to explore motorists sensitivities to a kilometre-based charging regime focused around crash-risk reduction. Responses are gathered through a SC experiment that pivots off actual driving behaviour collected over a five week period using an in-vehicle Global Positioning System (GPS) device. This provision of greater reality using revealed preference (RP) information ensures that the alternatives in the SC experiment are embedded in reality, providing motorists with a more realistic context for their choices. The study demonstrates with the improved affordability, power and consumer familiarity with GPS devices, the integration of GPS recorded travel information with SC experiments is a now a feasible solution which can help enrich the quality of the reference alternatives in SC experiments in the future

Stable Electromyographic Sequence Prediction During Movement Transitions using Temporal Convolutional Networks

Transient muscle movements influence the temporal structure of myoelectric signal patterns, often leading to unstable prediction behavior from movement-pattern classification methods. We show that temporal convolutional network sequential models leverage the myoelectric signal's history to discover contextual temporal features that aid in correctly predicting movement intentions, especially during interclass transitions. We demonstrate myoelectric classification using temporal convolutional networks to effect 3 simultaneous hand and wrist degrees-of-freedom in an experiment involving nine human-subjects. Temporal convolutional networks yield significant $(p<0.001)$ performance improvements over other state-of-the-art methods in terms of both classification accuracy and stability.Comment: 4 pages, 5 figures, accepted for Neural Engineering (NER) 2019 Conferenc

Valuing injection frequency and other attributes of type 2 diabetes treatments in Australia: A discrete choice experiment

© 2018 The Author(s). Background: Multiple pharmacotherapy options are available to control blood glucose in Type 2 Diabetes Mellitus (T2DM). Patients and prescribers may have different preferences for T2DM treatment attributes, such as mode and frequency of administration, based on their experiences and beliefs which may impact adherence. As adherence is a pivotal issue in diabetes therapy, it is important to understand what patients value and how they trade-off the risks and benefits of new treatments. This study aims to investigate the key drivers of choice for T2DM treatments, with a focus on injection frequency, and explore patients' associated willingness-to-pay. Methods: A discrete choice experiment (DCE) was used to present patients with a series of trade-offs between different treatment options, injectable and oral medicines that were made up of 10 differing levels of attributes (frequency and mode of administration, weight change, needle type, storage, nausea, injection site reactions, hypoglycaemic events, instructions with food and cost). A sample of 171 Australian consenting adult T2DM patients, of which 58 were receiving twice-daily injections of exenatide and 113 were on oral glucose-lowering treatments, completed the national online survey. An error components model was used to estimate the relative priority and key drivers of choice patients place on different attributes and to estimate their willingness to pay for new treatments. Results: Injection frequency, weight change, and nausea were shown to be important attributes for patients receiving injections. Within this cohort, a once-weekly injection generated an additional benefit over a twice-daily injection, equivalent to a weighted total willingness to pay of AUD$22.35 per month. Conclusions: Based on the patient preferences, the importance of frequency of administration and other non-health benefits can be valued. Understanding patient preferences has an important role in health technology assessment, as the identification of the value as well as the importance weighting for each treatment attribute may assist with funding decisions beyond clinical trial outcomes

2018 UK national guideline for the management of infection with Neisseria gonorrhoeae

This guideline offers recommendations for the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of gonorrhoea in people aged 16 years and older. For individuals under the age of 16 years please see the British Association for Sexual Health and HIV (BASHH) guideline on STI and Related Conditions in Children and Young People. The guidelines are primarily aimed at level 3 sexual health services within the United Kingdom (UK) although the principles of the recommendations could be adopted at all levels

A randomised trial of early palliative care for maternal stress in infants prenatally diagnosed with single-ventricle heart disease

AbstractChildren with single-ventricle disease experience high mortality and complex care. In other life-limiting childhood illnesses, paediatric palliative care may mitigate maternal stress. We hypothesised that early palliative care in the single-ventricle population may have the same benefit for mothers. In this pilot randomised trial of early palliative care, mothers of infants with prenatal single-ventricle diagnoses completed surveys measuring depression, anxiety, coping, and quality of life at a prenatal visit and neonatal discharge. Infants were randomised to receive early palliative care – structured evaluation, psychosocial/spiritual, and communication support before surgery – or standard care. Among 56 eligible mothers, 40 enrolled and completed baseline surveys; 38 neonates were randomised, 18 early palliative care and 20 standard care; and 34 postnatal surveys were completed. Baseline Beck Depression Inventory-II and State-Trait Anxiety Index scores exceeded normal pregnant sample scores (mean 13.76±8.46 versus 7.0±5.0 and 46.34±12.59 versus 29.8±6.35, respectively; p=0.0001); there were no significant differences between study groups. The early palliative care group had a decrease in prenatal to postnatal State-Trait Anxiety Index scores (−7.6 versus 0.3 in standard care, p=0.02), higher postnatal Brief Cope Inventory positive reframing scores (p=0.03), and a positive change in PedsQL Family Impact Module communication and family relationships scores (effect size 0.46 and 0.41, respectively). In conclusion, these data show that mothers of infants with single-ventricle disease experience significant depression and anxiety prenatally. Early palliative care resulted in decreased maternal anxiety, improved maternal positive reframing, and improved communication and family relationships.</jats:p

Persistence of an outbreak of gonorrhoea with high-level resistance to azithromycin in England, November 2014‒May 2018

Between November 2014 and May 2018, 118 laboratory-confirmed cases of high-level azithromycin resistant Neisseria gonorrhoeae were identified in England. Cases emerged among heterosexuals in Leeds but spread across England and into sexual networks of men who have sex with men as the outbreak progressed. The few epidemiological links identified indicate substantial under-diagnosis of cases and this, along with the upturn in cases in 2017, highlights the difficulties in controlling the outbreak

Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 - emergence of multiple antibiotic resistance calls for vigilance.

Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US_NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its 'parent' strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US_NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci

Conformational Studies of Ortho- and Meto-Isomers and Methyl, Dimethyl, and Chloro Ortho-Substituted Analogues of Dantrolene Using Ab Initio SCF-MO Procedures

The conformation of the nitro group of nitroaromatic compounds relative to the aromatic ringsystem is suggested to affect their metabolic activation and mutagenicity. We have recently showed the nitrophenylfuran skeletal muscle relaxant, dantrolene, tobe a potent mutagen inSalmonella. Synthesis of or^o-substituted analogues of dantrolene was achieved in an effort to alter the conformation of the nitro group ina manner that willdecrease the mutagenicity. Using ab initio techniques we investigated the minimum energy conformation of the nitro group of dantrolene (/mitro) and its o-and mnitro isomers as well as the nitro group conformation of dantrolene\u27s ortho- mono- and di- substituted analogues. The most stable conformer for each isomer and analogue was found by optimizing the bond lengths and bond angles for each molecule and rotating about bonds ofinterest using the STO-3G basis set in the Gaussian-92 program at the Hartree-Fock level

Is previous azithromycin treatment associated with azithromycin resistance inNeisseria gonorrhoeae? A cross-sectional study using national surveillance data in England

OBJECTIVES: It has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance inNeisseria gonorrhoeae(NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectalChlamydia trachomatis(CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin. METHODS: Azithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013-2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013-2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012-2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin. RESULTS: Modal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients. CONCLUSIONS: We found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions