Promoting transportation cycling for women: The role of bicycle infrastructure

Objective. Females are substantially less likely than males to cycle for transport in countries with low bicycle transport mode share. We investigated whether female commuter cyclists were more likely to use bicycle routes that provide separation from motor vehicle traffic. Methods. Census of cyclists observed at 15 locations (including off-road bicycle paths, on-road lanes and roads with no bicycle facilities) within a 7.4 km radius of the central business district (CBD) of Melbourne, Australia, during peak commuting times in February 2004. Results. 6589 cyclists were observed, comprising 5229 males (79.4%) and 1360 females (20.6%). After adjustment for distance of the bicycle facility from the CBD, females showed a preference for using off-road paths rather than roads with no bicycle facilities (odds ratio [OR]=1.43, 95% confidence interval [CI]: 1.12, 1.83), or roads with on-road bicycle lanes (OR=1.34, 95% CI: 1.03, 1.75). Conclusions. Consistent with gender differences in risk aversion, female commuter cyclists preferred to use routes with maximum separation from motorized traffic. Improved cycling infrastructure in the form of bicycle paths and lanes that provide a high degree of separation from motor traffic is likely to be important for increasing transportation cycling amongst under-represented population groups such as women.https://www.ncbi.nlm.nih.gov/pubmed/1769818

Measuring factors influencing valuation of nonmotorized improvement measures

This paper presents the application of a new methodology for data collection based on multiple survey methods to study how drivers and transit users value nonmotorized improvements. This multi-method survey consisted on a combination of user’s willingness to change, stated tolerance and contingent valuation experiments. Random parameter probit models were used to analyze data on willingness to cycle. Willingness to change to cycling is related to travel purpose, transportation mode, travel time and education level. Policies for promoting the use of bicycles should target these profiles so as to be more effective. Random parameter ordered probit models were used to study how different cycling measures were valued by respondents. The protection and maintenance of cycle lanes are significantly more valued than other improvement measures. The design of future cycling facilities should consider increasing safety and travel time reduction. Senior citizen’s willingness to change to cycling value to a lesser extent cycling improvement measures than people traveling to work or study. Strategies to promote cycling in each case are discussed.Ruiz Sánchez, T.; Bernabé, JC. (2014). Measuring factors influencing valuation of nonmotorized improvement measures. Transportation Research Part A: Policy and Practice. 67:195-211. doi:10.1016/j.tra.2014.06.008S1952116

BRITICE Glacial Map, version 2: a map and GIS database of glacial landforms of the last British-Irish Ice Sheet

During the last glaciation, most of the British Isles and the surrounding continental shelf were covered by the British–Irish Ice Sheet (BIIS). An earlier compilation from the existing literature (BRITICE version 1) assembled the relevant glacial geomorphological evidence into a freely available GIS geodatabase and map (Clark et al. 2004: Boreas 33, 359). New high-resolution digital elevation models, of the land and seabed, have become available casting the glacial landform record of the British Isles in a new light and highlighting the shortcomings of the V.1 BRITICE compilation. Here we present a wholesale revision of the evidence, onshore and offshore, to produce BRITICE version 2, which now also includes Ireland. All published geomorphological evidence pertinent to the behaviour of the ice sheet is included, up to the census date of December 2015. The revised GIS database contains over 170 000 geospatially referenced and attributed elements – an eightfold increase in information from the previous version. The compiled data include: drumlins, ribbed moraine, crag-and-tails, mega-scale glacial lineations, glacially streamlined bedrock (grooves, roches moutonnées, whalebacks), glacial erratics, eskers, meltwater channels (subglacial, lateral, proglacial and tunnel valleys), moraines, trimlines, cirques, trough-mouth fans and evidence defining ice-dammed lakes. The increased volume of features necessitates different map/database products with varying levels of data generalization, namely: (i) an unfiltered GIS database containing all mapping; (ii) a filtered GIS database, resolving data conflicts and with edits to improve geo-locational accuracy (available as GIS data and PDF maps); and (iii) a cartographically generalized map to provide an overview of the distribution and types of features at the ice-sheet scale that can be printed at A0 paper size at a 1:1 250 000 scale. All GIS data, the maps (as PDFs) and a bibliography of all published sources are available for download from: https://www.sheffield.ac.uk/geography/staff/clark_chris/britice

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

A concise guide to developing and using quantitative models in conservation management

Quantitative models are powerful tools for informing conservation management and decision-making. As applied modeling is increasingly used to address conservation problems, guidelines are required to clarify the scope of modeling applications and to facilitate the impact and acceptance of models by practitioners. We identify three key roles for quantitative models in conservation management: (a) to assess the extent of a conservation problem; (b) to provide insights into the dynamics of complex social and ecological systems; and, (c) to evaluate the efficacy of proposed conservation interventions. We describe 10 recommendations to facilitate the acceptance of quantitative models in conservation management, providing a basis for good practice to guide their development and evaluation in conservation applications. We structure these recommendations within four established phases of model construction, enabling their integration within existing workflows: (a) design (two recommendations); (b) specification (two); (c) evaluation (one); and (d) inference (five). Quantitative modeling can support effective conservation management provided that both managers and modelers understand and agree on the place for models in conservation. Our concise review and recommendations will assist conservation managers and modelers to collaborate in the development of quantitative models that are fit-for-purpose, and to trust and use these models appropriately while understanding key drivers of uncertainty.Pablo García‐Díaz, Thomas A.A. Prowse, Dean P. Anderson, Miguel Lurgi Rachelle N. Binny, Phillip Casse

Review of gender, socioeconomic status, and ethnic background considerations reported in active school travel intervention studies

Introduction: Trends over the last half century have shown that fewer children today are engaging in active modes of travel to and from school than in previous generations. Interventions promoting active school travel (AST) can be effective at reversing these trends and increasing rates of AST among children. This paper aims to explore (1) how studies of AST interventions have considered or framed multiple equity factors, namely those related to gender, socioeconomic status (SES), and ethnic background, in the design and evaluation of AST interventions, and (2) to what extent studies of AST interventions report these equity considerations in their analyses, outcomes, programming, and discussions. Methods: Six databases were used (BIOSIS Previews, GeoBase, PubMed, SCOPUS, SPORTDiscus, and Web of Science) to obtain AST literature published between 2010 and 2019 from around the world. The inclusion criteria applied in this review included a focus on an AST intervention for children (aged 5–19 years), quantitative results, and a primary outcome related to AST. A total of 69 papers were included in the review. Results: Across AST intervention studies, equity considerations were scarcely reported. Among the explicit mentions, gender and socioeconomic status were reported most often compared to ethnic background. Some papers reported differential effects among groups. Gender, SES, and ethnic background were, when reported, generally considered as variables that were controlled for within study samples. Conclusions: Suggestions to address equity within studies of AST interventions include reporting equity considerations made throughout the intervention and its evaluation in the published article. Using and reporting equity frameworks to develop AST interventions and conducting sub-group analyses during evaluation allows for greater assessment of equity effects and improved utility and applicability of the AST intervention. Ensuring the integration of equity into AST literature is needed to support evidence-based and equitable practices

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570