Improving Truck Safety at Interchanges

DTFH61-88-R-00072This report offers highway engineers guidance in designing interchanges so as to reduce the likelihood of truck accidents on highway interchanges. This report summarizes research showing that the interaction between truck dynamics and interchange geometry can contribute to rollovers, jackknifes, and other loss-of-control accidents. Engineers can apply corrective actions to six specific ramp design features that were found to contribute to truck accidents: poor transitions to superelevation, abrupt changes in compound curves, short deceleration lanes preceding tight-radius exits, curbs placed on the outside of ramp curves, lowered friction levels on high speed ramps, and substantial downgrades leading to tight ramp curves. Countermeasures for these design problems include incorporating a greater safety margin into formulations for side friction factors, reviewing and modifying posted speed limits, improving curve condition and downgrade signs at interchanges, increasing deceleration lane length, overlaying curbs with wedges of pavement or eliminating curbs altogether, resurfacing ramps with high-friction overlays, and redesigning sites where accidents are common

A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings

BACKGROUND: Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported. A potential method of improving the health of the most deprived groups is to increase their income. State funded welfare programmes of financial benefits and benefits in kind are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them. One method of exploring the health effects of income supplementation is, therefore, to measure the health effects of welfare benefit maximisation programmes. We conducted a systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings. METHODS: Published and unpublished literature was accessed through searches of electronic databases, websites and an internet search engine; hand searches of journals; suggestions from experts; and reference lists of relevant publications. Data on the intervention delivered, evaluation performed, and outcome data on health, social and economic measures were abstracted and assessed by pairs of independent reviewers. Results are reported in narrative form. RESULTS: 55 studies were included in the review. Only seven studies included a comparison or control group. There was evidence that welfare rights advice delivered in healthcare settings results in financial benefits. There was little evidence that the advice resulted in measurable health or social benefits. This is primarily due to lack of good quality evidence, rather than evidence of an absence of effect. CONCLUSION: There are good theoretical reasons why income supplementation should improve health, but currently little evidence of adequate robustness and quality to indicate that the impact goes beyond increasing income

Clinical and Economic Effects of a Therapeutic Substitution Policy for Proton Pump Inhibitors in Aboriginal Patients in Northern Communities in Canada's Northwest Territories

Background and objective: Proton pump inhibitors (PPIs), which are used to treat gastroesophageal symptoms, can vary in price, but are thought not to differ in clinical benefits. Health Canada's Non-Insured Health Benefits Program instituted a therapeutic substitution policy for PPIs as a cost-containment strategy in 2005. The objective of this pilot study was to identify signals of what might be occurring as a result of this policy in Aboriginal people in northern, isolated communities. Methods: Five pharmacies in the Northwest Territories identified a sample of patients who were affected by the substitution policy. Eligible patients who provided informed consent had a face-to-face or telephone interview with a pharmacist using a standardized questionnaire. Results: Of 66 identified patients, 44 consented to be interviewed, and 40 were used in the analyses: 70% were female and the mean age of the patients for whom data were analyzed was 57 years. Thirty-four (85%) patients reported health problems after the switch in PPI. Nineteen (48%) patients visited a local nursing station or physician and six (15%) visited a hospital for assessment because of perceived health problems following the switch in PPI. During the initial 15 months of the therapeutic substitution policy, there was a net increment in drug costs of $Can30.96 (year 2006 values) per person due to drug wastage, delayed switching to the policy PPI, and switching back to the patient's original PPI. A conservative estimate of the additional healthcare service costs related to health problems perceived to be due to the switch was$Can36_624.41 for the 40 patients. Conclusions: The majority of the sampled patients who took part in the PPI therapeutic substitution policy experienced problems following the PPI switch that were possibly associated with either diminished treatment efficacy or adverse drug effects. Although causality was not proven, patient perceptions in this sample did influence resource use, resulting in no net savings (average incremental cost of $Can915.61 per patient) during the first 15 months of the policy.Cost-analysis, Gastrointestinal-disorders, Generic-substitution, Proton-pump-inhibitors