Safety in Numbers and Bicycle Safety: A Detailed Analysis of the Denver Metropolitan Area

Recently across the US, there has been a push to accommodate and encourage the viability of alternative modes of transportation—especially bicycling. Leaders across all levels of government, trade groups, advocacy and policy groups, and others are promoting different methods to make urban areas more bikeable. Now, as planning practice is moving towards implementing a transportation system that serves different types of travelers, the US faces challenges involved with retrofitting existing automobile-oriented streets. While implementing bicycle safety initiatives is becoming a popular movement among municipalities, there have been differing opinions on the best way to make cities more bikable in academic literature (Pucher & Buehler, 2012). There is an ongoing debate about what types of improvements will be the most effective at reducing crash rates and/or decreasing individual risk for cyclists. Since 2003, one of the key factors in this debate has been the phenomenon of “safety in numbers.” “Safety in numbers,” or SiN, describes the observed inverse correlation between bicycle ridership and cyclist risk (Jacobsen, 2003). As ridership numbers increase, the relative risk per cyclist is said to decrease (all else being equal). When examining large-scale datasets, such as national ridership counts and crash statistics, research suggests there is a significant negative, non-linear correlation (exponentially decreasing) between ridership and crashes per rider. This means that while the total number of crashes increases with ridership, the rate of crashes per rider decreases. While bicycle safety and SiN are well-researched topics, there are still many questions about the SiN effect that are still unclear. First, the full character of the SiN effect is not explicit in the existing literature. Nearly all studies of the phenomenon have been conducted with large units of analysis (cities, countries, etc.). No study to the researcher’s knowledge has considered the SiN effect at the individual street level with real data. Second, because SiN has not been studied with small units, there has not been a way to control for road conditions that also effect bicycle crash rates. And third, it is not clear how all of the factors that determine cyclist injury and fatalities—including SiN, bicycle infrastructure, speed limit, road design, congestion, etc.—interact with one another. These gaps in collective understanding about safety in numbers has led to disagreements among scholars about its nature and implications for practice. One of the major debates surrounding SiN and policy has been its use as an argument to dissuade investment in separated bicycle infrastructure. Some think that separated infrastructure may undermine some of the safety benefits that may affect cyclists because of SiN; the goal of this type of infrastructure is to limit motorists’ conflict points with cyclists, and because of this, separated infrastructure may actually endanger other cyclists on the road because fewer cyclists are interacting with drivers in mixed traffic, lessening drivers’ incentives to adjust their behavior (assuming that behavior modification underlies the SiN effect) (Thompson et al., 2017). Despite limited understanding about this topic, SiN is has been used to make policy justifications, specifically pitting policy-only solutions against infrastructure improvement ones (Bhatia & Wier, 2011; City of Berkeley, 2010). It is crucial, then to understand the SiN effect more fully. My research addresses these gaps in the literature and provides recommendation for practice. My research reports several major findings. First, the safety in numbers effect is reflected on the individual road segment level; using a Cragg double hurdle model, I showed that numbers are a significant predictor of crashes, even when other control variables—infrastructure, congestion measures, speed limit, functional class, median household income, and road length—are added to the model. Second, my research shows that the SiN effect is best characterized by a non-linear, exponentially decreasing mathematical model, even on the segment level. Third, my research created detailed predictions that quantify how the SiN effect changes under different conditions. The most notable of these findings was twofold. First, there was no significant difference in the predicted number of crashes for segments with or without bike lanes as the number of trips increased. And second, facilities with separated bike lanes also receive a safety benefit from increased exposure, but the benefit is not as strong as on segments without separated bike lanes. In summary, my research verified existence of SiN on the road segment level as well as characterizes the effect mathematically. I also suggest that practicing planners should encourage more biking to improve overall road user safety, but that this should be done in tandem with other measures such as bicycle infrastructure

Chronic cough and esomeprazole: A double-blind placebo-controlled parallel study

Background and objective: Gastro-oesophageal reflux has been implicated in the pathogenesis of chronic cough. Guidelines on management suggest a therapeutic trial of anti-reflux medication. Esomeprazole is a proton pump inhibitor licensed for the long-term treatment of acid reflux in adults and we compared the effects of esomeprazole and placebo on patients with chronic cough. Methods: This was a prospective, single-centre, randomized, double-blind, placebo-controlled, parallel group study conducted over 8 weeks. Fifty adult non-smokers with chronic cough and normal spirometry were randomized. Patients completed cough-related quality-of-life and symptom questionnaires and subjective scores of cough frequency and severity at the beginning and end of the study. They also kept a daily diary of symptom scores. Citric acid cough challenge and laryngoscopic examination were performed at baseline and the end of the study. The primary outcome was improvement in cough score. Results: There were no differences in cough scores in the placebo and treatment arms of the study although some significant improvements were noted when compared to baseline. In the cough diary scores there was a trend towards greater improvement in the treatment arm in patients with dyspepsia. Conclusions: Esomeprazole did not have a clinically important effect greater than placebo in patients with cough. It suggests a marked placebo effect in the treatment of cough. There is paucity of evidence on which to base the treatment of reflux-associated cough. We demonstrate that acid suppressive therapy does not lead to a significant clinical effect in these patients. There may be some improvement in those with coexisting dyspeptic symptoms and therapy should be restricted to this group. © 2011 Asian Pacific Society of Respirology

The impact of socio-economic status on melanoma clinical trial participation: an observational cohort study from Australia.

Low socio-economic status (SES) is reported to be a barrier to participation in cancer clinical trials due to out-of-pocket costs associated with trial participation, logistical barriers to attend screening services in different diagnostic and treatment centers, and associated cultural or linguistic barriers. One study of clinical trial participation in the ocular melanoma population, reported somewhat different results, whereby people of an older age (≥60 years), lower education level, and those with non-managerial jobs were more likely to participate in a clinical trial, than their younger, more educated counterparts. The aim of the present study was to determine whether SES was associated with participation in clinical trials for people with cutaneous melanoma

The impact of socio-economic status on melanoma clinical trial participation: an observational cohort study from Australia.

Low socio-economic status (SES) is reported to be a barrier to participation in cancer clinical trials due to out-of-pocket costs associated with trial participation, logistical barriers to attend screening services in different diagnostic and treatment centers, and associated cultural or linguistic barriers. One study of clinical trial participation in the ocular melanoma population, reported somewhat different results, whereby people of an older age (≥60 years), lower education level, and those with non-managerial jobs were more likely to participate in a clinical trial, than their younger, more educated counterparts. The aim of the present study was to determine whether SES was associated with participation in clinical trials for people with cutaneous melanoma

Patients' perspectives of long-term follow-up for localised cutaneous melanoma

Background Little is known about the value of long-term follow-up for localised cutaneous melanoma from the patients' perspective. This study aimed to explore the benefits and potential downsides of follow-up; feelings about changes to frequency of follow-up, and patient-centred recommendations for improving follow-up care. Methods Qualitative analysis of 29 in-depth interviews conducted with Australian patients undergoing long-term follow-up after surgical treatment of stage I/II melanoma. Results Patient-perceived benefits of follow-up included reassurance, early detection of new melanomas and non-melanoma skin cancers, education about skin self-examination, the opportunity to ask questions, and reinforcement of ‘sunsafe’ behaviours. Downsides included anxiety leading up to and during follow-up visits; inconvenience of travel to attend visits; and lost work time. Patients varied in their engagement with skin self-examination, and their views on multiple skin excisions, but highly valued access to specialists for unscheduled visits. Most patients felt their follow-up intervals could be extended to 12 months if recommended by their clinician. Conclusion The benefits and potential downsides of follow-up should be discussed with patients when deciding on a melanoma follow-up plan to achieve a balance between inducing additional patient anxiety and providing reassurance. Follow-up intervals of 12 months appear to be acceptable to patients

Follow-up of early stage melanoma: specialist clinician perspectives on the functions of follow-up and implications for extending follow-up intervals

BACKGROUND: There is limited evidence on the relative effectiveness of different follow-up schedules for patients with AJCC stage I or II melanoma, but less frequent follow-up than is currently recommended has been proposed. OBJECTIVES: To describe melanoma clinicians' perspectives on the functions of follow-up, factors that influence follow-up intervals, and important considerations for extending intervals. METHODS: Qualitative interviews with 16 clinicians (surgical oncologists, dermatologists, melanoma unit physicians) who conduct follow-up at two of Australia's largest specialist centers. RESULTS: Follow-up is conducted for early detection of recurrences or new primary melanomas, to manage patient anxiety, support patient self-care, and as part of shared care. Recommended intervals are based on guidelines but account for each patient's clinical risk profile, level of anxiety, patient education requirements, capacity to engage in skin self-examination, and how the clinician prefers to manage any suspicious lesions. CONCLUSIONS: To revise guidelines and implement change it is important to understand the rationale underpinning existing practice. Extended follow-up intervals for early stage melanoma are more likely to be adopted after the first year when patients are less anxious and sufficiently prepared to conduct self-examination. Clinicians may retain existing schedules for highly anxious patients or those unable to examine themselves

A mixed methods systematic review of digital interventions to support the psychological health and well-being of people living with dermatological conditions

Background: Dermatological conditions can have a substantial impact on psychological as well as physical health yet dedicated face-to-face psychological support for patients is lacking. Thus, individuals may require additional support to self-manage dermatological conditions effectively. Digital technology can contribute to long-term condition management, but knowledge of the effectiveness of digital interventions addressing psychological (cognitive, emotional, and behavioural) aspects of dermatological conditions is limited. Objectives: To identify, determine the effectiveness, and explore people’s views and experiences of digital interventions supporting the psychological health of people with dermatological conditions. Methods: A mixed methods systematic review informed by JBI methodology. The protocol was registered on PROSPERO. Eight electronic databases were searched for papers written between January 2002 and October 2021. Data screening and extraction were conducted in Covidence. The methodological quality of studies were scrutinised against JBI critical appraisal tools. Intervention characteristics were captured using the Template for Intervention Description and Replication checklist and guide. Data were synthesised using a convergent segregated approach. The results were reported in a narrative summary. Results: Twenty-three papers were identified from 4,883 references, including 15 randomised controlled trials. Nineteen interventions were condition-specific, 13 were delivered online, 16 involved an educational component, and 7 endorsed established, evidence-based therapeutic approaches. Improvements in knowledge, mood, quality of life, the therapeutic relationship, and reduced disease severity in the short to medium term, were reported, although there was substantial heterogeneity within the literature. Thirteen studies captured feedback from users, who considered various digital interventions as convenient and helpful for improving knowledge, emotion regulation, and personal control, but technical and individual barriers to use were reported. Use of established qualitative methodologies was limited and, in some cases, poorly reported. Conclusion: Some web-based digital psychological interventions seem to be acceptable to people living with mainly psoriasis and eczema. Whilst some digital interventions benefitted cognitive and emotional factors, heterogeneity and inconsistencies in the literature meant definitive statements about their effectiveness could not be drawn. Interdisciplinary and patient-centred approaches to research are needed to develop and test quality digital interventions supporting the psychological health of adults living with common and rare dermatological conditions