Effect of Median Design on Rural Freeway Safety

2008 ◽  
Vol 2060 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Andrew P. Tarko ◽  
Natalie M. Villwock ◽  
Nicolas Blond
Keyword(s):  
Opposite Direction ◽  
Negative Binomial ◽  
Prediction Models ◽  
Negative Binomial Regression ◽  
Well Being ◽  
Crash Severity ◽  
Before And After ◽  
Single Vehicle ◽  
Median Width ◽  
The Impact

Although median barriers are an absolute means of preventing drivers from crossing road medians and colliding with vehicles moving in the opposite direction, they may cause additional crashes. This perhaps complex safety effect of median barriers has not been investigated well. Being able to predict the safety impact of most types of median barriers on rural freeways is becoming more desirable because some state departments of transportation plan to expand many of their four-lane rural freeways to six lanes to accommodate increases in traffic volume. Realistic crash prediction models sensitive to the median design would provide the needed guidance useful in designing adequate median treatments on widened freeways. The impact of median designs on crash frequency was investigated in this study through negative binomial regression and before-and-after studies based on data collected in eight participating states. The impact on crash severity was investigated with a logit model. The separate effects of changes in median geometry were quantified for single-vehicle, multiple-vehicle same direction, and multiple-vehicle opposite direction crashes. The results were significantly different and indicated that reducing the median width without adding barriers (the remaining median width is still reasonably wide) increases the severity of crashes, particularly opposite direction crashes. Further, reducing the median and installing concrete barriers eliminates opposite direction crashes but doubles the frequency of single-vehicle crashes and tends to lessen the frequency of same direction crashes. The crash severity also tends to increase.

scholarly journals Association Between Federal Value-Based Incentive Program Implementation and Hospital-Onset C. difficile Infection Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s133-s133
Author(s):  
Mohammad Alrawashdeh ◽  
Chanu Rhee ◽  
Heather Hsu ◽  
Grace Lee
Keyword(s):  
Program Implementation ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Neutralization Assay ◽  
Nucleic Acid Amplification ◽  
Teaching Hospitals ◽  
Future Research ◽  
Testing Methods ◽  
Toxigenic Culture ◽  
The Impact

Background: The Hospital-Acquired Conditions Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) are federal value-based incentive programs that financially reward or penalize hospitals based on quality metrics. Hospital-onset C. difficile infection (HO-CDI) rates reported to the CDC NHSN became a target quality metric for both HACRP and HVBP in October 2016, but the impact of these programs on HO-CDI rates is unknown. Methods: We used an interrupted time-series design to examine the association between HACRP/HVBP implementation in October 2016 and quarterly rates of HO-CDI per 10,000 patient days among incentive-eligible acute-care hospitals conducting facility-wide HO-CDI NHSN surveillance between January 2013 and March 2019. Generalized estimating equations were used to fit negative binomial regression models to assess for immediate program impact (ie, level change) and changes in the slope of HO-CDI rates, controlling for each hospital’s predominant method for CDI testing (nucleic acid amplification including PCR (NAAT), enzyme immunoassay for toxin (EIA), or other testing method including cell cytotoxicity neutralization assay and toxigenic culture). Results: Of the 265 study hospitals studied, most were medium-sized (100–399 beds, 55%), not-for-profit (77%), teaching hospitals (70%), and were located in a metropolitan area (87%). Compared to EIA, rates of HO-CDI were higher when detected by NAAT (incidence rate ratio [IRR], 1.55; 95% CI, 1.41–1.70) or other testing methods (IRR, 1.47; 95% CI, 1.26–1.71). Controlling for CDI testing methods, HACRP/HVBP implementation was associated with an immediate 6% decline in HO-CDI rates (IRR, 0.94; 95% CI, 0.89–0.99) and a 4% decline in slope per year-quarter thereafter (IRR, 0.96; 95% CI, 0.95–0.97) (Fig. 1). Conclusions: HACRP/HVBP implementation was associated with both immediate and gradual improvements in HO-CDI rates, independent of CDI testing methods of differing sensitivity. Future research may evaluate the precise mechanisms underlying this improvement and if this impact is sustained in the long term.Funding: NoneDisclosures: None

scholarly journals The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Layana Costa Alves ◽  
Mauro Niskier Sanchez ◽  
Thomas Hone ◽  
Luiz Felipe Pinto ◽  
Joilda Silva Nery ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Negative Binomial ◽  
Malaria Incidence ◽  
Panel Study ◽  
Negative Binomial Regression ◽  
Brazilian Amazon ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Percentage Point Increase ◽  
The Impact

Abstract Background Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. Methods A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. Results A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994–0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004–2015 corresponding to be a reduction of 7.2% in the malaria incidence. Conclusions Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.

scholarly journals The impact of teaching on the duration of common urological operations

2016 ◽  
Vol 10 (5-6) ◽  
pp. 172 ◽  
Author(s):  
Blayne Welk ◽  
Jennifer Winick-Ng ◽  
Andrew McClure ◽  
Chris Vinden ◽  
Sumit Dave ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Potential Effect ◽  
Sensitivity Analyses ◽  
Teaching Hospitals ◽  
Operative Duration ◽  
Open Radical Prostatectomy ◽  
Academic Hospitals ◽  
The Impact

Introduction: The ability of academic (teaching) hospitals to offer the same level of efficiency as non-teaching hospitals in a publicly funded healthcare system is unknown. Our objective was to compare the operative duration of general urology procedures between teaching and non-teaching hospitals. Methods: We used administrative data from the province of Ontario to conduct a retrospective cohort study of all adults who underwent a specified elective urology procedure (2002–2013). Primary outcome was duration of surgical procedure. Primary exposure was hospital type (academic or non-teaching). Negative binomial regression was used to adjust relative time estimates for age, comorbidity, obesity, anesthetic, and surgeon and hospital case volume.Results: 114 225 procedures were included (circumcision n=12 280; hydrocelectomy n=7221; open radical prostatectomy n=22 951; transurethral prostatectomy n=56 066; or mid-urethral sling n=15 707). These procedures were performed in an academic hospital in 14.8%, 13.3%, 28.6%, 17.1%, and 21.3% of cases, respectively. The mean operative duration across all procedures was higher in academic centres; the additional operative time ranged from 8.3 minutes (circumcision) to 29.2 minutes (radical prostatectomy). In adjusted analysis, patients treated in academic hospitals were still found to have procedures that were significantly longer (by 10‒21%). These results were similar in sensitivity analyses that accounted for the potential effect of more complex patients being referred to tertiary academic centres.Conclusions: Five common general urology operations take significantly longer to perform in academic hospitals. The reason for this may be due to the combined effect of teaching students and residents or due to inherent systematic inefficiencies within large academic hospitals.

scholarly journals Lively Social Space, Well-Being Activity, and Urban Design: Findings From a Low-Cost Community-Led Public Space Intervention

2016 ◽  
Vol 49 (6) ◽  
pp. 685-716 ◽  
Author(s):  
Jamie Anderson ◽  
Kai Ruggeri ◽  
Koen Steemers ◽  
Felicia Huppert
Keyword(s):  
Public Space ◽  
Urban Design ◽  
Design Research ◽  
Local Community ◽  
Social Space ◽  
Low Cost ◽  
Well Being ◽  
Observation Data ◽  
Before And After ◽  
The Impact

Empirical urban design research emphasizes the support in vitality of public space use. We examine the extent to which a public space intervention promoted liveliness and three key behaviors that enhance well-being (“connect,” “be active,” and “take notice”). The exploratory study combined directly observed behaviors with self-reported, before and after community-led physical improvements to a public space in central Manchester (the United Kingdom). Observation data ( n = 22,956) and surveys (subsample = 212) were collected over two 3-week periods. The intervention brought significant and substantial increases in liveliness of the space and well-being activities. None of these activities showed increases in a control space during the same periods. The findings demonstrate the feasibility of the research methods, and the impact of improved quality of outdoor neighborhood space on liveliness and well-being activities. The local community also played a key role in conceiving of and delivering an effective and affordable intervention. The findings have implications for researchers, policy makers, and communities alike.

“Mother’s Health and Well-Being Matters: Is a Mediated Social Cohesion Public Health Intervention Feasible?”

2021 ◽  
pp. 089011712110553
Author(s):  
Cheryl Jones ◽  
Marley Gibbons ◽  
Kate Magsamen-Conrad ◽  
Kathleen T. Ulanday ◽  
Jessica Watterson ◽  
...  
Keyword(s):  
New York ◽  
Low Socioeconomic Status ◽  
Public Health Intervention ◽  
Well Being ◽  
Careful Consideration ◽  
Before And After ◽  
Washington Heights ◽  
Additional Support ◽  
Risk Of Cancer ◽  
The Impact

Purpose To test the feasibility of introducing ‘Free Time for Wellness’ (FT4W) an intervention to increase healthy behaviours and reduce the risk of cancer. Design Feasibility study; Setting: Washington Heights, New York, USA is a low socioeconomic status area. Subjects Mothers aged 18 and above with children under 12 years of age and living in Washington Heights were recruited. Intervention FT4W, a community-based intervention delivered through a neighbourhood-based app, offering weekly dance and yoga classes, food pantry visits and group playdates. Childcare professionals cared for participants' children during wellness activities. Measures A bespoke before and after survey was designed and tested for its ability to collect relevant data to assess the impact of FT4W. Outcomes included recruitment rates, participation, attrition, acceptability, and success of the community champion. Analysis Comparisons of proportions and means Results Twenty-one mothers participated in the study of which 90% attended ≥ 1 FT4W activity; 65% ≥ 2; 52% ≥ 3. The survey was completed by a 100% of participants indicating it was easy to understand and not too burdensome. All measures detected change in constructs from baseline to follow-up. Availability of childcare was the most commonly (66%) reported reason participants were able to engage in the offered wellness activities. Conclusion Conducting a larger-scale trial to assess the impact of FT4W is feasible considering 4 major lessons. (1) Recruitment, retention, and acceptability rates were high; however, moms need additional support to increase participation in wellness activities and improve tech literacy. (2) Research measures were sensitive enough to detect change, but the timing of assessments needs to be considered. (3) Participants greatly valued access to professional childcare. (4) The Community Champion is a necessary, but difficult role to fill that requires careful consideration by the Institutional Review Board (IRB).

Impact of Monovalent Rotavirus Vaccine on Rotavirus Hospitalizations among Children Younger Than 5 Years of Age in the Ouest and Artibonite Departments, Haiti, 2013 to 2019

2021 ◽  
Author(s):  
Anne-Marie Desormeaux ◽  
Eleanor Burnett ◽  
Gérard Joseph ◽  
Mentor Ali Ber Lucien ◽  
Negar Aliabadi ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Hospital Admissions ◽  
Absolute Number ◽  
Sensitivity Analyses ◽  
Rotavirus Vaccine ◽  
Vaccine Introduction ◽  
Rotavirus Vaccination ◽  
Before And After ◽  
Rotavirus Diarrhea ◽  
The Impact

Rotavirus is responsible for 26% of diarrheal deaths in Latin America and the Caribbean. Haiti introduced the monovalent rotavirus vaccine in April 2014. The objective of this analysis is to describe the impact of the rotavirus vaccine on hospitalizations among Haitian children younger than 5 years old during the first 5 years after introduction. This analysis includes all children with diarrhea who were enrolled as part of a sentinel surveillance system at two hospitals from May 2013 to April 2019. We compare the proportion of rotavirus-positive specimens in each post-vaccine introduction year to the pre-vaccine period. To account for the potential dilution of the proportion of rotavirus-positive specimens from a waning cholera outbreak, we also analyzed annual trends in the absolute number of positive stools, fit a two-component finite-mixture model to the negative specimens, and fit a negative binomial time series model to the pre-vaccine rotavirus-positive specimens to predict the number of rotavirus diarrhea hospital admissions in the absence of rotavirus vaccination. The overall percentage of rotavirus-positive specimens declined by 22% the first year after introduction, increased by 17% the second year, and declined by 33% to 50% the subsequent 3 years. All sensitivity analyses confirmed an overall decline. We observed a clear annual rotavirus seasonality before and after vaccine introduction, with the greatest activity in December through April, and a biennial pattern, with high sharp peaks and flatter longer periods of increased rotavirus activity in alternating years, consistent with suboptimal vaccination coverage. Overall, our study shows evidence that the introduction of the rotavirus vaccine reduced the burden of severe rotavirus diarrhea.

scholarly journals Trends of limb amputation considering type, level, sex and age in Saskatchewan, Canada 2006–2019: an in-depth assessment

2022 ◽  
Vol 80 (1) ◽  
Author(s):  
Samuel Kwaku Essien ◽  
David Kopriva ◽  
A. Gary Linassi ◽  
Audrey Zucker-Levin
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Limb Amputation ◽  
Annual Percent Change ◽  
Discharge Data ◽  
Resident Population ◽  
True Incidence ◽  
Depth Analysis ◽  
The Impact ◽  
Extremity Amputation

Abstract Background Most epidemiologic reports focus on lower extremity amputation (LEA) caused specifically by diabetes mellitus. However, narrowing scope disregards the impact of other causes and types of limb amputation (LA) diminishing the true incidence and societal burden. We explored the rates of LEA and upper extremity amputation (UEA) by level of amputation, sex and age over 14 years in Saskatchewan, Canada. Methods We calculated the differential impact of amputation type (LEA or UEA) and level (major or minor) of LA using retrospective linked hospital discharge data and demographic characteristics of all LA performed in Saskatchewan and resident population between 2006 and 2019. Rates were calculated from total yearly cases per yearly Saskatchewan resident population. Joinpoint regression was employed to quantify annual percentage change (APC) and average annual percent change (AAPC). Negative binomial regression was performed to determine if LA rates differed over time based on sex and age. Results Incidence of LEA (31.86 ± 2.85 per 100,000) predominated over UEA (5.84 ± 0.49 per 100,000) over the 14-year study period. The overall LEA rate did not change over the study period (AAPC -0.5 [95% CI − 3.8 to 3.0]) but fluctuations were identified. From 2008 to 2017 LEA rates increased (APC 3.15 [95% CI 1.1 to 5.2]) countered by two statistically insignificant periods of decline (2006–2008 and 2017–2019). From 2006 to 2019 the rate of minor LEA steadily increased (AAPC 3.9 [95% CI 2.4 to 5.4]) while major LEA decreased (AAPC -0.6 [95% CI − 2.1 to 5.4]). Fluctuations in the overall LEA rate nearly corresponded with fluctuations in major LEA with one period of rising rates from 2010 to 2017 (APC 4.2 [95% CI 0.9 to 7.6]) countered by two periods of decline 2006–2010 (APC -11.14 [95% CI − 16.4 to − 5.6]) and 2017–2019 (APC -19.49 [95% CI − 33.5 to − 2.5]). Overall UEA and minor UEA rates remained stable from 2006 to 2019 with too few major UEA performed for in-depth analysis. Males were twice as likely to undergo LA than females (RR = 2.2 [95% CI 1.99–2.51]) with no change in rate over the study period. Persons aged 50–74 years and 75+ years were respectively 5.9 (RR = 5.92 [95% Cl 5.39–6.51]) and 10.6 (RR = 10.58 [95% Cl 9.26–12.08]) times more likely to undergo LA than those aged 0–49 years. LA rate increased with increasing age over the study period. Conclusion The rise in the rate of minor LEA with simultaneous decline in the rate of major LEA concomitant with the rise in age of patients experiencing LA may reflect a paradigm shift in the management of diseases that lead to LEA. Further, this shift may alter demand for orthotic versus prosthetic intervention. A more granular look into the data is warranted to determine if performing minor LA diminishes the need for major LA.

scholarly journals Geographical factors in access: investigating the impact of distance on the use of primary care extended hours, an administrative data study.

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Jen Murphy ◽  
William Whittaker ◽  
Mark Elliot ◽  
Rathi Ravindrarajah
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Unmet Need ◽  
Negative Binomial Regression ◽  
City Region ◽  
Hub Location ◽  
Barriers To Access ◽  
Access To Primary Care ◽  
The Right ◽  
The Impact

IntroductionNHS national targets mandate extended opening hours of doctors’ surgeries as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. Research has shown that other factors impact access and it may not simply be availability that limits an individual’s ability to access healthcare. Aims and Objectives To determine whether distance, familiarity and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked an appointments dataset to publicly available population datasets. With that linked dataset, we used negative binomial regression to model count data relating to uses of the extended hours service in one care commissioning group in the Greater Manchester city region. The dataset included 32,693 appointments across 4 hubs serving 37 practices. ResultsFamiliarity and distance are important in predicting the number of uses of the extended hours service at a GP practice level. For a theoretical pair of practices collocated at the hub location, the model predicts a use rate of 101.2 for the non hub compared with 283.7 for the hub, a 180% uplift. For a pair of non-hub practices, one located the mean distance from the hub, the other located one mile further away, the model predicts 64.8 uses for the nearer practice, and 46.5 uses for the far practice, a 28% penalty. ConclusionThe results indicate geographical inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub model does not address barriers to access. Providers should consider whether or not this type of model actually works to facilitate access. This is particularly of importance in the context of closing health inequality gaps.

scholarly journals Assessing the Impact of Nightlight Gradients on Street Robbery and Burglary in Cincinnati of Ohio State, USA

2019 ◽  
Vol 11 (17) ◽  
pp. 1958 ◽  
Author(s):  
Hanlin Zhou ◽  
Lin Liu ◽  
Minxuan Lan ◽  
Bo Yang ◽  
Zengli Wang
Keyword(s):  
Negative Binomial ◽  
Infrared Imaging ◽  
Negative Impact ◽  
Positive Impact ◽  
Negative Binomial Regression ◽  
Information Criterion ◽  
Binomial Regression ◽  
Street Robbery ◽  
The Impact

Previous research has recognized the importance of edges to crime. Various scholars have explored how one specific type of edges such as physical edges or social edges affect crime, but rarely investigated the importance of the composite edge effect. To address this gap, this study introduces nightlight data from the Visible Infrared Imaging Radiometer Suite sensor on the Suomi National Polar-orbiting Partnership Satellite (NPP-VIIRS) to measure composite edges. This study defines edges as nightlight gradients—the maximum change of nightlight from a pixel to its neighbors. Using nightlight gradients and other control variables at the tract level, this study applies negative binomial regression models to investigate the effects of edges on the street robbery rate and the burglary rate in Cincinnati. The Akaike Information Criterion (AIC) of models show that nightlight gradients improve the fitness of models of street robbery and burglary. Also, nightlight gradients make a positive impact on the street robbery rate whilst a negative impact on the burglary rate, both of which are statistically significant under the alpha level of 0.05. The different impacts on these two types of crimes may be explained by the nature of crimes and the in-situ characteristics, including nightlight.

scholarly journals Sex Differences and Commonalities in the Impact of a Palatable Meal on Thalamic and Insular Connectivity

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1627
Author(s):  
Lisa Kilpatrick ◽  
Teodora Pribic ◽  
Barbara Ciccantelli ◽  
Carolina Malagelada ◽  
Dan M. Livovsky ◽  
...  
Keyword(s):  
Sex Differences ◽  
Well Being ◽  
Neural Mechanisms ◽  
Healthy Individuals ◽  
Resonance Imaging ◽  
Subjective Responses ◽  
Biological Variable ◽  
Before And After ◽  
Meal Ingestion ◽  
The Impact

The neural mechanisms underlying subjective responses to meal ingestion remain incompletely understood. We previously showed in healthy men an increase in thalamocortical, and a decrease in insular-cortical connectivity in response to a palatable meal. As sex is increasingly recognized as an important biological variable, we aimed to evaluate sex differences and commonalities in the impact of a well-liked meal on thalamic and anterior insular connectivity in healthy individuals. Participants (20 women and 20 age-matched men) underwent resting-state magnetic resonance imaging (rsMRI) before and after ingesting a palatable meal. In general, the insula showed extensive postprandial reductions in connectivity with sensorimotor and prefrontal cortices, while the thalamus showed increases in connectivity with insular, frontal, and occipital cortices, in both women and men. However, reductions in insular connectivity were more prominent in men, and were related to changes in meal-related sensations (satiety and digestive well-being) in men only. In contrast, increases in thalamic connectivity were more prominent in women, and were related to changes in satiety and digestive well-being in women only. These results suggest that brain imaging may provide objective and sex-specific biomarkers of the subjective feelings associated with meal ingestion.

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