Tackling barriers to COVID-19 vaccine uptake in London: a mixed-methods evaluation.

BACKGROUND: In response to the COVID-19 pandemic, the first vaccine was administered in December 2020 in England. However, vaccination uptake has historically been lower in London than in other English regions. METHODS: Mixed-methods: This comprised an analysis of cumulative percentage uptake across London between 8 December 2020 and 6 June 2021 by vaccine priority cohorts and ethnicity. We also undertook thematic analyses of uptake barriers, interventions to tackle these and key learning from a qualitative survey of 27 London local authority representatives, vaccine plans from London's five Integrated Care Systems and interviews with 38 London system representatives. RESULTS: Vaccine uptake was lower in Black ethnic (57-65% uptake) compared with the White British group (90% uptake). Trust was a critical issue, including mistrust in the vaccine itself and in authorities administering or promoting it. The balance between putative costs and benefits of vaccination created uptake barriers for zero-hour and shift workers. Intensive, targeted and 'hyper-local' initiatives, which sustained community relationships and were not constrained by administrative boundaries, helped tackle these barriers. CONCLUSIONS: The success of the national vaccination programme depended on conceding local autonomy, investing in responsive and long-term partnerships to engender trust through in-depth understanding of communities' beliefs.

Implementation of a Low-Cost Data Acquisition System on an E-Scooter for Micromobility Research.

In recent years, cities are experiencing changes in the ways of moving around, increasing the use of micromobility vehicles. Bicycles are the most widespread transport mode and, therefore, cyclists' behaviour, safety, and comfort have been widely studied. However, the use of other personal mobility vehicles is increasing, especially e-scooters, and related studies are scarce. This paper proposes a low-cost open-source data acquisition system to be installed on an e-scooter. This system is based on Raspberry Pi and allows collecting speed, acceleration, and position of the e-scooter, the lateral clearance during meeting and overtaking manoeuvres, and the vibrations experienced by the micromobility users when riding on a bike lane. The system has been evaluated and tested on a bike lane segment to ensure the accuracy and reliability of the collected data. As a result, the use of the proposed system allows highway engineers and urban mobility planners to analyse the behaviour, safety, and comfort of the users of e-scooters. Additionally, the system can be easily adapted to another micromobility vehicle and used to assess pavement condition and micromobility users' riding comfort on a cycling network when the budget is limited.

Analysis and prediction of injury severity in single micromobility crashes with Random Forest.

Urban micromobility represents a significant shift towards sustainable cities, underscoring the paramount importance of its safety. With the surge in micromobility adoption, collisions involving micromobility devices, such as bicycles and e-scooters, have surged in recent years. The second most common crash type involving these vehicles is one that only involves a micromobility vehicle (single micromobility crashes). This study analyzed 6030 single micromobility crashes that occurred in Spanish urban areas from 2016 to 2020. The Random Forest methodology was applied to create a classification model for the purpose of characterizing these crashes, predicting their injury severity, and identifying the primary influencing factors. To address the issue of imbalanced data, resulting from the relatively smaller dataset of fatal and seriously injured crashes compared to slightly injured ones, the Synthetic Minority Oversampling Technique (SMOTE) was applied. The results indicate that certain behaviors, such as not wearing a helmet, riding for leisure, and instances of speeding violations, have the potential to increase injury severity. Additionally, crashes occurring at intersections or at cycle lanes with bad pavement conditions are likely to result in more severe outcomes. Furthermore, the concurrent presence of various other factors also contributes to an escalation in crash injury severity. These findings have the potential to provide valuable insights to authorities, assisting them in the decision-making process to enhance micromobility safety and thereby promoting the creation of more equitable and sustainable urban environments.

Analysis of the consequences of car to micromobility user side impact crashes.

INTRODUCTION: The strong rise in modes of travel commonly referred to as micromobility has changed the mobility patterns and lifestyles in cities worldwide, especially after the COVID-19 pandemic. It has led to a significant increase in the number of crashes involving these types of vehicles, especially bicycles and stand-up e-scooters. The risk of crashes is higher at intersections where motor-vehicles perform a turning maneuver crossing a bike lane. METHOD: The consequences of a passenger car-to-micromobility vehicle side-impact crashes, considering both bicycle and e-scooter, were studied based on the results of the simulation of several scenarios with PC-Crash software. Two injury criteria were applied: Head Injury Criterion (HIC15) and 3 ms chest acceleration criterion. RESULTS: When motor-vehicle speed is lower than 50 km/h, the 3 ms chest acceleration never exceeds the 60 g threshold. However, at 50 km/h, it is close to 50 g in the case of e-scooter rides. At this speed, HIC15 is considerably greater than 1000, both for bicycles and for e-scooters, and the safety margin of 700 is exceeded at 45 km/h for e-scooters. CONCLUSIONS: In case of motor vehicle-to-micromobility vehicle side-impact crash, riding a bicycle is safer than riding an e-scooter since the observed HIC15 experienced by the cyclists is lower than that experienced by the e-scooter rider when motor vehicle speed is greater than 30 km/h. PRACTICAL APPLICATIONS: To reduce micromobility users injury risk at intersections, motor vehicle speed limit should be equal or lower than 40 km/h. At this impact speed, the activation of hood or bumper airbags could be justified.

The role of glucose in cognition, risk of dementia, and related biomarkers in individuals without type 2 diabetes mellitus or the metabolic syndrome: A systematic review of observational studies.

BACKGROUND: Excessive blood glucose promotes neuropathological cognitive decline in individuals with type 2 diabetes mellitus and the metabolic syndrome, but no systematic synthesis of the evidence for the same association exists in individuals without these conditions. OBJECTIVES: To systematically review studies exploring the role of glucose on cognition, dementia risk, and related biomarkers in adults without diabetes or metabolic syndrome. DATA SOURCES: We searched databases from inception until July 2021 and manually searched the reference lists of included studies. Risk of bias was assessed using the Joanna Briggs Institute tool. RESULTS: We found 46 observational studies including approximately 98,216 participants. Substantial heterogeneity in study results precluded drawing definitive conclusion whether blood glucose levels are associated with cognition or dementia risk. Higher blood glucose, however, was associated with greater amyloid burden, brain atrophy, and reduced cortical thickness. CONCLUSIONS AND IMPLICATIONS: High glucose concentrations in blood may exacerbate dementia-related neuropathology but whether this translates into pathological cognitive decline or elevate dementia risk later in life remains unclear.

Evaluation of the Influence of Road Geometry on Overtaking Cyclists on Two-Lane Rural Roads.

Road cycling, both individually and in groups, is common in Spain, where most two-lane rural roads have no cycle lanes. Due to this, and the difference in speed between drivers and cyclists, the overtaking manoeuvre is one of the most dangerous interactions. This study analyses how road geometry influences the overtaking manoeuvre performance. Field data of 1355 overtaking manoeuvres were collected using instrumented bicycles, riding along different rural road segments, and considering individual, medium and large groups of cyclists. The safety variables that characterise the overtaking manoeuvre are overtaking vehicle speed and lateral clearance. These variables have been correlated to geometric characteristics of the road, such as the type of centre line, the horizontal alignment, the speed limit, and the road cross section. Regression models have been fitted considering each cyclist group size and configuration. For individuals and medium groups, wider roads generate higher lateral clearances and lower overtaking speeds, while for large groups only the solid centre line was significant, generating lower clearances and higher speeds. Results suggest that other factors need to be considered, especially for large groups. Results offer a deeper understanding of the phenomenon by providing key points for improving road geometry design, such as widening the shoulders.

Association of mental disorders with firearm suicides: A systematic review with meta-analyses of observational studies in the United States.

BACKGROUND: In the United States (US), 61% of all suicide cases may involve firearms, and some evidence suggests that mental disorders may play a role in suicide by firearm. We performed the first systematic review and meta-analyses to investigate: (i) whether mental disorders are associated with suicide by firearm, and (ii) whether the risk of using a firearm compared with alternative means is associated with higher levels of suicide in individuals with a mental disorder METHODS AND FINDINGS: We searched twelve databases from inception to the 24th of May 2020. We retrieved 22 observational studies conducted in the US. Random-effects meta-analyses showed individuals who had a diagnosis of a mental disorder had lower odds (odds ratios (OR)= 0.50, 95% CI: 0.36 to 0.69; I2=100 (95% CI: 87 to 100%), of dying by suicide with a firearm than those who did not have a diagnosis of a mental disorder. Secondary analysis showed that decedents who had a mental health diagnosis resulted in lower odds of dying by suicide by using firearms than using other means LIMITATIONS: Risk of bias revealed a heterogeneous and poor definition of mental disorders as well as lack of control for potential demographic confounding factors. In the meta-analyses, studies were combined in the same analytic sample as 77% of these studies did not specify the type of mental disorder CONCLUSION: While our results seem to suggest that having a mental disorder may not be consistently associated with the odds of dying by suicide using a firearm, the presence of substantial heterogeneity and high risk of bias precludes any firm conclusions.

Driver Behavior When Overtaking Cyclists Riding in Different Group Configurations on Two-Lane Rural Roads.

The presence of cyclists on Spanish rural roads is ever increasing and currently frequent, and thus becoming a serious safety concern. In rural environments, the risk of a crash is higher than in rural areas. The main cause is the higher speed of motor vehicles during overtaking manoeuvres. This manoeuvre is especially challenging when cyclists ride in groups as they may change size, length, shape, and speed along their route. These variables and those related to road cross-section can influence driver behaviour when overtaking a group of cyclists. To study this, instrumented bicycles were used to ride along five road segments with different geometric and traffic characteristics. Cyclists rode individually and in groups. Overtaking was evaluated by analysing the lateral distance, the speed, and other characteristics of the manoeuvre. Wider roads presented higher lateral clearances and overtaking speeds. Narrower roads had a high opposing lane invasion but a high level of compliance with the minimum lateral clearance. A higher clearance and lower speed of overtaking vehicles was registered when cyclists rode in line. Compliance with the 1.5 m clearance depended on the group configuration, being higher when cyclists rode in line. However, overtaking cyclists riding two abreast presented more accelerative manoeuvres, especially on narrow roads.

Micromobility Users' Behaviour and Perceived Risk during Meeting Manoeuvres.

Mobility patterns and lifestyles have changed in recent years in cities worldwide, thanks to the strong rise in modes of travel commonly referred to as micromobility. In this context, e-scooters have experienced a great rise globally which has led to an increase of crashes involving this type of micromobility vehicle in urban areas. Thus, there is a need to study e-scooter users' behaviour and their interaction with cyclists. This research aimed at characterizing the meeting manoeuvre between micromobility users along diverse typologies of two-way bicycle track by using an instrumented e-scooter. As a result, bicycle tracks having concrete or vegetated curb presented lower clearance distance (≈0.8 m) than those without edge elements (>1 m), with no statistically significant differences found between the interaction with bicycles and e-scooters. Additionally, an online questionnaire was proposed to assess users' perceived risk during the meeting manoeuvre, concluding that micromobility users feel safer and more comfortable riding on pavements away from parked or moving motorized traffic, and on protected bicycle tracks.

New geometric design consistency model based on operating speed profiles for road safety evaluation.

To assist in the on-going effort to reduce road fatalities as much as possible, this paper presents a new methodology to evaluate road safety in both the design and redesign stages of two-lane rural highways. This methodology is based on the analysis of road geometric design consistency, a value which will be a surrogate measure of the safety level of the two-lane rural road segment. The consistency model presented in this paper is based on the consideration of continuous operating speed profiles. The models used for their construction were obtained by using an innovative GPS-data collection method that is based on continuous operating speed profiles recorded from individual drivers. This new methodology allowed the researchers to observe the actual behavior of drivers and to develop more accurate operating speed models than was previously possible with spot-speed data collection, thereby enabling a more accurate approximation to the real phenomenon and thus a better consistency measurement. Operating speed profiles were built for 33 Spanish two-lane rural road segments, and several consistency measurements based on the global and local operating speed were checked. The final consistency model takes into account not only the global dispersion of the operating speed, but also some indexes that consider both local speed decelerations and speeds over posted speeds as well. For the development of the consistency model, the crash frequency for each study site was considered, which allowed estimating the number of crashes on a road segment by means of the calculation of its geometric design consistency. Consequently, the presented consistency evaluation method is a promising innovative tool that can be used as a surrogate measure to estimate the safety of a road segment.