Are car safety systems associated with more speeding violations? Evidence from police records in Israel.

Over the past decade, the popularity of installing advanced driver-assistance systems (ADAS) in cars has increased markedly. However, the effectiveness of ADAS is subject to debate, primarily because these systems intervene in drivers' perceptions and actions and could lead to adaptive behavior. Using complete national data for the installation of three leading safety systems and speeding tickets issued over the course of an entire year, allowed us to pinpoint the impact of these safety systems at a national level. Employing zero-inflated negative binomial regression models, we found that the installation of the three safety systems was associated with higher number of speeding tickets. These findings are in line with the literature that indicates adaptive behavior in the context of risk. However, when we accounted for the proneness to commit other traffic violations, the effect of the safety systems on the prevalence of speeding tickets was evident only for those prone to violations. Further research should be conducted to identify which drivers will be more likely to be affected and under what circumstances and safety system types.

Assessing the emission consequences of an energy rebound effect in private cars in Israel.

The UN Sustainable Development Goal, SDG 7.3, is to double the global rate of improvement in energy efficiency by 2030. To meet this and other energy targets, countries encourage the development and adoption of energy-efficient products. An extensively researched phenomenon in this context is the energy rebound effect, especially in transportation. However, the direct relationship between the energy rebound effect and car emission levels has barely been investigated. Understanding this relationship is important, because energy-related emissions are closely linked to mortality, morbidity, and climate change. We assess the emission consequences in the private car market in Israel of a rebound effect associated with a policy promoting energy-efficient cars. We find that the baseline rebound before introduction of the policy was 40%. In the following three periods marked by policy changes, it grew to 54%, 69%, and 88%. Using household data with specific car characteristics and usage, we calculate the added greenhouse gas (GHG) emission consequences of this rebound by the end of the studied period to be about 5% of the country's per-capita target. Notably, estimates for the emission consequences using "average car" values were almost twice as high. The reason for this gap derives from the co-dependance between car usage and car efficiency. We discuss the implications of this gap in meeting emission goals.

Management of chronic knee pain caused by postsurgical or posttraumatic neuroma of the infrapatellar branch of the saphenous nerve.

PURPOSE: Injury to the infrapatellar branch of the saphenous nerve (IBSN) is a relatively common complication after knee surgery, which can interfere with patient satisfaction and functional outcome. In some cases, injury to the IBSN can lead to formation of a painful neuroma. The purpose of this study was to report the results of surgical treatment in a series of patients with IBSN painful neuroma. METHODS: We retrospectively identified 37 patients who underwent resection of IBSN painful neuroma at our institution, after failure of non-operative treatment for a minimum of 6 months. Injury to the IBSN resulted from prior orthopedic surgery, vascular surgery, tumor resection, trauma, or infection. Leg pain and health-related quality of life were measured using the numeric rating scale (NRS) and EuroQol 5 dimensions (EQ-5D) questionnaire, respectively. Clinically meaningful improvement in leg pain was defined as reduction in NRS by at least 3 points. Predictors of favorable and unfavorable surgical outcome were investigated using multivariable logistic regression analysis. RESULTS: Patient-reported leg pain, health-related quality of life, and overall satisfaction with the surgical outcome were obtained at 94 ± 52.9 months after neuroma surgery. Postoperative patient-reported outcomes were available for 25 patients (68% of the cohort), of whom 20 patients (80.0%) reported improvement in leg pain, 17 patients (68.0%) reported clinically meaningful improvement in leg pain, and 17 patients (68%) reported improvement in health-related quality of life. The average NRS pain score improved from 9.43 ± 1.34 to 5.12 ± 3.33 (p < 0.01) and the average EQ-5D functional score improved from 10.48 ± 2.33 to 7.84 ± 2.19 (p < 0.01). Overall patient reported satisfaction with the surgical outcome was good to excellent for 18 patients (72.0%). Older age, multiple prior orthopedic knee surgeries, and failed prior attempts to resect an IBSN neuroma were associated with non-favorable surgical outcome. CONCLUSION: We conclude that surgical intervention is efficacious for appropriately selected patients suffering from IBSN painful neuroma.

Imperfect food markets in times of crisis: economic consequences of supply chain disruptions and fragmentation for local market power and urban vulnerability.

As these lines were written, the Covid-19 pandemic crisis was continuing to threaten countries around the globe. The worldwide consensus that physical distancing is an effective instrument for mitigating the spread of the virus has led policymakers to temporarily limit the freedom of movement of people between and within countries, cities, and even neighborhoods. These public health-related restrictions on human mobility yielded an unprecedented fragmentation of international and national food distribution systems. Focusing on food retailing - usually being modestly oligopolistic - we take a micro-economic perspective as we analyze the potential consequences this disruption has for the physical as well as for the economic access of households to food at the local level. As the mobility constraints implemented substantially reduced competition, we argue that food retailers might have been tempted to take advantage of the implied fragmentation of economic activity by exploiting their temporarily raised market power at the expense of consumers and farmers. We illustrate our point by providing empirical evidences of rising wholesale-retail as well as farm-retail price margins observed during the Covid-19 crisis. Subsequently, we review existing empirical approaches that can be used to quantify and decompose the micro-economic effects of crises on food demand and supply as well as the size and structure of the market, costs of trade, and economic welfare. The employment of such approaches facilitates policymakers' understanding of micro-economic effects of public health-induced mobility restrictions on economic activity.

Ambulatory physical activity during the initial training phase in a Naval Commando Unit.

BACKGROUND: There is a positive correlation between the volume of physical activity performed and the incidence of lower extremity overuse injuries. Difficulty in evaluating the amount of activity in which highly specialised military units are engaged has prevented the implementation of a strict training programme designed to minimise overuse injuries. PURPOSE: To quantify the ambulatory physical activity performed by trainees during the initial training phase in a Naval Commando Unit, with a view to developing more exact physical performance guidelines for the unit and the Israel Defense Forces, in general. METHODS: Twenty-four accelerometers were worn by two teams each day. Trainees were instructed to wear the device on their non-dominant wrist 24 h a day, during all types of activities. Twice a week, the devices were collected, checked for damage and recharged, and the data were transferred to a computer. RESULTS: Six trainees failed to complete the 9-week training period. Of the total 1512 accelerometer-days, 1075 readings (71%) were included in the study data. Trainees ambulated on average a distance of 15.5±8.61 km/day and 95.5 km/week. Accelerometer readings (estimated distances) were averaged each week for the two teams. The total distance measured over the 9-week study period was 911.15 km in team A and 808.38 km in team B. The total distance measured in both teams was, thus, almost double the planned 440 km (p=0.001). CONCLUSIONS: Trainees greatly exceeded the planned safe distance. High variability was observed between trainees from the same team.

Evaluation of acute bronchodilator reversibility in patients with symptoms of GOLD stage I COPD.

BACKGROUND: Patients with symptoms of GOLD stage I chronic obstructive pulmonary disease (COPD) can have significant abnormalities of ventilatory mechanics with greater exertional symptoms and exercise limitation than age-matched healthy subjects. In such patients the impact of bronchodilator therapy remains unknown and is difficult to evaluate. METHODS: The acute effects of nebulised ipratropium bromide 500 microg (IB) on resting pulmonary function and on dyspnoea and ventilatory parameters during symptom-limited constant work rate cycle exercise were measured. In a randomised double-blind crossover study, 16 patients with COPD (mean (SD) post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 90 (7)% predicted, FEV(1)/forced vital capacity (FVC) 59 (7)%) with a significant smoking history (mean (SD) 44 (16) pack-years) inhaled either IB or placebo on each of two separate visits. Pulmonary function tests and cycle exercise at 80-85% of each subject's maximal work capacity were performed 2 h after dosing. RESULTS: Compared with placebo, FEV(1) increased 5 (9)% predicted, residual volume decreased 12 (20)% predicted and specific airway resistance decreased 81 (93)% predicted (all p<0.05) after IB. At a standardised time during exercise, dynamic inspiratory capacity and tidal volume significantly increased in tandem by 0.12 and 0.16 litres, respectively (each p<0.05), dyspnoea fell by 0.9 (1.8) Borg units (p = 0.07) and dyspnoea/ventilation ratios fell significantly (p<0.05). The fall in dyspnoea intensity at higher submaximal ventilations correlated with the concurrent decrease in end-expiratory lung volume (p<0.05). CONCLUSION: In patients with symptoms of GOLD stage I COPD, IB treatment is associated with modest but consistent improvements in airway function, operating lung volumes and dyspnoea intensity during exercise. These results provide a physiological rationale for a trial of bronchodilator therapy in selected patients with milder but symptomatic COPD.

Mechanisms of exertional dyspnea in patients with cancer.

Exertional dyspnea is an important symptom in cancer patients, and, in many cases, its cause remains unexplained after careful clinical assessment. To determine mechanisms of exertional dyspnea in a variety of cancer types, we evaluated cancer outpatients with clinically important unexplained dyspnea (CD) at rest and during exercise and compared the results with age-, sex-, and cancer stage-matched control cancer (CC) patients and age- and sex-matched healthy control participants (HC). Participants (n = 20/group) were screened to exclude clinical cardiopulmonary disease and then completed dyspnea questionnaires, anthropometric measurements, muscle strength testing, pulmonary function testing, and incremental cardiopulmonary treadmill exercise testing. Dyspnea intensity was greater in the CD group at peak exercise and for a given ventilation and oxygen uptake (P < 0.05). Peak oxygen uptake was reduced in CD compared with HC (P < 0.05), and breathing pattern was more rapid and shallow in CD than in the other groups (P < 0.05). Reduced tidal volume expansion during exercise correlated with reduced inspiratory capacity, which, in turn, correlated with reduced inspiratory muscle strength. Patients with cancer had a relatively reduced diffusing capacity of the lung for carbon monoxide, reduced skeletal muscle strength, and lower ventilatory thresholds during exercise compared with HC (P < 0.05). There were no significant between-group differences in measurements of airway function, pulmonary gas exchange, or cardiovascular function during exercise. In the absence of evidence of airway obstruction or restrictive interstitial lung disease, the shallow breathing pattern suggests ventilatory muscle weakness as one possible explanation for increased dyspnea intensity at a given ventilation in CD patients.