The effects of pedestrian gestures on driver yielding at crosswalks: A systematic replication.

Applied research on decreasing pedestrian injuries often focuses on how to increase driver yielding behavior but rarely studies what pedestrians can do to increase their safety. There is a lack of empirical research focusing on how pedestrians can effectively signal their need to cross the street when there is no traffic light directing the pedestrian and oncoming traffic. As a replication and extension of Crowley-Koch et al. (2011), this study examined the effects of two pedestrian gestures, an extended arm and raised hand, on driver yielding behavior at 3 crosswalks in Oklahoma City. Research assistants implemented gestures prior to crossing the street as cars approached the crosswalk. Data were collected on the percentage of drivers yielding to the pedestrian. Both pedestrian gestures increased driver yielding across all 3 sites when compared to no gesture. Results were discussed in terms of future research and practical solutions towards increasing pedestrian safety.

The accuracy of mean corpuscular volume guided anaemia classification in primary care.

BACKGROUND: Anemia can be categorized into micro-, normo- or macrocytic anemia based on the mean corpuscular volume (MCV). This categorization might help to define the etiology of anemia. METHODS: The cohort consisted of patients newly diagnosed with anaemia in primary care. Seven aetiologies of anaemia were defined, based on an extensive laboratory protocol. Two assumptions were tested: (i) MCV <80 fl (microcytic) excludes vitamin B12 deficiency, folic acid deficiency, suspected haemolysis and suspected bone marrow disease as anaemia aetiology. (ii) MCV >100 fl (macrocytic) excludes iron deficiency anaemia, anaemia of chronic disease and renal anaemia as anaemia aetiology. RESULTS: Data of 4129 patients were analysed. One anaemia aetiology could be assigned to 2422 (59%) patients, more than one anaemia aetiology to 888 (22%) patients and uncertainty regarding the aetiology remained in 819 (20%) patients. MCV values were within the normal range in 3505 patients (85%). In 59 of 365 microcytic patients (16%), the anaemia aetiology was not in accordance with the first assumption. In 233 of 259 macrocytic patients (90%), the anaemia aetiology was not in accordance with the second assumption. CONCLUSIONS: Anaemia aetiologies might be ruled out incorrectly if MCV guided classification is used as a first step in the diagnostic work-up of anaemia. We recommend using a broader set of laboratory tests, independent of MCV.

Examining generalization of motorist yielding at an adjacent crosswalk with variations of the gateway sign configuration.

The gateway sign configuration has been effective at increasing motorist yielding and reducing speeds at crosswalks. A gateway configuration uses in-street signs at a crosswalk on each edge of the roadway and on each lane line. Although this intervention is effective at increasing motorist yielding at uncontrolled crosswalks, the limits of the intervention have yet to be tested. The present study examined if 1) the effects of the gateway intervention on one crosswalk would generalize to an untreated adjacent crosswalk, and 2) if the effects of an offset configuration of signs which partially treated each crosswalk could maximize the effects of that generalization. Experiment 1 showed that less yielding occurred at the untreated crosswalk than at the treated crosswalk, though yielding was higher than baseline. In Experiment 2, results showed that an offset gateway configuration could produce comparable levels of yielding at both crosswalks.

Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study.

OBJECTIVES: To describe all iron deficiency anaemia (IDA)-related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival. DESIGN AND SETTING: Retrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands. PARTICIPANTS: Men and women aged ≥50 years with a new diagnosis of IDA (ie, no anaemia 2 years previously). METHOD: From February 2007 to February 2018, all relevant data were collected from the files of the referral hospital. Early IDA-related cause was defined as established within 18 weeks after IDA diagnosis. Cox proportional-hazards regression was used to analyse survival of patients with CRC diagnosis. RESULTS: 587 patients with IDA were included with a median follow-up of 4.6 years. Early and late IDA-related causes could be established in 32% and 8% of patients, respectively. Early and late CRC was found in 8% and 2% of patients, respectively, and were located mainly right sided. After adjustment for age, gender and TNM classification, mortality risk was lower in patients with IDA with early CRC diagnosis, but not significantly (HR 0.30, 95% CI 0.09 to 1.02). CONCLUSION: Even with extended follow-up, the cause of IDA remains elusive in the majority of patients with IDA in general practice. However, patients with IDA are at increased risk for in particular right-sided CRC and a late diagnosis of CRC appears to have a detrimental effect on survival in patients with IDA.

Diagnostics in anaemia of chronic disease in general practice: a real-world retrospective cohort study.

BACKGROUND: Limited research has been performed that focused on the diagnosis of the underlying cause of anaemia of chronic disease (ACD) in general practice or on prevalence data of the underlying causes of ACD in general practice, although this is one of the most common types of anaemia. AIM: To clarify the diagnostic strategies of GPs in patients newly diagnosed with ACD and to determine the most common underlying causes. DESIGN & SETTING: Retrospective cohort study. METHOD: Patients newly diagnosed with ACD were selected based on laboratory criteria. ACD was defined as confirmed anaemia and ferritin levels above 100 µg/l combined with decreased iron and/or reduced transferrin. Additional medical information on patients was obtained from the electronic medical files of the GP and/or the referral hospital. RESULTS: Of the 267 analysed patients with ACD, additional investigations were performed in 205 patients (77%); in 31 patients (12%) the cause was apparent at the time of diagnosis, and for 31 patients (12%) no additional investigations were requested. In 210 (79%) of the 267 patients, an underlying cause was established, with infection (n = 68, 32%), autoimmune disease (n = 51, 24%) and malignancy (n = 48, 23%) as the most frequently observed etiologies. In 35 (13%) of the ACD patients, oral iron supplementation was prescribed by the GP. This was mainly done in patients with severe anaemia or less enhanced ferritin levels. CONCLUSION: For most patients with newly diagnosed ACD, the GP undertakes additional investigations to establish underlying causes. However, the cause of ACD remains unknown in a small proportion of patients. The use of oral iron supplementation in these patients requires caution.

The effectiveness of a routine versus an extensive laboratory analysis in the diagnosis of anaemia in general practice.

Background We investigated the percentage of patients diagnosed with the correct underlying cause of anaemia by general practitioners when using an extensive versus a routine laboratory work-up. Methods An online survey was distributed among 836 general practitioners. The survey consisted of six cases, selected from an existing cohort of anaemia patients ( n = 3325). In three cases, general practitioners were asked to select the laboratory tests for further diagnostic examination from a list of 14 parameters (i.e. routine work-up). In the other three cases, general practitioners were presented with all 14 laboratory test results available (i.e. extensive work-up). General practitioners were asked to determine the underlying cause of anaemia in all six cases based on the test results, and these answers were compared with the answers of an expert panel. Results A total of 139 general practitioners (partly) responded to the survey (17%). The general practitioners were able to determine the underlying cause of anaemia in 53% of cases based on the routine work-up, whereas 62% of cases could be diagnosed using an extensive work-up ( P = 0.007). In addition, the probability of a correct diagnosis decreased with the patient's age and was also affected by the underlying cause itself, with anaemia of chronic disease being hardest to diagnose ( P = 0.003). Conclusion The use of an extensive laboratory work-up in patients with newly diagnosed anaemia is expected to increase the percentage of correct underlying causes established by general practitioners. Since the underlying cause can still not be established in 31.3% of anaemia patients, further research is necessary.

Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice.

BACKGROUND: Macrocytic anaemia (MCV ≥ 100 fL) is a relatively common finding in general practice. However, literature on the prevalence of the different causes in this population is limited. The prevalence of macrocytic anaemia and its underlying aetiology were analysed in a general practice population. The potential effect of the different aetiology on survival was also evaluated. METHODS: Between the 1st of February 2007 and the 1st of February 2015, patients aged 50 years or older and presenting to their general practitioner with a newly diagnosed anaemia, were included in the study. Anaemia was defined as haemoglobin level below 13.7 g/dL in men and below 12.1 g/dL in women. A broad range of laboratory tests was performed for each patient. The causes of anaemia were consequently determined by two independent observers based on the laboratory results. RESULTS: Of the 3324 included patients, 249 (7.5 %) displayed a macrocytic anaemia and were subsequently analysed. An underlying explanation could be established in 204 patients (81.9 %) with 27 patients (13.2 %) displaying multiple causes. Classic aetiology (i.e. alcohol abuse, vitamin B12/folic acid deficiency, haemolysis and possible bone marrow disease) was found in 115 patients. Alternative causes (i.e. anaemia of chronic disease, iron deficiency, renal anaemia and other causes) were encountered in 101 patients. In addition, a notable finding was the median gamma GT of 277 U/L in patients diagnosed with alcohol abuse (N = 24, IQR 118.0-925.5) and 23 U/L in the remaining cohort (N = 138, IQR 14.0-61.0). The distribution of gamma GT values was statistically different (P < 0.001). Five year survival rates were determined for six categories of causes, ranging from 39.9 % (95 % CI 12.9-66.9) for renal anaemia to 76.2 % (95 % CI 49.4-103.0) for the category multiple causes. CONCLUSION: In addition to classic explanations for macrocytosis, alternative causes are frequently encountered in patients with macrocytic anaemia in general practice.

Time-series intervention analysis of pedestrian countdown timer effects.

Pedestrians account for 40-50% of traffic fatalities in large cities. Several previous studies based on relatively small samples have concluded that Pedestrian Countdown Timers (PCT) may reduce pedestrian crashes at signalized intersections, but other studies report no reduction. The purposes of the present article are to (1) describe a new methodology to evaluate the effectiveness of introducing PCT signals and (2) to present results of applying this methodology to pedestrian crash data collected in a large study carried out in Detroit, Michigan. The study design incorporated within-unit as well as between-unit components. The main focus was on dynamic effects that occurred within the PCT unit of 362 treated sites during the 120 months of the study. An interrupted time-series analysis was developed to evaluate whether change in crash frequency depended upon of the degree to which the countdown timers penetrated the treatment unit. The between-unit component involved comparisons between the treatment unit and a control unit. The overall conclusion is that the introduction of PCT signals in Detroit reduced pedestrian crashes to approximately one-third of the preintervention level. The evidence for this reductionis strong and the change over time was shown to be a function of the extent to which the timers were introduced during the intervention period. There was no general drop-off in crash frequency throughout the baseline interval of over five years; only when the PCT signals were introduced in large numbers was consistent and convincing crash reduction observed. Correspondingly, there was little evidence of change in the control unit.

A comparison of gateway in-street sign configuration to other driver prompts to increase yielding to pedestrians at crosswalks.

Increasing motorists' yielding of the right of way to pedestrians in crosswalks reduces the number of collisions between motorists and pedestrians. In this study we examined a gateway in-street sign configuration (1 in-street sign installed between the 2 travel lanes in each direction, and 1 on both edges of the roadway in each direction) on multilane roads. The first experiment compared the efficacy of adding multiple in-street signs used in a gateway configuration with a single sign between the 2 travel lanes in each direction. The second experiment compared the gateway in-street sign configuration with a more expensive pedestrian hybrid beacon. The third experiment compared the gateway in-street sign configuration with the more expensive rectangular rapid flashing beacon. The results demonstrated that the gateway in-street sign configuration produced very high levels of driver yielding, and that it was as effective as the 2 more expensive treatments.

The effects of external motivation and real-time automated feedback on speeding behavior in a naturalistic setting.

OBJECTIVE: In this field experiment, the authors tested an alerting system and a monetary incentive system with the objective of reducing speeding more than 5 mph faster than the posted speed limit. BACKGROUND: Speeding is a factor in a significant number of traffic fatalities. The systems tested in this project have been evaluated outside but not within the United States. These studies indicated that similar systems led to reductions in speeding. METHOD: For this study, eight vehicles were instrumented such that vehicle speed and speed limits were linked in real time. A total of 50 participants drove assigned vehicles for 4 weeks. Week 1 was a baseline period; during Week 2 or Week 3, 40 participants experienced the alerting system that issued auditory and visual advisory signals when drivers exceeded the limit by 5 mph or more. Of these 40 individuals, 20 experienced the monetary incentive system during Weeks 2 and 3; Week 4 was a return-to-baseline period. A control group of 10 drivers experienced neither system during the study. RESULTS: Results indicated that the incentive system resulted in significant reductions in driving faster than the posted limit, and the feedback system led to modest changes in speeding. In the condition in which drivers experienced the feedback and incentive, reductions in speeding were similar to those found during the incentive-only condition. CONCLUSION: The technology tested in this study has potential to benefit traffic safety by reducing the incidence of driving faster than the posted limit, which should lead to a reduction in speed-related crashes. APPLICATION: Insurers provide incentive-based discounts on premiums. Combining this technology with such a discount program may improve traffic safety significantly.

The effects of a rectangular rapid-flashing beacon on vehicle speed.

In 2008, nearly 31% of vehicle fatalities were related to failure to adhere to safe vehicle speeds (National Highway Traffic Safety Administration [NHTSA], 2009). The current study evaluated the effect of a rectangular rapid-flashing beacon (RRFB) triggered by excessive speed on vehicle speed using a combined alternating treatments and reversal design. The percentage of vehicles traveling above 41 mph (66 km per hour) decreased by 20%, and speed distributions showed a shift toward lower speeds during the RRFB condition.

Increasing following headway with prompts, goal setting, and feedback in a driving simulator.

We evaluated the effects of prompting, goal setting, and feedback on following headway of young drivers in a simulated driving environment and assessed whether changes produced in following headway were associated with reductions in hard braking when drivers were and were not using cell phones. Participants were 4 university students. During baseline, drivers spent half of the time talking on cell phones while driving. At the start of the intervention, drivers were prompted to increase following headway while on the cell phones and were provided a specific target for following headway. Drivers were given feedback on increasing following headway when on cell phones at the end of each session. The intervention package was associated with an increase in following headway and a decrease in hard braking when participants were on and off the cell phones. Cell phone use did not affect any of the measures.

Effects of pedestrian prompts on motorist yielding at crosswalks.

Pedestrian safety is a serious concern at busy intersections and pedestrian campuses across the nation. Although crosswalks and signs inform pedestrians where to cross, there is no standard protocol for pedestrians to signal drivers that they wish to use the crosswalks, except to stand in or at the crosswalk. We examined the effects of two pedestrian prompts, a raised hand and extended arm, on motorist yielding at uncontrolled crosswalks. The two prompts were effective at increasing yielding.

A feedback intervention to increase digital and paper checklist performance in technically advanced aircraft simulation.

This study examined whether pilots operating a flight simulator completed digital or paper flight checklists more accurately after receiving postflight graphic and verbal feedback. The dependent variable was the number of checklist items completed correctly per flight. Following treatment, checklist completion with paper and digital checklists increased from 38% and 39%, respectively, to nearly 100% and remained close to 100% after feedback and praise for improvement were withdrawn. Performance was maintained at or near 100% during follow-up probes.

Using accelerator pedal force to increase seat belt use of service vehicle drivers.

This study evaluated a device that applied a sustained increase in accelerator pedal back force whenever drivers exceeded a preset speed criterion without buckling their seat belts. This force was removed once the belt was fastened. Participants were 6 commercial drivers who operated carpet-cleaning vans. During baseline, no contingency was in place for unbuckled trips. The pedal resistance was introduced via a multiple baseline design across groups. On the first day of treatment, the device was explained and demonstrated for all drivers of the vehicle. The treatment was associated with an immediate sustained increase in seat belt compliance to 100%. Occasionally, drivers initially did not buckle during a trip and encountered the force. In all instances, they buckled within less than 25 s. These results suggest that the increased force was sufficient to set up an establishing operation to reinforce seat belt buckling negatively. Drivers indicated that they were impressed with the device and would not drive very long unbelted with the pedal force in place.

Increasing seat belt use in service vehicle drivers with a gearshift delay.

This study evaluated a device that prevents drivers from shifting vehicles into gear for up to 8 s unless seat belts are buckled. Participants were 101 commercial drivers who operated vans, pickups, or other light trucks from the U.S. and Canada. The driver could escape or avoid the delay by fastening his or her seat belt before shifting out of park. Unbelted participants experienced either a constant delay (8 s) or a variable delay (M  =  8 s). A 16-s delay was introduced for those U.S. drivers who did not show significant improvement. Seat belt use increased from 48% to 67% (a 40% increase) for U.S. drivers and from 54% to 74% (a 37% increase) for Canadian drivers. The fixed delay was more effective for U.S. drivers than the variable delay, but there was no difference between these two delay schedules for Canadian drivers. After the driver fastened his or her seat belt, it tended to remain fastened for the duration of the trip.

The effect of feedback on the accuracy of checklist completion during instrument flight training.

This study examined whether pilots completed airplane checklists more accurately when they receive postflight graphic and verbal feedback. Participants were 8 college students who are pilots with an instrument rating. The task consisted of flying a designated flight pattern using a personal computer aviation training device (PCATD). The dependent variables were the number of checklist items completed correctly. A multiple baseline design across pairs of participants with withdrawal of treatment was employed in this study. During baseline, participants were given postflight technical feedback. During intervention, participants were given postflight graphic feedback on checklist use and praise for improvements along with technical feedback. The intervention produced near perfect checklist performance, which was maintained following a return to the baseline conditions.

Observations of how drivers fasten their seatbelts in relation to various startup tasks.

Observational data were collected to determine the percentage of drivers that followed various seatbelt buckling sequences. Observers scored the buckling sequence and recorded the time between various startup events and fastening the seatbelt of 1600 drivers in two urban areas, Pinellas County, Florida, and Halifax, Nova Scotia, Canada. The results indicated that most drivers waited to buckle their seatbelt until after they started their vehicle or placed it into gear, with a substantial proportion buckling after placing the vehicle in motion. These results suggest that a salient second seatbelt reminder that was initiated 30s after placing the vehicle in gear would only be experienced by persons who do not buckle their seatbelt and less than 1% of drivers who buckle their seatbelt more than 29 s after placing the vehicle in gear.

Impact of a comprehensive safety program on bicycle helmet use among middle-school children.

A bicycle helmet program was evaluated in three middle schools using a multiple baseline across schools design. Two of the three schools had histories of enforcement of helmet use. During baseline many students riding their bikes to and from school did not wear their helmets or wore them incorrectly. A program that consisted of peer data collection of correct helmet use, education on how to wear a bicycle helmet correctly, peer goal setting, public posting of the percentage of correct helmet use, and shared reinforcers, all of which were implemented by the school resource officer, increased afternoon helmet use and afternoon correct helmet use in all three schools. Probe data collected a distance from all three schools indicated that students did not remove their helmets once they were no longer in close proximity to the school, and probe data collected in the morning at two of the schools showed that the behavior change transferred to the morning.

Recognition distance of pedestrian traffic signals by individuals with low vision.

Forty-one individuals with moderate-to-severe vision loss participated in a study to determine the minimum distance they required to correctly identify three different pedestrian traffic icon symbols, one of which was presented with an augmented light source. We found that subjects could identify the WALK icon without the augmented light source information, or animated eyes, from farther away than either the WALK icon with the augmented light source information or the DON'T WALK icon. These results differ from those of a previous study, which found that subjects could correctly identify the WALK icon with the augmented light source from a greater distance than the WALK or DON'T WALK icons without the augmented light source.