Investigating the rates and impacts of near misses and related incidents among UK cyclists

The paper investigates the occurrence of non-injury incidents among cyclists in the UK, seeking to (i) generate a rate that can be compared with injury rates, (ii) analyse factors affecting incident rates, and (iii) analyse factors affecting the impact of incidents on cyclists. We collected data on non-injury cycling ‘incidents’ (near misses and other frightening and/or annoying incidents) from 1692 online diaries of cycle trip stages1 and incidents, participants having signed up in advance for a specific day. Following data cleaning and coding, a dataset was created covering 1532 diary days and 3994 records of incidents occurring within the UK. Incident rates were calculated and compared to injury risks for cyclists. Cross-tabulation and regression were used to identify factors affecting incident rates and the effect an incident has on the cyclist. Frightening or annoying non-injury incidents, unlike slight injuries, are an everyday experience for most people cycling in the UK. For regular cyclists ‘very scary’ incidents (rated as 3 on a 0–3 scale) are on average a weekly experience, with deliberate aggression experienced monthly. Per mile, non-injury incidents were more frequent for people making shorter and slower trips. People aged over 55 were at lower risk, as were those cycling at the weekend and outside the morning peak. Incidents that involved motor vehicles, especially those involving larger vehicles, were more frightening than those that did not. Near miss and other non-injury incidents are widespread in the UK and may have a substantial impact on cycling experience and uptake. Policy and research should initially target the most frightening types of incident, such as very close passes and incidents involving large vehicles. Further attention needs to be paid to the experiences of groups under-represented among cyclists, such as women making shorter trips.

Detailed phenotypic and genotypic characterization of bietti crystalline dystrophy

OBJECTIVE: To provide a detailed phenotype/genotype characterization of Bietti crystalline dystrophy (BCD). DESIGN: Observational case series. PARTICIPANTS: Twenty patients from 17 families recruited from a multiethnic British population. METHODS: Patients underwent color fundus photography, near-infrared (NIR) imaging, fundus autofluorescence (FAF) imaging, spectral domain optical coherence tomography (SD-OCT), and electroretinogram (ERG) assessment. The gene CYP4V2 was sequenced. MAIN OUTCOME MEASURES: Clinical, imaging, electrophysiologic, and molecular genetics findings. RESULTS: Patients ranged in age from 19 to 72 years (median, 40 years), with a visual acuity of 6/5 to perception of light (median, 6/12). There was wide intrafamilial and interfamilial variability in clinical severity. The FAF imaging showed well-defined areas of retinal pigment epithelium (RPE) loss that corresponded on SD-OCT to well-demarcated areas of outer retinal atrophy. Retinal crystals were not evident on FAF imaging and were best visualized with NIR imaging. Spectral domain OCT showed them to be principally located on or in the RPE/Bruch's membrane complex. Disappearance of the crystals, revealed by serial recording, was associated with severe disruption and thinning of the RPE/Bruch's membrane complex. Cases with extensive RPE degeneration (N = 5) had ERGs consistent with generalized rod and cone dysfunction, but those with more focal RPE atrophy showed amplitude reduction without delay (N = 3), consistent with restricted loss of function, or that was normal (N = 2). Likely disease-causing variants were identified in 34 chromosomes from 17 families. Seven were novel, including p.Met66Arg, found in all 11 patients from 8 families of South Asian descent. This mutation appears to be associated with earlier onset (median age, 30 years) compared with other substitutions (median age, 41 years). Deletions of exon 7 were associated with more severe disease. CONCLUSIONS: The phenotype is highly variable. Several novel variants are reported, including a highly prevalent substitution in patients of South Asian descent that is associated with earlier-onset disease. Autofluorescence showed sharply demarcated areas of RPE loss that coincided with abrupt edges of outer retinal atrophy on SD-OCT; crystals were generally situated on or in the RPE/Bruch's complex but could disappear over time with associated RPE disruption. These results support a role for the RPE in disease pathogenesis.