A regional environmental accounting matrix and integrated environmental economic analyses to support regional planning

This research deals with the deepening and use of an environmental accounting matrix in Emilia-Romagna, RAMEA air emissions (regional NAMEA), carried out by the Regional Environment Agency (Arpa) in an European project. After a depiction of the international context regarding the widespread needing to integrate economic indicators and go beyond conventional reporting system, this study explains the structure, update and development of the tool. The overall aim is to outline the matrix for environmental assessments of regional plans, draw up sustainable reports and monitor effects of regional policies in a sustainable development perspective. The work focused on an application of a Shift-Share model, on the integration with eco-taxes, industrial waste production, energy consumptions, on applications of the extended RAMEA as a policy tool, following Eurostat guidelines. The common thread is the eco-efficiency (economic-environmental efficiency) index. The first part, in English, treats the methodology used to build a more complete tool; in the second part RAMEA has been applied on two regional case studies, in Italian, to support decision makers regarding Strategic Environmental Assessments’ processes (2001/42/EC). The aim is to support an evidence-based policy making by integrating sustainable development concerns at all levels. The first case study regards integrated environmental-economic analyses in support to the SEA of the Regional Waste management plan. For the industrial waste production an extended and updated RAMEA has been developed as a useful policy tool, to help in analysing and monitoring the state of environmental-economic performances. The second case study deals with the environmental report for the SEA of the Regional Program concerning productive activities. RAMEA has been applied aiming to an integrated environmental-economic analysis of the context, to investigate the performances of the regional production chains and to depict and monitor the area where the program should be carried out, from an integrated environmental-economic perspective.

Comparative DNA sequence and methylation analyses of orthologous genes in humans and non-human primates: Genetic and epigenetic footprints of evolution

Welche genetische Unterschiede machen uns verschieden von unseren nächsten Verwandten, den Schimpansen, und andererseits so ähnlich zu den Schimpansen? Was wir untersuchen und auch verstehen wollen, ist die komplexe Beziehung zwischen den multiplen genetischen und epigenetischen Unterschieden, deren Interaktion mit diversen Umwelt- und Kulturfaktoren in den beobachteten phänotypischen Unterschieden resultieren. Um aufzuklären, ob chromosomale Rearrangements zur Divergenz zwischen Mensch und Schimpanse beigetragen haben und welche selektiven Kräfte ihre Evolution geprägt haben, habe ich die kodierenden Sequenzen von 2 Mb umfassenden, die perizentrischen Inversionsbruchpunkte flankierenden Regionen auf den Chromosomen 1, 4, 5, 9, 12, 17 und 18 untersucht. Als Kontrolle dienten dabei 4 Mb umfassende kollineare Regionen auf den rearrangierten Chromosomen, welche mindestens 10 Mb von den Bruchpunktregionen entfernt lagen. Dabei konnte ich in den Bruchpunkten flankierenden Regionen im Vergleich zu den Kontrollregionen keine höhere Proteinevolutionsrate feststellen. Meine Ergebnisse unterstützen nicht die chromosomale Speziationshypothese für Mensch und Schimpanse, da der Anteil der positiv selektierten Gene (5,1% in den Bruchpunkten flankierenden Regionen und 7% in den Kontrollregionen) in beiden Regionen ähnlich war. Durch den Vergleich der Anzahl der positiv und negativ selektierten Gene per Chromosom konnte ich feststellen, dass Chromosom 9 die meisten und Chromosom 5 die wenigsten positiv selektierten Gene in den Bruchpunkt flankierenden Regionen und Kontrollregionen enthalten. Die Anzahl der negativ selektierten Gene (68) war dabei viel höher als die Anzahl der positiv selektierten Gene (17). Eine bioinformatische Analyse von publizierten Microarray-Expressionsdaten (Affymetrix Chip U95 und U133v2) ergab 31 Gene, die zwischen Mensch und Schimpanse differentiell exprimiert sind. Durch Untersuchung des dN/dS-Verhältnisses dieser 31 Gene konnte ich 7 Gene als negativ selektiert und nur 1 Gen als positiv selektiert identifizieren. Dieser Befund steht im Einklang mit dem Konzept, dass Genexpressionslevel unter stabilisierender Selektion evolvieren. Die meisten positiv selektierten Gene spielen überdies eine Rolle bei der Fortpflanzung. Viele dieser Speziesunterschiede resultieren eher aus Änderungen in der Genregulation als aus strukturellen Änderungen der Genprodukte. Man nimmt an, dass die meisten Unterschiede in der Genregulation sich auf transkriptioneller Ebene manifestieren. Im Rahmen dieser Arbeit wurden die Unterschiede in der DNA-Methylierung zwischen Mensch und Schimpanse untersucht. Dazu wurden die Methylierungsmuster der Promotor-CpG-Inseln von 12 Genen im Cortex von Menschen und Schimpansen mittels klassischer Bisulfit-Sequenzierung und Bisulfit-Pyrosequenzierung analysiert. Die Kandidatengene wurden wegen ihrer differentiellen Expressionsmuster zwischen Mensch und Schimpanse sowie wegen Ihrer Assoziation mit menschlichen Krankheiten oder dem genomischen Imprinting ausgewählt. Mit Ausnahme einiger individueller Positionen zeigte die Mehrzahl der analysierten Gene keine hohe intra- oder interspezifische Variation der DNA-Methylierung zwischen den beiden Spezies. Nur bei einem Gen, CCRK, waren deutliche intraspezifische und interspezifische Unterschiede im Grad der DNA-Methylierung festzustellen. Die differentiell methylierten CpG-Positionen lagen innerhalb eines repetitiven Alu-Sg1-Elements. Die Untersuchung des CCRK-Gens liefert eine umfassende Analyse der intra- und interspezifischen Variabilität der DNA-Methylierung einer Alu-Insertion in eine regulatorische Region. Die beobachteten Speziesunterschiede deuten darauf hin, dass die Methylierungsmuster des CCRK-Gens wahrscheinlich in Adaption an spezifische Anforderungen zur Feinabstimmung der CCRK-Regulation unter positiver Selektion evolvieren. Der Promotor des CCRK-Gens ist anfällig für epigenetische Modifikationen durch DNA-Methylierung, welche zu komplexen Transkriptionsmustern führen können. Durch ihre genomische Mobilität, ihren hohen CpG-Anteil und ihren Einfluss auf die Genexpression sind Alu-Insertionen exzellente Kandidaten für die Förderung von Veränderungen während der Entwicklungsregulation von Primatengenen. Der Vergleich der intra- und interspezifischen Methylierung von spezifischen Alu-Insertionen in anderen Genen und Geweben stellt eine erfolgversprechende Strategie dar.

Fish quality assessment through the application of chemico-physical, sensory and microbiological analyses

The quality of fish products is indispensably linked to the freshness of the raw material modulated by appropriate manipulation and storage conditions, specially the storage temperature after catch. The purpose of the research presented in this thesis, which was largely conducted in the context of a research project funded by Italian Ministry of Agricultural, Food and Forestry Policies (MIPAAF), concerned the evaluation of the freshness of farmed and wild fish species, in relation to different storage conditions, under ice (0°C) or at refrigeration temperature (4°C). Several specimens of different species, bogue (Boops boops), red mullet (Mullus barbatus), sea bream (Sparus aurata) and sea bass (Dicentrarchus labrax), during storage, under the different temperature conditions adopted, have been examined. The assessed control parameters were physical (texture, through the use of a dynamometer; visual quality using a computer vision system (CVS)), chemical (through footprint metabolomics 1H-NMR) and sensory (Quality Index Method (QIM). Microbiological determinations were also carried out on the species of hake (Merluccius merluccius). In general obtained results confirmed that the temperature of manipulation/conservation is a key factor in maintaining fish freshness. NMR spectroscopy showed to be able to quantify and evaluate the kinetics for unselected compounds during fish degradation, even a posteriori. This can be suitable for the development of new parameters related to quality and freshness. The development of physical methods, particularly the image analysis performed by computer vision system (CVS), for the evaluation of fish degradation, is very promising. Among CVS parameters, skin colour, presence and distribution of gill mucus, and eye shape modification evidenced a high sensibility for the estimation of fish quality loss, as a function of the adopted storage conditions. Particularly the eye concavity index detected on fish eye showed a high positive correlation with total QIM score.

Development of a field method to assess root parasites of woody plants - ecological analyses of the grapevine-phylloxera interaction

The development and the growth of plants is strongly affected by the interactions between roots, rootrnassociated organisms and rhizosphere communities. Methods to assess such interactions are hardly torndevelop particularly in perennial and woody plants, due to their complex root system structure and theirrntemporal change in physiology patterns. In this respect, grape root systems are not investigated veryrnwell. The aim of the present work was the development of a method to assess and predict interactionsrnat the root system of rootstocks (Vitis berlandieri x Vitis riparia) in field. To achieve this aim, grapernphylloxera (Daktulosphaira vitifoliae Fitch, Hemiptera, Aphidoidea) was used as a graperoot parasitizingrnmodel.rnTo develop the methodical approach, a longt-term trial (2006-2009) was arranged on a commercial usedrnvineyard in Geisenheim/Rheingau. All 2 to 8 weeks the top most 20 cm of soil under the foliage wallrnwere investigated and root material was extracted (n=8-10). To include temporal, spatial and cultivarrnspecific root system dynamics, the extracted root material was analyzed digitally on the morphologicalrnproperties. The grape phylloxera population was quantified and characterized visually on base of theirrnlarvalstages (oviparous, non oviparous and winged preliminary stages). Infection patches (nodosities)rnwere characterized visually as well, partly supported by digital root color analyses. Due to the knownrneffects of fungal endophytes on the vitality of grape phylloxera infested grapevines, fungal endophytesrnwere isolated from nodosity and root tissue and characterized (morphotypes) afterwards. Further abioticrnand biotic soil conditions of the vineyards were assessed. The temporal, spatial and cultivar specificrnsensitivity of single parameters were analyzed by omnibus tests (ANOVAs) and adjacent post-hoc tests.rnThe relations between different parameters were analyzed by multiple regression models.rnQuantitative parameters to assess the degeneration of nodosity, the development nodosity attachedrnroots and to differentiate between nodosities and other root swellings in field were developed. Significantrndifferences were shown between root dynamic including parameters and root dynamic ignoringrnparameters. Regarding the description of grape phylloxera population and root system dynamic, thernmethod showed a high temporal, spatial and cultivar specific sensitivity. Further, specific differencesrncould be shown in the frequency of endophyte morphotypes between root and nodosity tissue as wellrnas between cultivars. Degeneration of nodosities as well as nodosity occupation rates could be relatedrnto the calculated abundances of grape phylloxera population. Further ecological questions consideringrngrape root development (e.g. relation between moisture and root development) and grape phylloxerarnpopulation development (e.g. relation between temperature and population structure) could be answeredrnfor field conditions.rnGenerally, the presented work provides an approach to evaluate vitality of grape root systems. Thisrnapproach can be useful, considering the development of control strategies against soilborne pests inrnviticulture (e.g. grape phylloxera, Sorospheara viticola, Roesleria subterranea (Weinm.) Redhaed) as well as considering the evaluation of integrated management systems in viticulture.

Geotechnical characterization of mixed sandy and silty soils using piezocone tests: Analysis of partial drainage phenomena and rate effects on the experimental soil response

The cone penetration test (CPT), together with its recent variation (CPTU), has become the most widely used in-situ testing technique for soil profiling and geotechnical characterization. The knowledge gained over the last decades on the interpretation procedures in sands and clays is certainly wide, whilst very few contributions can be found as regards the analysis of CPT(u) data in intermediate soils. Indeed, it is widely accepted that at the standard rate of penetration (v = 20 mm/s), drained penetration occurs in sands while undrained penetration occurs in clays. However, a problem arise when the available interpretation approaches are applied to cone measurements in silts, sandy silts, silty or clayey sands, since such intermediate geomaterials are often characterized by permeability values within the range in which partial drainage is very likely to occur. Hence, the application of the available and well-established interpretation procedures, developed for ‘standard’ clays and sands, may result in invalid estimates of soil parameters. This study aims at providing a better understanding on the interpretation of CPTU data in natural sand and silt mixtures, by taking into account two main aspects, as specified below: 1)Investigating the effect of penetration rate on piezocone measurements, with the aim of identifying drainage conditions when cone penetration is performed at a standard rate. This part of the thesis has been carried out with reference to a specific CPTU database recently collected in a liquefaction-prone area (Emilia-Romagna Region, Italy). 2)Providing a better insight into the interpretation of piezocone tests in the widely studied silty sediments of the Venetian lagoon (Italy). Research has focused on the calibration and verification of some site-specific correlations, with special reference to the estimate of compressibility parameters for the assessment of long-term settlements of the Venetian coastal defences.

A New Prediction Model for Slope Stability Analysis

The instability of river bank can result in considerable human and land losses. The Po river is the most important in Italy, characterized by main banks of significant and constantly increasing height. This study presents multilayer perceptron of artificial neural network (ANN) to construct prediction models for the stability analysis of river banks along the Po River, under various river and groundwater boundary conditions. For this aim, a number of networks of threshold logic unit are tested using different combinations of the input parameters. Factor of safety (FS), as an index of slope stability, is formulated in terms of several influencing geometrical and geotechnical parameters. In order to obtain a comprehensive geotechnical database, several cone penetration tests from the study site have been interpreted. The proposed models are developed upon stability analyses using finite element code over different representative sections of river embankments. For the validity verification, the ANN models are employed to predict the FS values of a part of the database beyond the calibration data domain. The results indicate that the proposed ANN models are effective tools for evaluating the slope stability. The ANN models notably outperform the derived multiple linear regression models.

Soil-structure interaction during tunnelling in urban area: observations and 3D numerical modelling

This work illustrates a soil-tunnel-structure interaction study performed by an integrated,geotechnical and structural,approach based on 3D finite element analyses and validated against experimental observations.The study aims at analysing the response of reinforced concrete framed buildings on discrete foundations in interaction with metro lines.It refers to the case of the twin tunnels of the Milan (Italy) metro line 5,recently built in coarse grained materials using EPB machines,for which subsidence measurements collected along ground and building sections during tunnelling were available.Settlements measured under freefield conditions are firstly back interpreted using Gaussian empirical predictions. Then,the in situ measurements’ analysis is extended to include the evolving response of a 9 storey reinforced concrete building while being undercrossed by the metro line.In the finite element study,the soil mechanical behaviour is described using an advanced constitutive model. This latter,when combined with a proper simulation of the excavation process, proves to realistically reproduce the subsidence profiles under free field conditions and to capture the interaction phenomena occurring between the twin tunnels during the excavation. Furthermore, when the numerical model is extended to include the building, schematised in a detailed manner, the results are in good agreement with the monitoring data for different stages of the twin tunnelling. Thus, they indirectly confirm the satisfactory performance of the adopted numerical approach which also allows a direct evaluation of the structural response as an outcome of the analysis. Further analyses are also carried out modelling the building with different levels of detail. The results highlight that, in this case, the simplified approach based on the equivalent plate schematisation is inadequate to capture the real tunnelling induced displacement field. The overall behaviour of the system proves to be mainly influenced by the buried portion of the building which plays an essential role in the interaction mechanism, due to its high stiffness.

Statistical analysis of the error associated with the simplification of the stratigraphy in geotechnical models

The uncertainties in the determination of the stratigraphic profile of natural soils is one of the main problems in geotechnics, in particular for landslide characterization and modeling. The study deals with a new approach in geotechnical modeling which relays on a stochastic generation of different soil layers distributions, following a boolean logic – the method has been thus called BoSG (Boolean Stochastic Generation). In this way, it is possible to randomize the presence of a specific material interdigitated in a uniform matrix. In the building of a geotechnical model it is generally common to discard some stratigraphic data in order to simplify the model itself, assuming that the significance of the results of the modeling procedure would not be affected. With the proposed technique it is possible to quantify the error associated with this simplification. Moreover, it could be used to determine the most significant zones where eventual further investigations and surveys would be more effective to build the geotechnical model of the slope. The commercial software FLAC was used for the 2D and 3D geotechnical model. The distribution of the materials was randomized through a specifically coded MatLab program that automatically generates text files, each of them representing a specific soil configuration. Besides, a routine was designed to automate the computation of FLAC with the different data files in order to maximize the sample number. The methodology is applied with reference to a simplified slope in 2D, a simplified slope in 3D and an actual landslide, namely the Mortisa mudslide (Cortina d’Ampezzo, BL, Italy). However, it could be extended to numerous different cases, especially for hydrogeological analysis and landslide stability assessment, in different geological and geomorphological contexts.

Paleoclimate reconstruction using LA-ICP-MS analyses of ostracods and stalagmite

Als paläoklimatische Archive können unter anderem Stalagmiten und Klappen von Ostrakoden herangezogen werden. Bisher gab es noch keine veröffentlichten Ergebnisse räumlich hochaufgelöster Spurenelementverteilungen in einzelnen Ostrakodenklappen. Das gleiche gilt für die Bestimmung radiogener Blei-Isotope in Stalagmiten. Um klimatische Prozesse vergangener Zeiten zu untersuchen, wurde eine neue LA-ICP-MS (Laserablations – Massenspektrometrie mit induktiv gekoppeltem Plasma) Technik für hochaufgelöste in-situ Messungen von Spurenelementen und Bleiisotopen entwickelt. rnrnZunächst wurden geeignete Materialien für die Kalibrierung der Technik untersucht; als Proben dienten die Silikatreferenzgläser BAM-S005-A und BAM-S005B der Bundesanstalt für Materialforschung und –prüfung (BAM). Die Homogenität dieser Referenzgläser wurde mit LA-ICP-MS und den anderen mikroanalytischen Methoden EPMA (Elektronenmikrosonde) und SIMS (Ionensonde) überprüft. Die Ergebnisse zeigten, dass alle Haupt- und die meisten Spurenelemente in beiden Gläsern selbst im Mikrometerbereich homogen verteilt sind. Ausnahmen sind einige Spurenelemente, wie Cs, Cl, Cr, Mo und Ni, die heterogen in den Gläsern verteilt sind. Die Hauptelementzusammensetzung von BAM-S005-A und BAM-S005-B wurde mit Hilfe der EPMA bestimmt, wobei die Ergebnisse die Referenzwerte des BAM-Zertifikats bestätigten. Mit Ausnahme von Sr, Ba, Ce und Pb, stimmten die LA-ICP-MS-Spurenelementwerte mit den zertifizierten Werten innerhalb der angegebenen Fehlergrenzen überein. Gründe für die Diskrepanz der vier oben erwähnten Elemente sind noch unklar, aber sind möglicherweise durch fehlerhafte Referenzwerte zu erklären. Zusätzlich wurden 22 Spurenelemente gemessen, deren Gehalte von BAM nicht zertifiziert wurden. Aufgrund dieser Untersuchungen konnte festgestellt werden, dass beide BAM-Gläser für mikroanalytische Anwendungen geeignet sind.rnrnUm neuartige paläoklimatische Proxies im Calcit von Ostrakoden aus tibetanischen Seesedimenten zu untersuchen, wurde die Spurenelementvariabilität in einzelnen Ostrakodenklappen durch eine neue LA-ICP-MS-Technik bestimmt. Klappen von Ostrakoden der drei Arten (Leucocytherella sinensis Huang, 1982, ?Leucocythere dorsotuberosa Huang, 1982 und ?L. dorsotuberosa f. postilirata sensu Pang, 1985) wurden aus zwei Sedimentkernen des Nam Co Sees auf dem Hochplateau von Tibet gewonnen. Zwei LA-ICP-MS-Varianten, Spot- bzw. Linienanalyse, wurden verwendet, um die Elementkonzentrationen der Spurenelemente Mg, Sr, Ba, U und die der Seltenen Erdelemente (SEE) in den Klappen einzelner Ostrakoden zu bestimmen. Die Ergebnisse zeigten, dass die Linienanalyse präzisere Daten als die Spotanalyse liefert und sie wurde daher vorgezogen. Signifikante Unterschiede in der Spurenelementzusammensetzung zwischen den verschiedenen Arten der Ostrakoden wurden nicht gefunden. Variationen der Elementverhältnisse Mg/Ca und Sr/Ca in den Klappen stimmen mit veröffentlichten Seenspiegelschwankungen während des Holozäns überein, was zeigt, dass Mg- und Sr-Messungen in den Ostrakoden zur Untersuchung paläohydrochemischer Prozesse in diesem Gebiet herangezogen werden kann. Die gute Korrelation, die in dieser Arbeit zwischen Ba/Ca und Sr/Ca gefunden wurde, ist ein Hinweis darauf, dass der Einbau von Ba und Sr in die Klappen durch den gleichen Mechanismus erfolgte. Eine mögliche Beziehung zwischen dem U/Ca-Verhältnis in den Ostrakoden und den Redoxbedingungen auf dem Boden des Sees in der Vergangenheit wird diskutiert. Relativ geringe und konstante La/Ca-Verhältnisse wurden festgestellt, deren Ursache möglicherweise entweder auf der SEE-Charakteristik des Seewassers, auf biologischen Prozessen in den Ostrakoden oder auf Kontamination von Fe-Mn und/oder organischen Substanzen beruhen. Weitere Untersuchungen an Proben aus diesem Gebiet, speziell Klappen von lebenden Ostrakoden, sind notwendig, um den Gehalt von Ba, U und den SEE in Ostrakoden als paläoklimatische Proxies von Umweltbedingungen zu verwenden.

[Molecular analyses for (early) recognition of hematologic diseases - sense and sensibility for molecular analysis: the art of intelligent decision-making]

During the last 10 years several molecular markers have been established as useful tools among the armamentarium of a hematologist. As a consequence, the number of performed hematologic molecular analyses has immensely increased. Often, such tests replace or complement other laboratory methods. Molecular markers can be useful in many ways: they can serve for diagnostics, describe the prognostic profile, predict which types of drugs are indicated, and can be used for the therapeutic monitoring of the patient to indicate an adequate response or predict resistance or relapse of the disease. Many markers fulfill more than one of these aspects. Most important, however, is the right choice of analyses at the right time-points!

Meta-analyses qualify metzincins and related genes as acute rejection markers in renal transplant patients

Definition of acute renal allograft rejection (AR) markers remains clinically relevant. Features of T-cell-mediated AR are tubulointerstitial and vascular inflammation associated with excessive extracellular matrix (ECM) remodeling, regulated by metzincins, including matrix metalloproteases (MMP). Our study focused on expression of metzincins (METS), and metzincins and related genes (MARGS) in renal allograft biopsies using four independent microarray data sets. Our own cases included normal histology (N, n = 20), borderline changes (BL, n = 4), AR (n = 10) and AR + IF/TA (n = 7). MARGS enriched in all data sets were further examined on mRNA and/or protein level in additional patients. METS and MARGS differentiated AR from BL, AR + IF/TA and N in a principal component analysis. Their expression changes correlated to Banff t- and i-scores. Two AR classifiers, based on METS (including MMP7, TIMP1), or on MARGS were established in our own and validated in the three additional data sets. Thirteen MARGS were significantly enriched in AR patients of all data sets comprising MMP7, -9, TIMP1, -2, thrombospondin2 (THBS2) and fibrillin1. RT-PCR using microdissected glomeruli/tubuli confirmed MMP7, -9 and THBS2 microarray results; immunohistochemistry showed augmentation of MMP2, -9 and TIMP1 in AR. TIMP1 and THBS2 were enriched in AR patient serum. Therefore, differentially expressed METS and MARGS especially TIMP1, MMP7/-9 represent potential molecular AR markers.

Twist and shout: one decade of meta-analyses of erythropoiesis-stimulating agents in cancer patients

Anemia associated with cancer and cancer therapy is a common and important issue in the treatment of patients with malignant disease. Conventionally, blood transfusions are used to treat severe cancer-related anemia. Short- and long-acting preparations of recombinant human erythropoiesis-stimulating agents (ESAs) offer an alternative treatment option. Multiple studies and subsequent meta-analyses have demonstrated that ESA treatment increases hemoglobin levels and reduces the likelihood of transfusion for a proportion of treated patients. However, studies that attempted to evaluate whether ESAs improve tumor response and survival have generated conflicting evidence. Results of smaller trials reporting improved survival outcomes were contradicted by large randomized controlled trials that reported more deaths in patients receiving ESAs. In addition, there is strong evidence that cancer patients receiving ESAs have an increased risk of thromboembolic and cardiovascular events. We herein review the main meta-analyses published in the field, their strengths and weaknesses, their contribution to patient management and future perspectives for systematic reviews.

Mortality from road traffic accidents in Switzerland: longitudinal and spatial analyses

Road traffic accidents (RTA) are an important cause of premature death. We examined socio-demographic and geographical determinants of RTA mortality in Switzerland by linking 2000 census data to RTA mortality records 2000-2005 (ICD-10 codes V00-V99). Data from 5.5 million residents aged 18-94 years, 1744 study areas, and 1620 RTA deaths were analyzed, including 978 deaths (60.4%) in motor vehicle occupants, 254 (15.7%) in motorcyclists, 107 (6.6%) in cyclists, and 259 (16.0%) in pedestrians. Weibull survival models and Bayesian methods were used to calculate hazard ratios (HR), and standardized mortality ratios (SMR) across study areas. Adjusted HR comparing women with men ranged from 0.04 (95% CI 0.02-0.07) in motorcyclists to 0.43 (95% CI 0.32-0.56) in pedestrians. There was a u-shaped relationship with age in motor vehicle occupants and motorcyclists. In cyclists and pedestrians, mortality increased after age 55 years. Mortality was higher in individuals with primary education (HR 1.53; 95% CI 1.29-1.81), and higher in single (HR 1.24; 95% CI 1.05-1.46), widowed (HR 1.31; 95% CI 1.05-1.65) and divorced individuals (HR 1.62; 95% CI 1.33-1.97), compared to persons with tertiary education or married persons. The association with education was particularly strong for pedestrians (HR 1.87; 95% CI 1.20-2.91). RTA mortality increased with decreasing population density of study areas for motor vehicle occupants (test for trend p<0.0001) and motorcyclists (p=0.0021) but not for cyclists (p=0.39) or pedestrians (p=0.29). SMR standardized for socio-demographic and geographical variables ranged from 82 to 190. Prevention efforts should aim to reduce inequities across socio-demographic and educational groups, and across geographical areas, with interventions targeted at high-risk groups and areas, and different traffic users, including pedestrians.

Small study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study

Objective To examine the presence and extent of small study effects in clinical osteoarthritis research. Design Meta-epidemiological study. Data sources 13 meta-analyses including 153 randomised trials (41 605 patients) that compared therapeutic interventions with placebo or non-intervention control in patients with osteoarthritis of the hip or knee and used patients’ reported pain as an outcome. Methods We compared estimated benefits of treatment between large trials (at least 100 patients per arm) and small trials, explored funnel plots supplemented with lines of predicted effects and contours of significance, and used three approaches to estimate treatment effects: meta-analyses including all trials irrespective of sample size, meta-analyses restricted to large trials, and treatment effects predicted for large trials. Results On average, treatment effects were more beneficial in small than in large trials (difference in effect sizes −0.21, 95% confidence interval −0.34 to −0.08, P=0.001). Depending on criteria used, six to eight funnel plots indicated small study effects. In six of 13 meta-analyses, the overall pooled estimate suggested a clinically relevant, significant benefit of treatment, whereas analyses restricted to large trials and predicted effects in large trials yielded smaller non-significant estimates. Conclusions Small study effects can often distort results of meta-analyses. The influence of small trials on estimated treatment effects should be routinely assessed.