Rural Expressway Intersection Synthesis of Practice and Crash Analysis, 2004

This report presents a national synthesis of rural expressway, two-way stop -controlled (TWSC) intersection safety strategies and intersection designs and an analysis of Iowa expressway TWSC intersection crash characteristics. A rural expressway is a multi-lane highway with a divided median and with mostly at -grade intersections, although some intersections may be grade separated. The synthesis of intersection strategies is conducted in two parts. The first is a literature review and the second part is a national survey of strategies currently being applied by state transportation agencies. The characterization of crash patterns at TWSC expressway intersections is examined through the analysis of 5 years of crash data at 644 intersections.

Effect of short-term creatine supplementation on renal responses in men.

There is an increasing utilisation of oral creatine (Cr) supplementation among athletes who hope to enhance their performance but it is not known if this ingestion has any detrimental effect on the kidney. Five healthy men ingested either a placebo or 20 g of creatine monohydrate per day for 5 consecutive days. Blood samples and urine collections were analysed for Cr and creatinine (Crn) determination after each experimental session. Total protein and albumin urine excretion rates were also determined. Oral Cr supplementation had a significant incremental impact on arterial content (3.7 fold) and urine excretion rate (90 fold) of this compound. In contrast, arterial and urine Crn values were not affected by the Cr ingestion. The glomerular filtration rate (Crn clearance) and the total protein and albumin excretion rates remained within the normal range. In conclusion, this investigation showed that short-term oral Cr supplementation does not appear to have any detrimental effect on the renal responses of healthy men.

Personality and personality disorders in urban and rural Africa: results from a field trial in Burkina Faso

When conducting research in different cultural settings, assessing measurement equivalence is of prime importance to determine if constructs and scores can be compared across groups. Structural equivalence implies that constructs have the same meaning across groups, metric equivalence implies that the metric of the scales remains stable across groups, and full scale or scalar equivalence implies that the origin of the scales is the same across groups. Several studies have observed that the structure underlying both normal personality and personality disorders (PDs) is stable across cultures. Most of this cross-cultural research was conducted in Western and Asian cultures. In Africa, the few studies were conducted with well-educated participants using French or English instruments. No research was conducted in Africa with less privileged or preliterate samples. The aim of this research was to study the structure and expression of normal and abnormal personality in an urban and a rural sample in Burkina Faso. The sample included 1,750 participants, with a sub-sample from the urban area of Ouagadougou (n = 1,249) and another sub-sample from a rural village, Soumiaga (n = 501). Most participants answered an interview consisting of a Mooré language adaptation of the Revised NEO Personality Inventory and of the International Personality Disorders Examination. Mooré is the language of the Mossi ethnic group, and the most frequently spoken local language in Burkina Faso. A sub-sample completed the same self-report instruments in French. Demographic variables only had a small impact on normal and abnormal personality traits mean levels. The structure underlying normal personality was unstable across regions and languages, illustrating that translating a complex psychological inventory into a native African language is a very difficult task. The structure underlying abnormal personality and the metric of PDs scales were stable across regions. As scalar equivalence was not reached, mean differences cannot be interpreted. Nevertheless, these differences could be due to an exaggerated expression of abnormal traits valued in the two cultural settings. Our results suggest that studies using a different methodology should be conducted to understand what is considered, in different cultures, as deviating from the expectations of the individual's culture, and as a significant impairment in self and interpersonal functioning, as defined by the DSM-5.

Managing Decisions Regarding Rural Expressway Routes and Associated Highway Bypasses, 2009

For several years, the Iowa Department of Transportation has constructed bypasses along rural highways. Most bypasses were constructed on the state’s Commercial Industrial Network (CIN). Now that work on the CIN has been completed and the system is open to traffic, it is possible to study the impacts of bypasses. In the past, construction of highway bypasses has led community residents and business people to raise concerns about the loss of business activity. For policy development purposes, it is essential to understand the impacts that a bypass might have on safety, the community, and economics. By researching these impacts, policies can be produced to help to alleviate any negative impacts and create a better system that is ultimately more cost-effective. This study found that the use of trade area analysis does not provide proof that a bypass can positively or negatively impact the economy of a rural community. The analysis did show that, even though the population of a community may be stable for several years and per capita income is increasing, sales leakage still occurs. The literature, site visits, and data make it is apparent that a bypass can positively affect a community. Some conditions that would need to exist in order to maximize a positive impact include the installation of signage along the bypass directing travelers to businesses and services in the community, community or regional plans that include the bypass in future land development scenarios, and businesses adjusting their business plans to attract bypass users. In addition, how proactive a community is in adapting to the bypass will determine the kinds of effects felt in the community. Results of statistical safety analysis indicate that, at least when crashes are separated by severity, bypasses with at-grade accesses appear to perform more poorly than either the bypasses with fully separated accesses or with a mix of at-grade and fully separated accesses. However, the benefit in terms of improved safety of bypasses with fully separated accesses relative to bypasses with a mixed type of accesses is not statistically conclusive.

Safety Analysis of Low-Volume Rural Roads in Iowa, 2010

Iowa features an extensive surface transportation system, with more than 110,000 miles of roadway, most of which is under the jurisdiction of local agencies. Given that Iowa is a lower-population state, most of this mileage is located in rural areas that exhibit low traffic volumes of less than 400 vehicles per day. However, these low-volume rural roads also account for about half of all recorded traffic crashes in Iowa, including a high percentage of fatal and major injury crashes. This study was undertaken to examine these crashes, identify major contributing causes, and develop low-cost strategies for reducing the incidence of these crashes. Iowa’s extensive crash and roadway system databases were utilized to obtain needed data. Using descriptive statistics, a test of proportions, and crash modeling, various classes of rural secondary roads were compared to similar state of Iowa controlled roads in crash frequency, severity, density, and rate for numerous selected factors that could contribute to crashes. The results of this study allowed the drawing of conclusions as to common contributing factors for crashes on low-volume rural roads, both paved and unpaved. Due to identified higher crash statistics, particular interest was drawn to unpaved rural roads with traffic volumes greater than 100 vehicles per day. Recommendations for addressing these crashes with low-cost mitigation are also included. Because of the isolated nature of traffic crashes on low-volume roads, a systemic or mass action approach to safety mitigation was recommended for an identified subset of the entire system. In addition, future development of a reliable crash prediction model is described.

Acute post-exercise oxygen uptake, hormone and plasma metabolite response in obese men.

This study aimed to compare oxygen uptake (  V˙O2), hormone and plasma metabolite responses during the 30 min after submaximal incremental exercise (Incr) performed at the same relative/absolute exercise intensity and duration in lean (L) and obese (O) men. Eight L and 8 O men (BMI: 22.9±0.4; 37.2±1.8 kg · m(-2)) completed Incr and were then seated for 30 min.   V˙O2 was monitored during the first 10 min and from the 25-30(th) minutes of recovery. Blood samples were drawn for the determination of hormone (catecholamines, insulin) and plasma metabolite (NEFA, glycerol) concentrations. Excess post-exercise oxygen consumption (EPOC) magnitude during the first 10 min was similar in O and in L (3.5±0.4; 3.4±0.3 liters, respectively, p=0.86). When normalized to percent change (  V˙O2END=100%), %   V˙O2END during recovery was significantly higher from 90-120 s in O than in L (p≤0.04). There were no significant differences in catecholamines (p≥0.24), whereas insulin was significantly higher in O than in L during recovery (p=0.01). The time-course of glycerol was similar from 10-30 min of recovery (-42% for L; -41% for O, p=0.85), whereas significantly different patterns of NEFA were found from 10-30 min of recovery between groups (-18% for L; +8% for O, p=0.03). Despite similar EPOC, a difference in   V˙O2 modulation between groups was observed, likely due to faster initial rates of   V˙O2 decline in L than in O. The different patterns of NEFA between groups may suggest a lower NEFA reesterification during recovery in O, which was not involved in the rapid EPOC component.

Evaluation of Low-Cost Treatments on Rural Two-Lane Curves, TR-579, 2012

The objective of this project was to evaluate low-cost measures to reduce speeds on high-crash horizontal curves. The researchers evaluated two low-cost treatments in Iowa to determine their effectiveness in reducing speeds on rural two-lane roadways. This report summarizes how the research team selected sites and collected data, and the results. The team selected six sites. Retroreflective post treatments were added to existing chevrons at four sites and on-pavement curve markings were added at two sites. The researchers collected speed data before and after installation of the two treatments. The study compared several speed metrics to assess the effectiveness of the treatments. Overall, both were moderately effective in reducing speeds. The most significant impact of the treatments was in reducing the percentage of vehicles traveling over the posted or advisory speed by 5, 10, 15, or 20 or more mph. This result suggests that the treatments are most effective in reducing high-end speeds.

A mixed ecologic-cohort comparison of physical activity & weight among young adults from five populations of African origin.

BACKGROUND: Examination of patterns and intensity of physical activity (PA) across cultures where obesity prevalence varies widely provides insight into one aspect of the ongoing epidemiologic transition. The primary hypothesis being addressed is whether low levels of PA are associated with excess weight and adiposity. METHODS: We recruited young adults from five countries (500 per country, 2500 total, ages 25-45 years), spanning the range of obesity prevalence. Men and women were recruited from a suburb of Chicago, Illinois, USA; urban Jamaica; rural Ghana; peri-urban South Africa; and the Seychelles. PA was measured using accelerometry and expressed as minutes per day of moderate-to-vigorous activity or sedentary behavior. RESULTS: Obesity (BMI ≥ 30) prevalence ranged from 1.4% (Ghanaian men) to 63.8% (US women). South African men were the most active, followed by Ghanaian men. Relatively small differences were observed across sites among women; however, women in Ghana accumulated the most activity. Within site-gender sub-groups, the correlation of activity with BMI and other measures of adiposity was inconsistent; the combined correlation across sites was -0.17 for men and -0.11 for women. In the ecological analysis time spent in moderate-to-vigorous activity was inversely associated with BMI (r = -0.71). CONCLUSION: These analyses suggest that persons with greater adiposity tend to engage in less PA, although the associations are weak and the direction of causality cannot be inferred because measurements are cross-sectional. Longitudinal data will be required to elucidate direction of association.

The Evolution of Sexual Dysfunction in Young Men Aged 18-25 Years

PURPOSE: To assess the evolution of sexual dysfunctions among young males after an average of 15 months follow-up to determine the predictive factors for this evolution and the characteristics differentiating young males who continue reporting a sexual dysfunction from those who do not. METHODS: We conducted a prospective cohort study in two Swiss military recruitment centers mandatory for all Swiss national males aged 18-25 years. A total of 3,700 sexually active young males filled out a questionnaire at baseline (T0) and follow-up (T1: 15.5 months later). Main outcome measures were self-reported premature ejaculation (PE) and erectile dysfunction (ED). RESULTS: Overall, 43.9% of young males who reported (PE) and 51% of those reporting (ED) at T0 still reported it at T1. Moreover, 9.7% developed a PE problem and 14.4% developed an ED problem between T0 and T1. Poor mental health, depression, and consumption of medication without prescription were predictive factors for PE and ED. Poor physical health, alcohol consumption, and less sexual experience were predictive factors for PE. ED persistence was associated with having multiple sexual partners. CONCLUSIONS: This is the first longitudinal study to examine sexual dysfunctions among young males. Our results show high prevalence rates among young males for maintaining or developing a sexual dysfunction over time. Consequently, when consulting with young males, health professionals should inquire about sexual dysfunctions as part of their routine psychosocial assessment and leave the subject open for discussion. Future research should examine in more detail the relationship between sexual dysfunctions and poor mental health.

Spine bone texture assessed by trabecular bone score (TBS) predicts osteoporotic fractures in men: The Manitoba Bone Density Program.

INTRODUCTION: One quarter of osteoporotic fractures occur in men. TBS, a gray-level measurement derived from lumbar spine DXA image texture, is related to microarchitecture and fracture risk independently of BMD. Previous studies reported the ability of spine TBS to predict osteoporotic fractures in women. Our aim was to evaluate the ability of TBS to predict clinical osteoporotic fractures in men. METHODS: 3620 men aged ≥50 (mean 67.6years) at the time of baseline DXA (femoral neck, spine) were identified from a database (Province of Manitoba, Canada). Health service records were assessed for the presence of non-traumatic osteoporotic fracture after BMD testing. Lumbar spine TBS was derived from spine DXA blinded to clinical parameters and outcomes. We used Cox proportional hazard regression to analyze time to first fracture adjusted for clinical risk factors (FRAX without BMD), osteoporosis treatment and BMD (hip or spine). RESULTS: Mean followup was 4.5years. 183 (5.1%) men sustain major osteoporotic fractures (MOF), 91 (2.5%) clinical vertebral fractures (CVF), and 46 (1.3%) hip fractures (HF). Correlation between spine BMD and spine TBS was modest (r=0.31), less than correlation between spine and hip BMD (r=0.63). Significantly lower spine TBS were found in fracture versus non-fracture men for MOF (p<0.001), HF (p<0.001) and CVF (p=0.003). Area under the receiver operating characteristic curve (AUC) for incident fracture discrimination with TBS was significantly better than chance (MOF AUC=0.59, p<0.001; HF AUC=0.67, p<0.001; CVF AUC=0.57, p=0.032). TBS predicted MOF and HF (but not CVF) in models adjusted for FRAX without BMD and osteoporosis treatment. TBS remained a predictor of HF (but not MOF) after further adjustment for hip BMD or spine BMD. CONCLUSION: We observed that spine TBS predicted MOF and HF independently of the clinical FRAX score, HF independently of FRAX and BMD in men. Studies with more incident fractures are needed to confirm these findings.

A prospective development study investigating focal irreversible electroporation in men with localised prostate cancer: Nanoknife Electroporation Ablation Trial (NEAT).

INTRODUCTION: Focal therapy may reduce the toxicity of current radical treatments while maintaining the oncological benefit. Irreversible electroporation (IRE) has been proposed to be tissue selective and so might have favourable characteristics compared to the currently used prostate ablative technologies. The aim of this trial is to determine the adverse events, genito-urinary side effects and early histological outcomes of focal IRE in men with localised prostate cancer. METHODS: This is a single centre prospective development (stage 2a) study following the IDEAL recommendations for evaluating new surgical procedures. Twenty men who have MRI-visible disease localised in the anterior part of the prostate will be recruited. The sample size permits a precision estimate around key functional outcomes. Inclusion criteria include PSA ≤ 15 ng/ml, Gleason score ≤ 4 + 3, stage T2N0M0 and absence of clinically significant disease outside the treatment area. Treatment delivery will be changed in an adaptive iterative manner so as to allow optimisation of the IRE protocol. After focal IRE, men will be followed during 12 months using validated patient reported outcome measures (IPSS, IIEF-15, UCLA-EPIC, EQ-5D, FACT-P, MAX-PC). Early disease control will be evaluated by mpMRI and targeted transperineal biopsy of the treated area at 6 months. DISCUSSION: The NEAT trial will assess the early functional and disease control outcome of focal IRE using an adaptive design. Our protocol can provide guidance for designing an adaptive trial to assess new surgical technologies in the challenging landscape of health technology assessment in prostate cancer treatment.

Evaluating the Relationship between the Driver and Roadway to Address Rural Intersection Safety using the SHRP 2 Naturalistic Driving Study Data, RB05-013, 2016

Rural intersections account for 30% of crashes in rural areas and 6% of all fatal crashes, representing a significant but poorly understood safety problem. Transportation agencies have traditionally implemented countermeasures to address rural intersection crashes but frequently do not understand the dynamic interaction between the driver and roadway and the driver factors leading to these types of crashes. The Second Strategic Highway Research Program (SHRP 2) conducted a large-scale naturalistic driving study (NDS) using instrumented vehicles. The study has provided a significant amount of on-road driving data for a range of drivers. The present study utilizes the SHRP 2 NDS data as well as SHRP 2 Roadway Information Database (RID) data to observe driver behavior at rural intersections first hand using video, vehicle kinematics, and roadway data to determine how roadway, driver, environmental, and vehicle factors interact to affect driver safety at rural intersections. A model of driver braking behavior was developed using a dataset of vehicle activity traces for several rural stop-controlled intersections. The model was developed using the point at which a driver reacts to the upcoming intersection by initiating braking as its dependent variable, with the driver’s age, type and direction of turning movement, and countermeasure presence as independent variables. Countermeasures such as on-pavement signing and overhead flashing beacons were found to increase the braking point distance, a finding that provides insight into the countermeasures’ effect on safety at rural intersections. The results of this model can lead to better roadway design, more informed selection of traffic control and countermeasures, and targeted information that can inform policy decisions. Additionally, a model of gap acceptance was attempted but was ultimately not developed due to the small size of the dataset. However, a protocol for data reduction for a gap acceptance model was determined. This protocol can be utilized in future studies to develop a gap acceptance model that would provide additional insight into the roadway, vehicle, environmental, and driver factors that play a role in whether a driver accepts or rejects a gap.