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Despite the recent decline in child deaths caused by road traffic crashes in high income countries, low- and middle-income countries (LMIC) have yet to experience a similar trend. Children are among the most vulnerable of road users accounting for 30–40 % of all road traffic deaths in LMICs, 50 % of which are vehicle occupants. Previous research suggests that children ages 0–9 are the second most vulnerable age group in Ghana with 54 % of the children being fatally injured in injury-related crashes. However, little has been done to identify the associated factors influencing injury severity outcomes for child passengers in Ghana. This study investigates the factors that are associated with the various injury severity outcomes for child vehicle occupants less than 9 years old involved in road crashes in Ghana from 2014 to 2020. Results indicate that older child passengers (aged 5–8) were associated with lower injury severities compared to younger passengers. Additionally, crashes in which the driver sustained more severe injuries resulted in a higher likelihood of the child passengers sustaining a fatal injury. Findings from this research emphasize the issue of child passenger safety and support transportation policy and decision making to reduce risks of injury for child passengers.

Informal urban communities (IUCs) in sub-Saharan Africa constitute some two-thirds of SSA cities. IUCs are often associated with lower-quality housing, low-income populations, low car ownership, and poor mobility infrastructure. As such, most IUC dwellers rely on shared mobility modes that are unsafe and inconvenient. The current study examines potential and perceived access in terms of travel distance and time to six selected socioeconomic activity types in selected IUCs in Kumasi-Ghana, and Dar es Salaam-Tanzania. This was underpinned by evaluating residents’ perception of ease of access to workplace in relation to demographics, neighborhood characteristics, transport services characteristics, and travel characteristics. The applied multinomial logistic regression identified factors relating to age, education, income, travel time, road condition, access to major roads, travel modes, community location, inclusivity, safety, and affordability as strong indicators to enhance travel experiences. Across all activity types, the potential travel time underestimates the perceived travel time by 133% in Kumasi-Ghana, and 50% in Dar es Salaam-Tanzania. The overall access to socioeconomic activities based on travel distance and times was found to be relatively more favorable in Kumasi-Ghana than those in Dar es Salaam-Tanzania.

As the number of motor vehicles on roads in the United States of America continues to grow, there is an increasing risk for all road users to be involved in a traffic incident. Although congestion and traveller delay are common traffic incidents, workplace-related injury or fatality among incident response personnel are a serious problem. The injuries may be alleviated with the help of effective laws about incident response personnel safety standards, including state move-over laws. This paper provides an overview, as of July 2024, of existing incident response personnel (“move-over”) laws for all fifty states. This study finds that there is a great variation in such laws among states, which may lead to challenges with comprehension and compliance. States that offer the least amount of protection to their incident response personnel were identified. Recommendations are provided on specific elements of the legislation to offer greater protection to the incident response personnel while working on the side of the roads. The nuances and the variation in move-over laws can make it difficult for drivers to understand what the law requires of them. The findings of this paper will be of interest to researchers, stakeholders, and policymakers working in the field of transportation and occupational safety.

Objective Clinical observations suggest that individuals with a diagnosis of bipolar face difficulties regulating emotions and impairments to their cognitive processing, which can contribute to high-risk behaviours. However, there are few studies which explore the types of risk-taking behaviour that manifest in reality and evidence suggests that there is currently not enough support for the management of these behaviours. This study examined the types of risk-taking behaviours described by people who live with bipolar and their access to support for these behaviours. Methods Semi-structured interviews were conducted with n = 18 participants with a lived experience of bipolar and n = 5 healthcare professionals. The interviews comprised open-ended questions and a Likert-item questionnaire. The responses to the interview questions were analysed using content analysis and corpus linguistic methods to develop a classification system of risk-taking behaviours. The Likert-item questionnaire was analysed statistically and insights from the questionnaire were incorporated into the classification system. Results Our classification system includes 39 reported risk-taking behaviours which we manually inferred into six domains of risk-taking. Corpus linguistic and qualitative analysis of the interview data demonstrate that people need more support for risk-taking behaviours and that aside from suicide, self-harm and excessive spending, many behaviours are not routinely monitored. Conclusion This study shows that people living with bipolar report the need for improved access to psychologically informed care, and that a standardised classification system or risk-taking questionnaire could act as a useful elicitation tool for guiding conversations around risk-taking to ensure that opportunities for intervention are not missed. We have also presented a novel methodological framework which demonstrates the utility of computational linguistic methods for the analysis of health research data.

BackgroundOnline forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. ObjectiveThis study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. MethodsWe conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. ResultsSynthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. ConclusionsThis is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. Trial RegistrationPROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528

Abstract Background Suicidal thoughts, acts, plans and deaths are considerably more prevalent in people with non-affective psychosis, including schizophrenia, compared to the general population. Social isolation and interpersonal difficulties have been implicated in pathways which underpin suicidal experiences in people with severe mental health problems. However, the interactions between psychotic experiences, such as hallucinations and paranoia, suicidal experiences, and the presence, and indeed, absence of interpersonal relationships is poorly understood and insufficiently explored. The current study sought to contribute to this understanding. Methods An inductive thematic analysis was conducted on transcripts of 22, individual, semi-structured interviews with adult participants who had both non-affective psychosis and recent suicidal experiences. A purposive sampling strategy was used. Trustworthiness of the analysis was assured with researcher triangulation. Results Participants relayed both positive and negative experiences of interpersonal relationships. A novel conceptual model is presented reflecting a highly complex interplay between a range of different suicidal experiences, psychosis, and aspects of interpersonal relationships. Three themes fed into this interplay, depicting dynamics between perceptions of i. not mattering and mattering, ii. becoming disconnected from other people, and iii. constraints versus freedom associated with sharing suicidal and psychotic experiences with others. Conclusion This study revealed a detailed insight into ways in which interpersonal relationships are perceived to interact with psychotic and suicidal experiences in ways that can be both beneficial and challenging. This is important from scientific and clinical perspectives for understanding the complex pathways involved in suicidal experiences. Trial registration ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 .); 5th June 2017). Registration was recorded prior to participant recruitment commencing.

Road traffic crashes are a leading cause of serious injuries and fatalities globally and place unnecessary developmental and economic burdens on low- and middle-income countries (LMIC) as they account for the vast majority of the world's road related deaths. This is typically due to both the increased frequency of dangerous crash types and the increased severity of said crash types. Rollover crashes while quite rare are a particularly dangerous crash type among other various crash types. In the case of Namibia, rollover crashes reportedly accounted for 34% of both road related injuries and fatalities in Namibia for 2020. When compared to high-income countries the issue of rollover crash severity in Namibia and like sub-Saharan African (SSA) countries becomes apparent. Therefore, it crucial to understand the contributing factors and their associated effects on rollover crash severities in these countries. This study aims to investigate and identify the significant factors influencing crash severities and their associated impact magnitudes on single-vehicle rollover crashes in Namibia by adopting a mixed logit with heterogeneity in means and variances approach to account for unobserved heterogeneity in the data. Although it is not without its limitations the dataset used in this study includes single-vehicles rollover crash instances from 2014 to 2016 within Namibia and is able to provide unique details for the crash observations including various driver, environmental, roadway, and vehicle characteristics. Results from this study indicate several factors including weekends, open roadways, and minibuses to be significantly increasing the crash severity of single-vehicle rollover crashes. Additionally, results provide a basis for which researchers and policy makers can understand rollover crashes in Namibia and adopt an appropriate approach to address this issue, such as, Safe Systems. Such an approach would include but not be limited to the implementation of roadside features, educational campaigns, speed enforcement, and vehicle standards policy.

Connected and Automated Vehicles (CAVs) offer the potential to improve roadway capacity and safety. Thus, improving road infrastructure condition could be prioritized to eliminate further degradation of the transportation infrastructure. In order to foster the adoption of CAVs, incentives can be used; but there is a need to identify what type of incentive would be most effective. To identify effective incentive types, this study uses electric vehicles (EV) and hybrid vehicles as a surrogate to CAVs because of the similarities in obstacles faced for wider adoption. This study then provides some recommendations by examining incentives offered in 15 different countries and by reviewing the literature on the effectiveness of incentive types.

Welding inspection is a critical process that can be severely time-consuming, resulting in productivity delays, especially when destructive or invasive processes are required. This paper defines the novel approach to investigate the physical correlation between common imperfections found in arc welding and the propensity to determine these through the identification of signatures using acoustic emission sensors. Through a set of experiments engineered to induce prominent imperfections (cracks and other anomalies) using a popular welding process and the use of AE technology (both airborne and contact), it provides confirmation that the verification of physical anomalies can indeed be identified through variations in obtained noise frequency signatures. This in situ information provides signals during and after solidification to inform operators of the deposit/HAZ integrity to support the advanced warning of unwanted anomalies and of whether the weld/fabrication process should be halted to undertake rework before completing the fabrication. Experimentation was carried out based on an acceptable set of parameters where extracted data from the sensors were recorded, analysed, and compared with the resultant microstructure. This may allow signal phenomena to be captured and catalogued for future use in referencing against known anomalies.

Crashes occur from a combination of factors related to the driver, roadway, and vehicle factors. The impact of vehicles on road crashes is a critical consideration within road safety analysis, even though not much studies have been conducted in this area. This study assessed how various vehicle and other crash factors are significantly associated with crash outcomes. To do this, historical vehicle defect-related crashes were obtained for the state of Alabama from 2016 to 2020. After data cleaning, a crash injury severity model was developed using the random parameters multinomial logit with heterogeneity in means approach to account for possible unobserved heterogeneity in the data. A spatial analysis was further conducted to better understand vehicle defect crashes as a broader societal issue and potentially explore their connection with the socio-demographic characteristics of the drivers of these vehicles. The preliminary data analysis showed that brake and tire defects accounted for about 65% of the vehicle defects associated with the crashes. The model estimation results revealed that improper tread depth and headlight defects were associated with major injury outcomes, while brake defects were more associated with minor injuries. Also, crashes associated with speeding, drunk driving, failure to use seatbelts, and those that occurred on curved roads left with downgrades were likely to result in major injuries. Findings from the spatial analysis showed that postal codes with higher median incomes are more likely to record lower vehicle defect-related crashes, unlike those that have higher proportions of females and African Americans. The study's findings provide data-driven evidence for sustained safety campaigns, workshops, and training on basic vehicle maintenance practices in the low-income communities in the state.

ABSTRACTThe rise in automobiles within rapidly developing nations in Sub-Saharan Africa necessitates the exploration of sustainable transportation alternatives, especially in urban regions. Walking and cycling are essential active modes of transport that can improve city residents’ well-being and economic vitality. However, their adoption as mobility choices depends on infrastructure limitations and residents’ perception of their safety. This study investigates the impact of socio-demographic and neighborhood characteristics on the safety perception of active mobility within the Accra metropolis of Ghana. The study utilized survey data on residents’ mobility habits and willingness to use active transport modes for daily commutes. Most of the respondents are permanent residents of Accra, and 51% are between 18–35 years old. The developed random parameter ordered logit model reveals that the perception of safety varies across the population and is influenced by respondents’ demographic characteristics and neighborhood configuration. Notably, factors related to walking duration to bus stops, income level, and household size, unplanned neighborhoods, among others, decrease residents’ safety perception of active mobility. The study offers valuable insights that can aid in planning future urban active mobility systems in Accra to establish safer and more sustainable transportation choices for the city’s residents.

As contemporary colleges and universities continue to undergo unprecedented growth, more and more students commuting to campus face parking and physical infrastructural connectivity problems. Using the case of a US college campus, this paper identifies areas in which physical infrastructural connectivity limits students’ ability to commute to campus, either due to gaps in the network or lack of awareness of the network. Graph theory application was used to gauge the overall connectivity of the sidewalk, bike lane, and bus route networks available to students at the university. Through GIS mapping, relationships between these networks were identified, as well as gaps in these networks. In addition, a survey of students’ commuting patterns was performed to identify how students travel to campus and their overall familiarity with the alternative transportation networks. Insights from this study could enhance planning for inter-modal connectivity and make student commuting safer, more accessible, more eco-friendly, and more convenient even as the student population continues to increase.

Introduction Studies have shown some benefits to single approaches to psychological therapies for the treatment of anxiety in people with intellectual disability such as modified cognitive–behavioural therapy and mindfulness. To our knowledge, no studies have used a multicomponent approach for the individual treatment of anxiety-related disorders in this population group. A co-production group of clinical experts and people with intellectual disability has created a novel multicomponent anxiety management programme (MCAMP-ID). The aims of this study are to investigate (1) the feasibility of this approach in reducing anxiety for people with a mild/moderate intellectual disability, (2) the feasibility of outcome measures and (3) the feasibility of completing a future randomised controlled trial of this programme. The data from this feasibility study will be used to inform trial design and to complete power calculation.Methods and analysis Sixty people with intellectual disability will be invited to participate in the study across four intellectual disability services within one mental health trust in Northwest England. The specialist services will deliver either treatment as usual (TAU) or the novel intervention (MCAMP-ID). MCAMP-ID comprises of 10 individual sessions delivered by a member of the clinical team once a week for between 10 and 12 weeks. TAU will be based on standard treatment currently delivered to meet the person’s specific needs. The outcomes of the study will be feasibility of recruitment, attrition, adherence to the programme and suitability of outcome measures. A mixed-methods approach will be used to assess outcomes.Ethics and dissemination The study received approval from the Research Ethics Committee and Health Research Authority (23/EM/0044) through the Integrated Research Application System (IRAS ID: 315557) in March 2023. Participants will provide informed consent before taking part. Study findings will be presented at conferences and published within a peer-reviewed journal.Trial registration number ISRCTN16062949.

Head-on collisions are often linked to more serious injuries compared to other types of crashes, due to the intense impact they cause. In low- and middle-income countries, these collisions frequently involve high occupancy public transportation vehicles, leading to higher fatality rates per crash. Given the high risk of injury and potential for multiple casualties, this study delves into the factors influencing the outcomes of head-on crashes and the number of fatalities in Ghana. The study analyzed six years of historical head-on collision data from Ghana and developed two models to address the issue. The injury-severity analysis was performed using a random parameter multinomial logit with heterogeneity in means and variances approach and aimed to identify the factors that have a significant impact on the severity of injuries sustained in head-on collisions, while the random parameters negative binomial fatality count model was designed to examine the factors that contribute to the number of fatalities in these crashes in the country. Results showed that head-on collisions with drivers over 65, buses, motorcycles, and those between 25 and 65 years of age were more likely to result in fatalities. Speeding and vehicle malfunctions were also found to be significant contributing factors to fatal head-on collisions. Head-on crashes involving minibuses and incidents where the driver was attempting to overtake another vehicle were found to be more likely to result in a higher number of fatalities. The results of this study uncover an intriguing interaction between human-related elements and socioeconomic factors, which pose obstacles to the Government's endeavor to upgrade the major highways in the country. Additionally, the increasing need for transportation has led to the presence of vehicles on the roads that may not meet safety standards. Consequently, it is no surprise that several of the study's findings align with expectations. Nevertheless, within the specific context of Ghana, these findings furnish compelling data-driven evidence supporting the adoption and implementation of the safe systems approach as a means to tackle fatal head-on collisions in the country.

We present a genome assembly of Caretta caretta (the Loggerhead sea turtle; Chordata, Testudines, Cheloniidae), generated from genomic data from two unrelated females. The genome sequence is 2.13 gigabases in size. The assembly has a busco completion score of 96.1% and N50 of 130.95 Mb. The majority of the assembly is scaffolded into 28 chromosomal representations with a remaining 2% of the assembly being excluded from these.

IntroductionSuicide is a leading cause of death globally. People with psychosis are at increased risk of suicide death and up to half experience suicidal thoughts and/or engage in suicidal behaviors in their lifetime. Talking therapies can be effective in alleviating suicidal experiences. However, research is yet to be translated into practice, demonstrating a gap in service provision. The barriers and facilitators in therapy implementation require a thorough investigation including the perspectives of different stakeholders such as service users and mental health professionals. This study aimed to investigate stakeholders’ (health professionals and service users) perspectives of implementing a suicide-focused psychological therapy for people experiencing psychosis in mental health services.MethodsFace-to-face, semi-structured interviews with 20 healthcare professionals and 18 service users were conducted. Interviews were audio recorded and transcribed verbatim. Data were analyzed and managed using reflexive thematic analysis and NVivo software.ResultsFor suicide-focused therapy to be successfully implemented in services for people with psychosis, there are four key aspects that need to be considered: (i) Creating safe spaces to be understood; (ii) Gaining a voice; (iii) Accessing therapy at the right time; and (iv) Ensuring a straightforward pathway to accessing therapy.DiscussionWhilst all stakeholders viewed a suicide-focused therapy as valuable for people experiencing psychosis, they also recognize that enabling successful implementation of such interventions will require additional training, flexibility, and resources to existing services.

University students are young, open to new technologies, and their perceptions of the Shared Autonomous Vehicles (SAVs) may indicate their travel behaviors in the future. College towns in small urban or suburban areas offer researchers a unique environment to understand the travel behaviors of future commuters, and test emerging mobility services, such as SAVs. The study performs a survey with the aim of understanding university student perception regarding SAVs. The survey was conducted among the University of Alabama students in Tuscaloosa. The key survey questions include their knowledge and attitudes about AV and shared mobility. The results showed 97% of respondents are aware of AVs, but only 41% know specific automation technologies. As for shared mobility services, 98% of respondents are familiar with Uber and Lyft services. The survey also asked survey participants to indicate their Willingness-To-Pay (WTP) for hypothetical SAV services in three price scenarios. The prices were assumed as relative to the cost of using ride-hailing services with human drivers such as Uber and Lyft. Random parameter ordered logit models were developed to uncover the correlates of the WTP for SAV services. The models identified significant relationships between the WTP and various factors related to respondents’ socio-demographics, awareness of AV companies, and experiences with human-driver ride-hailing services. The awareness of AV companies and ride-hailing services is positively related to the WTP for SAV services. Students who know more AV companies appear to have a greater WTP, and students who are heavy users of Uber or Lyft services are also likely to SAV users in the future. Significant variations were also found in model estimates, indicating that some relationships could vary significantly across observations due to the unobserved heterogeneity. The findings offer insights to decision-makers and investors trying to estimate the market potential of emerging mobility services with AVs.

People with diabetes will have some coexisting mental illness most of the time and its evaluation and management are essential for the well-being of the person. With this background, the Global Mental Health Assessment Tool (GMHAT) app was used to screen for mental illness among type 2 diabetes mellitus patients attending a tertiary care hospital in Mysore, India. Methods: A cross-sectional study was conducted on 100 patients who were on treatment for type 2 diabetes for at least 6 months from the Out-Patient Department of KR Hospital, Mysore. Interviews were conducted using a structured GMHAT. Data were entered in MS Excel and analysed using SPSS version 21.0. Chi-square, Independent T-test/Mann–Whitney tests were used to investigate associations between the variables. Results: The mean age of the study participants was 48.8 ± 11.6 years. Among the 100 diabetic patients, 39% (n = 39) had mental illness and among the 39 subjects, 21% had depression, 14% had anxiety disorder and 4% suffered from organic disorder. Apart from diabetes, 29, 17, 13, 27, 23 and 20% had hypertension, chronic kidney disease, liver disease, retinopathy, neuropathy and nephropathy, respectively, as comorbid conditions. Conclusion: There is a higher prevalence of mental illness in patients with diabetes mellitus. The prevalence rate increases with an increase in the chronicity of diabetes. The use of the GMHAT app could help in rapid assessment and accurate diagnoses.

The transportation sector is critical to the emergency response during a hurricane. This research does a systematic assessment of the literature to determine how the transportation system actively engages in the aftermath of a hurricane by examining the transportation system's major function indicators- “Evacuation Routing”, “Emergency Services”, and “Search & Rescue”. To accomplish this goal, 86 academic publications were examined using the Web of Science and Scopus databases. The emergency response functions of the transportation system were evaluated using academic research methods, with various modes of transport considered. In the studies, optimization and simulation techniques were found to be common research methodologies, whereas personal cars and public transportation were used more often than other modes of transportation. The findings of the study may provide useful guidelines to researchers in the area, as well as serve as a research reference for future studies on hurricane emergency transportation system response.

Despite the health and environmental benefits of walking as an active and sustainable mode of transport, the increasing number of road crashes involving pedestrians has become a public health concern. This study investigates the direct and indirect effects of various contributing factors on pedestrian injury severity in pedestrian-motor vehicle crashes. Data on pedestrian-vehicle crashes from North Carolina between 2015 and 2019, including the pedestrian pre-crash actions and injury severity, were used. Path analysis was applied to uncover the inter-relationship between contributing factors, pedestrian pre-crash behaviors, and injury severity using random parameter ordered logit and mixed logit models. The results indicate that pedestrian intoxication, lighting condition, number of lanes, speed limit, and vehicle type contribute directly and indirectly (through pre-crash behaviors) to increasing injury severity. It was also observed that pedestrian position and traffic control directly decreased injury severity but indirectly increased injury severity through pre-crash behaviors. This study provides valuable information about the relationship between various crash factors and pedestrian injury severity. For researchers and agencies interested in pedestrian safety improvements, this study gives valuable insight by uncovering the roles of pedestrians’ pre-crash action on injury severity outcomes. For countermeasures, the study recommends better street lighting and re-evaluation of posted speed limits on roads with high pedestrian traffic. A regular educational campaign should inform pedestrians of the importance of yielding to motorists at locations without crosswalks. Also, drivers’ compliance with existing pedestrian-vehicle interaction laws should be monitored, especially at intersections.

BackgroundMental health (MH) peer online forums offer robust support where internet access is common, but healthcare is not, e.g., in countries with under-resourced MH support, rural areas, and during pandemics. Despite their widespread use, little is known about who posts in such forums, and in what mood states. The discussion platform Reddit is ideally suited to study this as it hosts forums (subreddits) for MH and non-MH topics. In bipolar disorder (BD), where extreme mood states are core defining features, mood influences are particularly relevant.ObjectivesThis exploratory study investigated posting patterns of Reddit users with a self-reported BD diagnosis and the associations between posting and emotions, specifically: 1) What proportion of the identified users posts in MH versus non-MH subreddits? 2) What differences exist in the emotions that they express in MH or non-MH subreddit posts? 3) How does mood differ between those users who post in MH subreddits compared to those who only post in non-MH subreddits?MethodsReddit users were automatically identified via self-reported BD diagnosis statements and all their 2005-2019 posts were downloaded. First, the percentages of users who posted only in MH (non-MH) subreddits were calculated. Second, affective vocabulary use was compared in MH versus non-MH subreddits by measuring the frequency of words associated with positive emotions, anxiety, sadness, anger, and first-person singular pronouns via the LIWC text analysis tool. Third, a logistic regression distinguished users who did versus did not post in MH subreddits, using the same LIWC variables (measured from users' non-MH subreddit posts) as predictors, controlling for age, gender, active days, and mean posts/day.Results1) Two thirds of the identified 19,685 users with a self-reported BD diagnosis posted in both MH and non-MH subreddits. 2) Users who posted in both MH and non-MH subreddits exhibited less positive emotion but more anxiety and sadness and used more first-person singular pronouns in their MH subreddit posts. 3) Feminine gender, higher positive emotion, anxiety, and sadness were significantly associated with posting in MH subreddits.ConclusionsMany Reddit users who disclose a BD diagnosis use a single account to discuss MH and other concerns. Future work should determine whether users exhibit more anxiety and sadness in their MH subreddit posts because they more readily post in MH subreddits when experiencing lower mood or because they feel more able to express negative emotions in these spaces. MH forums may reflect the views of people who experience more extreme mood (outside of MH subreddits) compared to people who do not post in MH subreddits. These findings can be useful for MH professionals to discuss online forums with their clients. For example, they may caution them that forums may underrepresent people living well with BD.

The trucking sector contributes significantly to the economic vitality of the United States. Large trucks are primarily used for transporting goods within and across states. Despite its economic importance, large truck crashes constitute public safety concerns. To minimize the consequences, there is a need to understand the factors that contribute to the severity outcomes of truck-involved crashes. Since many large truck drivers transport goods across several states, the driver-centered crash factors are expected to differ between in-state and out-of-state drivers. For this reason, this study developed two random parameters multinomial logit models with heterogeneity in means and variances to examine the factors contributing to the severity of crashes involving in-state and out-of-state large truck drivers in Alabama. The study was based on the 2016–2020 large truck crashes in Alabama. After data cleaning and preparation, it was observed that approximately 20% of in-state and 23% of out-of-state large truck crashes were fatigue-related. There were more speeding related crashes (12.4%) among in-state large truck drivers, but the contribution of speeding to crash severity outcomes was only significant in the out-of-state model. More crashes related to red light running violation (14.2%) were observed among out-of-state drivers, pointing to the fundamental issues of fatigue and unfamiliarity with the operations of signalized intersections in Alabama. The study contributes to the literature on large truck crashes by uncovering the nuances in crashes involving in-state and out-of-state large truck drivers. Despite the seeming similarity in factors that influence crash outcomes, this study provides the basis for truck drivers’ training and communication campaigns on the differences that may exist in roadway characteristics from state to state. Also, policy formulations and strategies that prioritizes the well-being of the large truck drivers and creates a better working condition for them should be explored.

This study contributes to efforts towards creating livable communities, by identifying and proposing countermeasures for factors that are associated with residential area crashes. Three risky driving pre-crash actions: driving under the influence of alcohol or drug, aggressive driving, and speeding were considered. The study used residential area crash data from Alabama, USA and developed a latent class multinomial logit model to identify factors associated with the pre-crash actions. The results showed that male drivers had 0.44% and 2.09% higher chances to be at fault in driving under the influence of alcohol or drug and aggressive driving crashes, respectively, while female drivers were found to have a 1.82% higher likelihood to be at fault in speeding-related crashes but less likely to be at fault in aggressive driving or driving under the influence of alcohol or drug-related crashes in residential areas. Speeding and driving under the influence of were found to be the leading contributing factors in rural area residential crashes whereas aggressive driving was more pronounced in urban areas. These findings provide a basis for the implementation of appropriate crash countermeasures to reduce residential area crashes, as part of efforts geared towards promoting community safety and livability across the state.

BackgroundRelatives of people with psychosis or bipolar disorder experience high levels of distress but are typically not offered the support they need. Online peer forums may offer a solution, but knowledge about who uses them, how, and why is limited. This study reported on online forum use during the Relatives Education and Coping Toolkit (REACT) trial. ObjectiveWe aimed to report who used the forum and why; how sociodemographic factors are associated with participation; the relationship among frequency, type of use, and outcomes; and how the forum was used. MethodsThe relationships between key sociodemographic characteristics, levels of forum use, and distress were statistically analyzed. We used thematic and semantic analyses to understand the reasons for relatives joining the forum and the key topics initiated by them. We also used the University Centre for Computer Corpus Research on Language Semantic Analysis System to compare how relatives and REACT supporters (moderators) used the forum. ResultsA total of 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59.4% (207/348) of the relatives across the entire age range, with no significant associations between sociodemographic factors and forum participation, or between level or type of use and relatives’ distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns, and talk about stressful events. Relatives were most concerned about recent events, negative emotions linked to caring, experiences of conflict or threat, and concerns about suicide. These posts underscored both the challenges the relatives were facing and the fact that they felt safe sharing them in this context. ConclusionsAlthough only a proportion of REACT participants engaged actively with its forum, they were widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support, and guidance and to offer detailed information about their experiences. The topics raised highlighted the burden carried by relatives and the potential value of easy-access, moderated, peer-supported forums in helping relatives to manage the challenges they faced.

Online food delivery (OFD) is one of the top industries in the Online-to-offline (O2O) commerce sector. Deliverymen need to complete a large number of delivery orders in limited default time every day, which cause high working stress to them. Therefore, a high level of traffic violations and crashes by deliverymen and corresponding negative impact on public safety are observed. To reduce traffic violations by deliverymen and resulting crashes, a hierarchical online food delivery framework is proposed, which is based on data from questionnaire surveys conducted in Xi'an City, China. The study includes the analysis of the root cause correlated with traffic violations during online food delivery as part of an empirical study on the priority delivery fee by applying a conditional price sensitivity measurement (PSM) model. The feasibility and rationality of the framework are further investigated by using cross analysis of urban dwellers' occupation, income, and commuting cost. The results identify that, through rationally shunting the demand of online food delivery, prolonging the default delivery duration, and providing diversified delivery services, the proposed hierarchical online food delivery mechanism is able to relieve the stress of deliverymen during peak hours of food requests. This reduces the willingness of deliverymen to engage in traffic violations, and other risky behaviors during food delivery trips. All of which facilitate high-quality and timely online food delivery service while enabling improved safety of deliverymen and others as part of enhanced public safety and health.

BackgroundProviding long-term care for a family member with psychosis can cause significant distress for informal carers due to the trauma of seeing their loved one in crisis, dealing with the difficult symptoms of psychosis and the burden of providing care. An important aspect of carers' adjustment can be construed as their personal recovery in relation to having a relative affected by psychosis. Self-report measures are increasingly used to assess personal recovery in service users, but less is known about the utility of such tools for carers.AimsThis review aimed to identify all self-report measures assessing aspects of carers' personal recovery, and to quality appraise them.MethodsAcademic Search Ultimate, CINAHL, MEDLINE, PsychINFO and PubMed were searched for articles that reported the development of self-report measures created for carers of those with psychosis. Studies were appraised using the Consensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) checklist. A Levels of Evidence synthesis provided overall quality scores for each measure.ResultsThe search identified 3,154 articles for initial screening. From a total of 322 full text articles, 95 self-report measures were identified with a final 10 measures included for the quality assessment showing varying levels of psychometric rigor.ConclusionsThe results show that no single self-report measure is currently available for use to comprehensively assess personal recovery for carers, highlighting the need for further research in this area and the development of a new measure.

BackgroundHealth researchers are increasingly using natural language processing (NLP) to study various mental health conditions using both social media and electronic health records (EHRs). There is currently no published synthesis that relates specifically to the use of NLP methods for bipolar disorder, and this scoping review was conducted to synthesize valuable insights that have been presented in the literature. ObjectiveThis scoping review explored how NLP methods have been used in research to better understand bipolar disorder and identify opportunities for further use of these methods. MethodsA systematic, computerized search of index and free-text terms related to bipolar disorder and NLP was conducted using 5 databases and 1 anthology: MEDLINE, PsycINFO, Academic Search Ultimate, Scopus, Web of Science Core Collection, and the ACL Anthology. ResultsOf 507 identified studies, a total of 35 (6.9%) studies met the inclusion criteria. A narrative synthesis was used to describe the data, and the studies were grouped into four objectives: prediction and classification (n=25), characterization of the language of bipolar disorder (n=13), use of EHRs to measure health outcomes (n=3), and use of EHRs for phenotyping (n=2). Ethical considerations were reported in 60% (21/35) of the studies. ConclusionsThe current literature demonstrates how language analysis can be used to assist in and improve the provision of care for people living with bipolar disorder. Individuals with bipolar disorder and the medical community could benefit from research that uses NLP to investigate risk-taking, web-based services, social and occupational functioning, and the representation of gender in bipolar disorder populations on the web. Future research that implements NLP methods to study bipolar disorder should be governed by ethical principles, and any decisions regarding the collection and sharing of data sets should ultimately be made on a case-by-case basis, considering the risk to the data participants and whether their privacy can be ensured.

Abstract Background Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis. Methods The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6 months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders. Discussion This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be efficacious. Trial registration ClinicalTrials.gov ( NCT03114917 ), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666 ); 5th June 2017). Registration was recorded prior to participant recruitment commencing.

Freeway service patrol (FSPs) programs have been considered as an effective tool for traffic incident management in minimizing the adverse effects of traffic incidents. In this study, random parameters hazard-based duration modeling method was used to evaluate the impact of the newly implemented Alabama Service and Assistance Patrol (ASAP) program, using incident clearance time as a performance measure. It was determined that there is a statistically significant difference in the factors that influence incidents clearance times between incidents that occurred inside and outside the ASAP regions. A total of five variables (on-road, nighttime, peak hours, rain, and fire response present) were observed to have random effects along with ten fixed effects variables on incidents occurring inside the ASAP regions. On the other hand, incidents that occurred outside the ASAP regions were found to have three random effects variables (on-road, nighttime, and fire response present) and seven fixed effects variables. The estimation results indicate a significant association of incident clearance times to incident related variables such as involvement of CMVs, fatality, vehicle towing, seat belt indicated as involved, and on-road incidents that occurred both inside and outside the ASAP regions. The results also reveal that incident clearance times are influenced strongly by temporal variables (e.g., nighttime), traffic factors (e.g., AADT), and operational variables (e.g., fire response present) for incidents both inside and outside the ASAP area models. Overall, it was observed that the incident clearance times recorded in the regions where the ASAP program is in effect are significantly different. The findings of this study are expected to be useful for the state traffic incident management (TIM) agencies in developing and executing strategies to minimize incident clearance times. Ultimately, the study provides a data-driven evidence-based assessment of the ASAP program in the state.

ABSTRACT INTRODUCTIONIn 2013, the United States Preventive Services Task Force recommended annual low-dose computed tomography (CT) screening for lung cancer in high-risk adults with a significant smoking history. These screenings result in large numbers of incidental findings, and although most of these do not warrant further investigation, there have been reported cases of incidental findings identified on CT screening that led to successful treatment of a previously undiagnosed comorbidity. CASE HISTORYHere, we report a case of papillary renal cell carcinoma that was detected incidentally on low-dose CT in an asymptomatic individual, a rare diagnosis considering that renal neoplasms account for

The older population in the U.S. is increasing and the physiological, cognitive, and psychological changes of aging can potentially pose mobility barriers for them. A medical condition further impedes travel opportunities and hinders continued engagement in civic and social life, adversely impacting their quality of life. This study uses the 2001 and 2017 National Household Travel Survey (NHTS) data and analyzes the socio-demographic, attitudinal, and travel characteristics associated with older population long-distance travel patterns to support policy changes that address their emerging travel needs. The study results find a shift in trend in the mode preference of the new generation of older people with a medical condition. They are less likely to drive a car and prefer riding a bus or some other transport modes. They are also more likely to travel more over the weekend and evening hours. The older individuals are also more likely to travel long distances for work/business, religious trips, visits to family, friends, and relatives, but not for shopping, medical, and recreational purposes. Income and education levels of the older population with a medical condition directly impact their long-distance travel and are likely to increase in the future. The new generation of older people with a medical condition (i.e., 2017 data) are less likely to self-regulate travel by limiting or giving up driving and are more likely to be self-dependent by refusing to ask for rides or use special transportation. As a result, more older drivers with medical conditions can be expected to drive on the roads in the future adding to their road safety risks as well as those of others. This warrants transport policy changes to support safer mobility options for older people for their continued active community life and well-being.

Introduction: Increasing mephedrone use is a major public health concern in India. There are limited data on sociodemographic determinants and psychiatric comorbidity associated with stimulant use disorder (mephedrone) (SUD-M) from India. Aim: The primary objective of this study was to report the clinical and social correlates of SUD-M among those presenting to specialist mental health services in Mumbai, India. Methods: Patients with SUD-M were recruited from a clinical setting. Standardized culturally validated assessments were carried out to obtain information about sociodemographics and mental health: comorbid psychopathology Brief Psychiatric Rating Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Minnesota Multiphasic Personality Inventory-2 for personality traits and a clinical assessment for diagnosis of mental disorder using DSM-5. Results: SUD-M was more common among young men from the low socioeconomic position. The most common reasons for choosing mephedrone over other substances were better high from the drug and peer pressure. There were no associations between sociodemographic factors with the severity of SUD-M. Around 40% of the patients with SUD-M had psychiatric comorbidity. Psychotic disorders and anxiety symptoms were most common. Family history of substance use, comorbid substance use, and comorbid psychiatric disorders were directly related to the severity of SUD-M. Conclusions: This was a cross-sectional study with a relatively smaller sample size of self-nominating participants limiting the generalizability of findings to a wider population. Therapeutic implication of this finding is that prompt attention and treatment of the comorbid psychiatric disorder is essential while treating patients with SUD-M. Further population-based studies are recommended for a better understanding of the burden of SUD-M.

Although the school bus is considered a safe form of transportation, school bus crashes are a major safety concern. School bus crashes are a result of driver error of either the at-fault school bus or another at-fault vehicle (where the school bus is not at fault). To examine the risk factors associated with school bus related crashes and crash outcomes, this study segments and develops two binary logit models for each school bus crash type. A total of 1702 school bus related crashes recorded between 2009 and 2016 were used to estimate the model. According to the model results, sideswipe collisions were less likely to result in injury outcomes for at-fault school buses than rear-end and side-impact collisions. Speeding, driving impaired or under the influence, and negotiating a curve all have significant positive associations with injury outcomes in not-at-fault school bus crashes. This study’s practical implications include enforcing the school bus safe driving guidelines, training programs for school bus drivers that include elements of nonroutine trips, training for crossing guards, and awareness programs for drivers of other vehicles to instill safe driving practices around school buses.

Annually, side impact crashes contribute to a significant proportion of road fatalities. These crashes typically occur as a result of traffic violations at intersections. This study contributes to efforts in addressing side impact crashes at unsignalized intersections by performing a path analysis to unravel some behavioral trajectories through which these crashes occur. The study further investigated how these behavioral pathways influence the severity of the crashes. Crashes that occurred at unsignalized four-way intersections and T-junctions in Alabama were used for model estimations. Three precrash actions, failed to yield right-of-way at the stop sign, failed to yield right-of-way at a turn, and running stop sign, were considered. The model estimation results reveal that some of the crash factors were more associated with certain precrash factors but not others at either four-way intersections or T-junctions or both. It was observed that side impact crashes that occurred under daylight conditions at four-way intersections, for instance, were less likely to involve running a stop sign but more likely to involve failure to yield at the stop sign and failure to yield right-of-way at a turn, but under dark and unlit roadway conditions, the at-fault drivers were more likely to run a stop sign or fail to yield at a stop sign but less likely to be involved in failure to yield right-of-way at a turn. This approach to injury severity analysis uncovers complex underlying relationships between precrash actions, other contributing factors, and crash outcomes.

Like many countries in sub-Saharan Africa, Ghana has witnessed an increase in the use of motorcycles for both commercial transport and private transport of people and goods. The rapid rise in commercial motorcycle activities has been attributed to the problem of urban traffic congestion and the general lack of reliable and affordable public transport in rural areas. This study investigates and compares factors that are associated with motorcycle crash injury outcomes in rural and urban areas of Ghana. This comparison is particularly important because the commercial use of motorcycles and their rapid growth in urban areas are a new phenomenon, in contrast to rural areas where people have long relied on motorcycles for their transportation needs. Preliminary analysis of the crash data revealed that more of the rural area crashes occurred under dark and unlit roadway conditions, while urban areas recorded more intersection-related crashes. Additionally, it was found that more pedestrian collisions happened in urban areas, while head-on collisions happened more in rural areas. The model estimation results show that collisions with a pedestrian, run-off-road, and collisions that occur under dark and unlit roadway conditions were more likely to result in fatal injury. Findings from this study are expected to help in crafting and targeting appropriate countermeasures to effectively reduce the occurrence and severity of motorcycle crashes throughout the country and, indeed, sub-Saharan Africa.

The COVID-19 travel restriction orders have significantly reduced travel and generally lowered the risk of road traffic collisions, but many accounts suggest an increase in risky driving behaviors and consequent fatal crashes during the shelter-in-place period. Risky driving behaviors including failure to wear a seatbelt, speeding, and drunk driving were observed to be the leading contributing factors of the fatalities. Whereas the fatal crashes that characterized the shelter-in-place period has become a topical issue, the high number of crashes that occurred as a result of the panic shopping and increased travel activities in the weeks before the shelter-in-place order have not received much attention. In this study, we investigated the differences and similarities in the effects of the factors that were associated with crash injury severity before, during, and after the shelter-in-place order. The study used crash data from the state of Alabama for the 2020 calendar year. Preliminary data analysis revealed interesting variations in crash trends across the three periods. It was found that the highest weekly crash frequency occurred in the immediate week before the shelter-in-place order, and a higher proportion of crashes that occurred between 6 p.m. and 6 a.m. and those that occurred in residential areas happened during the shelter-in-place period while shopping area crashes, manufacturing/industrial area crashes, rear-end collisions, and crashes involving female drivers occurred mostly before the shelter-in-place period. Three injury severity models were developed using random parameters logit with heterogeneity in means and variances approach. The results showed that major injury crashes occurred mainly in rural areas and occurred due to speeding, fatigue driving, and failure to use a seatbelt. The effects of these factors on crash outcome did not vary across the year, indicating that the shelter-in-place order did not impact the driving behaviors of the driver population that got into major injury crashes. The results further revealed that the effects of some crash factors, such as road type and manner of collision, varied across the periods. The findings of the study provide a deeper, data-driven understanding of how driving behaviors and associated crash outcomes may be affected by extreme events such as the COVID-19 shelter-in-place.

The study explores the recent trends in school travel using the 2017 National Household Travel Survey data. The study also investigates the exogenous factors affecting the school travel mode choice using random parameters multinomial logit (RPMNL) model. The results indicate that urban school trips range between 3 and 5 miles, whereas, average rural trips are longer than 6 miles. School commute times are higher among lower-income households. Further, the share of school bus and auto has declined while that of walking and biking has increased in 2017. This change is significant among high school students. Like other studies, the findings of the RPMNL model confirm that students within shorter distances from school are more likely to walk or bike to school. However, the likelihood of riding a school bus for distances >15 miles is higher than that of auto, indicating a policy implication to support school transportation budgets, especially in rural school districts. Lower-income households have a higher likelihood of riding the school bus. Females are more likely to use a car and less likely to bike to school. Interestingly, households with more than three vehicles are more likely to use the school bus compared to no-vehicle households. Children living in rented houses are less likely to ride the school bus or car. Also, an increase in gas price is indirectly but positively linked with walking, biking, and auto use. The findings from this study will assist policymakers in formulating policies and planning decisions towards improvements in the current school travel trends.

Namibia, like other low- and middle-income countries, is facing a public health crisis from deaths and injuries attributable to road crashes. The crash fatality rate in Namibia was recently estimated to be 23.9 per 100,000 population. Such a high rate of road deaths exacts serious social and economic stress on many countries, hence the need to critically examine and understand factors driving this trend. This paper seeks to enhance the understanding of some underlying factors that influence road safety in Namibia and, by extension, serve as an illustrative example for an analysis of similar data within the context of other developing countries. A latent class multinomial logit model was estimated to examine factors that are associated with crashes involving different categories of vehicles commonly used in Namibia. The findings from this study provide evidence of crash contributing factors such as driver age, visibility constraints, rainfall effects, and characteristics of crash locations associated with different transport modes. In highlighting additional contributing factors related to roadway features and vehicle categories, this work forms the foundation of a Safe Systems approach towards addressing road crashes in Namibia and, other countries with similar road safety challenges. Keywords: Road safety, Transport mode, Latent class analysis, Namibia

Users in planned purchasing undergo significantly different decision-making process compared to impulsive purchasing. Although several researchers have investigated user behavior of buying products from planned categories such as, organic products and halal products, research in the domain of selecting a specific brand within a category are limited. A qualitative study was conducted among users across several Asian markets such as China, Hong Kong, Taiwan, South Korea and Thailand to understand factors influencing the brand selection process in a planned purchase context. The qualitative study used a content analysis-based approach, with a code sheet incorporating elements associated to purchase behavior, among over 100 users across the countries. The qualitative study revealed that factors such as recommendations from friends, family members, and sales consultants, TV programs like advertisements and product informative programs, and other parameters like in-store presence of the brand, product information on the package, and aesthetic appeal of the package have a positive influence on the users’ brand selection process. Findings from the qualitative study were used to formulate multiple hypotheses about the relative importance of these different factors. These hypotheses were evaluated using an online survey among users from several Asian markets (predominantly India, Philippines, and Singapore), with a base size of 63. Statistical investigations were done using the t-test with p-value of 0.05. Results from the current study provide data that strengthens knowledge in the domain of consumer psychology and are relevant for product designers and marketers, who are designing and commercializing products in planned purchase categories.

Abstract Background Late adolescence and early adulthood is a period of highest incidence for onset of mental health problems. Transition to college environment has been associated with many risk factors such as the initial disruption—and subsequent irregularity—of the student’s sleep and activity schedule. We tested the feasibility of using blue blocking glasses (BBG) at night in first year higher education students with sleep complaints, to obtain preliminary evidence for the impact of BBG on sleep, activity, and mood. Methods Participants were 13 first year undergraduates (from 10 different academic courses) living on campus for the first time with sleep complaints/disorders confirmed at screening via the Duke Structured Interview Schedule for Sleep Disorders. We used a 2-week, balanced crossover design (BBG vs placebo glasses; participants were unaware which was the active intervention) with computer-generated random allocation. Exploratory analyses provided descriptive and frequency summaries to evaluate feasibility of the intervention. Results Preliminary evidence supports the feasibility and acceptability of the trial; almost all screened participants consented and completed the protocol with high adherence; missing data were negligible. Additionally, the effectiveness of BBGs to enhance sleep, mood, and activity levels in young adults was supported. Conclusions The results of this feasibility trial suggest that BBG have potential as an inexpensive and feasible intervention for reducing sleep and circadian dysregulation in young adult students. A larger trial, following this successfully implemented protocol, is necessary to fully test the efficacy of BBG.

Abstract Background In bipolar spectrum disorder, some individuals experience ongoing, frequent fluctuations in mood outside of affective episodes. There are currently no evidence-based psychological interventions designed to address this. This feasibility study is a phase II evaluation of a dialectical behavioural therapy-informed approach (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). It seeks to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme. Methods/design Patients will be randomised 1:1 to either treatment as usual only (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points will be at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point for the candidate primary outcome measures. We aim to recruit 48 individuals meeting diagnostic criteria for a bipolar spectrum disorder and reporting frequent mood swings outside of acute episodes, through primary and secondary care services and self-referral. To evaluate feasibility and acceptability, we will examine recruitment and retention rates, completion rates for study measures and feedback from participants on their experience of study participation and therapy. Discussion Proceeding to a definitive trial will be indicated if the following criteria are met: (1) trial participation does not lead to serious negative consequences for our participants; (2) any serious concerns about the acceptability and feasibility of the trial procedures can be rectified prior to a definitive trial; (3) follow-up data at 9 months are available for at least 60% of participants; (4) at least 60% of patients in the ThrIVe-B arm complete treatment. Trial registration ISRCTN, ISRCTN54234300. Registered on 20 July 2017.

Abstract Background The primary objective of this randomised controlled trial (RCT) is to establish the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments. The intervention is a guided self-help, mindfulness based intervention (MBI) developed in consultation with consumers, designed specifically for web-based delivery, with email coaching support. Methods/design This international RCT will involve a comparison of the effectiveness and cost-effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants will be recruited primarily via social media channels. Main inclusion criteria are: a diagnosis of BD (confirmed via a phone-administered structured diagnostic interview), no current mood episode, history of 10 or more mood episodes, no current psychotic features or active suicidality, under the care of a medical practitioner. Block randomisation will be used for allocation to the interventions, and participants will retain access to the program for 6 months. Evaluations will be conducted at pre- and post- treatment, and at 3- and 6- months follow-up. The primary outcome measure will be the Brief Quality of Life in Bipolar Disorder Scale (Brief QoL.BD), collected immediately post-intervention at 5 weeks (T1). Secondary measures include BD-related symptoms (mania, depression, anxiety, stress), time to first relapse, functioning, sleep quality, social rhythm stability and resource use. Measurements will be collected online and via telephone assessments at baseline (T0), 5 weeks (T1), three months (T2) and six months (T3). Candidate moderators (diagnosis, anxiety or substance comorbidities, demographics and current treatments) will be investigated as will putative therapeutic mechanisms including mindfulness, emotion regulation and self-compassion. A cost-effectiveness analysis will be conducted. Acceptability and any unwanted events (including adverse treatment reactions) will be documented and explored. Discussion This definitive trial will test the effectiveness and cost-effectiveness of a novel QoL focused, mindfulness based, online guided self-help intervention for late stage BD, and investigate its putative mechanisms of therapeutic action. Trial registration ClinicalTrials.gov: NCT03197974. Registered 23 June 2017.

Background: Co-morbid substance misuse, particularly alcohol, is common in bipolar disorder (BD) and associated with worse treatment outcomes. Research into psychological interventions for substance misuse in BD is at an early stage and no studies have specifically targeted problematic alcohol use. This paper describes the context and protocol for a feasibility and acceptability randomised controlled trial (RCT) evaluating a novel intervention combining motivational interviewing and cognitive behavioural therapy (MI-CBT) for participants with BD and problematic alcohol use, developed in collaboration with people with lived experience of both issues. Methods and design: An RCT will assess the feasibility and acceptability of MI-CBT in addition to treatment as usual (TAU) compared with TAU alone. Participants will be recruited from across the North West of England through NHS services and self-referral. The primary outcomes will be the feasibility and acceptability of the intervention assessed by recruitment to target, adherence to intervention, retention rate at follow-up, absence of adverse events and qualitative analysis of participants' reported experiences of intervention. The effect size of the impact of the intervention on alcohol use and mood outcomes will also be estimated. In addition, we will explore a number of potential process variables in therapy. Discussion: This is the first RCT evaluating MI-CBT for BD and problematic alcohol use. Given the prevalence and impact of alcohol problems in BD this novel integrated intervention may have potential to offer important improvements in clinical and functional outcomes. Keywords: Bipolar, Alcohol, Substance, Motivational interviewing, Trial registration number: ISRCTN14774583

In this essay, I describe a Human Rights course in which I focused on refugee rights through a service-learning project with a refugee resettlement agency. I will summarize my own approach to “radical teaching,” my objectives for the course, the course itself, and the impact of the course on the students. Ideally, I would describe the impact on the refugees with whom the students interacted, but I was not able to collect narratives in that regard.

Background: Drunk-driving is a major crash risk factor, and crashes resulting from this risky behavior tend to be serious and have significant economic and societal impacts. The presence of passengers and their demographics and activities can influence risky driving behaviors such as drunk-driving. However, passengers could either be an “enabling” factor to take more risks or could be an “inhibiting” factor by ensuring safe driving by a drunk-driver. Objective: This study examines whether the presence of passengers affects the contributing factors of single-vehicle (SV) drunk-driving crashes, by presenting a severity analysis of single- and multi-occupant SV drunk-driving crashes, to identify risk factors that contribute to crash severity outcomes, for the effective implementation of relevant countermeasures. Method: A total of 7407 observations for 2012–2016 from the crash database of the State of Alabama was used for this study. The variables were divided into six classes: temporal, locational, driver, vehicle, roadway, and crash characteristics and injury severities into three: severe, minor, and no injury. Two latent class multinomial logit models—one each for single- and multi-occupant crashes—were developed, to analyze the effects of significant factors on injury severity outcomes using marginal effects. Results: The estimated results show that collision with a ditch, run-off road, intersection, winter season, wet roadway, and interstate decreased the probability of severe injuries in both single- and multi-occupant crashes, whereas rural area, road with downward grade, dark and unlit roadway, unemployed driver, and driver with invalid license increased the likelihood of severe injuries for both single- and multi-occupant crashes. Female drivers were more likely to be severely injured in single-occupant crashes, but less likely in multi-occupant crashes. A significant association was found between severe injuries and weekends, residential areas, and crash location close (

Background: Bipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment. Objectives: A programme of linked studies to reduce relapse and suicide in BD. Design: There were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5). Setting: Participants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)]. Participants: Aged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Interventions: In WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively. Main outcome measures: In WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation. Results: Group PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio test p = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2; p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD: n = 72, 72% retention to follow-up; MI-CBT: n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans. Limitations: Inferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group. Conclusion: The programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support. Future work: Future work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated. Trial registration: Current Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583. Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.

Factors related to drivers and their driving habits dominate the causation of traffic crashes. An in-depth understanding of the human factors that influence risky driving could be of particular importance to facilitate the application of effective countermeasures. This paper sought to investigate effects of human-centered crash contributing factors on crash outcomes. To select the methodology that best accounts for unobserved heterogeneity between crash outcomes, latent class (LC) logit model and random parameters logit (RPL) model were developed. Model estimation results generally show that serious injury crashes were more likely to involve unemployed drivers, no seatbelt use, old drivers, fatigued driving, and drivers with no valid license. Comparison of model fit statistics shows that the LC logit model outperformed the RPL model, as an alternative to the traditional multinomial logit (MNL) model.

In 2012, the English Higher Education system witnessed one of the biggest hikes in the cost of university participation seen in the sector, with the annual fee for most undergraduate degree programme raised to a new limit of £9,000. Accompanying this rise in ‘headline’ fees was a series of changes to the repayment mechanism that allowed the move to be framed in progressive terms by policymakers and other advocates. A small dip in applications followed, but the UK’s widening participation agenda seemed not to be bruised by the hike, with the proportion of students from less advantaged backgrounds applying to higher education institutions (including higher prestige universities) remaining constant. This paper examines the messages that were communicated alongside the 2012 fees rise, its aim being to help shed light on how public discourses about participation in the higher fees era are framed. It is argued that the greater overall expense for most students in terms of lifetime repayments was partially obscured in favour of a narrative that emphasised the short-term benefits for middle-earning graduates and long-term concessions for lower-earning graduates. Using the contemporary English model as a case study, the wider implications for quality and, more particularly, equity of a less regulated, more market-driven higher education system are explored. Attention is also paid to the impact on selection procedures and on broader questions about the extent to which university is (and is perceived as) a public or private good.