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Another difficulty with studies that have compared bicycling and walking to other modes of transportation is that they may imply that the facilities and safety benefits of the different mode are comparable, when they are not. The idea of sharing road space is a difficult one for most motorists and administrators to accept, and the resulting discomfort and safety risks to motorists are a potential liability for cyclists. Research has suggested that the potential benefits of shared-space facilities are greater in countries where the modes are more dissimilar [ 85 ]. As most of the studies reviewed here were conducted in North America, the reader may question whether the conclusions reached are applicable to other countries. However, the only North American study reviewed here (that of Anderson and Collie [ 66 ]) found that shared space in urban areas supported greater levels of cycling by pedestrians than by motorists. This may have at least as much to do with shared-space architecture itself as the modal user. However, the study had no comparison with walking and therefore it is unclear how much of the safety benefit for pedestrians was due to modal substitution.
Assessing the effectiveness of interventions to reduce bicycle injury risk is challenging. For example, injury and crash data can only be collected for a limited period of time, and improvements are usually measured after time lags, which may exceed the typical duration of the intervention. Injuries can also be concentrated in localized areas, making it difficult to attribute the cause to any particular intervention. To date, most of the studies reviewed here reported on only one intervention with one cycle-related injury outcome or crash outcome. The extent to which the interventions are effective in reducing such outcomes (and injuries as well as crashes) is often difficult to determine:
new legislation to promote bicycling in the uk is focused on getting more people to commute by bicycle. to date, this focus has been on safer cycling infrastructure, the provision of more secure bicycle parking, the promotion of cycling as a healthy and environmentally friendly option, and the provision of more cycle lanes. the evidence from the north american literature suggests that infrastructure can improve cycling levels, but the evidence from europe indicates that more research is needed on the relative effectiveness of the various forms of infrastructure. specifically, longitudinal studies that examine changes in cycling levels over time are needed to determine whether the positive effects of infrastructure on cycling levels are sustainable.
the identification of mutations and variants in pc1/pc2 is complicated by the fact that the polycystin complex is expressed in several tissues, and that heterozygous loss of either pc1 or pc2 causes a milder phenotype than homozygous loss, with heterozygous loss of either gene resulting in the same phenotype as homozygous loss of the other gene [ smith et al 2011 ]. it is therefore possible that there are multiple proteins encoded by the pc1/pc2 locus, and that they have different functions in the kidney. in addition, there are multiple alleles of the polycystin genes, with more than 20 known to date [ smith et al 2011, smith et al 2012, wang et al 2013, lemos et al 2014, lin et al 2014, wang et al 2014, bello-reuss et al 2015, chebib et al 2015, hama & park 2016, lemos & ehrlich 2018 ]. this heterogeneity, and the possibility that the polycystin complex may have a variety of different functions, makes it difficult to establish the most important loci in any given tissue or cell type, or the downstream pathways or mechanisms involved.
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