Dashboards for Real-time Monitoring of Winter Operations Activities and After-action Assessment

The Indiana Department of Transportation (INDOT) operates a fleet of nearly 1100 snowplows and spends up to $60M annually on snow removal and de-icing as part of their winter operation maintenance activities. Systematically allocating resources and optimizing material application rates can potentially save revenue that can be reallocated for other roadway maintenance operations. Modern snowplows are beginning to be equipped with a variety of Mobile Road Weather Information Sensors (MARWIS) which can provide a host of analytical data characterizing on-the-ground conditions during periods of wintry precipitation. Traffic speeds fused with road conditions and precipitation data from weather stations provide a uniquely detailed look at the progression of a winter event and the performance of the fleet. This research uses a combination of traffic speeds, MARWIS and North American Land Data Assimilation System (NLDAS) data to develop real-time dashboards characterizing the impact of precipitation and pavement surface temperature on mobility. Twenty heavy snow events were identified for the state of Indiana from November 2018 through April 2019. Two particular instances, that impacted 182 miles and 231 miles of interstate at their peaks occurred in January and March, respectively, and were used as a case study for this paper. The dashboards proposed in this paper may prove to be particularly useful for agencies in tracking fleet activity through a winter storm, helping in resource allocation and scheduling and forecasting resource needs

Pulsed phytoplankton supply to the rocky subtidal zone: influence of internal waves.

Hydrographic measurements indicate that the thermocline and the phytoplankton-rich chlorophyll maximum layer are vertically displaced over a rocky pinnacle in the central Gulf of Maine by internal waves with maximum amplitudes of 27 m. Such predictable downwelling events are linked to rapid, 2- to 3-fold increases in chlorophyll a, an indicator of phytoplankton concentration, in pulses of warm water recorded 4 cm above the bottom (29-m depth). The 1.5-5.6 degrees C temperature fluctuations had an average period of 10.6 min and were generated on both ebb and flood tides. Local lee waves and the arrival of solitons propagated from Georges Bank are hypothesized to explain the timing of the internal waves. Because internal waves and chlorophyll maxima are pervasive features of stratified temperate seas, this mechanism of food coupling should be common in other rocky subtidal habitats

Adult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patients

BACKGROUND The incidence of endometrial cancer increases with age and is associated with medical comorbidities such as obesity and diabetes. While a few cohort studies of less than 500 patients showed an association between comorbidity and survival in endometrial cancer patients, the degree of association needs to be better described. The Adult Comorbidity Evaluation 27 (ACE-27) is a validated comorbidity instrument that provides a score (0–3) based on the number and severity of medical comorbidities. OBJECTIVE This study was performed to explore the association between medical comorbidities and survival of endometrial cancer patients. STUDY DESIGN Patients diagnosed with endometrial cancer from 2000–2012 were identified from the prospectively maintained Siteman Cancer Center tumor registry. Patients undergoing primary surgical treatment for endometrioid, serous and clear cell endometrial carcinoma were included. Patients primarily treated with radiation, chemotherapy or hormone therapy were excluded. Patients with uterine sarcomas or neuroendocrine tumors were excluded. Patients with missing ACE-27 scores were also excluded from analysis. Information including patient demographics, ACE-27 score, tumor characteristics, adjuvant treatment and survival data were extracted from the database. The association of ACE-27 and overall as well as recurrence-free survival was explored in a multivariable Cox regression analysis after controlling for variables found to be significantly associated with survival in univariable analysis. RESULTS A total of 2073 patients with a median age of 61 years (range 20–94) at diagnosis were identified. ACE-27 score was 0, 1, 2 and 3 in 22%, 38%, 28% and 12% of patients, respectively. Stage distribution was I (73%), II (5%), III (15%) and IV (7%) and grade distribution was 1 (52%), 2 (23%) and 3 (25%). Most patients had endometrioid histology (87%) followed by serous (11%) and clear cell (3%). The median OS for the entire cohort was 54 months [95% confidence interval (CI) 3, 154 months] and median PFS was 50 months [95% CI 2, 154 months]., On univariable analysis, age, race, marital status, stage, grade, histology and treatment type were significantly associated with overall survival and recurrence-free survival. After adjusting for these covariates, patients with ACE-27 score of 2 had a 52% higher risk of death [95% CI 1.16, 2.00] and patients with ACE-27 score of 3 had a 2.35-fold increased risk of death [95% CI 1.73, 3.21] compared to patients with an ACE-27 score of 0. Similarly, patients with ACE-27 score of 2 had a 38% higher risk of recurrence [95% CI 1.07, 1.78] and patients with ACE-27 score of 3 had a 2.05-fold increased risk of recurrence [95% CI 1.53, 2.75] compared to patients with an ACE-27 score of 0. We found no interaction between ACE-27 score and age, stage or treatment type. CONCLUSIONS Our findings demonstrate the importance of comorbidities in estimating the prognosis of endometrial cancer patients, even after adjusting for age and known tumor-specific prognostic factors like stage, grade, histology and adjuvant treatment

Self-interest And Public Interest: The Motivations Of Political Actors

Self-Interest and Public Interest in Western Politics showed that the public, politicians, and bureaucrats are often public spirited. But this does not invalidate public-choice theory. Public-choice theory is an ideal type, not a claim that self-interest explains all political behavior. Instead, public-choice theory is useful in creating rules and institutions that guard against the worst case, which would be universal self-interestedness in politics. In contrast, the public-interest hypothesis is neither a comprehensive explanation of political behavior nor a sound basis for institutional design

Effect of a care transition intervention by pharmacists: an RCT

Abstract Background Pharmacists may improve medication-related outcomes during transitions of care. The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager (PCM) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events, rehospitalization and emergency department visits. Methods Design. Randomized, controlled trial of 945 participants assigned to enhanced, minimal and usual care groups conducted 2007 to 2012. Subjects. Participants with cardiovascular-related conditions and/or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine, family medicine, cardiology or orthopedics. Intervention. The minimal group received admission history, medication reconciliation, patient education, discharge medication list and medication recommendations to inpatient team. The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3–5 days post-discharge. Participants were followed for 90 days post-discharge. Main Outcomes and Measures. Medication appropriateness index (MAI), adverse events, adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression, as models accommodating random effects due to pharmacists indicated little clustering. Results Study groups were similar at baseline and the intervention fidelity was high. There were no statistically significant differences by study group in medication appropriateness, adverse events or adverse drug events at discharge, 30-day and 90-day post-discharge. The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days, and this was true across all study groups. Post-discharge, about 16% of all participants experienced an adverse event, and this did not differ by study group (p > 0.05). Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge, where 15% of all participants had a 30-day readmission. Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group. Conclusion The pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups. Trial registration Clinicaltrials.gov registration: NCT00513903 , August 7, 2007.http://deepblue.lib.umich.edu/bitstream/2027.42/109686/1/12913_2014_Article_3640.pd