A Method for Determining Offtracking of Multiple Unit Vehicle Combinations

The required road width around curves on forest roads is largely determined by the difference in wheel paths between the inside front tractor wheel and the inside rear trailer wheel. This difference, known as offtracking, is a function of the vehicle and road geometry. This paper presents a method for determining the offtracking of fixed and variable length multiple unit vehicle combinations travelling over forest roads. The computational method numerically integrates the differential equations which compute the path (tractrix) that the rear of a vehicle follows from a given steering curve. A unique three-point solution method is used to determine the instantaneous center of rotation for trailers in the vehicle combination. The method is shown to have good agreement with experimental data. It is suitable for use on microcomputers for single and multiple curves. A microcomputer program, OFFTRACK, was developed using this methodology

A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus

Background: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness. Methods: The authors conducted a randomized, controlled trial comparing telemedicine case management to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. The primary endpoints were HgbA1c, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. Results: In the intervention group (n = 844), mean HgbA1c improved over one year from 7.35% to 6.97% and from 8.35% to 7.42% in the subgroup with baseline HgbA1c ≥7% (n = 353). In the usual care group (n = 821) mean HgbA1c improved over one year from 7.42% to 7.17%. Adjusted net reductions (one-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p = 0.006), systolic and diastolic blood pressure, 3.4 (p = 0.001) and 1.9 mm Hg (p < 0.001), and LDL cholesterol, 9.5 mg/dL (p < 0.001). In the subgroup with baseline HgbA1c ≥7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p = 0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dL. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York. Conclusion: Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL cholesterol levels at one year of follow-up