North American practice-based recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension

Complications of portal hypertension, including ascites, gastrointestinal bleeding, hepatic hydrothorax, and hepatic encephalopathy, are associated with significant morbidity and mortality. Despite few high-quality randomized controlled trials to guide therapeutic decisions, transjugular intrahepatic portosystemic shunt (TIPS) creation has emerged as a crucial therapeutic option to treat complications of portal hypertension. In North America, the decision to perform TIPS involves gastroenterologists, hepatologists, and interventional radiologists, but TIPS creation is performed by interventional radiologists. This is in contrast to other parts of the world where TIPS creation is performed primarily by hepatologists. Thus, the successful use of TIPS in North America is dependent on a multidisciplinary approach and technical expertise, so as to optimize outcomes. Recently, new procedural techniques, TIPS stent technology, and indications for TIPS have emerged. As a result, practices and outcomes vary greatly across institutions and significant knowledge gaps exist. In this consensus statement, the Advancing Liver Therapeutic Approaches group critically reviews the application of TIPS in the management of portal hypertension. Advancing Liver Therapeutic Approaches convened a multidisciplinary group of North American experts from hepatology, interventional radiology, transplant surgery, nephrology, cardiology, pulmonology, and hematology to critically review existing literature and develop practice-based recommendations for the use of TIPS in patients with any cause of portal hypertension in terms of candidate selection, procedural best practices and, post-TIPS management; and to develop areas of consensus for TIPS indications and the prevention of complications. Finally, future research directions are identified related to TIPS for the management of portal hypertension

Processes of Small Culvert Inspection and Asset Management

Proper drainage is essential for pavement to maximize life expectancy and minimize maintenance. Culverts are a critical asset to facilitate drainage. As with many assets, culverts deteriorate with age and require regular inspection. It is important to have a formalized process of inventory and inspection that is efficient and can effectively support culvert asset management. The current culvert inspection and asset management processes for the Indiana Department of Transportation (INDOT) have been modeled over the years on the bridge inspection process and were recently evaluated. A study was undertaken to further evaluate the current culvert asset management practices. Approximately 700 small culverts and catch basins were visited and evaluated using both the traditional culvert inspection practices and a revised asset management evaluation scale. The paper summarizes the findings of this evaluation and concludes by making recommendations for process improvements. These recommendations include the addition of photos to the culvert database, a revised rating scale, advanced planning of inspection schedules, a formalized process for culvert reassessments, the creation of a separate catch basin inlet inventory, various improvements to the inventory process, and a dedicated staff to complete inspections efficiently. It is also noted that building a reliable database will show historical trends and can eventually lead to a study of small culvert inspections and culvert longevity, which will lead to improved asset management

Processes of Small Culvert Inspection and Asset Management

Proper drainage is essential for pavement to maximize life expectancy and minimize maintenance. Culverts are a critical asset to facilitate drainage. As with many assets, culverts deteriorate with age and require regular inspection. It is important to have a formalized process of inventory and inspection that is efficient and can effectively support culvert asset management. The current culvert inspection and asset management processes for the Indiana Department of Transportation (INDOT) have been modeled over the years on the bridge inspection process and were recently evaluated. A study was undertaken to further evaluate the current culvert asset management practices. Approximately 700 small culverts and catch basins were visited and evaluated using both the traditional culvert inspection practices and a revised asset management evaluation scale. The paper summarizes the findings of this evaluation and concludes by making recommendations for process improvements. These recommendations include the addition of photos to the culvert database, a revised rating scale, advanced planning of inspection schedules, a formalized process for culvert reassessments, the creation of a separate catch basin inlet inventory, various improvements to the inventory process, and a dedicated staff to complete inspections efficiently. It is also noted that building a reliable database will show historical trends and can eventually lead to a study of small culvert inspections and culvert longevity, which will lead to improved asset management

Lifespan of long-lived growth hormone receptor knockout mice was not normalized by housing at 30°C since weaning

Growth hormone receptor knockout (GHRKO) mice are remarkably long-lived and have improved glucose homeostasis along with altered energy metabolism which manifests through decreased respiratory quotient (RQ) and increased oxygen consumption (VO2 ). Short-term exposure of these animals to increased environmental temperature (eT) at 30°C can normalize their VO2 and RQ. We hypothesized that increased heat loss in the diminutive GHRKO mice housed at 23°C and the consequent metabolic adjustments to meet the increased energy demand for thermogenesis may promote extension of longevity, and preventing these adjustments by chronic exposure to increased eT will reduce or eliminate their longevity advantage. To test these hypotheses, GHRKO mice were housed at increased eT (30°C) since weaning. Here, we report that contrasting with the effects of short-term exposure of adult GHRKO mice to 30°C, transferring juvenile GHRKO mice to chronic housing at 30°C did not normalize the examined parameters of energy metabolism and glucose homeostasis. Moreover, despite decreased expression levels of thermogenic genes in brown adipose tissue (BAT) and elevated core body temperature, the lifespan of male GHRKO mice was not reduced, while the lifespan of female GHRKO mice was increased, along with improved glucose homeostasis. The results indicate that GHRKO mice have intrinsic features that help maintain their delayed, healthy aging, and extended longevity at both 23°C and 30°C

Impacts to Traffic Behavior from Queue Warning Truck: Current Pilot Project

The Indiana Department of Transportation (INDOT) started deploying queue warning trucks ahead of interstate work zones to alert motorists of queued traffic. Along with visually alerting the motorists, digital alerts were integrated with navigational applications such as Apple Maps, Waze, and the in-vehicle infotainment system of Stellantis vehicles. More than 45,000 hours of alerting was provided to motorists across various interstates in Indiana over a 26-month period. This report evaluated the impact of queue warning trucks on traffic using hard braking events and traffic speeds provided by granular connected trajectory vehicle data. Evaluation of over 370 hours of queuing with the presence of queue trucks and 52 hours of queuing without the queue trucks indicated a decrease in hard braking events by 80% when trucks were present with digital alerts. It was also observed that traffic speeds started to reduce approximately 1,500 to 2,000 ft in advance of deployed queue trucks

Implementation of Enhanced Probe Data (CANBUS) for Tactical Workzone and Winter Operations Management

For over a decade, segment-based probe data has been extensively used by transportation stakeholders for monitoring mobility on Indiana roadways. However, enhanced probe data from connected vehicles includes a richer dataset that can provide more detailed real-time and after-action reviews. This enhanced data includes detailed vehicle trajectories, at 3s resolution, and “event data.” This event data is near real-time and includes hard-braking events, hard-acceleration events, weather-related data, including wiper activations and some seat belt usage data. This project developed a set of methodologies and resulting visualizations that enables the use of emerging connected vehicle data in operational decision-making on work zone management and winter operations activities. Each month approximately 13 billion connected vehicle records are ingested for Indiana. During peak periods, approximately 625,000 records per minute are ingested. Without substantial processing, this large data set is “data-rich, information-poor.” This study developed techniques to rapidly assign relevant data to interstate segments so that visual graphics could be efficiently generated. This provided the ability for both real-time monitoring as well as after action assessment to identify opportunities to improve both work zone operations and winter operation activities. The summaries derived from these datasets have helped promote effective actionable dialog among agencies, contractors, and public safety colleagues towards the overarching goal of improving interstate safety and mobility

Prioritizing Roadway Pavement Marking Maintenance Using Lane Keep Assist Sensor Data

There are over four million miles of roads in the United States, and the prioritization of locations to perform maintenance activities typically relies on human inspection or semi-automated dedicated vehicles. Pavement markings are used to delineate the boundaries of the lane the vehicle is driving within. These markings are also used by original equipment manufacturers (OEM) for implementing advanced safety features such as lane keep assist (LKA) and eventually autonomous operation. However, pavement markings deteriorate over time due to the fact of weather and wear from tires and snowplow operations. Furthermore, their performance varies depending upon lighting (day/night) as well as surface conditions (wet/dry). This paper presents a case study in Indiana where over 5000 miles of interstate were driven and LKA was used to classify pavement markings. Longitudinal comparisons between 2020 and 2021 showed that the percentage of lanes with both lines detected increased from 80.2% to 92.3%. This information can be used for various applications such as developing or updating standards for pavement marking materials (infrastructure), quantifying performance measures that can be used by automotive OEMs to warn drivers of potential problems with identifying pavement markings, and prioritizing agency pavement marking maintenance activities

Intervention leads to improvements in the nutrient profile of snacks served in afterschool programs: a group randomized controlled trial

Widely adopted nutrition policies for afterschool programs (ASPs) focus on serving a fruit/vegetable daily and eliminating sugar-sweetened foods/beverages. The impact of these policies on the nutrient profile of snacks served is unclear. Evaluate changes in macro/micronutrient content of snacks served in ASPs. A 1-year group randomized controlled trial was conducted in 20 ASPs serving over 1700 elementary-age children. Intervention ASPs received a multistep adaptive framework intervention. Direct observation of snack served was collected and nutrient information determined using the USDA Nutrient Database, standardized to nutrients/100 kcal. By post-assessment, intervention ASPs reduced total kcal/snack served by 66 kcal (95CI -114 to -19 kcal) compared to control ASPs. Total fiber (+1.7 g/100 kcal), protein (+1.4 g/100 kcal), polyunsaturated fat (+1.2 g/100 kcal), phosphorous (+49.0 mg/100 kcal), potassium (+201.8 mg/100 kcal), and vitamin K (+21.5 μg/100 kcal) increased in intervention ASPs, while added sugars decreased (-5.0 g/100 kcal). Nutrition policies can lead to modest daily caloric reductions and improve select macro/micronutrients in snacks served. Long-term, these nutritional changes may contribute to healthy dietary habits

Crowdsourcing/Winter Operations Dashboard Upgrade

INDOT has recently completed the deployment of Parsons telematics-based dash-cameras, automatic vehicle locator (AVL) positions, and spreader rate monitoring across their winter operations fleet. The motivation of this study was to develop dashboards that integrate connected vehicle data into the real-time monitoring and after-action review of winter storms. Each month approximately 13 billion connected vehicle records are ingested for the state of Indiana and almost 99 billion weather data records are ingested nationwide in 15-minute intervals. This study developed techniques to utilize this connected vehicle data and weather data to monitor real-time mobility of interstates and post storm after-action assessments to identify improvement opportunities of winter operations activities. In multiple instances, these agile reviews have influenced operational changes in snow removal and maintenance around the state, leading to a marked improvement in observed mobility and safety