Innovative Methods to Strengthen Internal KYTC Communications

Communication is the linchpin of every organization. Poor communication leads to inefficiencies, frustration among staff, and employee disaffection and disengagement. Although some state transportation agencies have adopted comprehensive strategic plans for internal communications, many have taken a more piecemeal approach, with some Offices and units (e.g., incident management) developing their own plans that apply only to their operations. The latter approach is less than ideal because establishing a comprehensive communications plan provides an organizing framework for all communications within an organization and is critical for uniting staff around a shared sense of purpose and equipping them with the tools they need to realize the organization’s mission and vision. Crafting a solid communications plan also helps to clarify responsibilities, map information flows, break down informational and disciplinary silos, and strengthen employee engagement. If the Kentucky Transportation Cabinet (KYTC) were to embark on the development of a strategic plan for internal communications, it would benefit from adopting several best practices: (1) treating communication as a core competency, (2) improving mentorship opportunities, (3) minimizing clutter by eliminating information redundancies and cutting extraneous content from messages, and (4) seizing opportunities to build employee engagement throughout the agency. As a precursor to developing the communications plan, the Cabinet would benefit from conducting a thorough communications audit to identify communication strengths and weaknesses and identify performance metrics to measure the effectiveness of communications. If a plan was formally adopted, KYTC staff would need to devise a communications toolbox that contains strategies and tactics for increasing engagement and streamlining information flows. Regular performance assessments can be used to identify when and how the communications plan and toolkit should be updated

KYTC Department of Aviation Aircraft Maintenance Technician (AMT) Program Optimization

The aviation industry is a linchpin of Kentucky’s economy. Major firms such as UPS, Amazon, and DHL have major hubs at Louisville Muhammad Ali International Airport (SDF) and Cincinnati/Northern Kentucky International Airport (CVG). As of December 2022, 4,570 aircraft mechanics and service technicians (AMTs) were employed in the state. Demand in this sector is poised to grow. As such, it is critical to understand what resources Kentucky has available to train the next generation of professionals and the number of people the aviation industry is likely to employ statewide over the next decade. Kentucky and the surrounding states are home to 35 programs that train AMTs. Most of Kentucky’s AMTs graduate from Jefferson Community and Technical College and Somerset Community College (Maysville Community and Technical College is launching an AMT program), schools in southern Ohio, or arrive from out of state. Each year, Kentucky adds over 300 AMTs through immigration to Kentucky and graduates from AMT programs. AMT programs are critical sources of workers, but schools struggle to keep faculty on staff, with turnover in the 30-40% range due to low pay. Based on historical data, two mathematical models were developed to forecast the number of AMT jobs Kentucky will add between 2023 and 2035. These models suggest the number of AMTs will increase to a range between 2,311 and 3,027. Based on these projections, supply and demand for AMTs will reach equilibrium in 2027. To ensure Kentucky avoids a shortage of AMTs, expanding the number of training and certification programs and running programs at or near their capacity is critical

Analysis and Assessment of the Reimbursement Rates and Mechanisms for Kentucky’s Publicly Funded Ferries

The Kentucky Transportation Cabinet (KYTC) reimburses publicly operated ferries, including when they cease operations due to severe weather or unforeseen events. Reimbursement procedures are not codified in law and are largely based on historical practice. To determine how the Cabinet should handle reimbursement, funding, oversight of ferry services moving forward, the Kentucky Transportation Center (KTC) reviewed practices adopted by 10 other states and conducted a detailed analysis of Kentucky’s current approach. Of the states KTC examined, only Tennessee reimburses ferry operations for closures (at 50 percent of the normal hourly rate for a period up to 48 hours). Half of the states KTC examined make state funding available for ferry operations, others either devolve oversight to the local level or provide no funding assistance. In Kentucky, operating standards for ferry services are not consistent and no uniform method has been devised to calculate reimbursement rates. In light of these findings, KYTC should create detailed auditing guidelines to improve the consistency of ferry service financial statements; pursue funding sources it has not previously taken advantage of, and generate long-term forecasts of the state’s ferry operations. Lastly, the Cabinet should ask the General Assembly to revisit and modify several statutes pertaining to ferries which contain outdated language that has little relevance to the modern transportation system

Extended Weight Systems Pavement Analysis

SPR 22-57-2Kentucky established its Extended Weight Coal or Coal By-products Haul Road System (EWCHRS) in 1986. This road network includes segments of the Coal Haul Highway System on which more than 50,000 tons coal or coal byproducts were transported by motor vehicles during the previous calendar year. In the past few years, the state has introduced extended weight (EW) systems focused on petroleum products and metal commodities. Trucks can operate above posted weight limits on these networks by paying annual fees that range from $160 to$2,000. While EW networks benefit motor carriers by improving efficiency, vehicles that exceed weight limits can damage pavement and reduce its service life. This study examines the relationship between pavement age and pavement condition on EWCHRS routes and non-EWCHRS routes to understand the implications of EW networks for infrastructure life-cycles. Using data from 2008 through 2020 (with the exception of 2016) to perform regression analysis, researchers found that routes which spent at least 20% of the study period on the EWCHRS saw pavement life decline by 1.5 \u2013 2 years. In general, a positive correlation was observed between exposure on the EWCHRS and loss of pavement life, which can increase maintenance, repair, and rehabilitation costs. While the future of commodity-specific EW networks in Kentucky is unclear, data management strategies can be adopted by the Kentucky Transportation Cabinet to improve its support of existing and future EW networks

Central nervous system inflammation induces muscle atrophy via activation of the hypothalamic–pituitary–adrenal axis

Systemic and CNS-delimited inflammation triggers skeletal muscle catabolism in a manner dependent on glucocorticoid signaling

Pathophysiology and treatment of inflammatory anorexia in chronic disease

Decreased appetite and involuntary weight loss are common occurrences in chronic disease and have a negative impact on both quality of life and eventual mortality. Weight loss in chronic disease comes from both fat and lean mass, and is known as cachexia. Both alterations in appetite and body weight loss occur in a wide variety of diseases, including cancer, heart failure, renal failure, chronic obstructive pulmonary disease and HIV. An increase in circulating inflammatory cytokines has been implicated as a uniting pathogenic mechanism of cachexia and associated anorexia. One of the targets of inflammatory mediators is the central nervous system, and in particular feeding centers in the hypothalamus located in the ventral diencephalon. Current research has begun to elucidate the mechanisms by which inflammation reaches the hypothalamus, and the neural substrates underlying inflammatory anorexia. Research into these neural mechanisms has suggested new therapeutic possibilities, which have produced promising results in preclinical and clinical trials. This review will discuss inflammatory signaling in the hypothalamus that mediates anorexia, and the opportunities for therapeutic intervention that these mechanisms present

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens