Evaluation of New Simplified Dynamic Lane Merging Systems (SDLMS) for Short-Term Work Zone Lane Closure Configuration

To improve traffic safety and mobility in work zone areas, the Dynamic Lane Merge (DLM) systems, intelligent work zone traffic control systems, have been explored by several states of the U.S.A. The DLM can take two forms; dynamic early merge and dynamic late merge. The DLM systems were designed to advise drivers on definite merging locations. Up to date, there are no studies that contrast both merging schemes in the field under matching work zone settings. This study suggests two Simplified Dynamic Lane Merging Systems (SDLMS) (early merge and late merge) to supplement the current Florida Maintenance Of Traffic (MOT) plans for a three-to-two- work zone lane closure configuration. Data was collected in work zones on I-95, Florida for three different maintenance of traffic plan treatments. The first maintenance of traffic plan treatment was the standard MOT plan employed by FDOT. The second MOT was the early SDLMS and the third MOT was the late SDLMS. Results showed that dynamic early merging (early SDLMS) outperforms late SDLMS and the conventional Florida MOT plans under lower demand volumes. However, results also showed that late SDLMS outperforms early SDLMS and MAS under higher demand volumes

EFFECT OF PULSED GALVANIC ELECTRO STIMULATION AND ULTRASUONBD ON BURN HEALING. A RANDOMIZED CLINICAL TRIALS

The goal of this study is to evaluate the effect of pulsed galvanic electro stimulation of high voltage and ultrasound on the healing of induced burn applied on rats. 48 rats (Sprague Dawley), mass between 300g and 400g, age between 3 months and 4 months. These rats are putted and the same experimental conditions of alimentation and hygiene. Rats are divided into 3 groups of 16 rats each. Each rat was induced to a uniform burn of second degree by a specific device fabricated specially to this study. Group ES undergoes a treatment of electro stimulation by a pulsed galvanic current of high voltage for 10 min daily during 2 weeks. Group US undergoes a treatment of pulsed ultrasound of 1w/cm² for 2 minutes daily during 2 weeks Group control GC undergoes placebo treatment. Measure are done by digital camera, results are analyzed by specific program (AutoCad) on computer. Wound healing between the three groups are different and statistical tests ( T-tests and ANOVA) done between the two groups US and GC show no significant difference in the reduction of the surface of healing between them (α˃0.05), whereas the comparison between ES group and the two others group was significant (α˂0.05). At the end of the second week of treatment, the best healing was presented in ES group where the wound was healed by 61.4 % whereas the groups GC and US were 11.9 % and 14.9 % respectively. Therefore the ES group have the best results between than others groups (GC and US)

The epidemiology and economic burden of obesity and related cardiometabolic disorders in the United Arab Emirates: A systematic review and qualitative synthesis

Copyright © 2018 Hadia Radwan et al. Background. Noncommunicable diseases (NCDs) are considered as a global health problem and considered as a public health priority with the more considerable increasing trend of obesity and cardiometabolic disorders rates in the Middle Eastern countries. This systematic review aims at assessing the prevalence, incidence rates, and trends, as well as the cost of obesity and related cardiometabolic disorders in the United Arab Emirates (UAE). Methods. A highly sensitive strategy was used to retrieve original observational studies, addressing the epidemiology and cost of obesity and related cardiometabolic disorders in the UAE, irrespective of nationality (nationals and expatriates). The search was conducted on April 4, 2017, within numerous electronic databases and the grey literature. Standardized and validated methods were used for data extraction and analysis as well as quality assessment. Results. 6789 records were retrieved, of which 36 were deemed eligible. High prevalence rates were reported for obesity, diabetes, hypertension, and metabolic syndrome in all studies. However, the definitions and methods employed by the studies were highly variable. The risk of bias in the epidemiological studies ranged between low and medium. Only one study reported the cost of illness for diabetes. In this study, the estimated cost per patient was $2,015 (adjusted to the year 2015), and it became twofold and sixfold higher in patients with microvascular and macrovascular complications, respectively. Conclusions. Obesity and related cardiometabolic disorders are highly prevalent in the UAE, but quoting a precise prevalence for them is difficult given the methodological heterogeneity of the epidemiological studies addressing them. Nonetheless, we detected a 2-3-fold increase in the prevalence of overweight and obesity in the UAE between 1989 and 2017. It is hopeful that this systematic review will provide an insight into direct future studies, especially longitudinal studies exploring obesity and cardiometabolic risks and their costs

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Silmänliikkeet luettaessa tehtävänannon kannalta oleellista ja epäoleellista lausetta

Tutkimuksen tavoitteena oli kuvata kouluikäisten oppilaiden lukuprosessia simuloidussa internetympäristössä tapahtuneen tiedonhakutehtävän tiedonannon lukemisessa. Lukuprosessia mitattiin silmänliikkeiden avulla. Käytetyt silmänliikemittarit olivat ensimmäisen lukukerran kesto, fiksaatioiden kokonaiskesto, toisen lukukerran todennäköisyys sekä viimeisestä lauseesta palatessa käytetty aika. Mittareita vertailtiin lausetyyppiin ja lukijakohtaisiin tekijöihin suhteutettuna. Lausetyypit jaoteltiin niiden oleellisuuden mukaan. Lukijakohtaisia tekijöitä olivat luetunymmärtämistaito, keskittymiskyky sekä aiempi aihetietämys. Tuloksissa havaittiin, että tehtävänannon kannalta oleellista lausetta prosessoitiin eniten lähes kaikilla mittareilla mitattuna, kun taas epäoleellista lausetta prosessoitiin merkitsevästi vähemmän. Lukijakohtaisten tekijöiden havaittiin olevan yhteydessä lukuprosessiin eri tavoin riippuen siitä, oliko lause oleellinen vai epäoleellinen. Tulokset osoittivat esimerkiksi paremman keskittymiskyvyn lisäävän oleellisessa lauseessa vietettyä aikaa ja paremman luetunymmärtämistaidon vähentävän epäoleellisessa lauseessa vietettyä aikaa

Cloze-testi luetun ymmärtämisen mittarina 3. ja 4.-luokkalaisilla

Tutkimuksessa tarkasteltiin, miten kehittämämme cloze-testi mittaa luetun ymmärtämistä 3.- 4. -luokkalaisilla. Tutkimus on osa Niilo Mäki Instituutin ReadDrama-hanketta, jossa tutkitaan lukuteatterin vaikuttavuutta lukuharjoittelun muotona. Kaikki 114 osallistujaa tulivat samasta Jyväskylän alakoulusta, josta kerättiin aineisto kevätlukukauden 2019 aikana. Vertailtavaksi testiksi otettiin Suomessa yleisessä käytössä oleva Ala-asteen lukutesti eli ALLU. Testejä vertailemalla arvioitiin clozen validiteettia luetun ymmärtämisen testinä. Lisäksi osallistujilta mitattiin kognitiivisia taustatekijöitä luetun ymmärtämisen teorioita integroivaan malliin (eng. Integrated Model of Reading Comprehensio, IMREC) pohjautuen. Tarkoituksena oli selvittää, mitkä kognitiiviset prosessit ovat aktiivisina luetun ymmärtämisen aikana ja tarkastella niiden yhteyttä cloze-testiin. Mitattaviksi kognitiivisiksi taustatekijöiksi valittiin lukusujuvuus, sanaston laajuus, näönvarainen päättelykyky, kielellinen päättelykyky, lyhytkestoinen muisti ja työmuisti. Testien välisiä yhteyksiä sekä kognitiivisten taustatekijöiden yhteyttä luetun ymmärtämisen testeihin tarkasteltiin korrelaatiomatriisin ja regressiomallien avulla. Testien välinen vahva korrelaatio ja kummankin testin pääosin samankaltaiset korrelaatiot kognitiivisiin taustatekijöihin antavat viitteitä siitä, että testit mittaavat samaa taitoa. Tulokset viittaavat siihen, että cloze-testillä voi mitata validisti luetun ymmärtämistä 3.-4. - luokkalaisilla, kun sen tuloksia verrattiin Ala-asteen lukutestin tuloksiin. Kognitiivisista taustatekijöistä päättelykyky korostui cloze-testissä enemmän kuin ALLUssa. Päättelykyky vaikuttaa olevan keskeinen komponentti luetun ymmärtämisessä

Freeway Work-Zone Crash Analysis and Risk Identification Using Multiple and Conditional Logistic Regression

Work-zone safety continues to be a priority and a concern for the Federal Highway Association as well as most state departments of transportation. The main objective of this study is to uncover work-zone freeway crash characteristics to help develop countermeasures that limit work-zones’ hazards. The Florida Crash Records Database for years 2002, 2003, and 2004 was utilized for this study. Conditional logistic regression along with stratified sampling and multiple logistic regression models were estimated to unveil work-zone freeway crash traits. According to the models’ results, roadway geometry, weather condition, age, gender, lighting condition, residence code, and driving under the influence of alcohol and/or drugs are significant risk factors associated with work-zone crashes