Learning the Repair Urgency for a Decision Support System for Tunnel Maintenance

The transport network in many countries relies on extended portions which run underground in tunnels. As tunnels age, repairs are required to prevent dangerous collapses. However repairs are expensive and will affect the operational efficiency of the tunnel. We present a decision support system (DSS) based on supervised machine learning methods that learns to predict the risk factor and the resulting repair urgency in the tunnel maintenance planning of a European national rail operator. The data on which the prototype has been built consists of 47 tunnels of varying lengths. For each tunnel, periodic survey inspection data is available for multiple years, as well as other data such as the method of construction of the tunnel. Expert annotations are also available for each 10m tunnel segment for each survey as to the degree of repair urgency which are used for both training and model evaluation. We show that good predictive power can be obtained and discuss the relative merits of a number of learning methods

An ontological approach for pathology assessment and diagnosis of tunnels

Tunnel maintenance requires complex decision making, which involves pathology diagnosis and risk assessment, to ensure full safety while optimising maintenance and repair costs. A Decision Support System (DSS) can play a key role in this process by supporting the decision makers in identifying pathologies based on disorders present in various tunnel portions and contextual factors affecting a tunnel. Another key aspect is to identify which spatial stretches within a tunnel contain pathologies of similar kinds within neighbouring tunnel segments. This paper presents PADTUN, a novel intelligent decision support system that assists with pathology diagnosis and assessment of tunnels with respect to their disorders and diagnosis influencing factors. It utilises semantic web technologies for knowledge capture, representation, and reasoning. The core of PADTUN is a family of ontologies which represent the main concepts and relations associated with pathology assessment, and capture the decision process concerning tunnel maintenance. Tunnel inspection data is linked to these ontologies to take advantage of inference capabilities offered by semantic technologies. In addition, an intelligent mechanism is presented which exploits abstraction and inference capabilities. Thus PADTUN provides the world’s first semantically based intelligent DSS for tunnel maintenance. PADTUN was developed by an interdisciplinary team of tunnel experts and knowledge engineers in real-world settings offered by the NeTTUN EU Project. An evaluation of the PADTUN system is performed using real-world tunnel data and diagnosis tasks. We show how the use of semantic technologies allows addressing the complex issues of tunnel pathology inferencing, aiding in, and matching transportation experts’ expectations of decision support. The methodology is applicable to any linear transport structures, offering intelligent ways to aid with complex decision processes related to diagnosis and maintenance

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures

BACKGROUND: Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. METHODS/DESIGN: FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. DISCUSSION: This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. TRIAL REGISTRATION: The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813)

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Mar