Modeling Driver\u27s Route Choice Behavior Under the Influence of Advanced Traveler Information Systems (Vol. 2; Vol. 1: 96/10)

This research consisted of two parts; this report is volume 2 of 2 volumes; Volume 1 is Report No. FHWA/IN/JHRP-96/10. The first part developed a set of incident clearance time prediction models for the Borman Expressway. The second part consisted of modeling driver’s route choice behavior under the influence of advanced traveler information systems. Volume 2 of this report describes the modeling driver\u27s route choice behavior under the iinfluence of Advanced Traveler Information Systems. These models can help in understanding the behavior and response of travelers under the influeince of Advanced Traveler Information Systmes.r The products of this research project will be incorpored in the Advanced Traffic Managment System that is being implemented on the Morman Expressway, a 16-mile segment of *-80 n northwest Indiana

Hypergraph Acyclicity and Propositional Model Counting

We show that the propositional model counting problem #SAT for CNF- formulas with hypergraphs that allow a disjoint branches decomposition can be solved in polynomial time. We show that this class of hypergraphs is incomparable to hypergraphs of bounded incidence cliquewidth which were the biggest class of hypergraphs for which #SAT was known to be solvable in polynomial time so far. Furthermore, we present a polynomial time algorithm that computes a disjoint branches decomposition of a given hypergraph if it exists and rejects otherwise. Finally, we show that some slight extensions of the class of hypergraphs with disjoint branches decompositions lead to intractable #SAT, leaving open how to generalize the counting result of this paper

Motor Control System for Near-Resonance High-cycle Fatigue Testing

This research project develops a low-cost high-cycle fatigue (HCF) testing system comprised of an AC motor, variable frequency drive (VFD), eccentric cam, and feedback controller. The system acts as a forced harmonic oscillator leveraging mechanical resonance to vibrate a specimen at a frequency required to induce the testing\u27s strain amplitudes. This system depends highly on the material being tested. As such, the controller incorporates material characteristics. A frequency sweep measures the strain amplitude to characterize the specimen. Additionally, other measurements such as acceleration can be used as a proxy control variables for strain. A function converts the control variable to frequency. This function tunes a proportional integral derivative (PID) controller to emphasize stable control. This function, coupled with a tuned PID controller, converts the correction update into a voltage signal that commands a motor speed to reach the desired strain amplitude. Testing showed that a longer feedback loop time of 5 seconds was necessary to adequately control the system since the control variables are oscillatory by nature and need to be averaged over time to estimate accurate updates. Also, specimens with low damping are more subject to transient effects; consequently, rapid updates degrade system performance. Overall, the system tested over 250,000 cycles and various specimens. The main limitation of the system is a maximum strain amplitude limited by the specific specimen resonant peak. However, adjusting the system\u27s fixed displacement enables transferring more force to the specimen, changing the shape of the resonant peak

Assessment of Degenerative Changes in Superficial Digital Flexor Tendon in Clinical Normal Horses

The equine tendon is a highly specialized cord that ensures optimal transmission of movements from muscles to bones. The tendon is elastic, capable of easily resuming its original shape after being stretched and resistant to stretching under physiological condition. Flexor tendons show a high incidence of partial central core rupture preceded by degeneration. Thus, injuries of superficial digital flexor tendon (SDFT) are common in athletic horses. Equine tendons were isolated from the forelimbs of 45 normal thoroughbreds consisting of 13 young, 22 middle and 10 old aged horses. The sex distribution was not taken into account. The horses were euthanised and forelimb tendon samples obtained. Gross examination showed tendon discolouration suggesting presence of degeneration in the apparently normal tendon. Tendon samples were obtained from the central core of the mid-metacarpal region of the forelimb SDFT. The fixed SDFT samples were processed and embedded in wax using a technique modified for the study and stained with haematoxylin and eosin (H&E) stain. All sections were examined under light, confocal laser microscopic and image analysis techniques. When the degenerative changes in the h orse forelimb SDFT were compared, the left SDFT showed more degenerative changes than the right. This reflects the local racing condition which is conducted in anti-clockwise manner. This study also showed that the degree of degenerative changes was higher (Pc0.05) in old horses compared to young horse, but not higher than the middle aged horses. Tendon thickness was compared using the ultrasonography and caliper methods. The mean values for the thickness of the forelimb SDFT obtained using the caliper method (23.3 k1.7 mm) were at least 25% greater than those obtained using the ultrasound method (17.2 k 2.1 mm) suggesting an overestimation of the caliper method. Measurements using the caliper are obviously less accurate because it measures the thickness of the tendon as well as the thickness the skin and the underlying tissues. The width of the SDFT measured by ultrasonography is by transverse scans only.The rate of healing of SDFT was compared in thoroughbreds and ponies. The SDFTs of five thoroughbreds and five ponies were injured surgically. The healing of each SDFT was monitored for six months. After six months, SDFT in ponies showed a complete healing, whereas in the thoroughbreds, granulation tissue was still clearly evident. The results showed that SDFT of ponies healed faster than that of thoroughbreds. The tendon and muscle samples of thoroughbreds and ponies were analysed for lactic acid (LA). The tendon of thoroughbreds has a higher resting LA concentration (3.04k0.42 mmoUL) than the ponies (1.45k.0.12 mmolIL) and increased to (7.45*0.71 mmol1L) and (3.42 k0.89 mmol/L) in thoroughbreds and ponies. Similarly, the muscle of thoroughbreds had a higher resting LA - - concentration (13.63 & 1.33 mmollL) than the ponies (1.82 k 0.09 mmol/L) and -- increased to 27 * 3.94 mmol/L and 18.91 * 5.35 mmol/L in thoroughbreds and ponies respectively after exercise. The increase of activity in muscle is reflected in a similar increase in the LA content of SDFT suggesting that the accumulation of LA in the tendon was the result of increased muscle LA production from increased a ctivity. The accumulation of LA m ay render the tendon p rone to injury. This study suggested that tendon degeneration showed a greater intensity in the left than the right SDFT. While thoroughbreds had a greater resting tendon and muscle LA concentration than ponies. This may be related to the fact that thoroughbreds have a greater muscle mass and higher physical activity than ponies. Plasma creatine kinase (CK) and plasma aspertate aminotransferase (AST) concentrated in horses are not good indicators of the increase in muscle activity

Association Between Visual Analogue Scale (VAS) and Inflammatory Markers (ESR & CRP) in Patients with Knee Osteoarthritis Before and After Injection with Platelets –Rich Plasma(PRP)

Osteoarthritis (OA) are defined as a progressive architecture destruction of the joints compared to slow healing of these joints which leads to reduce protection against degeneration and the movement of the joint is associated with roughness and accompanied by pain. Often this disease affect the knee joint, it may affect any other joints in the body. It is considered the most common disease among people over age 60. The aim of this study is to evaluate the efficacy of platelets-rich plasma injection in treatment of knee osteoarthritis and estimation of the biological and immunological markers associated with the treatment. This study involved 50 patients suffering from inflammation of the knee joint, most of these patients attended Al-Shaheed Firooz hospital in wasit Governorate and private Clinics of Orthopedic and Rheumatology in the district during the period from April 2015 until October 2015. Diagnosis of OA was done according to kellgren and Lawrance system.The age range of patients was 35 - 65 years; 31 females and 19 males. All patient groups were injected in the knee joint by a specialist physician with two injections (Two week apart) during one month with platelets-rich plasma (PRP) after its preparation from the same patient's blood in a sterile condition. This was done after the signing of the patient or one of his relatives on the written consent to conduct the injection process after explaining and clarifying the principle of injection and the purpose.The level of pain to patients group was measured by Visual Analogue Scale (VAS). The enzyme linked immunnosorbant assay (ELISA) was applied to estimate the concentration of C.Reactive protein in serum of patients group as well as healthy control the rate of Erythrocyte Sedimentation Rate (ESR) was also estimated .All these tests were done to all patients groups before and after injections with PRP. Statistical analysis showed no significant differences between males and females ages (54.5±1.2 males, 53.2±2.1 females).The study showed significant decrease in the mean of the Visual Analogue Scale (VAS) of patients before and after injections with (PRP) 5.98 ± 0.129,8.46 ± 0.104, respectively, with highly significant differences (P=000.0) , also the study showed that there was a differences with no significant differences in VAS between age groups (30ʹs, 40ʹs, 50ʹs , 60ʹs) before and after injections with PRP (7.5,8.0 ,8.38 ,9.05), (5.0,5.55,5.69,6.7) respectively.The study also revealed a difference in the mean for inflammatory marker C. reactive protein concentration before and after injections with PRP (7.156± 0.328 µg/ml, 5.384± 0.196) respectively, with highly significant differences (P=0.000).The study also revealed a difference in the mean of ESR before and after injections with PRP (35.66± 0.879 mm/1hr, 23.7±0.856) (respectively), with highly significant differences (P=0.000). Positive correlation were obtained between VAS score and CRP as well as ESR after treatment. Keywords: Osteoarthritis, PRP, VAS score, ESR, CRP

Analysis of Patient Handoff between Providers at a Tertiary Urban Medical Center

Introduction. Few studies have quantified the total number of attending and consulting physicians involved in inpatients’ care, and no other research quantifies the total number of all providers participating in inpatients’ care. The purpose of this study was to calculate the number of attending hand-offs, the attending encounter time, and the total number of providers participating in inpatients’ care for all admitted patients at a tertiary urban medical center. Methods. The study design was an observational retrospective cohort. Subjects included pediatric and adult patients who were admitted to and discharged from Ascension Via Christi St. Francis (AVCSF) in Wichita, Kansas between November 01, 2019 and January 31, 2020. Data were abstracted from the Cerner Electronic Medical Record. Variables included: patient demographics, admitting diagnosis, diagnosis related group (DRG), admission service, and duration of inpatient stay. Provider variables abstracted included provider type and provider specialty. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means ± standard deviation. Results. The sample included information from 200 patient charts. Patients’ ages ranged from 5 to 94 years, with a mean of 61 years. Approximately 52% were female and 74.9% were admitted to a surgical service. The length of all inpatients’ stays ranged from less than 1 day to 31 days, with a mean of 4 days. Seventy-six different DRGs were recorded. The most frequent attending specialties for medical patients were hospital medicine, internal medicine, general surgery, and interventional cardiology. Consulting physicians had more patient encounters than any other healthcare provider. For all inpatients, an average of two attending physicians participated in care over the duration of their stay with a range of one to six attending physicians. There was an average of one hand-off between attending physicians. Patients had an average of five consulting physicians, two resident physicians, two physician assistants, and two nurse practitioners during a stay. There was an average of 10 total providers, with a range of one to 46 total providers participating in care. Conclusions. Understanding the provider data surrounding an inpatient stay is a foundational step in assessing the quality of the provider-inpatient encounter and potential areas for improvement. In this study, the average number of attending physicians and handoffs was reasonable; however, the total number of providers involved in care was relatively high. Assessment of staffing and scheduling requirements by hospital administration could identify areas of improvement to reduce the potential for medical error caused by multiple providers being involved in patient care.  &nbsp

Influence of dietary protein on glomerular filtration before and after bariatric surgery: a cohort study

BACKGROUND: Obesity-associated elevations in glomerular filtration rate (GFR) are common and may play a role in the development of kidney disease, so identifying the underlying mechanism is important. We therefore studied whether reductions in dietary protein intake, which is known to modulate GFR, explain why GFR decreases after bariatric surgery-induced weight loss. STUDY DESIGN: Cohort study with participants as their own controls. SETTING & PARTICIPANTS: 8 severely obese patients with normal kidney function were recruited from bariatric surgery centers in Indianapolis, IN. All participants were placed on a fixed-protein (50-g/d) diet for 1 week before and after a minimum of a 20-kg weight loss by bariatric surgery and were followed up closely by dieticians for adherence. PREDICTOR: Ad lib versus low-protein diet before versus after bariatric surgery. OUTCOME: Measured GFR, using repeated-measures analysis, was used to estimate the independent effects of diet and surgery. MEASUREMENT: GFR was measured using plasma iohexol clearance. RESULTS: A median of 32.9 (range, 19.5-54.4)kg was lost between the first presurgery visit and first postsurgery visit. Dietetic evaluations and urinary urea excretion confirmed that patients generally adhered to the study diet. GFRs on an ad lib diet were significantly higher before compared to after surgery (GFR medians were 144 (range, 114-178) and 107 (range, 85-147) mL/min, respectively; P=0.01). Although bariatric surgery (-26mL/min; P=0.005) and dietary sodium intake (+7.5mL/min per 100mg of dietary sodium; P=0.001) both influenced GFR, consuming a low-protein diet did not (P=0.7). LIMITATIONS: Small sample size; mostly white women; possible lack of generalizability. CONCLUSIONS: The decrease in GFR observed after bariatric surgery is explained at least in part by the effects of surgery and/or dietary sodium intake, but not by low dietary protein consumption

Paraclinoid aneurysms: Outcome analysis and technical remarks of a microsurgical series

Abstract Introduction A critical appraisal of the surgical results of paraclinoid aneurysms is essential in the flow diverters era. This study overviews the data of a three-decade surgical series of paraclinoid aneurysms while focusing on their technical remarks. Methods Overall data of a surgical consecutive series of paraclinoid aneurysms treated between 1993 and 2021 were retrospectively reviewed. Aneurysms were classified according to size and projection. Indications for surgery were different based on the availability of endovascular techniques, especially flow diverter, at the time of treatment. A statistical comparison between ruptured and unruptured aneurysms was accomplished. Results 58 patients were operated upon. Ophthalmic aneurysms were 68%, giant aneurysms 20%, and ruptured aneurysms 45%. Clipping and bypass were executed in 91% and 9% of cases, respectively. An mRS of 0–2 was achieved in 77% of patients, independently by the clinical onset. The mortality rate was 5%. Visual field was improved or unchanged in 71% of elective patients, whereas the incidence of de novo third and sixth cranial nerves deficit was 8% and 5%, respectively. On an average follow-up of 53.3 ± 38 months, a complete and durable aneurysm exclusion was achieved in 91.3% of patients with a single surgery. Conclusions Microneurosurgery is still a valuable treatment option for selected ruptured and unruptured paraclinoid aneurysms. In our experience, it has proven to be definitive and durable, with acceptable morbidity and mortality. Clipping is the treatment of choice in most surgical cases, achieving a good visual outcome in symptomatic patients