Using “big Data” To Study Orthopaedic Trauma Populations: Looking At Fractures From A Bird’s Eye View As Illustrated By Three Studies

Background “Big data” is increasingly being used for orthopaedic research. However, the acute and complex nature of orthopaedic trauma makes data collection and data analysis difficult. This thesis presents three different clinical studies, which together illustrate how databases may best be used to answer clinical questions in orthopaedic trauma. Specifically the studies aim to show (1) how different databases capture trauma populations, (2) how databases may be used for hypothesis discovery studies, and (3) how databases may be used for hypothesis testing studies. Study Questions (1) How do populations of femoral shaft fracture patients differ in three commonly used national databases, specifically in regards to age and preexisting comorbidities? (2) What risk factors are associated with delayed surgery after elderly hip fractures in a national cohort and subsequently an institutional cohort? (3) Does hospital resource utilization differ between subpopulations of patients in Medicare Diagnosis Related Group 536 (fractures of the hip and pelvis), despite equal Medicare hospital reimbursement? Methodology (1) Patients with surgically managed femoral shaft fractures were identified in the Nationwide Inpatient Sample (NIS), National Surgical Quality Improvement Program (NSQIP) and National Trauma Data Bank (NTDB). The distributions of age and Charleston Comorbidity Index were compared between populations. (2) A retrospective cohort study was conducted of all elderly hip fracture patients receiving surgical management from 2011-2012 in the NTDB and from 2009-2015 at a single academic trauma center. Multivariate analysis was used to identify the independent effect of various risk factors on surgical timing. (3) Patients with hip fractures, non-operative pelvic fractures, acetabulum fractures, and operative pelvic fractures were identified in the 2011 – 2012 NTDB. Total inpatient length of stay, intensive care unit (ICU) stay, and ventilator time were compared across groups using multivariate analysis that controlled for patient and hospital factors. Results (1) A predominantly older population with more preexisting comorbidities was found in NSQIP (age = 71.5, CCI = 4.9), while a substantially younger population with fewer preexisting comorbidities was fond in NTDB (age = 45.2, CCI = 2.1). Bimodal distributions in the NIS population indicate a more mixed population (age = 56.9, CCI = 3.2). Differences in age were all statistically significant (p \u3c 0.001). (2) In the national cohort, mean time to surgery was 31.3 hours (standard deviation: 31.6 hours). The risk factors with largest association with delays were total arthroplasty surgery (coefficient, in hours [95% confidence interval]: 7.7 [6.1 – 9.3]) coagulopathy, including chronic anticoagulation (7.1 [6.1 – 8.0]), and congestive heart failure (6.9 [6.0 – 7.9]). In the institutional cohort, mean time to surgery was 32.4 hours (standard deviation: 29.0 hours). In this cohort, the only statistically significant risk factors associated with surgical timing were total arthroplasty surgery (24.5 [13.7 – 35.4]), transfer from outside hospital (22.1 [15.1 – 29.1]), warfarin anticoagulation (13.7 [8.5 – 18.8]), other anticoagulation (10.5 [2.4 – 18.5]), and preoperative hematocrit \u3c 35% (5.5 [2.0 – 9.0]). (3) After controlling for patient and hospital factors, the difference in inpatient length of stay compared to hip fracture patients was -0.2 days (95% C.I.: -0.4 to -0.1 days; P = 0.001) for non-operative pelvis fractures, 1.7 days (95% C.I.: 1.4 to 1.9 days; P \u3c 0.001) for acetabulum fractures, and 7.7 days (95% C.I.: 7.0 to 8.4 days; P \u3c 0.001) for operative pelvic fractures. Similar differences were also noted for IVU stay and ventilator time. Conclusion (1) While these three national databases have been commonly used for orthopaedic trauma research, differences in the populations they contain are not always readily apparent. Care must be taken to fully understand these populations before performing or evaluating database research, as these differences clearly affect observed outcomes. (2) Of all risk factors identified, access to arthroplasty and management of chronic anticoagulation may be the most modifiable in order to reduce delayed hip fracture surgeries. Physician call coverage and algorithms for more rapid reversal of anticoagulation, namely warfarin anticoagulation, warrant further investigation. (3) Because hospitals are reimbursed equally for these subgroups of Medicare DRG 536, those centers that care for a greater proportion of more-complex pelvic trauma will experience lower financial margins per trauma patient, limiting their potential for growth and investment compared with competing institutions that may not routinely see high-energy trauma

A Prototype Design for a Self-Balancing Tray

Self-balancing platforms are used in a variety of industries such as in construction to ensure a level place to pour concrete, in NASA’s design of the Apollo 13 rocket to ensure the Rocketship maintains a certain orientation, and in photography for camera stabilization on drones and handheld devices like the DJI Osmo. The purpose of these kinds of platforms is to ensure stability in an environment that is not typically stable so that tasks, such as construction or working in outer space, can be done easily and safely. The purpose of our Prototype is to create a smaller self-balancing platform that is useful in doing a small domestic task like keeping a tray of food balanced

Experimentation and Simulation of a Small-Scale Adsorption Cooling System in Temperate Climate

peer reviewedThis paper focuses on the analysis of the operation of a solar cooling system based upon an adsorption chiller. The air-conditioned building studied is a laboratory located in a temperate climate region (Belgium). The monitoring reveals thermal and electrical coefficient of performance (COP) of the cooling system for different time scale (10s to 1 month). The whole system including solar collectors, adsorption machine, recooling unit and hot storage is simulated. The models are then confronted to the measurements. Measurement period is shared between 2011 and 2012. Enhancements have been achieved during winter 2011 to have a more efficient system operation. The aim of this experimental work is to describe, for both measurement periods, the influence of operating conditions on the energy efficiency (thermal behavior and electrical consumption). On the simulation point of view, the main objective is to find accurate models for all the components. The adsorption chiller model is not yet precise enough to evaluate the performance of solar cooling in other conditions

Effectiveness of durian peel ethanol extract for lowering blood sugar levels in alloxan diabetic wistar rats

High blood sugar levels can be influenced by several factors, including high-carbohydrate food consumption and a lack of physical activity. To minimize the side effects of hyperglycemic treatment, efforts have been made to explore anti-hyperglycemic compounds from other sources, such as durian peel (Durio zibetthinus Murr.). This study aimed to determine the effectiveness of ethanol extract from durian peel in lowering alloxan-induced blood sugar levels in Wistar rats (Rattus novergicus). The study is an experimental research employing an alloxan-induced diabetic rat model. The rats were divided into five different groups: Group I (negative control), Group II (positive control), Group III (dose 25 × 10–30/gBW), Group IV (dose 50 × 10–30/gBW), and Group V (dose 100 × 10–30/gBW). The durian peel used in this study was extracted using the maceration method with ethanol as the solvent. The results of this study indicate that ethanol extract from durian peel significantly reduced blood sugar levels after 10 to 15 days of durian peel extract administration (p < 0.05)

PENGARUH STRATEGI PEMBELAJARAN HIGHER ORDER THINKING TERHADAP HASIL BELAJAR AKUNTANSI SISWA KELAS XI IPS DI SMAN 1 KABANJAHE TAHUN PEMBELAJARAN 2017/2018

Permasalahan dalam penelitian ini adalah rendahnya hasil belajar akuntansi siswa kelas XI IPS di SMAN 1 Kabanjahe. Penelitian ini bertujuan untuk mengetahui hasil belajar akuntansi dengan menggunakan strategi pembelajaran Higher Order Thinking pada siswa kelas XI IPS di SMAN 1 Kabanjahe pada pokok bahasan Laporan Keuangan Perusahaan Jasa. Penelitian ini dilaksanakan di SMA Negeri 1 Kabanjahe yang berlokasi di Jalan Jamin Ginting No. 31 Kabanjahe pada tahun pembelajaran 2017/2018 dengan jumlah populasi 136 orang. Sampel dalam penelitian ini diambil dengan teknik purposive sampling, yaitu kelas XI IPS 1 sebanyak 30 orang terpilih sebagai kelas eksperimen dan kelas XI IPS 2 sebanyak 30 orang terpilih sebagai kelas kontrol. Instrumen yang digunakan untuk mengumpulkan data adalah tes pilihan berganda sebanyak 25 soal yang masing-masing terdiri dari 5 opsi yang dikutip penulis dari buku sehingga validitas dan realibilitasnya telah teruji. Teknik analisis data yang digunakan yaitu dengan cara menghitung nilai mean dan standar deviasi. Dari hasil analisis data kelas eksperimen nilai rata-rata pre-test 39,33 dan post-test 78,40 dengan standar deviasi 9,40 dan 10,37. Sedangkan pada kelas kontrol nilai rata-rata pre-test 37,20 dan post-test 69,73 dengan standar deviasi 8,16 dan 9,31. Pengujian hipotesis dari hasil post-test yang dilakukan diperoleh thitung = 3,41, dan ttabel = 1,671. Dengan membandingkan kedua nilai tersebut maka dapat disimpulkan thitung > ttabel yaitu 3,41>1,671. Melalui kriteria pengujian hipotesis dapat ditentukan bahwa thitung > ttabel maka hipotesis diterima. Dengan demikian, dapat disimpulkan bahwa hasil belajar akuntansi yang diajar dengan strategi pembelajaran Higher Order Thinking lebih tinggi secara signifikan dibanding hasil belajar akuntansi yang diajarkan dengan metode pembelajaran Konvensional pada siswa kelas XI IPS SMAN 1 Kabanjahe Tahun Pembelajaran 2017/2018 pada pokok bahasan laporan keuangan perusahaan jasa

A coherence-matched linear source mechanism for subsonic jet noise

We investigate source mechanisms for subsonic jet noise using experimentally obtained datasets of high-Reynolds-number Mach 0.4 and 0.6 turbulent jets. The focus is on the axisymmetric mode which dominates downstream sound radiation for low polar angles and the frequency range at which peak noise occurs. A linearized Euler equation (LEE) solver with an inflow boundary condition is used to generate single-frequency hydrodynamic instability waves, and the resulting near-field fluctuations and far-field acoustics are compared with those from experiments and linear parabolized stability equation (LPSE) computations. It is found that the near-field velocity fluctuations closely agree with experiments and LPSE computations up to the end of the potential core, downstream of which deviations occur, but the LEE results match experiments better than the LPSE results. Both the near-field wavepackets and the sound field are observed directly from LEE computations, but the far-field sound pressure levels (SPLs) obtained are more than an order of magnitude lower than experimental values despite close statistical agreement of the near hydrodynamic field up to the potential core region. We explore the possibility that this discrepancy is due to the mismatch between the decay of two-point coherence with increasing distance in experimental flow fluctuations and the perfect coherence in linear models. To match the near-field coherence, experimentally obtained coherence profiles are imposed on the two-point cross-spectral density (CSD) at cylindrical and conical surfaces that enclose near-field structures generated with LEEs. The surface pressure is propagated to the far field using boundary value formulations based on the linear wave equation. Coherence matching yields far-field SPLs which show improved agreement with experimental results, indicating that coherence decay is the main missing component in linear models. The CSD on the enclosing surfaces reveals that the application of a decaying coherence profile spreads the hydrodynamic component of the linear wavepacket source on to acoustic wavenumbers, resulting in a more efficient acoustic source.This is the author accepted manuscript. The final version is available from Cambridge University Press via http://dx.doi.org/10.1017/jfm.2015.32

Ultraviolet relaxation dynamics in uracil: Time-resolved photoion yield studies using a laser-based thermal desorption source

Wavelength-dependent measurements of the RNA base uracil, undertaken with nanosecond ultraviolet laser pulses, have previously identified a fragment at m/z = 84 (corresponding to the C3H4N2O+ ion) at excitation wavelengths ≤232 nm. This has been interpreted as a possible signature of a theoretically predicted ultrafast ring-opening occurring on a neutral excited state potential energy surface. To further investigate the dynamics of this mechanism, and also the non-adiabatic dynamics operating more generally in uracil, we have used a newly built ultra-high vacuum spectrometer incorporating a laser-based thermal desorption source to perform time-resolved ion-yield measurements at pump wavelengths of 267 nm, 220 nm, and 200 nm. We also report complementary data obtained for the related species 2-thiouracil following 267 nm excitation. Where direct comparisons can be made (267 nm), our findings are in good agreement with the previously reported measurements conducted on these systems using cold molecular beams, demonstrating that the role of initial internal energy on the excited state dynamics is negligible. Our 220 nm and 200 nm data also represent the first reported ultrafast study of uracil at pump wavelengths 3(1ππ*) state. These measurements do not, however, provide any evidence for the appearance of the m/z = 84 fragment within the first few hundred picoseconds following excitation. This key finding indicates that the detection of this specific species in previous nanosecond work is not directly related to an ultrafast ring-opening process. An alternative excited state process, operating on a more extended time scale, remains an open possibility