Improvement of Fatal Crash Analysis and Follow-Up

Executive Summary Fatalities resulting from traffic crashes in Kentucky increased from a low of 638 in 2013 to 834 in 2016 (a 31% increase), and there is not a full understanding of the underlying causes for this trend. This study analyzes fatal crashes using data from both Kentucky’s crash reports and the National Highway Traffic Safety Administration’s (NHTSA) Fatal Accident Reporting System (FARS) to identify countermeasures to combat increasing fatal crash rates. In addition, this study compares Kentucky’s crash reports to the fatal crash data in FARS to identify data inconsistencies and recommend procedures to eliminate these inconsistencies. Emphasis was placed on fatal crashes involving alcohol and drugs because police-reported crash data in Kentucky do not clearly represent the magnitude of alcohol- and drug-related fatal crashes. More detailed analysis of fatal crashes involving alcohol and drugs provides an understanding of the patterns of impaired drivers in terms of their overall characteristics, crash locations, time of day, types of drugs, and other identifying factors that affect patterns and behavior. The study identified crashes involving mature drivers (65+) and lane departure crashes as fatal crash types with the greatest increases since 2013. Pedestrian, motorcycle, intersection, and impairment-related fatal crashes also demonstrated increasing fatal crash rates in 2016. Analysis of restraint use showed that almost 54% of the fatally injured people in 2016 were not wearing a seatbelt when one was available to them. Of those fatally injured in a motorcycle crash, nearly 72% were not wearing a helmet. Based on FARS data, there were 160 fatal crashes in Kentucky in which a driver tested positive for alcohol and 266 fatal crashes where a driver tested positive for at least one drug. The drugs most frequently found in drivers were tetrahydrocannabinol (THC), hydrocodone, and Xanax. In general, fatal crash frequency spiked during the morning and afternoon peak hour periods, with fatalities occurring more frequently between 11 am and 11 pm. The percent of potentially impaired (alcohol- and drug-involved) fatal crashes increased between 5 pm and 4 am from around 40% to a peak of 81% at 4 am. Eastern Kentucky was identified as a region with high fatal crash rates and potentially impaired fatal crash rates. Both Ballard and Union Counties in Western Kentucky showed high fatality and potentially impaired fatality rates as well. Comparisons between the FARS database and Kentucky’s crash reports revealed inconsistencies between the date, time, location, injury severity, and impairment indications in the two databases. Recommendations stemming from this study were divided into four categories: enforcement, legislation/licensing, public involvement, and data collection. The recommendations are aimed at reducing crash fatalities, improving crash data collection, and improving consistency between Kentucky’s crash reports and the national FARS database

Analysis of Traffic Crash Data in Kentucky 2015-2019

Executive Summary and Introduction This report documents an analysis of traffic crash data in Kentucky. A primary objective of this study was to determine average crash statistics for Kentucky highways. Where used, rates were calculated for various types of highways and for counties and cities. Difference criteria were used for exposure. Average and critical numbers, SPFs, and rates of crashes were calculated for various types of highways in rural and urban areas. These use crashes identified on highways where Annual Average Daily Traffic (AADT) volumes were available. The data in this report may be used to help identify problem areas. The other primary objective of this study was to provide data that can be used in the preparation of the problem identification portion of Kentucky’s Annual Highway Safety Plan (HSP). Crash statistics were analyzed and a summary of results and recommendations in several problem identification areas is presented. These general areas include; alcohol involvement, occupant protection, speed, teenage drivers, pedestrians, bicycles, motorcycles, trucks, and vehicle defects. Other areas included in the analysis for which specific recommendations were not made include, school bus crashes and train crashes. The crash data are stored in the Collision Report Analysis for Safer Highways (CRASH) database. This database is updated daily so the number of crashes in a given calendar year will continue to change for a substantial time after the end of that year. KTC captures an extract annually for analysis. Annual reports have previously been prepared since 1978 dealing with the calculation of statewide traffic crash rates for Kentucky and preparation of the problem identification portion of Kentucky’s Annual Highway Safety Plan. Traffic crash data for a five-year period were used in the preparation of this report. Kentucky has a systematic procedure to identify locations that have had abnormal rates or numbers of traffic crashes. However, before that procedure may be utilized, average crash rates and numbers must be determined for appropriate highway categories and for rural and urban areas. A primary objective of this study was to determine average traffic crash statistics for Kentucky. Those statistics may then be used in the high-crash location identification program to identify locations that should be investigated to determine whether changes should be made. A highway safety program is prepared each year for Kentucky in order to comply with Section 402, Title 23 of the United States Code. This program includes the identification, programming, budgeting, and evaluation of safety projects with the objective of reducing the number and severity of traffic crashes. The second major objective of this report is to provide data that may be included as the problem identification portion of Kentucky’s Annual Highway Safety Plan. Results from this report are used to provide benchmark data for that process

Seeking to Belong: How the Words of Internal and External Beneficiaries Influence Performance

In this paper, we examine how connecting to beneficiaries of one’s work increases performance, and argue that beneficiaries internal to an organization (i.e., one’s own colleague) can serve as an important source of motivation, even in jobs that – on the surface – may seem routine and low on potential impact. We suggest that this occurs because words of beneficiaries strengthen one’s sense of belongingness, a key driver of human behavior. Employees, in fact, seek to belong—and seek to enhance their sense of belongingness in work settings. We conducted two studies using both field and laboratory data from different populations to investigate the psychological consequences and performance benefits of connecting to beneficiaries of one’s work. In a longitudinal field experiment of fruit harvesters, we find that though beneficiary contact with the overall customer did not significantly improve productivity, contact with an internal beneficiary that made connectedness salient yielded a persistent increase in productivity relative to a control group. We validate this effect in the laboratory, and provide evidence that the effect is mediated by an enhanced sense of belongingness

Pathologist Concordance for Ovarian Carcinoma Subtype Classification and Identification of Relevant Histologic Features Using Microscope and Whole Slide Imaging.

CONTEXT.—: Despite several studies focusing on the validation of whole slide imaging (WSI) across organ systems or subspecialties, the use of WSI for specific primary diagnosis tasks has been underexamined. OBJECTIVE.—: To assess pathologist performance for the histologic subtyping of individual sections of ovarian carcinomas using a light microscope and WSI. DESIGN.—: A panel of 3 experienced gynecologic pathologists provided reference subtype diagnoses for 212 histologic sections from 109 ovarian carcinomas based on optical microscopy review. Two additional attending pathologists provided diagnoses and also identified the presence of a set of 8 histologic features important for ovarian tumor subtyping. Two experienced gynecologic pathologists and 2 fellows reviewed the corresponding WSI images for subtype classification and feature identification. RESULTS.—: Across pathologists specialized in gynecologic pathology, concordance with the reference diagnosis for the 5 major ovarian carcinoma subtypes was significantly higher for a pathologist reading on a microscope than each of 2 pathologists reading on WSI. Differences were primarily due to more frequent classification of mucinous carcinomas as endometrioid with WSI. Pathologists had generally low agreement in identifying histologic features important to ovarian tumor subtype classification with either an optical microscopy or WSI. This result suggests the need for refined histologic criteria for identifying such features. Interobserver agreement was particularly low for identifying intracytoplasmic mucin with WSI. Inconsistencies in evaluating nuclear atypia and mitoses with WSI were also observed. CONCLUSIONS.—: Further research is needed to specify the reasons for these diagnostic challenges and to inform users and manufacturers of WSI technology

Issues in the Differential Diagnosis of Uterine Low-grade Endometrioid Carcinoma, Including Mixed Endometrial Carcinomas: Recommendations from the International Society of Gynecological Pathologists

This article provides practical recommendations developed from the International Society of Gynecological Pathologists Endometrial Carcinoma Project to address 4 issues that may arise in the diagnosis of uterine corpus low-grade endometrioid carcinoma: (1) The distinction between atypical hyperplasia and low-grade endometrioid carcinoma. (2) The distinction between low-grade endometrioid carcinoma and serous carcinoma. (3) The distinction between corded and hyalinized or spindle cell variants of low-grade endometrioid carcinoma and carcinosarcoma. (4) The diagnostic criteria for mixed endometrial carcinomas, a rare entity that should be diagnosed only after exclusion of a spectrum of tumors including morphologic variants of endometrioid carcinoma, dedifferentiated endometrial carcinoma, carcinosarcoma, and endometrial carcinomas with ambiguous morphology

Target Zones in History and Theory: Lessons from an Austro-Hungarian Experiment (1896-1914)

The first known experiment with an exchange rate band took place in Austria- Hungary between 1896 and 1914. The rationale for introducing this policy rested on precisely those intuitions that the modern literature has emphasized: the band was designed to secure both exchange rate stability and monetary policy autonomy. However, unlike more recent experiences, such as the ERM, this policy was not undermined by credibility problems. The episode provides an ideal testing ground for some important ideas in modern macroeconomics: specifically, can formal rules, when faithfully adhered to, provide policy makers with some advantages such as short term autonomy? First, we find that a credible band has a "microeconomic" influence on exchange rate stability. By reducing uncertainty, a credible fluctuation band improves the quality of expectations, a channel that has been neglected in the modern literature. Second, we show that the standard test of the basic target zone model is flawed and develop an alternative methodology. We believe that these findings shed a new light on the economics of exchange rate bands

High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations

This review of challenging diagnostic issues concerning high-grade endometrial carcinomas is derived from the authors' review of the literature followed by discussions at the Endometrial Cancer Workshop sponsored by the International Society of Gynecological Pathologists in 2016. Recommendations presented are evidence-based, insofar as this is possible, given that the levels of evidence are weak or moderate due to small sample sizes and nonuniform diagnostic criteria used in many studies. High-grade endometrioid carcinomas include FIGO grade 3 endometrioid carcinomas, serous carcinomas, clear cell carcinomas, undifferentiated carcinomas, and carcinosarcomas. FIGO grade 3 endometrioid carcinoma is diagnosed when an endometrioid carcinoma exhibits >50% solid architecture (excluding squamous areas), or when an architecturally FIGO grade 2 endometrioid carcinoma exhibits marked cytologic atypia, provided that a glandular variant of serous carcinoma has been excluded. The most useful immunohistochemical studies to make the distinction between these 2 histotypes are p53, p16, DNA mismatch repair proteins, PTEN, and ARID1A. Endometrial clear cell carcinomas must display prototypical architectural and cytologic features for diagnosis. Immunohistochemical stains, including, Napsin A and p504s can be used as ancillary diagnostic tools; p53 expression is aberrant in a minority of clear cell carcinomas. Of note, clear cells are found in all types of high-grade endometrial carcinomas, leading to a tendency to overdiagnose clear cell carcinoma. Undifferentiated carcinoma (which when associated with a component of low-grade endometrioid carcinoma is termed "dedifferentiated carcinoma") is composed of sheets of monotonous, typically dyscohesive cells, which can have a rhabdoid appearance; they often exhibit limited expression of cytokeratins and epithelial membrane antigen, are usually negative for PAX8 and hormone receptors, lack membranous e-cadherin and commonly demonstrate loss of expression of DNA mismatch repair proteins and SWI-SNF chromatin remodeling proteins. Carcinosarcomas must show unequivocal morphologic evidence of malignant epithelial and mesenchymal differentiation

Historical influences on the current provision of multiple ecosystem services: is there a legacy of past landcover?

Ecosystem service provision varies temporally in response to natural and human-induced factors, yet research in this field is dominated by analyses that ignore the time-lags and feedbacks that occur within socio-ecological systems. The implications of this have been unstudied, but are central to understanding how service delivery will alter due to future land-use/cover change. Urban areas are expanding faster than any other land-use, making cities ideal study systems for examining such legacy effects. We assess the extent to which present-day provision of a suite of eight ecosystem services, quantified using field-gathered data, is explained by current and historical (stretching back 150 years) landcover. Five services (above-ground carbon density, recreational use, bird species richness, bird density, and a metric of recreation experience quality (continuity with the past) were more strongly determined by past landcover. Time-lags ranged from 20 (bird species richness and density) to over 100 years (above-ground carbon density). Historical landcover, therefore, can have a strong influence on current service provision. By ignoring such time-lags, we risk drawing incorrect conclusions regarding how the distribution and quality of some ecosystem services may alter in response to land-use/cover change. Although such a finding adds to the complexity of predicting future scenarios, ecologists may find that they can link the biodiversity conservation agenda to the preservation of cultural heritage, and that certain courses of action provide win-win outcomes across multiple environmental and cultural goods