Safety Evaluation of Changing Speed Limit from 55 mph to 60 mph on Two-Lane, Two-Way Road Segments

This paper describes the efforts to evaluate the safety impacts of increasing the speed limit from 55?mph to 60?mph on selected two-lane, two-way state highway road segments in Minnesota, U.S. An empirical Bayes (EB) before?after analysis was used to estimate crash modification factors (CMFs) for both segments (1,909.11?mi) and intersections (1,722 3-leg and 1,191 4-leg). Aggregate analysis conducted using all the segment and intersection data showed a 2.9% increase in total crashes, a 2.5% increase in injury (KABC) crashes, and a 0.05% reduction in the injury (KAB) crashes. These results?along with before-and-after operating speed data from another study by Minnesota Department of Transportation (MnDOT) (2019) showing that the 85th percentile operating speed remained the same and that the mean operating speeds increased by 1?mph following the speed limit increase?can lead to a conclusion that the speed limit increase from 55?mph to 60?mph had a minor effect on combined segment and intersection crashes or operating speeds. It is important to note that these results are specific to the corridors that were selected by MnDOT for the increase in speed limit; caution must be exercised when extending these to systemwide increases in speed limits in Minnesota or in other states, and when estimating long-term effects of speed limit increases as operating speeds can change over a longer period of time

Finite Element Modeling of Post-Tensioned Two-Way Concrete Slabs under Flexural Loading

Post-Tensioned (PT) method is a widely used technique to prevent cracking and to minimize the deflection which is resulted by loads. In this method, stress is applied after concrete placing and reach adequate hardening and strength. This paper investigates the structural behaviour of PT two-way concrete slabs. The main objective of this study involves a detailed flexural behavior analytical investigation of PT concrete two-way slab with the different bonded tendon layout. This will be achieved by non-linear Finite Element (FE) analysis programs method, to choose the most effective and optimum position of tendon layout with different number of tendons and applied load on the concrete two-way slab. A parametric study was conducted to investigate the effect of tendons layout on the overall behavior of post-tensioned two-way concrete slab. The result obtained from finite element analysis showed that the failure load in PT in both directions increased about 89 % as compared with slab PT in one direction

A PROPOSED DUAL SIZE DESIGN FOR ENERGY MINIMIZATION IN SUB-THRESHOLD CIRCUITS

Sub-threshold operation has received a lot of attention in limited performance applications.However, energy optimization of sub-threshold circuits should be performed with the concern of the performance limitation of such circuit. In this paper, a dual size design is proposed for energy minimization of sub-threshold CMOS circuits. The optimal downsizing factor is determined and assigned for some gates on the off-critical paths to minimize the energy at the maximum allowable performance. This assignment is performed using the proposed slack based genetic algorithm which is a heuristic-mixed evolutionary algorithm. Some gates are heuristically assigned to the original and the downsized design based on their slack time determined by static timing analysis. Other gates are subjected to the genetic algorithm to perform an optimal downsizing assignment taking into account the previous assignments. The algorithm is applied for different downsizing factors to determine the optimal dual size for low energy operation without a performance degradation. Experimental results are obtained for some ISCAS-85 benchmark circuits such as 74283, 74L85, ALU74181, and 16 bit ripple carry adder. The proposed design shows an energy per cycle saving ranged from (29.6% to 56.59%) depending on the utilization of available slack time from the off-critical paths

Operability, usefulness, and task-technology fit of an mHealth App for delivering primary health care services by community health workers in underserved areas of Pakistan and Afghanistan: Qualitative study

Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan.Objective: Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems.Methods: The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis.Results: Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants.Conclusions: The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology

Visual Perceptions Skills and its Association with Written Mathematical Communication Skills among Learning Disabilities Students in Jordan

# Aim The present research sought at investigating the association between visual perception skills and written mathematical communication skills among a sample of students with learning disabilities in mathematics in Jordan. # Method This was a cross-sectional correlational study that included a sample of 90 primary-stage students who were diagnosed as having learning disabilities in mathematics. To collect data, the researchers developed two data collection tools; the visual perception skills test (50 items) and the written mathematical communication skills test (6 items). The tests were validated and ensured for reliability before implementation on the original study sample. The data gathered in this study was analyzed using the Statistical Package of Social Sciences (SPSS). # Results The results showed that there was a significant statistical association between visual discrimination and Written mathematical communication skills test (r=0.218), visual closing test and Written mathematical communication skills test (r=0.411), shape relationship perception test and Written mathematical communication skills test (r=0.438), Visual Integration and Spatial Relationship Perception Test and Written mathematical communication skills test (r=0.614), Visual information recall test and Written mathematical communication skills test (r=0.154). The results showed that there was a significant positive association between visual perception skills and written mathematical communication skills (r=0.509). # Conclusion The study ended up with that there is a significant positive association between visual perception skills and written mathematical communication skills among students with learning disabilities in mathematics. The study recommends developing mathematical educational material based on the visual approach and improving these skills among students with learning disabilities to develop their written mathematical communication skills

High-tension Cable Median Barrier Safety Effectiveness Evaluation

(c) 1030652The objective of this study was to evaluate the change in crash frequency or severity of varying lateral offset distances of high-tension cable median barriers in Minnesota. Crash and traffic data from 2016 to present were conjoined with roadway cross-sectional data and high-tension cable barrier locations to perform cross-sectional analyses for interstate segments equal to or greater than 0.05-miles long. Negative binomial regression models were estimated and used to develop crash modification factors (CMFs) for the following crash types: total crashes, target crashes, and barrier crashes. In addition to evaluating the impact of lateral offset, a na\uefve before-after evaluation was completed to quantify the impact of installing high-tension cable barrier

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians