Prediction of Recovery From Severe Hemorrhagic Shock Using Logistic Regression.

This paper implements logistic regression models (LRMs) and feature selection for creating a predictive model for recovery form hemorrhagic shock (HS) with resuscitation using blood in the multiple experimental rat animal protocols. A total of 61 animals were studied across multiple HS experiments, which encompassed two different HS protocols and two resuscitation protocols using blood stored for short periods using five different techniques. Twenty-seven different systemic hemodynamics, cardiac function, and blood gas parameters were measured in each experiment, of which feature selection deemed only 25% of the them as relevant. The reduced feature set was used to train a final logistic regression model. A final test set accuracy is 84% compared to 74% for a baseline classifier using only MAP and HR measurements. Receiver operating characteristics (ROC) curve analysis and Cohens kappa statistics were also used as measures of performance, with the final reduced model outperforming the model, including all parameters. Our results suggest that LRMs trained with a combination of systemic hemodynamics, cardiac function, and blood gas parameters measured at multiple timepoints during HS can successfully classify HS recovery groups. Our results show the predictive ability of traditional and novel hemodynamic and cardiac function features and their combinations, many of which had not previously been taken into consideration, for monitoring HS. Furthermore, we have devised an effective methodology for feature selection and shown ways in which the performance of such predictive models should be assessed in future studies

Comprehensive Medication Management: Implications for the Patient and Pharmacist

Since 1979, state pharmacy practice laws have begun to allow pharmacists to provide advanced levels of care in collaboration with prescribers. These might be termed medication therapy management, collaborative practice, comprehensive medication management and other variations. Invariably, pharmacists working closely with prescribers and patients in care of chronic disease have achieved dramatic results including improvement in surrogate markers, decreased rates of secondary large organ disease, decreased mortality, decreased hospitalizations, and as a result decreased spending.1-28 This paper will discuss the profound impact of advanced practice models on patient care and the health care system, the current status of New York’s collaborative drug therapy management law, the comprehensive medication management proposal in Governor Cuomo’s fiscal year 2018 Budget bill, and its potential impact on morbidity and mortality when applied to chronic disease

Improving Queensland speed zoning practices

Queensland speed limits are assessed against the guidelines outlined within Part 4 of the Manual of Uniform Traffic Control Devices (MUTCD Part 4), which is maintained by the Queensland Department of Transport and Main Roads. This project was undertaken in order to develop recommendations for improvements in future revisions of MUTCD Part 4 that meet the needs of local government and industry users. The current framework outlined within MUTCD Part 4 can be difficult for practitioners to follow and often adds unnecessary cost and complexity to speed zoning processes. Results between different users may be inconsistent as a result. It is also structured towards application on State roads, which means that it does not consistently align with local government needs regarding transport planning and traffic operations. It is believed that amendments to particular elements of the guidelines will increase practicality in application and ensure consistent speed zoning in Queensland. Local and international guidelines for speed zoning were reviewed to understand the processes undertaken by other road authorities. The possibilities of using speed measuring technology and risk assessment tools to analyse speed limits were also considered. Interviews were conducted to identify stakeholder issues with MUTCD Part 4, and to assist in making informed recommendations for future revisions. Additionally, case studies were conducted using different speed zoning processes on a sample of roads to identify the strengths and weaknesses of processes used by other state and international road authorities. These results were compared to those obtained using MUTCD Part 4. Project tasks highlighted numerous aspects of MUTCD Part 4 that could be improved and provided a basis for recommendations to be considered in future revisions of the guidelines. Suggested recommendations include amendments to road function classification, criteria-based speed limits for all speed limits, flowchart mapping of processes for clarity, inclusion of design guidance to effect speed reductions and updates to the online assessment tool, QLIMITS. If adopted by the Department of Transport and Main Roads, future amendments to MUTCD Part 4 may result in more consistency in speed zoning practise and provide a document that will be practical for transport planning purposes. The suggested recommendations may also contribute to improving community understanding and acceptance of Speed Zoning procedures. Further work after completion of this project involves approaching The Department of Transport and Main Roads to discuss the project and suggested recommendations for consideration in future amendments to MUTCD Part 4