20 research outputs found
Field study on the behavior of right-turning vehicles in Malaysia and their contribution on the safety of unsignalized intersections
AbstractBehavior of right turning vehicles in the context of safety is characterized by their use of turning indicators and compliance with the stop rule. They are influence by the width of the carriageway and the variation in volume on the major road with respect to the traffic moving in the near and far side direction. Other factors affecting the behavior are the speed and spacing between vehicles moving on the major road. Lack of adequate past knowledge on the effect of geometric variation in terms of road width and directional variation in volume on the safety of unsignalized intersections have provided the motivation for this study. This paper focuses on the many factors that affect the behavior of right-turning vehicles resulting into conflicts. A brief account of the unique indigenous maneuver termed as the “Weaving Merging Right Turn” (WMRT) is provided and its effectiveness with respect to conventional right turn is evaluated. Data of 39,016 vehicles collected on 10 sites between January and June 2014 was analyzed. Multiple accidents were observed only on sites which had near side traffic volume greater than far side traffic volume. This result remains consistent with sites having single as well as multiple lanes per direction on the major roads. The number of conflicts for vehicles performing the WMRT was 2.5 times less as compared to the conventional right turn. Moreover WMRT was found to be the maneuver of choice for right turning motorcyclists with 60% of them opting for it over the conventional right turn on intersections having major road width less than 9m. None of the motorcyclists, which were involved in a traffic conflict, were observed to use their turning indicator. Moreover none of the motorcyclists, which experienced a traffic conflict, were found to comply with the stopping rule at sites with major road width less than 9m. On sites with major road width greater than 9m, 45% of motorcyclists, involved in a traffic conflict, complied with the stopping rule as compared to 79% by vehicles other than motorcycles
Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial
Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma.
Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We
aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.
Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries.
Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the
minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and
had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were
randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical
apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to
100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a
maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h
for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to
allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients
who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable.
This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.
Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid
(5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated
treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the
tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18).
Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and
placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein
thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of
5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).
Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our
results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a
randomised trial
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Accident Analysis Using Count Data for Unsignalized Intersections in Malaysia
AbstractAccident data could be of various types. Count data being one of them. Effective accident analysis requires classification of count data with respect to geometric and control parameters. This paper focuses on the analysis of the effects of road width, land use, lane marking and traffic control on safety of unsignalized intersections. Intersection lying in non-urban areas with single line marking and no control on minor road were found to be the most vulnerable. The results are discussed and the recommendations are provided
Evaluation of the dynamic modulus of asphalt mixture incorporating reclaimed asphalt pavement
376-384This paper presents the effects of
temperature and loading frequency on the dynamic modulus and phase angle of
asphalt mixtures incorporating reclaimed asphalt pavement (RAP) using the
asphalt mixture performance tester. Milling waste from Damansara-Puchong
Expressway is incorporated in asphalt mixtures in proportions of 0%, 10%, 20%,
30% and 40%. The asphalt mixtures are tested for dynamic modulus at three
temperatures (20, 40, 50°C) and six loading frequencies (0.1, 0.5, 1, 5, 10 and
25 Hz). At constant temperature, the dynamic modulus increased
as the loading frequency and RAP content increased. For
a given frequency, the dynamic modulus decreased while the phase angle increased
as the temperature increased. From statistical
analysis, test
temperature and frequency have significant effects with high effect size on the
measured dynamic modulus and phase angle. The interaction effect of frequency
and RAP give the highest effect size among the interaction effects in the
dynamic modulus test. The results also indicated that the highest performance
in terms of rutting and fatigue factors can be attained when the frequency of
cumulative traffic loading was from 15 to 20 Hz.
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Information technology risk management for water quality monitoring IoT infrastructure: a case study at Tasik Chini Unesco Biosphere Reserve
Due to its rich and diverse biodiversity of flora and fauna, Tasik Chini, a UNESCO Bisosphere Reserve, is a
national heritage that must be preserved and protected. Ensuring healthy water quality here is vital for the survival
of the ecosystem. Water quality was constantly being monitored through the use of a network of sensors and
telemetry system that collect parameters to determine Water Quality Index since 2004. However, two events have
rendered the setup to be inadequate: the economic activities around the lake and the big flood of 2014. Both events
has proven that the IoT infrastructure at Tasik Chini is inadequate to mitigate major disaster. The risk of both
natural and man-made disasters happening always increased yearly and has a huge impact on water quality
monitoring as well as the dissemination and sharing of data and results. A proper management plan to mitigate
these risks is needed. The purpose of this paper is to highlight a successful research methodology that has been
proposed and done in monitoring and improving Tasik Chini water quality. First, needs analysis were carried out
through face-to-face interaction with researchers and the indigenous community living within the vicinity of the
lake. Historical water quality data were also compiled and analyzed to validate the degradation of water quality
over the years. Second, a proper risk registers and risk respond plan was developed. The current telemetry and
network of sensors were reengineered by introducing new online tools for sharing and disseminating of water
quality data to more diverse stakeholders. Cloud and 4G services are now the integral part of monitoring. Third,
an early warning system has been developed to complete the setup