Expert consensus guidelines: Intravenous iron uses, formulations, administration, and management of reactions.

Intravenous iron has become an essential component for the treatment of iron deficiency and iron deficiency anemia. Individuals administering Intravenous iron should have knowledge in intravenous iron administration, including a pre-infusion assessment to evaluate infusion reaction risks, pre- and post-infusion monitoring, identification of and management of infusion reactions, accurate documentation of these reactions, laboratory monitoring and recognition and management of treatment-emergent hypophosphatemia. This comprehensive consensus provides step-by-step guidance and tools for practitioners to promote safe delivery of intravenous iron, recognition, and management of infusion reactions and treatment-emergent hypophosphatemia.

A traffic signal and loop detector dataset of an urban intersection regulated by a fully actuated signal control system.

Fully actuated signal controls are becoming increasingly popular in modern urban environments, attempting to reduce congestion locally, synchronize flows, or prioritize specific types of vehicles. This trend is expected to grow as more vehicles are expected to communicate via Vehicle-to-Infrastructure (V2I) communication. The presented dataset contains cleaned observations from a fully actuated signal control system with priority for public transportation. Time series data of traffic signals that regulate vehicle, public transportation, bicycle, and pedestrian traffic flows are available, showing where a traffic signal operates in a red or green phase. Also, loop detector data representing the occupancy at several locations at an urban intersection in Zurich, Switzerland is available. The data of all traffic signals and loop detectors corresponds to January and February 2019 and has a resolution of 1 s. Recent advances in transportation science show novel approaches for signalized intersections, but most publications assess their methodology on self-collected or simulated data. Therefore, the presented dataset aims at facilitating the development, calibration, and validation of novel methodological developments for modeling, estimation, forecasting, and other tasks in traffic engineering. Furthermore, it can be used as a real-world benchmark dataset for objectively comparing different methodologies.

Understanding congestion propagation by combining percolation theory with the macroscopic fundamental diagram.

The science of cities aims to model urban phenomena as aggregate properties that are functions of a system's variables. Following this line of research, this study seeks to combine two well-known approaches in network and transportation science: (i) The macroscopic fundamental diagram (MFD), which examines the characteristics of urban traffic flow at the network level, including the relationship between flow, density, and speed. (ii) Percolation theory, which investigates the topological and dynamical aspects of complex networks, including traffic networks. Combining these two approaches, we find that the maximum number of congested clusters and the maximum MFD flow occur at the same moment, precluding network percolation (i.e. traffic collapse). These insights describe the transition of the average network flow from the uncongested phase to the congested phase in parallel with the percolation transition from sporadic congested links to a large, congested cluster of links. These results can help to better understand network resilience and the mechanisms behind the propagation of traffic congestion and the resulting traffic collapse.

Social Behavior and COVID-19: Analysis of the Social Factors behind Compliance with Interventions across the United States.

Since its emergence, COVID-19 has caused a great impact in health and social terms. Governments and health authorities have attempted to minimize this impact by enforcing different mandates. Recent studies have addressed the relationship between various socioeconomic variables and compliance level to these interventions. However, little attention has been paid to what constitutes people's response and whether people behave differently when faced with different interventions. Data collected from different sources show very significant regional differences across the United States. In this paper, we attempt to shed light on the fact that a response may be different depending on the health system capacity and each individuals' social status. For that, we analyze the correlation between different societal (i.e., education, income levels, population density, etc.) and healthcare capacity-related variables (i.e., hospital occupancy rates, percentage of essential workers, etc.) in relation to people's level of compliance with three main governmental mandates in the United States: mobility restrictions, mask adoption, and vaccine participation. Our aim was to isolate the most influential variables impacting behavior in response to these policies. We found that there was a significant relationship between individuals' educational levels and political preferences with respect to compliance with each of these mandates.

Modular vehicle technology for emergency medical services.

While advancements in vehicular and wireless communication technologies are shaping the future of our transportation system, emergency medical services (EMS) are not receiving enough research attention. Their operations are still plagued by response delays that can often be life-threatening. Dispatching and redeployment systems identify the best practices regarding the allocation of the resources to emergencies and stations. Yet, the existing systems are unfortunately insufficient, and there is a growing need to embrace new technological solutions. This research introduces a smart system for EMS by leveraging the modular vehicle technology initially developed for transit systems. The proposed system relies on the design of vehicular modules that can couple and decouple to transfer patients from one module to another during transport. A fleet of medical transport vehicles is deployed to cooperate with the life support vehicles by providing, for example, transport and hospital admission tasks, thus allowing life support vehicles to answer pending emergency calls earlier. This is especially useful when there is a large demand for EMS (e.g. under the COVID-19 pandemic or other disasters such as the recent explosion in Beirut). This paper introduces a mathematical programming model to determine the optimal assignment decisions in a deterministic setting. This work is a proof of concept that demonstrates the applicability of the modular vehicle technology to EMS, evaluating the upper bound EMS performance that can be ultimately reached. A sensitivity analysis is conducted to provide insights and recommendations that are useful when selecting the weighting coefficients for the optimization function, to ensure a more efficient implementation of the modular vehicle technology for EMS. Also, the results of a comparative analysis show that the proposed system can adapt and offer larger benefits, in terms of response times and times to hospital, as demand increases and/or resources become more limited.

Scale, context, and heterogeneity: the complexity of the social space.

The social space refers to physical or virtual places where people interact with one another. It decisively influences the emergence of human behaviors. However, little is known about the nature and complexity of the social space, nor its relationship to context and spatial scale. Recently, the science of complex systems has bridged between fields of knowledge to provide quantitative responses to fundamental sociological questions. In this paper, we analyze the shifting behavior of social space in terms of human interactions and wealth distribution across multiple scales using fine-grained data collected from both official (US Census Bureau) and unofficial data sources (social media). We use these data to unveil how patterns strongly depend upon the observation scale. Therefore, it is crucial for any analysis to be framed within the appropriate context to avoid biased results and/or misleading conclusions. Biased data analysis may lead to the adoption of fragile and poor decisions. Including context and a proper understanding of the spatial scale are essential nowadays, especially with the pervasive role of data-driven tools in decision-making processes.

Breastfeeding education, early skin-to-skin contact and other strong determinants of exclusive breastfeeding in an urban population: a prospective study.

OBJECTIVE: The current study aims to demonstrate independent associations between social, educational and health practice interventions as determinants of exclusive breastfeeding in an urban Ecuadorian population. DESIGN: Prospective survival analyses. SETTING: Ecuadorian mother-child dyads in urban settings. PARTICIPANTS: We followed-up 363 mother-baby dyads who attended healthcare centres in Portoviejo, province of Manabi, for a median time (P25-P75) of 125 days (121-130 days). MAIN OUTCOME MEASURES: We performed a survival analysis, by setting the time-to-abandonment of exclusive breastfeeding measured in days of life, that is, duration of exclusive breastfeeding, periodically assessed by phone, as the primary outcome. Crude and adjusted mixed-effects Cox proportional hazards model were performed to estimate HRs for each explanatory variable. RESULTS: The incidence rate of abandonment of breastfeeding was 8.9 per 1000 person-days in the whole sample. Multivariate analysis indicated the three most significant protective determinants of exclusive breastfeeding were (a) sessions of prenatal breastfeeding education with an HR of 0.7 (95% CI: 0.5 to 0.9) per each extra session, (b) self-perception of milk production, with an HR of 0.4 (95% CI: 0.3 to 0.6) per each increase in the perceived quantity of milk production and (c) receiving early skin-to-skin contact with an HR of 0.1 (95% CI: <0.1 to 0.3) compared with those not receiving such contact, immediately after birth. CONCLUSIONS: Prenatal education on breastfeeding, self-perception of sufficient breast-milk production and early skin-to-skin contact appear to be strong protectors of exclusive breastfeeding among urban Ecuadorian mother-baby dyads.

Understanding traffic capacity of urban networks.

Traffic in an urban network becomes congested once there is a critical number of vehicles in the network. To improve traffic operations, develop new congestion mitigation strategies, and reduce negative traffic externalities, understanding the basic laws governing the network's critical number of vehicles and the network's traffic capacity is necessary. However, until now, a holistic understanding of this critical point and an empirical quantification of its driving factors has been missing. Here we show with billions of vehicle observations from more than 40 cities, how road and bus network topology explains around 90% of the empirically observed critical point variation, making it therefore predictable. Importantly, we find a sublinear relationship between network size and critical accumulation emphasizing decreasing marginal returns of infrastructure investment. As transportation networks are the lifeline of our cities, our findings have profound implications on how to build and operate our cities more efficiently.

[Actinic enteritis as a cause of digestive bleeding of obscure origin]. / Enteritis actínica como causa de hemorragia digestiva de origen oscuro.

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year- old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleeding’s source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB.

Enteritis actínica como causa de hemorragia digestiva de origen oscuro / Actinic enteritis as a cause of digestive bleeding of obscure origin

La enteritis actínica crónica es un trastorno del intestino delgado que ocurre a partir de los 6 meses post radioterapia y se puede manifestar como malabsorción, estenosis, formación de fístulas, abscesos locales, perforación y sangrado. Se reporta el caso de una paciente adulta mayor la cual presentó un cuadro de hemorragia digestiva de origen oscuro (HDO) secundario a enteritis actínica. Es una paciente mujer de 64 años con antecedente de neoplasia maligna de cérvix quien recibió sesiones de radioterapia y braquiterapia, La paciente un año después de dicho tratamiento presenta un cuadro crónico de melena y anemia, presentando hematoquezia en la última semana previa a la hospitalización. Al ingreso presenta inestabilidad hemodinámica con valores de hemoglobina en 2,7gr/dL. Se realiza una endoscopia, colonoscopia y tomografía abdomino pélvica, las cuales no mostraron la causa del sangrado, motivo por el cual se realiza una cápsula endoscópica evidenciando áreas de sangrado en intestino delgado medio y distal. La paciente vuelve a presentar un episodio de sangrado agudo siendo sometida a una cirugía de emergencia en donde se decide realizar resección de intestino más hemicolectomia derecha. En la biopsia de la pieza quirúrgica se encuentran hallazgos compatibles con enteropatía actínica. La paciente posterior a la cirugía evoluciona tórpidamente, llegando a fallecer. Describimos el presente caso y hacemos una recolección de la data existente debido a que es el primer caso en el Perú en el que se reporta a una enteritis actínica como causante de HDO...

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year-old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleedingÆs source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB...

Exploring the application of latent class cluster analysis for investigating pedestrian crash injury severities in Switzerland.

One of the major challenges in traffic safety analyses is the heterogeneous nature of safety data, due to the sundry factors involved in it. This heterogeneity often leads to difficulties in interpreting results and conclusions due to unrevealed relationships. Understanding the underlying relationship between injury severities and influential factors is critical for the selection of appropriate safety countermeasures. A method commonly employed to address systematic heterogeneity is to focus on any subgroup of data based on the research purpose. However, this need not ensure homogeneity in the data. In this paper, latent class cluster analysis is applied to identify homogenous subgroups for a specific crash type-pedestrian crashes. The manuscript employs data from police reported pedestrian (2009-2012) crashes in Switzerland. The analyses demonstrate that dividing pedestrian severity data into seven clusters helps in reducing the systematic heterogeneity of the data and to understand the hidden relationships between crash severity levels and socio-demographic, environmental, vehicle, temporal, traffic factors, and main reason for the crash. The pedestrian crash injury severity models were developed for the whole data and individual clusters, and were compared using receiver operating characteristics curve, for which results favored clustering. Overall, the study suggests that latent class clustered regression approach is suitable for reducing heterogeneity and revealing important hidden relationships in traffic safety analyses.

Partial proportional odds model-an alternate choice for analyzing pedestrian crash injury severities.

The conventional methods for crash injury severity analyses include either treating the severity data as ordered (e.g. ordered logit/probit models) or non-ordered (e.g. multinomial models). The ordered models require the data to meet proportional odds assumption, according to which the predictors can only have the same effect on different levels of the dependent variable, which is often not the case with crash injury severities. On the other hand, non-ordered analyses completely ignore the inherent hierarchical nature of crash injury severities. Therefore, treating the crash severity data as either ordered or non-ordered results in violating some of the key principles. To address these concerns, this paper explores the application of a partial proportional odds (PPO) model to bridge the gap between ordered and non-ordered severity modeling frameworks. The PPO model allows the covariates that meet the proportional odds assumption to affect different crash severity levels with the same magnitude; whereas the covariates that do not meet the proportional odds assumption can have different effects on different severity levels. This study is based on a five-year (2008-2012) national pedestrian safety dataset for Switzerland. A comparison between the application of PPO models, ordered logit models, and multinomial logit models for pedestrian injury severity evaluation is also included here. The study shows that PPO models outperform the other models considered based on different evaluation criteria. Hence, it is a viable method for analyzing pedestrian crash injury severities.

Endometrial resection and preoperative LH-RH agonists: a prospective 5-year trial.

OBJECTIVE: To evaluate the benefits of systematic preoperative treatment with LH-RH agonists prior to endometrial resection (ER). STUDY DESIGN: The study population was made up of 98 premenopausal women who underwent resectoscopic treatment for abnormal uterine bleeding (AUB) between January 1996 and December 1997. Only patients with endometrial polyps or dysfunctional bleeding were included. The population was divided into two groups: patients who had (group B) and those who had not (group A) received LH-RH before the surgical intervention. RESULTS: ER was carried out as a single procedure in 66 (67.5%) of the patients. ER plus polypectomy was necessary in 32 (32.5%) patients. There were no differences between the two groups as far as the operating time and total volume of distension medium were concerned. No intraoperative complications were seen in either group. A higher negative balance of distension medium was achieved in group A (320 +/- 23 mL versus 187 +/- 16 mL; P < 0.001), and this difference was not modified when cases with polyps were excluded. The failure rate was similar in both groups both at 12 months [group A 6 (14.8%) versus group B 7 (14.9%) patients] and at 60 months [group A, 11 (21.6%) versus group B 10 (21.2%) patients]. Likewise, the amenorrhea and hypomenorrhea rates at 12 months and at 60 months were also shown to be the same in both groups. When two doses of LH-RH are used and the failure rate is taken into account the cost of an acceptable outcome increases from 843.37 Euro to 1373.49 Euro per patient, while the total cost of a hysterectomy is 1355.42 Euro. CONCLUSIONS: Endometrial suppression with LH-RH agonists did not guarantee better results of ER, but they are strongly recommended during the learning curve to achieve a safer procedure.