Endoscopic Thyroidectomy for Large-Sized Goiters: Merits of the Axillo-Breast Approach with Gas Insufflation.

Background: Several minimal access approaches to the thyroid gland have been widely applied; nevertheless, such approaches are still challenging when dealing with large-sized thyroid nodules or goiters. We hereby evaluated the outcomes and highlighted the merits of endoscopic axillo-breast hemithyroidectomy (EABH) for large-sized unilateral goiters. Methods: Patients underwent EABH for unilateral large thyroid nodules ≥6 cm in its greatest dimension or unilateral large goiter (≥60 ml sonographic volume) whatever the size of its contained nodules were identified from a prospectively maintained database. Their demographic data, clinicopathological profiles, and surgical and esthetic outcomes are reported and analyzed. Results: Over a 2-year period, 33 patients matched the selection criteria. Their mean age was 34.75 ± 11.39 years. There were 30 women and 3 men. The majority of nodules were radiologically TIRADS3 and cytologically Bethesda 3. The mean sonographic dominant nodule greatest dimension was 5.29 ± 1.48 cm (range: 3-9.5 cm). The mean sonographic volume of the pathological lobe was 101.86 ± 54.45 ml (range: 60.11-236.88 ml). All cases were completed endoscopically with no conversion to open. The mean operative time was 110.76 ± 18.75 minutes. No significant postoperative complications were reported except for one case with temporary vocal cord paresis. Most (87.9%) of the patients were extremely satisfied with the procedure. Conclusion: EABH with our suggested key steps could be considered an effective valid approach for unilateral large goiters in trained hands and in patients desirous for cosmesis.

Exploring the Interplay of the CRISPR-CAS System with Antibiotic Resistance in Staphylococcus aureus: A Poultry Meat Study from Lahore, Pakistan.

Staphylococcus aureus is one of the major pathogens responsible for causing food poisoning worldwide. The emergence of antibiotic resistance in this bacterium is influenced by various factors. Among them, bacterial acquired defense systems described as clustered regularly interspaced short palindromic repeats (CRISPR)-cas system might be involved in antibiotic resistance development in bacteria. The current study was designed to assess the prevalence of S. aureus and its antibiotic resistance profile and identify the relationship of the CRISPR-cas system with antimicrobial resistance, followed by phylogenetic analysis. Total samples (n = 188) of poultry meat were collected from the poultry bird market of Lahore, Punjab, Pakistan. We used both phenotypic (antibiotic disc diffusion) and genotypic methods (PCR) to identify multi-drug resistant (MDR) strains of S. aureus. Additionally, the role of the CRISPR-Cas system in the isolated MDR S. aureus was also assessed. In addition, real-time quantitative PCR (qRT-PCR) was used to evaluate the association of the CRISPR-cas system with antimicrobial resistance. All of the S. aureus isolates showed 100% resistance against erythromycin, 97.5% were resistant to tetracycline, and 75% were resistant to methicillin. Eleven isolates were MDR in the current study. The CRISPR system was found in all MDR isolates, and fifteen spacers were identified within the CRISPR locus. Furthermore, MDR S. aureus isolates and the standard strain showed higher expression levels of CRISPR-associated genes. The correlation of said system with MDR isolates points to foreign gene acquisition by horizontal transfer. Current knowledge could be utilized to tackle antibiotic-resistant bacteria, mainly S. aureus.

Bacteremia and antimicrobial resistance pattern of uropathogens causing febrile urinary tract infection in a Pediatric University Hospital.

Introduction: Febrile urinary tract infections (UTIs) in children are among the most serious bacterial infections. Inadequate treatment can lead to kidney scarring and permanent kidney damage. Eight to ten percent of children with UTIs could have concomitant bacteremia. The study aimed to estimate the prevalence of UTI-associated bacteremia and identify common organisms causing UTIs and their antimicrobial susceptibility patterns to help guide empiric antimicrobial therapy. Methods: The current study was conducted over a 6-month period on children admitted with febrile UTIs at Alexandria University Children's Hospital. Blood and urine samples were collected for culture and antimicrobial susceptibility. Results: A total of 103 children with a median age of 12 months (IQR 6.0-24.0) were included in the study. Concomitant bacteremia was present in 63.1% (n=65). The median temperature of 38.40°C (IQR 38.15-38.60) and the median creatinine level of 0.18 mg/dL (IQR 0.14-0.25) were significantly higher in the bacteremic group compared to the non-bacteremic group (p=0.005, p=0.034, respectively). E. coli (n=51; 49.5%) and Klebsiella pneumoniae (n=30; 29.1%) were the most common isolated organisms. Most (n=68; 66%) of the isolated organisms were multidrug-resistant (MDR), followed by extensively drug-resistant (XDR) (n=16; 15.5%), and pan-drug-resistant (PDR) organisms (n=1; 1%). E. coli showed lower resistance to gentamicin and ceftriaxone (9.8 % and 13.7%, respectively). Conclusions: E. coli remains the most important UTI pathogen. Ceftriaxone and gentamicin are good empiric options for febrile UTIs in our hospital.

Heart rate variability as an indicator of COVID-19 induced myocardial injury: a retrospective cohort study.

BACKGROUND: Heart rate variability (HRV) is a valuable indicator of autonomic nervous system integrity and can be a prognostic tool of COVID-19 induced myocardial affection. This study aimed to compare HRV indices between patients who developed myocardial injury and those without myocardial injury in COVID-19 patients who were admitted to intensive care unit (ICU). METHODS: In this retrospective study, the data from 238 COVID-19 adult patients who were admitted to ICU from April 2020 to June 2021 were collected. The patients were assigned to myocardial injury and non-myocardial injury groups. The main collected data were R-R intervals, standard deviation of NN intervals (SDANN) and the root mean square of successive differences between normal heartbeats (RMSSD) that were measured daily during the first five days of ICU admission. RESULTS: The R-R intervals, the SDANN and the RMSSD were significantly shorter in the myocardial injury group than the non-myocardial group at the first, t second, third, fourth and the fifth days of ICU admission. There were no significant differences between the myocardial injury and the non-myocardial injury groups with regard the number of patients who needed mechanical ventilation, ICU length of stay and the number of ICU deaths. CONCLUSIONS: From the results of this retrospective study, we concluded that the indices of HRV were greatly affected in COVID-19 patients who developed myocardial injury.

Safety assessment of coordinated signalized intersections in a connected vehicle environment: a microsimulation approach.

In this study, the safety impact of the coupled implementation of signal coordination and connected vehicles (CVs) is examined in a microsimulation environment created in VISSIM. The Surrogate Safety Assessment Model (SSAM) was implemented to generate results of surrogate safety measures. The findings provided evidence that CVs can improve the safety performance at all market penetration rates (MPRs) of CVs in terms of all performance metrics. In addition, further safety improvements were achieved at higher CV MPRs. It was observed that coordinated signals had lower likelihoods of experiencing collisions compared to uncoordinated signals. Specifically, coordinated signals showed significantly higher time-to-collision (TTC) and post-encroachment time (PET) values when compared to uncoordinated signals at the 100% CV MPR only. Moreover, the impact of CV technologies on reducing the total number of conflicts (TNC) would be stronger than that of traffic signal coordination alone while both would lead to reductions in the TNC.

Investigating factors influencing rollover crash risk on mountainous interstates.

INTRODUCTION: The risk of rollover crashes on mountainous roads is a major concern for transportation authorities due to adverse weather conditions and complex topography. Such crashes incur hazardous consequences on road users' lives. Therefore, it is crucial to identify the contributing factors that give rise to these severe crashes in order to identify preventive measures. Furthermore, exploring the potential sources of heterogeneity of rollover crash contributing factors is equally important. METHOD: By having a dataset of single-vehicle crashes that occurred on mountainous curved sections in Wyoming, we applied a random parameters, otherwise known as mixed, logit model to identify the factors contributing to the increased risk of rollovers. Vehicle, driver, roadway, environmental, and crash attributes variables were considered as potential predictors in the model. Then, random parameters were identified to uncover the unobserved effects. RESULTS: Weather, road surface conditions, and speeding were found to have a significant impact on rollover crash risk. These factors were also found to exhibit unobserved heterogeneity effects, which could be attributed to the drivers' responses and conditions. Furthermore, it was found that the propensity of rollovers was higher for sports utility vehicles (SUVs) and pick-up trucks among other vehicle types. CONCLUSIONS: The results indicated that investigating the impact of these factors on the risk of rollovers while taking into account unobserved heterogeneity effects is an essential step for implementing countermeasures to reduce the frequency and severity of rollover crashes. Practical applications: This study uncovered insights into the factors that lead vehicles to overturn. This aids in suggesting appropriate safety countermeasures that mitigate the occurrences of rollover crashes to transportation agencies.

Software defect prediction using hybrid model (CBIL) of convolutional neural network (CNN) and bidirectional long short-term memory (Bi-LSTM).

In recent years, the software industry has invested substantial effort to improve software quality in organizations. Applying proactive software defect prediction will help developers and white box testers to find the defects earlier, and this will reduce the time and effort. Traditional software defect prediction models concentrate on traditional features of source code including code complexity, lines of code, etc. However, these features fail to extract the semantics of source code. In this research, we propose a hybrid model that is called CBIL. CBIL can predict the defective areas of source code. It extracts Abstract Syntax Tree (AST) tokens as vectors from source code. Mapping and word embedding turn integer vectors into dense vectors. Then, Convolutional Neural Network (CNN) extracts the semantics of AST tokens. After that, Bidirectional Long Short-Term Memory (Bi-LSTM) keeps key features and ignores other features in order to enhance the accuracy of software defect prediction. The proposed model CBIL is evaluated on a sample of seven open-source Java projects of the PROMISE dataset. CBIL is evaluated by applying the following evaluation metrics: F-measure and area under the curve (AUC). The results display that CBIL model improves the average of F-measure by 25% compared to CNN, as CNN accomplishes the top performance among the selected baseline models. In average of AUC, CBIL model improves AUC by 18% compared to Recurrent Neural Network (RNN), as RNN accomplishes the top performance among the selected baseline models used in the experiments.

A correlated random parameters approach to investigate large truck rollover crashes on mountainous interstates.

Rollover risk on mountainous interstates is a major concern for transportation agencies due to the combined mixed effects of adverse weather conditions and complex topography. Such crashes incur hazardous consequences on road users' lives. Therefore, a correlated random parameters logit modeling framework was employed to investigate the influences of crash precursors on rollover risk to identify effective safety countermeasures. This approach was selected to account for both the crash contributing factors' unobserved heterogeneity effects and the correlations among those effects. The data, used in this study, were those of single-truck crashes on Wyoming's interstate curved sections. The traditional logit and uncorrelated random parameters, or mixed, logit models were attempted as well. With that, the analysis results indicated that the fit of the correlated random parameters logit model was superior to those of the others. It also revealed insights regarding correlations among random parameters that were obscure in the other models. According to its results, on average, veering off the road, overcorrections and severe winds raised the risk of single-truck rollover crashes. On the other hand, median barriers, roadside guardrails, tight horizontal curves, icy road surfaces, wet surfaces and surfaces covered by loose material, in general, reduced the likelihood of rollovers. Correlations, such as those between severe winds and icy surfaces and those between roadside guardrails and icy surfaces, were inferred as well. This study's results will assist transportation officials in efficiently identifying appropriate countermeasures to mitigate the impact of truck rollovers particularly during adverse weather conditions.

Irreducible inflamed inguinal hernia with infected gangrenous omentum after laparoscopic appendectomy: a case report.

We reported a rare complication of laparoscopic appendectomy in a 19-year-old patient, who was admitted with acute appendicitis and had no history of inguinal hernia. He underwent laparoscopic appendectomy for suppurative appendicitis. Eight days later, he presented with irreducible incarcerated right inguinal hernia. A non-manifested congenital inguinal hernial sac has been symptomized after laparoscopic gas inflation inside the peritoneal cavity, which resulted in widening of the internal inguinal ring and protrusion of the omentum. Besides that, the omental content became inflamed and gangrenous as a consequence of the suppurative appendicitis and the presence of purulent fluid in the pelvis. Therefore, there were two complications that occurred simultaneously after laparoscopic appendectomy: a manifested right inguinal hernia and incarceration and gangrene of its contents. To our knowledge, this is the first reported case of irreducible inflamed inguinal hernia manifested for the first time after laparoscopic appendectomy.

[Retrorectal teratoma (dermoid cyst) of an adult - Diagnosis and treatment based on an example of a case report]. / Retrorektales Teratom (Dermoidzyste) des Erwachsenen ­ Diagnostik und Therapie am Beispiel einer Kasuistik.

MEDICAL HISTORY: A 29 year old woman was introduced to the surgical department with a history of pain in the lower lumbar spine. CLINICAL FINDINGS AND DIAGNOSIS: The cause of the pain was associated with a retrorectal presacral cystic mass. Diagnosis was made by performing a transvaginal ultrasound, a contrast CT scan and MRI of the pelvic. TREATMENT AND COURSE: Open surgery was performed. The histologic findings showed a monodermal cystic teratoma. The postoperative management showed no complications. CONCLUSION: Retrorectal Tumors not associated with the rectum in the small pelvic are rare. These tumors should be surgically removed.

Central Venous Access in Neonates: Comparison of Ultrasound-Guided Percutaneous Access and Minimal Surgical Open Methods.

Background: In neonates, percutaneous central venous catheter (CVC) insertion is often a challenging technique. Recent reports have reported the efficacy of ultrasound (US) guidance when performing such an intervention. We conducted this study to compare US-guided and minimal surgical CVC insertion regarding time and ease of insertion, reliability, and complications. Patients and Methods: This prospective randomized study included 92 neonates scheduled for CVC insertion. They were divided into two groups: Group A (46 neonates) underwent the US-guided approach and Group B (46 neonates) underwent the surgical approach. The number of attempts and the duration of the procedure were documented in both groups. In addition, intraoperative and postoperative complications were recorded. Results: Each of patient's age, gender, weight, and the indication of catheter insertion were statistically comparable between the two groups. The number of trials showed a significant increase in Group A (1.52 vs. 1.07 in Group Bp <0.001). Nevertheless, the time of the procedure was significantly decreased in the same group (3.68 vs. 10.21 in Group Bp <0.001). Table 2 summarizes the previous findings. Failure was encountered only in one case in Group A (2.2%), which was converted to the open surgical technique. In general, the incidence of complications showed no significant difference between the two approaches. Conclusion: Although US-guided CVC insertion is associated with an increased number of trials, the duration of the procedure is significantly diminished with its use. Furthermore, it has a high success rate in addition to a comparable complication profile with the traditional surgical method.

Is Spinal Dexmedetomidine Aggravating Hypotension after Tourniquet Deflation?

BACKGROUND AND AIMS: The addition of dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but may aggravate hypotension after tourniquet deflation. METHODS: Fifty patients were included in this prospective, double-blinded, randomized study, randomly divided into two equal groups of 25 patients each. Spinal anesthesia was performed using 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL of normal saline in control group (Group C) or 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL (5 µg) of dexmedetomidine in (Group D). Tourniquet pain was treated by 50 mg of meperidine and repeated in a dose of 20 mg, and the total meperidine consumption was calculated. After tourniquet deflation, heart rate and mean blood pressure were measured for 15 min in the operating room and at these times: before induction of anesthesia (baseline), after inflating tourniquet (inflation), 1 min before deflating tourniquet (predeflation), after tourniquet deflation (10 min postdeflation), and maximum blood pressure and heart rate changes. Duration of time that started before the minimum blood pressure and maximum heart rate was changed until recovery was recorded. RESULTS: Pain after torniquet inflation was significantly higher in the Group C compared to the Group D. The maximal change of blood pressure was lower in the dexmedetomidine than in the control group. The mean time between the maximal change in blood pressure reached and started to recover was 135 ± 14 s in the dexmedetomidine group and 80 ± 31 s in the control group (P < 0.01) and maximal heart rate change was lower in dexmedetomidine group than the control group. The time between the maximal heart rate changes until recovery was 113.2 ± 19 s in the dexmedetomidine group and 53.2 ± 11 s in the control group P < 0.01. CONCLUSION: Adding dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but aggravates the hemodynamic effect of tourniquet deflation.

The Impact of Sevoflurane and Propofol Anesthetic Induction on Bag Mask Ventilation in Surgical Patients with High Body Mass Index.

BACKGROUND AND AIMS: Obesity is associated with restrictive ventilatory pattern which causes rapid oxygen desaturation. Although obesity is considered as a risk factor for difficult airway management, failure to achieve effective bag mask ventilation (BMV) can be catastrophic. This study tried to assess the effect of both propofol and sevoflurane on the efficacy of BMV during anesthetic induction in obese patients. PATIENTS AND METHODS: A total of 200 cases were included, and they were randomly divided into two equal groups; Group S which included 100 cases who underwent sevoflurane induction, and Group P which included the remaining 100 cases who underwent propofol induction. RESULTS: No statistically significant difference was detected between the two groups regarding patient and air way characteristics (P > 0.05). Difficult BMV (DBMV) was encountered in 19% and 37% of cases in Groups S and P, respectively. The incidence of DBMV was significantly increased in the P group (P = 0.005). Furthermore, the severity of difficulty was more marked in the P group. Logistic regression analysis revealed that thyromental distance, presence of macroglossia, presence of beard, lack of teeth, history of snoring, as well as propofol induction were risk factors for DBMV. CONCLUSION: Sevoflurane can facilitate BMV and provide better intubation conditions in comparison to propofol during anesthetic induction in morbidly obese patients. Moreover, decreased thyromental distance, presence of macroglossia and beard, lack of teeth, and history of snoring are considered preoperative indicators of DBMV.

Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block on Postoperative Analgesia after Hysterectomy: A Randomized Controlled Study.

BACKGROUND AND AIM: Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects. SETTINGS AND DESIGN: A prospective, randomized, controlled double-blind trial that was carried out at a university hospital. PATIENTS AND METHODS: Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 µg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded. STATISTICAL ANALYSIS: Student's t-test, Mann-Whitney U-test, and Chi-square test were used. RESULTS: Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10-19.50) mg compared to 25 (17.50-37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus. CONCLUSIONS: Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy.

Impact of Pyloric Injection of Magnesium Sulfate-Lidocaine Mixture on Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: a Randomized-Controlled Trial.

BACKGROUND: One of the most common adverse effects of laparoscopic sleeve gastrectomy (LSG) is postoperative nausea and vomiting (PONV). The present study aimed to assess the impact of local injection of a mixture of magnesium sulfate and lidocaine into the pylorus on gastric intraluminal pressure (ILP) and PONV after LSG. METHODS: Patients with morbid obesity who underwent LSG were randomly allocated to one of two equal groups: treatment group (pyloric injection of a mixture of magnesium sulfate and lidocaine) and control group (pyloric injection of normal saline). PONV and antiemetic requirements were recorded at 6 and 24 h postoperatively. RESULTS: Seventy patients (63 female) with a mean age of 34.6 ± 9.9 years were included. The mean preoperative and postoperative gastric ILP was comparable in the two groups. The pyloric injection of magnesium sulfate-lidocaine mixture resulted in 31% reduction in the mean gastric ILP (19.4 ± 4.7 mmHg before injection to 13.4 ± 4.1 mmHg after injection, p < 0.0001). Pyloric injection of saline did not result in significant change in ILP (19.9 ± 4.9 vs 20.3 ± 5.1 mmHg). Of the treatment group patients, 17.1% had significant PONV at 6 h compared to 91.4% of control group patients (p < 0.0001). At 24 h, none of the treatment group patients had significant PONV versus 40% of the control group patients (p < 0.0001). CONCLUSION: Pyloric injection of magnesium sulfate-lidocaine mixture during LSG resulted in lower incidence of PONV and less use of antiemetic medications in the first 24 h after LSG without being associated with higher complication rate.

Comparative analysis of multiple techniques for developing and transferring safety performance functions.

Safety performance functions (SPFs) are crash count prediction models that are used for identifying high crash risk locations, evaluating road safety before and after countermeasure deployment and comparing the safety of alternative site designs. The traditional method of modeling crash counts is negative binomial (NB) regression. Furthermore, the Highway Safety Manual (HSM) provides analytical tools, including NB SPFs, to assess and improve road safety. Even though the HSM's SPFs are restricted to NB models, the road safety literature is rich with a variety of different modeling techniques. Researchers have calibrated the HSM's SPFs to local conditions using a calibration method prescribed by the HSM. However, studies in which SPFs are developed and transferred to other localities are uncommon. In this paper, we develop and transfer rural divided multilane highway segment SPFs of Florida, Ohio, Illinois, Minnesota, California, Washington and North Carolina to each state. For every state, NB, zero-inflated NB, Poisson lognormal (PLN), regression tree, random forest (RF), boosting and Tobit models are developed. A hybrid model that coalesces the predictions of both the Tobit and the NB model is proposed and developed as well. All SPFs are transferred to each state and their predictive performances are evaluated to discern which model type is the most transferable. According to the transferability results, there is no single superior model type. However, the Tobit, RF, tree, NB and hybrid models demonstrate better predictive performances than those of the other methods in a considerably large proportion of transferred SPFs.

Genetic and phenotypic characterization of the native rabbits in Middle Egypt.

AIM: Native rabbits in smallholder system are considered as important genetic resources, and the present study was aimed to study the genetic and phenotypic characterization and detection of the maternal origin of the native rabbit populations located at the Middle of Egypt. MATERIALS AND METHODS: A survey of native rabbit populations was conducted in three governorates (Fayum [FY], Beni Suef [BN], and El Menia [MN]). The phenotypic characterization of rabbits included the profile body of the head, ears, eyes, neck, and legs and the coat colors. The blood samples were collected for genetic characterization based on mitochondrial (cytochrome b) and the microsatellite markers. RESULTS: The phenotypic characterization of the body parts in the three populations was almost similar. The body weight of the mature rabbits in MN Government was significantly heaviest, and the measurements for the main body parts (body length, chest circumference, and abdominal girth) were the highest compared to the two populations. The results of mitochondrial (cytochrome b) analysis revealed that the rabbits from the three governments belonged to lineage A except one animal was recorded as lineage G from MN's rabbit population. The results of the microsatellite markers revealed that the genetic diversity between the three populations showed genetic interferences; however, a closer genetic relationship was observed between BN and MN than FY. The majority of the genetic diversity was the individual variability. CONCLUSION: The mitochondrial lineage A is the major lineage in rabbit populations in the area of the Middle Egypt understudy. The genetic populations' structure is the interferences among the three populations. A large-scale survey should be done on native rabbit populations for the sustainable management and conservation of the local breeds' genetic resources.

A new approach for calibrating safety performance functions.

Safety performance functions (SPFs) are statistical regression models used for estimating crash counts by roadway facility classification. They are required for identifying high crash risk locations, assessing the effectiveness of safety countermeasures and comparing road designs in terms of safety. Roadway agencies may opt to develop local SPFs or adopt them from elsewhere such as the national Highway Safety Manual (HSM), provided by the American Association of State Highway and Transportation Officials. The HSM offers a simple technique to calibrate its SPFs to conditions of specific jurisdictions. A more recent calibration technique, also known as the calibration function, is similar to that of the HSM. In this research, we develop SPFs of total crashes for rural divided multilane highway segments in four states. The states are Florida, Ohio, California and Washington. We also calibrate each SPF to each state using the HSM calibration method and the calibration function. Furthermore, we propose the use of the K nearest neighbor data mining method for calibrating SPFs. According to the goodness of fit (GOF) results, our proposed calibration method performs better than the other two methods.

Transferring and calibrating safety performance functions among multiple States.

Safety performance functions (SPFs), statistical regression models, by predicting traffic crash counts by crash type, severity and facility type, aid traffic engineers in the process of identifying high frequency crash locations. Developing SPFs requires the collection and processing of traffic, crash, road design and other characteristics' data. Jurisdictional agencies may choose not to develop their own SPFs and cut back on their resources by adopting SPFs provided by the national Highway Safety Manual (HSM). The HSM also provides a technique to calibrate its SPFs to the specific jurisdictions' conditions. Yet, the technique is subject to criticism. This research is aimed at exploring the transferability of SPFs of rural divided multilane highway segments of Florida, Ohio, Illinois, Minnesota, California, Washington and North Carolina. The SPFs are negative binomial (NB) models as are those provided by the HSM. We address the fault of instinctively applying the HSM's SPFs to a particular locality without verifying whether the SPFs are transferable to the locality and compare different states' crash patterns. Remarkably, it is found that specific SPFs of Ohio, Illinois, Minnesota and California are transferable to either of the four states. In addition, in this research, a calibration technique is proposed as an alternative to that of the HSM and two other calibration methods introduced in the traffic safety literature. They are the calibration function and the calibration of the transferred model's constant term in conjunction with the over-dispersion parameter. Our proposed calibration technique, namely local regression, is demonstrated to be more reliable than the HSM's and the ones previously proposed in the literature.

Comparison of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burn wounds.

PURPOSE OF PRESENTATION/STUDY: To compare the accuracy of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burns to decide whether early tangential excision and grafting or conservative management should be employed to optimize burn and patient management. STUDY PERIOD: March 2015 to November 2016. METHODS/PROCEDURE DETAILS: Ninety two wounds in 34 patients reporting within 5days of less than 40% burn surface area were included. Unstable patients, pregnant females and those who expired were excluded. The wounds were clinically assessed and LDI done concomitantly Plastic Surgeons blinded to each other's findings. Wound appearance, color, blanching, pain, hair follicle dislodgement were the clinical parameters that distinguished between superficial and deep partial thickness burns. On day 21, the wounds were again assessed for the presence of healing by the same plastic surgeons. The findings were correlated with the initial findings on LDI and clinical assessment and the results statistically analyzed. RESULTS/OUTCOME: The data of 92 burn wounds was analyzed using SPSS (ver. 17). Clinical assessment correctly identified the depth of 75 and LDI 83 wounds, giving diagnostic accuracies of 81.52% and 90.21% respectively. The sensitivity of clinical assessment was 81% and of LDI 92.75%, whereas the specificity was 82% for both. The positive predictive value was 93% for clinical assessment and 94% for LDI while the negative predictive value was 59% and 79% respectively. CONCLUSIONS: Predictive accuracy of LDI was found to be better than clinical assessment in the prediction of wound healing, the gold standard for wound healing being 21 days. As such it can prove to be a reliable and viable cost effective alternative per se to clinical assessment.