Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features

Objective National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated Methods A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary syndrome. Chart review was completed on patients with positive stress tests. Results The 3987 patients with suspected intermediate risk acute coronary syndrome underwent exercise stress testing. One thousand and twenty-seven (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of these 1027 patients had a positive exercise stress test (0.4% incidence of positive exercise stress testing). Of those, three patients had subsequent non-invasive functional testing that yielded a negative result. One patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079–0.115%) (one of 1027 patients). Conclusions Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome

Investment decision framework for infrastructure asset management: a probability-based approach

Australia’s civil infrastructure assets of roads, bridges, railways, buildings and other structures are worth billions of dollars. Road assets alone are valued at around A$ 140 billion. As the condition of assets deteriorate over time, close to A$10 billion is spent annually in asset maintenance on Australia's roads, or the equivalent of A$27 million per day. To effectively manage road infrastructures, firstly, road agencies need to optimise the expenditure for asset data collection, but at the same time, not jeopardise the reliability in using the optimised data to predict maintenance and rehabilitation costs. Secondly, road agencies need to accurately predict the deterioration rates of infrastructures to reflect local conditions so that the budget estimates could be accurately estimated. And finally, the prediction of budgets for maintenance and rehabilitation must provide a certain degree of reliability. A procedure for assessing investment decision for road asset management has been developed. The procedure includes: • A methodology for optimising asset data collection; • A methodology for calibrating deterioration prediction models; • A methodology for assessing risk-adjusted estimates for life-cycle cost estimates. • A decision framework in the form of risk map

Kindergarten students' understanding of probability concepts

This study explored kindergarten students’ intuitive strategies and understandings in probabilities. The paper aims to provide an in depth insight into the levels of probability understanding across four constructs, as proposed by Jones (1997), for kindergarten students. Qualitative evidence from two students revealed that even before instruction pupils have a good capacity of predicting most and least likely events, of distinguishing fair probability situations from unfair ones, of comparing the probability of an event in two sample spaces, and of recognizing conditional probability events. These results contribute to the growing evidence on kindergarten students’ intuitive probabilistic reasoning. The potential of this study for improving the learning of probability, as well as suggestions for further research, are discussed.

Probability based data analysis for road asset management

Road agencies require comprehensive, relevan and quality data describing their road assets to support their investment decisions. An investment decision support system for raod maintenance and rehabilitation mainly comprise three important supporting elements namely: road asset data, decision support tools and criteria for decision-making. Probability-based methods have played a crucial role in helping decision makers understand the relationship among road related data, asset performance and uncertainties in estimating budgets/costs for road management investment. This paper presents applications of the probability-bsed method for road asset management.

Probability and statistics

Now in its sixth edition, the Traffic Engineering Handbook continues to be a must have publication in the transportation industry, as it has been for the past 60 years. The new edition provides updated information for people entering the practice and for those already practicing. The handbook is a convenient desk reference, as well as an all in one source of principles and proven techniques in traffic engineering. Most chapters are presented in a new format, which divides the chapters into four areas-basics, current practice, emerging trends and information sources. Chapter topics include road users, vehicle characteristics, statistics, planning for operations, communications, safety, regulations, traffic calming, access management, geometrics, signs and markings, signals, parking, traffic demand, maintenance and studies. In addition, as the focus in transportation has shifted from project based to operations based, two new chapters have been added-"Planning for Operations" and "Managing Traffic Demand to Address Congestion: Providing Travelers with Choices." The Traffic Engineering Handbook continues to be one of the primary reference sources for study to become a certified Professional Traffic Operations Engineer™. Chapters are authored by notable and experienced authors, and reviewed and edited by a distinguished panel of traffic engineering experts.