Performance of square and inclined insulated rail joints based on field strain measurements

Insulated rail joints (IRJs) possess lower bending stiffness across the gap containing insulating endpost and hence are subjected to wheel impact. IRJs are either square cut or inclined cut to the longitudinal axis of the rails in a vertical plane. It is generally claimed that the inclined cut IRJs outperformed the square cut IRJs; however, there is a paucity of literature with regard to the relative structural merits of these two designs. This article presents comparative studies of the structural response of these two IRJs to the passage of wheels based on continuously acquired field data from joints strain-gauged closer to the source of impact. Strain signatures are presented in time, frequency, and avelet domains and the peak vertical and shear strains are systematically employed to examine the relative structural merits of the two IRJs subjected to similar real-life loading. It is shown that the inclined IRJs resist the wheel load with higher peak shear strains and lower peak vertical strains than that of the square IRJs.

Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3%) of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost). A further 119 (49%) could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status). Another 88 (36%) required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases) and 28 (11.5%) required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.