Development of an intelligent earthwork optimization system

Tese de Doutoramento em Engenharia Civil.

Efficacy And Safety Of Baerveldt Aqueous Shunts In Glaucoma Secondary To Anterior Segment Irradiation, For Uveal Melanoma

Purpose: Elevated IOP is commonly associated with iris and ciliary body melanoma. Traditional management requires the majority of eyes to undergo enucleation. The authors describe the first series of Baerveldt aqueous shunts in eyes with uveal melanoma, treated by total anterior segment irradiation.Methods: 25 consecutive patients with unilateral iris melanoma were prospectively recruited after obtaining informed consent. All patients underwent anterior segment proton beam irradiation, corneal limbal autografts and Baerveldt tube implantation at Jules Gonin Eye Hospital, Lausanne. Postoperative examinations were performed on day 1, weeks 1,3,6,9 and months 3,6,12 and annually thereafter. Success was defined as: IOP </=18mmHg (definition A); IOP </= 21mmHg and 20% reduction in IOP (definition B). All complications were recorded.Results: Mean age was 53; mean follow up, 10.3 months; mean interval to treatment following irradiation, 2.4 years; mean pre-op IOP was 29.9 mmHg; mean post-op IOP 14.1 mmHg; mean pre-op medications 3.0; post-op medications 1.3. Success rates were, definition A: 95%; definition B: 90%. Only11% had minor complications and there were no sight-threatening complications. Aggressive ocular hypertension was observed in the several eyes prior to shunt implantation. Two eyes were enucleated for non-glaucoma related sequelae.Conclusions: Baerveldt aqueous shunts are safe and efficacious following total anterior segment irradiation for uveal melanoma. The novel interdisciplinary approach improved ocular retention rates, offering a promising alternative to current management algorithms.

Trends in qualifying biomarkers in drug safety. Consensus of the 2011 meeting of the spanish society of clinical pharmacology.

In this paper we discuss the consensus view on the use of qualifying biomarkers in drug safety, raised within the frame of the XXIV meeting of the Spanish Society of Clinical Pharmacology held in Málaga (Spain) in October, 2011. The widespread use of biomarkers as surrogate endpoints is a goal that scientists have long been pursuing. Thirty years ago, when molecular pharmacogenomics evolved, we anticipated that these genetic biomarkers would soon obviate the routine use of drug therapies in a way that patients should adapt to the therapy rather than the opposite. This expected revolution in routine clinical practice never took place as quickly nor with the intensity as initially expected. The concerted action of operating multicenter networks holds great promise for future studies to identify biomarkers related to drug toxicity and to provide better insight into the underlying pathogenesis. Today some pharmacogenomic advances are already widely accepted, but pharmacogenomics still needs further development to elaborate more precise algorithms and many barriers to implementing individualized medicine exist. We briefly discuss our view about these barriers and we provide suggestions and areas of focus to advance in the field.

Adaptation of AHRQ patient safety indicators for use in ICD-10 administrative data by an international consortium.

Objective: The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSIs) for use with ICD-9-CM data. Many countries have adopted ICD-10 for coding hospital diagnoses. We conducted this study to develop an internationally harmonized ICD-10 coding algorithm for the AHRQ PSIs. Methods: The AHRQ PSI Version 2.1 has been translated into ICD-10-AM (Australian Modification), and PSI Version 3.0a has been independently translated into ICD-10-GM (German Modification). We converted these two country-specific coding algorithms into ICD-10-WHO (World Health Organization version) and combined them to form one master list. Members of an international expert panel-including physicians, professional medical coders, disease classification specialists, health services researchers, epidemiologists, and users of the PSI-independently evaluated this master list and rated each code as either "include," "exclude," or "uncertain," following the AHRQ PSI definitions. After summarizing the independent rating results, we held a face-to-face meeting to discuss codes for which there was no unanimous consensus and newly proposed codes. A modified Delphi method was employed to generate a final ICD-10 WHO coding list. Results: Of 20 PSIs, 15 that were based mainly on diagnosis codes were selected for translation. At the meeting, panelists discussed 794 codes for which consensus had not been achieved and 2,541 additional codes that were proposed by individual panelists for consideration prior to the meeting. Three documents were generated: a PSI ICD-10-WHO version-coding list, a list of issues for consideration on certain AHRQ PSIs and ICD-9-CM codes, and a recommendation to WHO to improve specification of some disease classifications. Conclusion: An ICD-10-WHO PSI coding list has been developed and structured in a manner similar to the AHRQ manual. Although face validity of the list has been ensured through a rigorous expert panel assessment, its true validity and applicability should be assessed internationally.

Adaptation au codage CIM-10 de 15 indicateurs de la sécurité des patients proposés par l'Agence étasunienne pour la recherche et la qualité des soins de santé (AHRQ) [ICD-10 adaptation of 15 Agency for Healthcare Research and Quality patient safety indicators].

BACKGROUND: In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed 20 Patient Safety Indicators (PSIs) to measure the occurrence of hospital adverse events from medico-administrative data coded according to the ninth revision of the international classification of disease (ICD-9-CM). The adaptation of these PSIs to the WHO version of ICD-10 was carried out by an international consortium. METHODS: Two independent teams transcoded ICD-9-CM diagnosis codes proposed by the AHRQ into ICD-10-WHO. Using a Delphi process, experts from six countries evaluated each code independently, stating whether it was "included", "excluded" or "uncertain". During a two-day meeting, the experts then discussed the codes that had not obtained a consensus, and the additional codes proposed. RESULTS: Fifteen PSIs were adapted. Among the 2569 proposed diagnosis codes, 1775 were unanimously adopted straightaway. The 794 remaining codes and 2541 additional codes were discussed. Three documents were prepared: (1) a list of ICD-10-WHO codes for the 15 adapted PSIs; (2) recommendations to the AHRQ for the improvement of the nosological frame and the coding of PSI with ICD-9-CM; (3) recommendations to the WHO to improve ICD-10. CONCLUSIONS: This work allows international comparisons of PSIs among the countries using ICD-10. Nevertheless, these PSIs must still be evaluated further before being broadly used.

Road Equipment Procurement and Utilization Study, October 2002

Final report of road equipment procurement and utilization study.

An Investigation of User Costs and Benefits of Winter Road Closures, June 2005

This project explores the user costs and benefits of winter road closures. Severe winter weather makes travel unsafe and dramatically increases crash rates. When conditions become unsafe due to winter weather, road closures should allow users to avoid crash costs and eliminate costs associated with rescuing stranded motorists. Therefore, the benefits of road closures are the avoided safety costs. The costs of road closures are the delays that are imposed on motorists and motor carriers who would have made the trip had the road not been closed. This project investigated the costs and benefits of road closures and found that evaluating the benefits and costs is not as simple as it appears. To better understand the costs and benefits of road closures, the project investigates the literature, conducts interviews with shippers and motor carriers, and conducts case studies of road closures to determine what actually occurred on roadways during closures. The project also estimates a statistical model that relates weather severity to crash rates. Although, the statistical model is intended to illustrate the possibility to quantitatively relate measurable and predictable weather conditions to the safety performance of a roadway. In the future, weather conditions such as snow fall intensity, visibility, etc., can be used to make objective measures of the safety performance of a roadway rather than relying on subjective evaluations of field staff. The review of the literature and the interviews clearly illustrate that not all delays (increased travel time) are valued the same. Expected delays (routine delays) are valued at the generalized costs (value of the driver’s time, fuel, insurance, wear and tear on the vehicle, etc.), but unexpected delays are valued much higher because they result in interruption of synchronous activities at the trip’s destination. To reduce the costs of delays resulting from road closures, public agencies should communicate as early as possible the likelihood of a road closure.

Volume of Traffic on the Primary Road System, 2002

The Office of Transportation Data, in cooperation with the Federal Highway Administration, prepares this biennial traffic report. This report is used by federal, state, and local governmental agencies in determining highway needs, construction priorities, route location and environmental impact studies, and the application of appropriate design standards. The general public uses this information in determining the amount of traffic that passes a given area as they make their development plans and propose land use changes. The above reflects only a few of the many technical uses for this data.

Tree and Brush Control For County Road Right-of-Way, Ocotober 2002

This manual summarizes the roadside tree and brush control methods used by all of Iowa's 99 counties. It is based on interviews conducted in Spring 2002 with county engineers, roadside managers and others. The target audience of this manual is the novice county engineer or roadside manager. Iowa law is nearly silent on roadside tree and brush control, so individual counties have been left to decide on the level of control they want to achieve and maintain. Different solutions have been developed but the goal of every county remains the same: to provide safe roads for the traveling public. Counties in eastern and southern Iowa appear to face the greatest brush control challenge. Most control efforts can be divided into two categories: mechanical and chemical. Mechanical control includes cutting tools and supporting equipment. A chain saw is the most widely used cutting tool. Tractor mounted boom mowers and brush cutters are used to prune miles of brush but have significant safety and aesthetic limitations and boom mowers are easily broken by inexperienced operators. The advent of tree shears and hydraulic thumbs offer unprecedented versatility. Bulldozers are often considered a method of last resort since they reduce large areas to bare ground. Any chipper that violently grabs brush should not be used. Chemical control is the application of herbicide to different parts of a plant: foliar spray is applied to leaves; basal bark spray is applied to the tree trunk; a cut stump treatment is applied to the cambium ring of a cut surface. There is reluctance by many to apply herbicide into the air due to drift concerns. One-third of Iowa counties do not use foliar spray. By contrast, several accepted control methods are directed toward the ground. Freshly cut stumps should be treated to prevent resprouting. Basal bark spray is highly effective in sensitive areas such as near houses. Interest in chemical control is slowly increasing as herbicides and application methods are refined. Fall burning, a third, distinctly separate technique is underused as a brush control method and can be effective if timed correctly. In all, control methods tend to reflect agricultural patterns in a county. The use of chain saws and foliar sprays tends to increase in counties where row crops predominate, and boom mowing tends to increase in counties where grassland predominates. For counties with light to moderate roadside brush, rotational maintenance is the key to effective control. The most comprehensive approach to control is to implement an integrated roadside vegetation management (IRVM) program. An IRVM program is usually directed by a Roadside Manager whose duties may be shared with another position. Funding for control programs comes from the Rural Services Basic portion of a county's budget. The average annual county brush control budget is about $76,000. That figure is thought not to include shared expenses such as fuel and buildings. Start up costs for an IRVM program are less if an existing control program is converted. In addition, IRVM budgets from three different northeastern Iowa counties are offered for comparison in this manual. The manual also includes a chapter on temporary traffic control in rural work zones, a summary of the Iowa Code as it relates to brush control, and rules on avoiding seasonal disturbance of the endangered Indiana bat. Appendices summarize survey and forest cover data, an equipment inventory, sample forms for record keeping, a sample brush control policy, a few legal opinions, a literature search, and a glossary.

Pavement Markings and Safety Final Report, November 2010

Previous research on pavement markings from a safety perspective tackled various issues such as pavement marking retroreflectivity variability, relationship between pavement marking retroreflectivity and driver visibility, or pavement marking improvements and safety. A recent research interest in this area has been to find a correlation between retroreflectivity and crashes, but a significant statistical relationship has not yet been found. This study investigates such a possible statistical relationship by analyzing five years of pavement marking retroreflectivity data collected by the Iowa Department of Transportation (DOT) on all state primary roads and corresponding crash and traffic data. This study developed a spatial-temporal database using measured retroreflectivity data to account for the deterioration of pavement markings over time along with statewide crash data to attempt to quantify a relationship between crash occurrence probability and pavement marking retroreflectivity. First, logistic regression analyses were done for the whole data set to find a statistical relationship between crash occurrence probability and identified variables, which are road type, line type, retroreflectivity, and traffic (vehicle miles traveled). The analysis looked into subsets of the data set such as road type, retroreflectivity measurement source, high crash routes, retroreflectivity range, and line types. Retroreflectivity was found to have a significant effect in crash occurrence probability for four data subsets—interstate, white edge line, yellow edge line, and yellow center line data. For white edge line and yellow center line data, crash occurrence probability was found to increase by decreasing values of retroreflectivity.

Temporary Traffic Control and Enforcement of Traffic Laws in Closed Road Sections, June 2007

Public travel by motor vehicles is often necessary in road and street sections that have been officially closed for construction, repair, and/or other reasons. This authorization is permitted in order to provide access to homes and businesses located beyond the point of closure. The MUTCD does address appropriate use of specific regulatory signs at the entrance to closed sections; however, direct guidance for temporary traffic control measures within these areas is not included but may be needed. Interpretation and enforcement of common practices may vary among transportation agencies. For example, some law enforcement officers in Iowa have indicated a concern regarding enforcement and jurisdiction of traffic laws in these areas because the Code of Iowa only appears to address violations on roadways open to “public travel.” Enforcement of traffic laws in closed road sections is desirable to maintain safety for workers and for specifically authorized road users. In addition, occasional unauthorized entry by motor vehicles is experienced in closed road areas causing property damage. Citations beyond simple trespass may be advisable to provide better security for construction sites, reduce economic losses from damage to completed work, and create safer work zones.

School Bus Safety Study: Kadyn’s Law, December 2012

In 2012, the Iowa legislature passed a bill for an act relating to school bus safety, including providing penalties for failure to obey school bus warning lamps and stop signal arms, providing for a school bus safety study and administrative remedies, and making an appropriation. The bill, referred to as Iowa Senate File (SF) 2218 or “Kadyn’s Law,” became effective March 16, 2012. A multiagency committee addressed three specific safety study elements of Kadyn’s Law as follows: * Use of cameras mounted on school buses to enhance the safety of children riding the buses and aid in enforcement of motor vehicle laws pertaining to stop-arm violations * Feasibility of requiring school children to be picked up and dropped off on the side of the road on which their home is located * Inclusion of school bus safety as a priority in driver training curriculum This report summarizes the findings for each of these topics.

Evaluation of Mitigation for Safety Concerns on Low-Volume, Unpaved Rural Roads, 2013.

The Institute for Transportation (InTrans) at Iowa State University completed work on an in-depth study of crash history on lowvolume, rural roads in Iowa in December 2010. Results indicated that unpaved roads with traffic volumes greater than 100 vehicles per day (vpd) exhibit significantly higher crash frequencies, rates, and densities than any other class of low-volume road examined, paved or unpaved. The total mileage for this class of roadway in Iowa is only about 4,400 miles, spread over 99 counties in the state, which is certainly a manageable number of miles for individual rural agencies. The purpose of this study was to identify and examine several unpaved, local road segments with higher than average crash frequencies, select and undertake potentially-beneficial mitigation, and evaluate the results as time allowed. A variety of low-cost options were considered, including engineering improvements, enhanced efforts by law enforcement, and educational initiatives. Using input, active support, and participation from local agencies and state and Federal safety advocates, the study afforded a unique opportunity to examine useful tools for local rural agencies to utilize in addressing safety on this particular type of roadway.

Evaluation of Mitigation for Safety Concerns on Low-Volume, Unpaved Rural Roads: Tech Transfer Summary, 2013.

The Institute for Transportation (InTrans) at Iowa State University completed work on an in-depth study of crash history on lowvolume, rural roads in Iowa in December 2010. Results indicated that unpaved roads with traffic volumes greater than 100 vehicles per day (vpd) exhibit significantly higher crash frequencies, rates, and densities than any other class of low-volume road examined, paved or unpaved. The total mileage for this class of roadway in Iowa is only about 4,400 miles, spread over 99 counties in the state, which is certainly a manageable number of miles for individual rural agencies. The purpose of this study was to identify and examine several unpaved, local road segments with higher than average crash frequencies, select and undertake potentially-beneficial mitigation, and evaluate the results as time allowed. A variety of low-cost options were considered, including engineering improvements, enhanced efforts by law enforcement, and educational initiatives. Using input, active support, and participation from local agencies and state and Federal safety advocates, the study afforded a unique opportunity to examine useful tools for local rural agencies to utilize in addressing safety on this particular type of roadway.

An Investigation of Signing Needs at Uncontrolled Local Road Intersections, HR-230, 1982

Iowa Counties have been experiencing significant tort claim liability due to the signing of local roads. One such problem is relative to the real or alleged need for signing at uncontrolled intersections of local roads. It has been assumed that the standard CROSS ROAD sign, which calls for a yellow diamond with a black cross, was sufficient to provide the necessary warning that a driver may be approaching an intersection which requires special precautionary driving attention. However, it is possible that this sign on a through highway might conflict with the legal status of the local county road. In light of this situation, it seemed worthwhile to know the extent to which uncontrolled local road intersections were perceived as a potential liability problem; the degree to which the standard CROSS ROAD sign communicated to the driver the message a county engineer wanted at these local road intersections; and whether there were any better signing alternatives available to communicate this hazard to the driver in this situation.