Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure.

OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.

Iowa Department of Transportation : A Design for Growth, 1971

This report has been prepared to provide a succinct documentation of the results of an intensive "finding" as to the requirement for an Iowa Department of Transportation, the recommended general organizational characteristics, and the implementation process requisite to instituting an Iowa Department of Transportation. This report specifies, in summary, the systematic procedure employed in the analysis, followed by a presentation of the fundamental concepts associated with a department of transportation and documentation of the "need" for a state department of transportation. The majority of the report is devoted to presentation of a best judgment as to how an Iowa Department of Transportation should be organized and implemented. The report concludes with a discussion of a recommended approach to the implementation of the department, and issues and recommendations for review.

Highway Location Reference Procedure Project, 1990

The purpose of the proposed Highway Location Reference Procedure is stated in the contract as follows: "Establishment of a highway network locational reference process that will primarily allow for the proper correlation of pavement management data, and secondarily provide the basis for other existing and future data base integration and for the planned Iowa DOT Geographic Information System. In addition, the locational reference process will be able to correlate network applications with a statewide spatial location method to facilitate the relationship of Iowa DOT data to that of other agencies and to allow for the graphic display of the network in map form." The Design Specifications and Implementation Plan, included in this Final Report, are intended to provide the basis for proceeding with immediate development and implementation of the pavement management system. These specifications will also support the future Iowa DOT implementation of other integrated data bases and/or the planned Geographic Information System.

Simplified design method for energy dissipating devices in retrofitting of seismically isolated bridges

Abstract: Highway bridges have great values in a country because in case of any natural disaster they may serve as lines to save people’s lives. Being vulnerable under significant seismic loads, different methods can be considered to design resistant highway bridges and rehabilitate the existing ones. In this study, base isolation has been considered as one efficient method in this regards which in some cases reduces significantly the seismic load effects on the structure. By reducing the ductility demand on the structure without a notable increase of strength, the structure is designed to remain elastic under seismic loads. The problem associated with the isolated bridges, especially with elastomeric bearings, can be their excessive displacements under service and seismic loads. This can defy the purpose of using elastomeric bearings for small to medium span typical bridges where expansion joints and clearances may result in significant increase of initial and maintenance cost. Thus, supplementing the structure with dampers with some stiffness can serve as a solution which in turn, however, may increase the structure base shear. The main objective of this thesis is to provide a simplified method for the evaluation of optimal parameters for dampers in isolated bridges. Firstly, performing a parametric study, some directions are given for the use of simple isolation devices such as elastomeric bearings to rehabilitate existing bridges with high importance. Parameters like geometry of the bridge, code provisions and the type of soil on which the structure is constructed have been introduced to a typical two span bridge. It is concluded that the stiffness of the substructure, soil type and special provisions in the code can determine the employment of base isolation for retrofitting of bridges. Secondly, based on the elastic response coefficient of isolated bridges, a simplified design method of dampers for seismically isolated regular highway bridges has been presented in this study. By setting objectives for reduction of displacement and base shear variation, the required stiffness and damping of a hysteretic damper can be determined. By modelling a typical two span bridge, numerical analyses have followed to verify the effectiveness of the method. The method has been used to identify equivalent linear parameters and subsequently, nonlinear parameters of hysteretic damper for various designated scenarios of displacement and base shear requirements. Comparison of the results of the nonlinear numerical model without damper and with damper has shown that the method is sufficiently accurate. Finally, an innovative and simple hysteretic steel damper was designed. Five specimens were fabricated from two steel grades and were tested accompanying a real scale elastomeric isolator in the structural laboratory of the Université de Sherbrooke. The test procedure was to characterize the specimens by cyclic displacement controlled tests and subsequently to test them by real-time dynamic substructuring (RTDS) method. The test results were then used to establish a numerical model of the system which went through nonlinear time history analyses under several earthquakes. The outcome of the experimental and numerical showed an acceptable conformity with the simplified method.

Optimal static and sequential design : a critical review

The aim of this thesis is to review and augment the theory and methods of optimal experimental design. In Chapter I the scene is set by considering the possible aims of an experimenter prior to an experiment, the statistical methods one might use to achieve those aims and how experimental design might aid this procedure. It is indicated that, given a criterion for design, a priori optimal design will only be possible in certain instances and, otherwise, some form of sequential procedure would seem to be indicated. In Chapter 2 an exact experimental design problem is formulated mathematically and is compared with its continuous analogue. Motivation is provided for the solution of this continuous problem, and the remainder of the chapter concerns this problem. A necessary and sufficient condition for optimality of a design measure is given. Problems which might arise in testing this condition are discussed, in particular with respect to possible non-differentiability of the criterion function at the design being tested. Several examples are given of optimal designs which may be found analytically and which illustrate the points discussed earlier in the chapter. In Chapter 3 numerical methods of solution of the continuous optimal design problem are reviewed. A new algorithm is presented with illustrations of how it should be used in practice. It is shown that, for reasonably large sample size, continuously optimal designs may be approximated to well by an exact design. In situations where this is not satisfactory algorithms for improvement of this design are reviewed. Chapter 4 consists of a discussion of sequentially designed experiments, with regard to both the philosophies underlying, and the application of the methods of, statistical inference. In Chapter 5 we criticise constructively previous suggestions for fully sequential design procedures. Alternative suggestions are made along with conjectures as to how these might improve performance. Chapter 6 presents a simulation study, the aim of which is to investigate the conjectures of Chapter 5. The results of this study provide empirical support for these conjectures. In Chapter 7 examples are analysed. These suggest aids to sequential experimentation by means of reduction of the dimension of the design space and the possibility of experimenting semi-sequentially. Further examples are considered which stress the importance of the use of prior information in situations of this type. Finally we consider the design of experiments when semi-sequential experimentation is mandatory because of the necessity of taking batches of observations at the same time. In Chapter 8 we look at some of the assumptions which have been made and indicate what may go wrong where these assumptions no longer hold.

Design of evacuation plans for densely urbanised city centres

The high population density and tightly packed nature of some city centres make emergency planning for these urban spaces especially important, given the potential for human loss in case of disaster. Historic and recent events have made emergency service planners particularly conscious of the need for preparing evacuation plans in advance. This paper discusses a methodological approach for assisting decision-makers in designing urban evacuation plans. The approach aims at quickly and safely moving the population away from the danger zone into shelters. The plans include determining the number and location of rescue facilities, as well as the paths that people should take from their building to their assigned shelter in case of an occurrence requiring evacuation. The approach is thus of the location–allocation–routing type, through the existing streets network, and takes into account the trade-offs among different aspects of evacuation actions that inevitably come up during the planning stage. All the steps of the procedure are discussed and systematised, along with computational and practical implementation issues, in the context of a case study – the design of evacuation plans for the historical centre of an old European city.

Design and application of experimental methods for steel sheet shearing

Shearing is the process where sheet metal is mechanically cut between two tools. Various shearing technologies are commonly used in the sheet metal industry, for example, in cut to length lines, slitting lines, end cropping etc. Shearing has speed and cost advantages over competing cutting methods like laser and plasma cutting, but involves large forces on the equipment and large strains in the sheet material. The constant development of sheet metals toward higher strength and formability leads to increased forces on the shearing equipment and tools. Shearing of new sheet materials imply new suitable shearing parameters. Investigations of the shearing parameters through live tests in the production are expensive and separate experiments are time consuming and requires specialized equipment. Studies involving a large number of parameters and coupled effects are therefore preferably performed by finite element based simulations. Accurate experimental data is still a prerequisite to validate such simulations. There is, however, a shortage of accurate experimental data to validate such simulations. In industrial shearing processes, measured forces are always larger than the actual forces acting on the sheet, due to friction losses. Shearing also generates a force that attempts to separate the two tools with changed shearing conditions through increased clearance between the tools as result. Tool clearance is also the most common shearing parameter to adjust, depending on material grade and sheet thickness, to moderate the required force and to control the final sheared edge geometry. In this work, an experimental procedure that provides a stable tool clearance together with accurate measurements of tool forces and tool displacements, was designed, built and evaluated. Important shearing parameters and demands on the experimental set-up were identified in a sensitivity analysis performed with finite element simulations under the assumption of plane strain. With respect to large tool clearance stability and accurate force measurements, a symmetric experiment with two simultaneous shears and internal balancing of forces attempting to separate the tools was constructed. Steel sheets of different strength levels were sheared using the above mentioned experimental set-up, with various tool clearances, sheet clamping and rake angles. Results showed that tool penetration before fracture decreased with increased material strength. When one side of the sheet was left unclamped and free to move, the required shearing force decreased but instead the force attempting to separate the two tools increased. Further, the maximum shearing force decreased and the rollover increased with increased tool clearance. Digital image correlation was applied to measure strains on the sheet surface. The obtained strain fields, together with a material model, were used to compute the stress state in the sheet. A comparison, up to crack initiation, of these experimental results with corresponding results from finite element simulations in three dimensions and at a plane strain approximation showed that effective strains on the surface are representative also for the bulk material. A simple model was successfully applied to calculate the tool forces in shearing with angled tools from forces measured with parallel tools. These results suggest that, with respect to tool forces, a plane strain approximation is valid also at angled tools, at least for small rake angles. In general terms, this study provide a stable symmetric experimental set-up with internal balancing of lateral forces, for accurate measurements of tool forces, tool displacements, and sheet deformations, to study the effects of important shearing parameters. The results give further insight to the strain and stress conditions at crack initiation during shearing, and can also be used to validate models of the shearing process.