Diagnostic accuracy of the tongue blade test combined with clinical signs to detect maxillary and mandibular fractures in the emergency department

BACKGROUND: To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test(TBT) to detect maxillary and mandibular fractures.METHODS: A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging(facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular fractures.RESULTS: A total of 98 patients were identified, of whom 31.6% had maxillary fractures and9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%.CONCLUSION: The clinical decision tool is potentially useful to rule out mandibular fractures,thus preventing unnecessary radiation exposure.

To scan or not to scan:Use of transient elastography in an integrated health system

BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for NAFLD.AIM To analyze how this CDST impacted health care utilization and patient outcomes.METHODS We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017(pre-CDST)or January 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and mortality.RESULTS We identified 958 patients who had FibroScan,115 before and 843 after the CDST was implemented.The percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was implemented.Though there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more referrals.Very few patients were hospitalized or died.CONCLUSION This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

Degree of Integrated Water Resources Management Implementation in Context of Climate Change in a Watershed:Case of Oueme Basin,Benin(West Africa)

This study is based on the hypothesis that the implementation of Integrated Water Resources Management(IWRM)tools in the Oueme watershed has not led to a systematic improvement in the degree of IWRM implementation in the Oueme Valley in Benin.Methodologically,data were collected through a semi-structured survey of stakeholder families in the study area using snowball sampling.The tool used was the form developed by the United Nations to collect data to assess the level of IWRM implementation.The four(4)assessment criteria,each covering a key component of IWRM,are the enabling environment,institutions and participation,management tools and financing.The results obtained per criteria according to the stepwise methodology adopted reveal on average a degree of implementation of 40 on a scale of 0 to 100 in the Oueme basin.This value varies according to the geographical area and the factors considered.This study,which is a decision-making tool,provides a guide for governments to monitor the progress of integrated water resources management in their territory.

Managing airport stormwater containing deicers： challenges and opportunities

Stormwater runoff at airports is a significant and costly issue, especially for the stormwater laden with deicing contaminants of high Biochemical Oxygen Demand （BOD） and aquatic toxicity. To reduce the loading of deicing constituents in stormwater and to manage the increasing pressure of tightening regulations, identifying fate and transport and evaluating environmental risks of deicing stormwater are of critical importance. In this review, the regulatory development of airport deicing stormwater management was first discussed, along with the milestone Airport Cooperative Research Program （ACRP） Report 14 publication. The deicer usage and fugitive losses can be reduced and the amount of deicer collected can be increased by having a better understanding of the fate and transport of deicing constituents in stormwater. As such, an overview and evaluation of the constituents of concern in deicers were provided to support the assessment of environmental impacts and mitigation recommendations. The state of knowledge of airport deicing stormwater management was then reviewed, which needs to be synthesized into a national guidance document. A guidebook and a decision tool for airports were proposed to adopt specific practical stormwater management strategies while balancing their priorities in environmental, economic, and social values against operational constraints. These challenges pose great opportunities to improve the current practices of airport deicing stormwater management.

Dual-modal Physiological Feature Fusion-based Sleep Recognition Using CFS and RF Algorithm

Research has demonstrated a significant overlap between sleep issues and other medical conditions.In this paper,we consider mild difficulty in falling asleep(MDFA).Recognition of MDFA has the potential to assist in the provision of appropriate treatment plans for both sleep issues and related medical conditions.An issue in the diagnosis of MDFA lies in subjectivity.To address this issue,a decision support tool based on dual-modal physiological feature fusion which is able to automatically identify MDFA is proposed in this study.Special attention is given to the problem of how to extract candidate features and fuse dual-modal features.Following the identification of the optimal feature set,this study considers the correlations between each feature and class and evaluates correlations between the inter-modality features.Finally,the recognition accuracy was measured using 10-fold cross validation.The experimental results for our method demonstrate improved performance.The highest recognition rate of MDFA using the optimal feature set can reach 96.22%.Based on the results of current study,the authors will,in projected future research,develop a real-time MDFA recognition system.

Transport network downsizing based on optimal sub-network

Transportation networks are sized to efficiently achieve some set of service objectives.Under particular circumstances,such as the COVID-19 pandemic,the demand for transportation can significantly change,both qualitatively and quantitatively,resulting in an over-capacitated and less efficient network.In this paper,we address this issue by proposing a framework for resizing the network to efficiently cope with the new demand.The framework includes a model to determine an optimal transportation sub-network that guarantees the following:(i)the minimal access time from any node of the urban network to the new sub-network has not excessively increased compared to that of the original transportation network;(ii)the delay induced on any itinerary by the removal of nodes from the original transportation network has not excessively increased;and(iii)the number of removed nodes from the transportation network is within a preset known factor.A solution is optimal if it induces a minimal global delay.We modelled this problem as a Mixed Integer Linear Program and applied it to the public bus transportation network of Lyon,France,in a case study.In order to respond to operational issues,the framework also includes a decision tool that helps the network planners to decide which bus lines to close and which ones to leave open according to specific trade-off preferences.The results on real data in Lyon show that the optimal sub-network from the MILP model can be used to feed the decision tool,leading to operational scenarios for network planners.

Supporting integrative maritime spatial planning by operationalising SEANERGY – a tool to study cross-sectoral synergies and conflicts

With growing pressures on marine ecosystems and on marine space,an increasingly needed strategy to optimise the use of marine space is to co-locate synergic marine human uses in close spatial–temporal proximity while separating conflicting marine human uses.The ArcMap toolbox SEANERGY is a new,cross-sectoral spatial decision support tool(DST)that enables maritime spatial planners to consider synergies and conflicts between marine uses to support assessments of co-location options.Cross-sectoral approaches are important to reach more integrative maritime spatial planning(MSP)processes.As this article demonstrates through a Baltic Sea analysis,SEANERGY presents a crosssectoral use catalogue for MSP through enabling the tool users to answer important specific questions to spatially and/or numerically weight potential synergies/conflicts between marine uses.The article discusses to what degree such a cross-sectoral perspective can support integrative MSP processes.While MSP integrative challenges still exist,SEANERGY enables MSP processes to move towards developing shared goals and initiate discussions built on best available knowledge regarding potential use-use synergies and use-use conflicts for whole sea basins at once.

Quantifying golf course nitrogen use efficiency

Background:Previous studies have surveyed golf courses to determine nitrogen(N)fertilizer application rates on golf courses,but no previous studies have attempted to quantify how efficiently golf courses use nitrogen.Methods:This study tests the ability of the growth potential(GP)N Requirement model as a benchmarking tool to predict a target level of N use on 76 golf courses in 5 regions of the US(Midwest,Northeast,East Texas,Florida,Northwest)and 3 countries in Europe(Denmark,Norway,UK).Results:The ratio of the golf course-wide N application rate to the GP N requirement prediction(termed the nitrogen efficiency score or NES)was 0.27,indicating that golf courses used 73%less N than predicted by the model.As such,the GP N Requirement model needs to be recalibrated to predict N use on golf courses.This was achieved by adjusting the Nmax coefficient in the model.N rates on golf courses were widely variable both within and across regions.All regions had a coefficient of variation in N rates of 0.46 or greater.Conclusions:The high variation in N rates,which is largely unexplained by climate,economic factors,grass type,and soil type,may be indicative of inefficient N use in golf course management.