BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by th...BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.展开更多
Rear-end crashes are among the most common crash types at signalized intersections. To examine the risk factors for the occurrence of this crash type, this study involved the analysis of nine years of intersection cra...Rear-end crashes are among the most common crash types at signalized intersections. To examine the risk factors for the occurrence of this crash type, this study involved the analysis of nine years of intersection crash records in the state of Wyoming. With that, the contributing factors related to crash, driver, environmental, and roadway characteristics, including pavement surface friction, were investigated. A binomial logistic regression modeling approach was applied to achieve the study’s objective. The results showed that three factors related to crash and driver’s attributes (commercial vehicle involvement, speeding, and driver’s age) and four factors related to environmental and roadway characteristics (lighting, weather conditions, area type, whether urban or rural and pavement friction) are associated with the risk of rear-end crash occurrence at signalized intersections. This study provides insights into the mitigation measures to implement concerning rear-end crashes at signalized intersections.展开更多
Every year,a substantial number of children sustain injuries and fatalities in motor vehicle crashes in Wyoming.Understanding the factors contributing to child injury is crucial for the development of appropriate miti...Every year,a substantial number of children sustain injuries and fatalities in motor vehicle crashes in Wyoming.Understanding the factors contributing to child injury is crucial for the development of appropriate mitigation measures that aid in alleviating the severity of such injuries.In this study,a hierarchical Bayesian binary logit regression model was developed to investigate the factors that contribute to children’s injuries resulting from crashes while accounting for possible intra-class correlation effects(those of unobserved factors common to children involved in the same crash).A strong correlation among crashes justified the use of the hierarchical Bayesian logit model.As per the modeling results,the children’s ages,safety restraint types,vehicle types,drivers’ages,alcohol/drug involvement,drivers’seat belt use habits,drivers’actions,manners of collision and environmental conditions contributed to child injury risk.The child’s age was found to be inversely related to the risk of injury.Similarly,among safety restraint types,rear-facing car seats and forward-facing car seats were found to reduce injury likelihoods in crashes.When it comes to the drivers’characteristics,the probability of incurring injuries among the child population increased in the presence of young,unbuckled and impaired drivers.Furthermore,improper driving actions,such as running off the road,raised the risk of incurring injuries to children.The findings of this study may be beneficial to authorities regarding developing and implementing road safety programs aimed at ameliorating child injury concerns.展开更多
One of the critical areas of road safety is motorcycle safety. Motorcyclists are more vulnerable to injuries than occupants of other motor vehicles when involved in crashes.Researchers have studied the relationships b...One of the critical areas of road safety is motorcycle safety. Motorcyclists are more vulnerable to injuries than occupants of other motor vehicles when involved in crashes.Researchers have studied the relationships between motorcycle crash severity and crash contributing factors. They are crash characteristics, roadway geometric design features,traffic characteristics, socio-demographics and environmental conditions. However, few researchers considered unobserved heterogeneity effects when modeling motorcycle crash injury severities, let alone interaction effects. In this research, motorcycle crashes in Wyoming that occurred from 2008 to 2017 were analyzed. Specifically, the injury severities of single motorcycle crashes and multiple vehicle crashes involving motorcycles were modeled. The response was whether the motorcycle crash incurred an incapacitating injury or fatality or not. The binary logistic regression and mixed binary logistic regression modeling structures were implemented. The mixed models revealed effects that otherwise would have been undisclosed in the binary logistic regression models’ results. According to the results of single motorcycle crashes, the majority of motorcycle-animal crashes and of motorcycle-barrier crashes were likely to be severe relative to other single motorcycle crashes. It was also found that horizontal curves increased the risk of severe injuries.Young riders were found to be less at risk of being gravely injured in single motorcycle crashes than older riders as well. Furthermore, riding under the influence and high posted speed limits increased the odds of severe crashes regardless of whether the crashes were single motorcycle crashes or multiple vehicle crashes involving motorcycles. Additionally,the mixed models uncovered interaction effects and unobserved effects pertaining to speed limits.展开更多
文摘BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.
文摘Rear-end crashes are among the most common crash types at signalized intersections. To examine the risk factors for the occurrence of this crash type, this study involved the analysis of nine years of intersection crash records in the state of Wyoming. With that, the contributing factors related to crash, driver, environmental, and roadway characteristics, including pavement surface friction, were investigated. A binomial logistic regression modeling approach was applied to achieve the study’s objective. The results showed that three factors related to crash and driver’s attributes (commercial vehicle involvement, speeding, and driver’s age) and four factors related to environmental and roadway characteristics (lighting, weather conditions, area type, whether urban or rural and pavement friction) are associated with the risk of rear-end crash occurrence at signalized intersections. This study provides insights into the mitigation measures to implement concerning rear-end crashes at signalized intersections.
基金funded by the Wyoming Department of Transportation(WyDOT)supported by the Mountain Plains Consortium(Grant Number 69A3551747108(FAST Act))。
文摘Every year,a substantial number of children sustain injuries and fatalities in motor vehicle crashes in Wyoming.Understanding the factors contributing to child injury is crucial for the development of appropriate mitigation measures that aid in alleviating the severity of such injuries.In this study,a hierarchical Bayesian binary logit regression model was developed to investigate the factors that contribute to children’s injuries resulting from crashes while accounting for possible intra-class correlation effects(those of unobserved factors common to children involved in the same crash).A strong correlation among crashes justified the use of the hierarchical Bayesian logit model.As per the modeling results,the children’s ages,safety restraint types,vehicle types,drivers’ages,alcohol/drug involvement,drivers’seat belt use habits,drivers’actions,manners of collision and environmental conditions contributed to child injury risk.The child’s age was found to be inversely related to the risk of injury.Similarly,among safety restraint types,rear-facing car seats and forward-facing car seats were found to reduce injury likelihoods in crashes.When it comes to the drivers’characteristics,the probability of incurring injuries among the child population increased in the presence of young,unbuckled and impaired drivers.Furthermore,improper driving actions,such as running off the road,raised the risk of incurring injuries to children.The findings of this study may be beneficial to authorities regarding developing and implementing road safety programs aimed at ameliorating child injury concerns.
文摘One of the critical areas of road safety is motorcycle safety. Motorcyclists are more vulnerable to injuries than occupants of other motor vehicles when involved in crashes.Researchers have studied the relationships between motorcycle crash severity and crash contributing factors. They are crash characteristics, roadway geometric design features,traffic characteristics, socio-demographics and environmental conditions. However, few researchers considered unobserved heterogeneity effects when modeling motorcycle crash injury severities, let alone interaction effects. In this research, motorcycle crashes in Wyoming that occurred from 2008 to 2017 were analyzed. Specifically, the injury severities of single motorcycle crashes and multiple vehicle crashes involving motorcycles were modeled. The response was whether the motorcycle crash incurred an incapacitating injury or fatality or not. The binary logistic regression and mixed binary logistic regression modeling structures were implemented. The mixed models revealed effects that otherwise would have been undisclosed in the binary logistic regression models’ results. According to the results of single motorcycle crashes, the majority of motorcycle-animal crashes and of motorcycle-barrier crashes were likely to be severe relative to other single motorcycle crashes. It was also found that horizontal curves increased the risk of severe injuries.Young riders were found to be less at risk of being gravely injured in single motorcycle crashes than older riders as well. Furthermore, riding under the influence and high posted speed limits increased the odds of severe crashes regardless of whether the crashes were single motorcycle crashes or multiple vehicle crashes involving motorcycles. Additionally,the mixed models uncovered interaction effects and unobserved effects pertaining to speed limits.
