Helicopter Transport of Trauma Patients Improves Survival Irrespective of Transport Time

Objectives Helicopter transport of trauma patients remains controversial. We examined the survival rates of patients undergoing helicopter versus ground transport to a Level 1 trauma center. Methods Retrospective analysis was performed on trauma patients treated between 2014 and 2017. Student’s t-test was used to compare air versus ground transport times. A logistic regression was then used to examine the association of transportation type on survival controlling for demographics, mechanism of injury, transport time, field intubation, and injury severity. Results Of 3967 patients identified, 69.6% (2762) were male, and the average age was 40 years. Most patients suffered blunt injuries (86.8%, 3445), while the remaining had penetrating injuries (11.6%, 459) or burns (1.6%, 63). The majority of patients were transferred by ground (3449) with only 13% (518) transferred by air. Patients transported by air had increased Injury Severity Score (ISS) with a median of 17 (IQR 9-24) versus 9 (IQR 5-14), increased length of stay (LOS) at 6 days versus 3 ( P < .001), and increased mortality at 12.6% vs 6.5% ( P < .001). Patients transported by air arrived 16.6 ± 6.7 minutes faster compared with ground for the zip codes examined. When adjusting for the mechanism of injury, ISS, age, gender, intubation status, and transport time, air transport was associated with an increased likelihood of survival (odds ratio [OR] = 1.57, 95% CI = 1.06-2.40). Conclusion In our analysis of 3967 patients, those transported by air had a significant improvement in the likelihood of survival compared with those transported by ground even when adjusting for both ISS and time.

Pengendalian Lampu Lalu Lintas Cerdas di Persimpangan Empat Ruas yang Kompleks Menggunakan Algoritma Adaptive Neuro Fuzzy Inference System

Masalah transportasi masih sering dihadapkan pada fenomena kemacetan arus lalu lintas yang berdampak pada kecelakaan lalu lintas, polusi, dan kerugian ekonomi. Salah satu cara untuk meminimalisir fenomena tersebut melalui pengendalian sistem lampu lalu lintas yang baik terhadap arus lalu lintas jangka pendek di persimpangan jalan. Pengendalian lampu lalu lintas secara statis terbukti belum optimal dalam meminimalisir kemacetan arus lalu lintas, salah satu penyebabnya karena kondisi arus lalu lintas yang bervariasi sehingga tidak mudah diprediksi. Fuzzy Inference System (FIS) sering terbukti mampu menunjukkan hasil yang lebih baik daripada pengendalian lampu lalu lintas secara statis. Namun FIS tidak dapat diterapkan pada kondisi arus lalu lintas yang bervariasi atau di persimpangan jalan yang berbeda karena metode tersebut tidak mampu mempelajari kondisi arus lalu lintas secara real time. Agar FIS mampu melakukan pembelajaran, maka pendekatan machine learning dapat diterapkan pada FIS. Salah satu pengembangannya adalah Adaptive Neuro Fuzzy Inference System (ANFIS) yang dapat mengendalikan lampu lalu lintas cerdas secara dinamis dengan hasil yang lebih baik daripada FIS. Namun umumnya ANFIS diuji coba pada persimpangan jalan yang normal. Bagaimana jika di persimpangan yang kompleks? Persimpangan yang memiliki beberapa ruas/jalur utama yang besar (jalur poros), sementara ruas laiinya kecil, bahkan terdapat ruas yang tidak berpotongan, sehingga ada prioritas untuk setiap ruasnya. Hasilnya, penerapan ANFIS (3 GaussMf) untuk pengendalian lampu lalu lintas cerdas/dinamis di persimpangan empat ruas yang kompleks mampu mereduksi Average Waiting Times (AWT) rata-rata sebesar 3,4071E-05 detik dengan 2,7156 RMSE rata-rata, menggunakan variabel Queues Quantity dan Priority Degree. Sedangkan jika menggunakan variabel Arrival Times, Transportation Type, dan Goal Junction, ANFIS (4 TrapMf) mampu mereduksi AWT sebesar 0,0779 detik dengan 19,7646 RMSE.

PENGARUH INFORMASI PELAYANAN PROLANIS DAN KESESUAIAN WAKTU TERHADAP PEMANFAATAN PROLANIS DI PUSAT LAYANAN KESEHATAN UNAIR

Background: The Chronic Disease Management Program (Prolanis) was a promotive and preventive program developed by BPJS Kesehatan in collaboration with Primary Health Care (FKTP). Target ratio of prolanis patient visit (RPPB) to FKTP in safe zone was at least 50% every month. Average range of RPPB at UnairHealth Service Center (PLK Unair) from January to July of 2017 was 15% out of 62 registered participants, still below the target of the safety zone determined by BPJS Kesehatan.Aims: This study aimed to analyze the influence of enabling factors and need factor for the utilization ofProlanis at PLK Unair.Method: This research was a correlational-analytic research by using cross sectional research design.Results: The result of this study showed that there was a significant influence between prolanis information (p=0,020) and time conformity (p=0,008) towards the utilization of prolanis in PLK Unair. Meanwhile, BPJS class, distance, travel time, availability of transportation, type of transportation, social relations, health workers,health facilities, waiting time, and need has no significant effect.Conclusion: The conclusion of this research is the utilization of prolanis in PLK Unair influenced by prolanis information and time conformity of the patients. PLK Unair needs to recollect the information of their patients, redesign the socialization media and conduct home visit as well as discuss the schedule of prolanis activitieswith the patients.Keywords: enabling factor, need factor, prolanis, utilization of health services

Design and Full-Scale Testing of Low-Cost Texas Department of Transportation Type T631 Bridge Rail for MASH Test Level 2 and 3 Applications

The purpose of this project was to design and test a low-cost bridge rail system that would be compatible with the Midwest Guardrail System (31 in. height) and minimized or eliminated deck damage when impacted by errant vehicles. The Texas Type T631 bridge rail developed for this project is a flexible, low-cost bridge rail system for Test Level 2 (TL-2) applications. The Texas Department of Transportation Type T631 bridge rail designed and developed for this project was evaluated under Manual for Assessing Safety Hardware (MASH) TL-2 in 2013. The bridge rail incorporated S3X5.7 steel sections designed to yield at the post baseplate. The post baseplate was designed to distribute the baseplate bearing and shear forces without causing damage to the 8-in.-thick reinforced concrete deck. The welds on the posts were designed such that the post yielded without tearing away from the top of the baseplate. The rail element consisted of a 12-gauge W-beam rail element. The rail element was attached to the post with a bolt of diameter 5/16 in. This bolt was designed to break away without adversely affecting vehicle performance. The posts were spaced 6 ft 3 in. on centers for TL-2. The post spacing was reduced to 3 ft 1½ in. on centers and evaluated for MASH Test Level 3 (TL-3) specifications in 2014. At the smaller post spacing, the T631 met all the performance requirements of MASH TL-3. Details of the design and testing of the T631 for MASH TL-2 and MASH TL-3 specifications are provided in this paper.