Appropriate maintenance treatment for Crohn's disease: results of a multidisciplinary international expert panel - EPACT II

Introduction: Biological. therapy has dramatically changed management of Crohn's disease (CD). New data have confirmed the benefit and relative long-term safety of anti-TNF alpha inhibition as part of a regular scheduled administration programme. The EPACT appropriateness criteria for maintenance treatment after medically-induced remission (MIR) or surgically-induced remission (SIR) of CD thus required updating. Methods: A multidisciplinary international expert panel (EPACT II, Geneva, Switzerland) discussed and anonymously rated detailed, explicit clinical indications based on evidence in the literature and personal expertise. Median ratings (on a 9-point scale) were stratified into three assessment categories: appropriate (7-9), uncertain (4-6 and/or disagreement) and inappropriate (1-3). Experts ranked appropriate medication according to their own clinical practice, without any consideration of cost. Results: Three hundred and ninety-two specific indications for maintenance treatment of CD were rated (200 for MIR and 192 for SIR). Azathioprine, methotrexate and/or anti-TNF alpha antibodies were considered appropriate in 42 indications, corresponding to 68% of all appropriate interventions (97% of MIR and 39% of SIR). The remaining appropriate interventions consisted of mesalazine and a "wait-and-see" strategy. Factors that influenced the panel's voting were patient characteristics and outcome of previous treatment. Results favour use of anti-TNF alpha agents after failure of any immunosuppressive therapy, while earlier primary use remains controversial. Conclusion: Detailed explicit appropriateness criteria (EPACT) have been updated for maintenance treatment of CD. New expert recommendations for use of the classic immunosuppressors as well as anti-TNF alpha agents are now freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Thin Maintenance Surfaces for Municipalities, TR-507, 2007

As streets age, officials must deal with rehabilitating and reconstructing these pavements to maintain a safe and comfortable ride. In light of nationwide budget shortfalls, cost-effective methods of extending pavement service life must be developed or the overall condition of street systems will continue to fall. Thin maintenance surfaces (TMSs) are a set of cost-effective preventive maintenance surfacing techniques that can be used to extend the life of bituminous pavement—pavement built with hot mix asphalt, hot mix asphalt overlays of portland cement concrete pavements, built-up seal coat (chip seal), stabilized materials, or a combination of these. While previous phases of TMS research have provided information about the uses of thin maintenance surfaces in rural settings, urban areas have different road maintenance challenges that should be considered separately. This research provides city street officials with suggestions for TMS techniques that street departments can easily test and include into their current programs. This research project facilitated the construction of TMS test sections in Cedar Rapids, Council Bluffs, and West Des Moines (all urban settings in Iowa). Test section sites and surfaces were selected to suit the needs of municipalities and were applied to roads with an array of various distresses and maintenance needs. Condition surveys of each test section were performed before construction, after construction, and after the first winter to record the amount and severity of existing distress and calculate the pavement condition index. Because conditions of the test sections varied greatly, determining which surface was most successful by comparing case studies was not feasible. However, some general conclusions can be made from this research. TMSs are suitable preventive maintenance techniques for a municipal street department’s program for preserving existing pavements. Careful attention should be paid to proper planning, quality control during construction, aggregate and binder selection, and aggregate embedment in order to support successful TMS application.

Aggregates for Thin Maintenance Surfaces, TR-435, 2003

Important qualities of aggregates used for thin maintenance surface (TMS) include an aggregates wear and skid resistance, shape, gradation, and size. The wear and skid resistance of an aggregate influences the lifetime of the individual aggregate particles, and thus the lifetime of the TMS. A TMS’s effectiveness is impacted by the shape, gradation, and size of the aggregate used for the surfacing material along with the lifetime of the aggregate.

Asphalt Binders for Thin Maintenance Surfaces, TR-435, 2003

Asphalt is used as a binder for thin maintenance surface (TMS) applications because of two key properties, it is waterproof and it adheres relatively well to the aggregate. Since asphalt is too stiff at room temperature to apply to the road surface, it is usually applied as either a cutback asphalt or an asphalt emulsion. The asphalt emulsions can be further divided into high float emulsions, cationic emulsions or polymer-modified binders, which are emulsions with polymers added to them. These types of binders are discussed further below.

Field Testing of Abrasive Delivery Systems in Winter Maintenance, TR-458, 2009

The key goals in winter maintenance operations are preserving the safety and mobility of the traveling public. To do this, it is in general necessary to try to increase the friction of the road surface above the typical friction levels found on a snow or ice covered roadway. Because of prior work on the performance of abrasives (discussed in greater detail in chapter 2) a key concern when using abrasives has become how to ensure the greatest increase in pavement friction when using abrasives for the longest period of time. There are a number of ways in which the usage of abrasives can be optimized, and these methods are discussed and compared in this report. In addition, results of an Iowa DOT test of zero-velocity spreaders are presented. Additionally in this study the results of field studies conducted in Johnson County Iowa on the road surface friction of pavements treated with abrasive applications using different modes of delivery are presented. The experiments were not able to determine any significant difference in material placement performance between a standard delivery system and a chute based delivery system. The report makes a number of recommendations based upon the reviews and the experiments.

Investigation of Materials for the Reduction and Prevention of Corrosion on Highway Maintenance Equipment, TR-472, 2009

The issue of corrosion of winter maintenance equipment is becoming of greater concern because of the increased use of liquid solutions of ice control chemicals, as opposed to their application in solid form. Being in liquid form, the ice control chemicals can more easily penetrate into the nooks and crannies on equipment and avoid being cleansed from the vehicle. Given this enhanced corrosive ability, methods must be found to minimize corrosion. The methods may include coatings, additives, cleansing techniques, other methods, and may also include doing nothing, and accepting a reduced equipment lifetime as a valid (perhaps) trade off with the enhanced benefits of using liquid ice control chemicals. In reality, some combination of these methods may prove to be optimal. Whatever solutions are selected, they must be relatively cheap and durable. The latter point is critical because of the environment in which maintenance trucks operate, in which scrapes, scratches and dents are facts of life. Protection methods that are not robust simply will not work. The purpose of this study is to determine how corrosion occurs on maintenance trucks, to find methods that would minimize the major corrosion mechanisms, and to

Performance Measurement for Highway Winter Maintenance Operations, TR-491, 2009

The goal of this research project was to develop a method to measure the performance of a winter maintenance program with respect to the task of providing safety and mobility to the travelling public. Developing these measures required a number of steps, each of which was accomplished. First, the impact of winter weather on safety (crash rates) and mobility (average vehicle speeds were measured by a combination of literature reviews and analysis of Iowa Department of Transportation traffic and Road Weather Information System data. Second, because not all winter storms are the same in their effects on safety and mobility, a method had to be developed to determine how much the various factors that describe a winter storm actually change safety and mobility. As part of this effort a storm severity index was developed, which ranks each winter storm on a scale between 0 (a very benign storm) and 1 (the worst imaginable storm). Additionally a number of methods of modeling the relationships between weather, winter maintenance actions and road surface conditions were developed and tested. The end result of this study was a performance measure based on average vehicle speed. For a given class of road, a maximum expected average speed reduction has been identified. For a given storm, this maximum expected average speed reduction is modified by the storm severity index to give a target average speed reduction. Thus, if for a given road the maximum expected average speed reduction is 20 mph, and the storm severity for a particular storm is 0.6, then the target average speed reduction for that road in that storm is 0.6 x 20 mph or 12 mph. If the average speed on that road during and after the storm is only 12 mph or less than the average speed on that road in good weather conditions, then the winter maintenance performance goal has been met.

Spontaneous 24-h GHRELIN secretion pattern in fasting subjects : maintenance of a meal-related pattern

RESUME OBJECTIF: Outre la stimulation de la sécrétion d'hormone de croissance, la ghréline cause une prise pondérale par augmentation de l'assimilation d'aliments et réduction de la consommation lipidique. Il a été décrit que les taux de ghréline augmentent durant la phase pré-prandiale et diminuent juste après un repas, ceci suggérant qu'elle puisse jouer un rôle d'initiateur de la prise du repas. Cependant, la sécrétion de ghréline chez des sujets à jeun n'a pas encore été étudiée en détail. DESSIN: Les profils de sécrétion de ghréline pendant 24 heures ont été étudiés chez six sujets volontaires sains (3 femmes, 3 hommes; 25.5 ans; BMI 22.8 kg/m2) et comparés aux profils plasmatiques de l'hormone de croissance, de l'insuline et du glucose. METHODE: Des échantillons sanguins ont été prélevés toutes les 20 minutes pendant 24 heures et les taux de ghréline ont été mesurés par radio-immuno essai, utilisant un anticorps polyclonal de lapin. Le profil circadien de la sécrétion de ghréline (cluster analysis) a été évalué. RESULTATS: Une augmentation puis une diminution spontanée des taux de ghréline ont été observées aux moments où les sujets auraient habituellement mangé. La ghréline a été sécrétée de façon pulsatile avec approximativement 8 pics par 24 heures. Une diminution générale des taux de ghréline a également été observée durant la période d'étude. Aucune corrélation n'a pu être observée entre les taux de ghréline, d'homione de croissance, d'insuline et de glucose. CONCLUSIONS: Cette étude montre que pendant une période de jeûne les taux de ghréline suivent un profil similaire à ceux décrits chez des sujets mangeant 3 fois par jour. Durant le jeûne, l'hormone de croissance, l'insuline et le glucose ne semblent pas être impliqués dans la régulation de la sécrétion de ghréline. En outre, nous avons observé que la sécrétion de ghréline est pulsatile. La variation des taux de ghréline, indépendamment des repas, chez des sujets à jeun, renforce les observations préalables selon lesquelles le système nerveux central est primairement impliqué dans la régulation de la prise alimentaire. ABSTRACT: OBJECTIVE: Ghrelin stimulates GH release and causes weight gain through increased food intake and reduced fat utiIization. Ghrelin levels were shown to rise in the preprandial period and decrease shortly after meal consumption, suggesting a role as a possible meal initiator. However, ghrelin secretion in fasting subjects has not yet been studied in detail. DESIGN: 24-h ghrelin profiles were studied in six healthy volunteers (three females; 25.5 years; body mass index 22.8 kg/m2) and compared with GH, insulin and glucose levels. METHODS: Blood samples were taken every 20 min during a 24-h fasting period and total ghrelin levels were measured by RIA using a polyclonal rabbit antibody. The circadian pattern of ghrelin secretion and pulsatility (Cluster analysis) were evaluated. RESULTS: An increase and spontaneous decrease in ghrelin were seen at the timepoints of customary meals. Ghrelin was secreted in a pulsatile manner with approximately 8 peaks/24 h. An overall decrease in ghrelin levels was observed during the study period. There was no correlation of ghrelin with GH, insulin or blood glucose levels. CONCLUSIONS: This pilot study indicates that fasting ghrelin profiles display a circadian pattern similar to that described in people eating three times per day. In a fasting condition. GH, insulin and glucose do not appear to be involved in ghrelin regulation. In addition, we round that ghrelin is secreted in a pulsatile pattern. The variation in ghrelin independently of meals in fasting subjects supports previous observations that it is the brain that is primarily involved in the regulation of meal initiation.

Report on a review of selected general and application controls over the University of Northern Iowa Facility Administration and Maintenance Information System for the period April 29, 2014 through June 5, 2014

Report on a review of selected general and application controls over the University of Northern Iowa Facility Administration and Maintenance Information System for the period April 29, 2014 through June 5, 2014

Maintenance of polymorphism : a theoretical approach using multilocus systems

Résumé La thématique de cette thèse peut être résumée par le célèbre paradoxe de biologie évolutive sur le maintien du polymorphisme face à la sélection et par l'équation du changement de fréquence gamétique au cours du temps dû, à la sélection. La fréquence d'un gamète xi à la génération (t + 1) est: !!!Equation tronquée!!! Cette équation est utilisée pour générer des données utlisée tout au long de ce travail pour 2, 3 et 4 locus dialléliques. Le potentiel de l'avantage de l'hétérozygote pour le maintien du polymorphisme est le sujet de la première partie. La définition commune de l'avantage de l'hétérozygote n'etant applicable qu'a un locus ayant 2 allèles, cet avantage est redéfini pour un système multilocus sur les bases de précédentes études. En utilisant 5 définitions différentes de l'avantage de l'hétérozygote, je montre que cet avantage ne peut être un mécanisme général dans le maintien du polymorphisme sous sélection. L'étude de l'influence de locus non-détectés sur les processus évolutifs, seconde partie de cette thèse, est motivée par les travaux moléculaires ayant pour but de découvrir le nombre de locus codant pour un trait. La plupart de ces études sous-estiment le nombre de locus. Je montre que des locus non-détectés augmentent la probabilité d'observer du polymorphisme sous sélection. De plus, les conclusions sur les facteurs de maintien du polymorphisme peuvent être trompeuses si tous les locus ne sont pas détectés. Dans la troisième partie, je m'intéresse à la valeur attendue de variance additive après un goulot d'étranglement pour des traits sélectionés. Une études précédente montre que le niveau de variance additive après goulot d'étranglement augmente avec le nombre de loci. Je montre que le niveau de variance additive après un goulot d'étranglement augmente (comparé à des traits neutres), mais indépendamment du nombre de loci. Par contre, le taux de recombinaison a une forte influence, entre autre en regénérant les gamètes disparus suite au goulot d'étranglement. La dernière partie de ce travail de thèse décrit un programme pour le logiciel de statistique R. Ce programme permet d'itérer l'équation ci-dessus en variant les paramètres de sélection, recombinaison et de taille de populations pour 2, 3 et 4 locus dialléliques. Cette thèse montre qu'utiliser un système multilocus permet d'obtenir des résultats non-conformes à ceux issus de systèmes rnonolocus (la référence en génétique des populations). Ce programme ouvre donc d'intéressantes perspectives en génétique des populations. Abstract The subject of this PhD thesis can be summarized by one famous paradox of evolu-tionary biology: the maintenance of polymorphism in the face of selection, and one classical equation of theoretical population genetics: the changes in gametic frequencies due to selection and recombination. The frequency of gamete xi at generation (t + 1) is given by: !!! Truncated equation!!! This equation is used to generate data on selection at two, three, and four diallelic loci for the different parts of this work. The first part focuses on the potential of heterozygote advantage to maintain genetic polymorphism. Results of previous studies are used to (re)define heterozygote advantage for multilocus systems, since the classical definition is for one diallelic locus. I use 5 different definitions of heterozygote advantage. And for these five definitions, I show that heterozygote advantage is not a general mechanism for the maintenance of polymorphism. The study of the influence of undetected loci on evolutionary processes (second part of this work) is motivated by molecular works which aim at discovering the loci coding for a trait. For most of these works, some coding loci remains undetected. I show that undetected loci increases the probability of maintaining polymorphism under selection. In addition, conclusions about the factor that maintain polymorphism can be misleading if not all loci are considered. This is, therefore, only when all loci are detected that exact conclusions on the level of maintained polymorphism or on the factor(s) that maintain(s) polymorphism could be drawn. In the third part, the focus is on the expected release of additive genetic variance after bottleneck for selected traits. A previous study shows that the expected release of additive variance increases with an increase in the number of loci. I show that the expected release of additive variance after bottleneck increases for selected traits (compared with neutral), but this increase is not a function of the number of loci, but function of the recombination rate. Finally, the last part of this PhD thesis is a description of a package for the statistical software R that implements the Equation given above. It allows to generate data for different scenario regarding selection, recombination, and population size. This package opens perspectives for the theoretical population genetics that mainly focuses on one locus, while this work shows that increasing the number of loci leads not necessarily to straightforward results.

Final Report (SPR Project 90-00-RB10-012) on the Maintenance Asset Management Project Phase I, 2012

This project resulted in the development of a proof of concept for a features inventory process to be used by field staff. The resulting concept is adaptable for different asset classes (e.g. culverts, guardrail) and able to leverage existing DOT resources such as the videolog and LRS and our current technology platforms including Oracle and our GIS web infrastructure. The concept examined the feasibility of newly available technologies, such as mobile devices, while balancing ease of use in the field. Implementation and deployment costs were also important considerations in evaluating the success of the project. These project funds allowed the pilot to address the needs of two DOT districts. A report of findings was prepared, including recommendations for or against full deployment of the pilot solution.

Final Report (SPR Project 90-00-RB10-012) on the Maintenance Asset Management Project Phase II, 2013

This project resulted in the development of a proof of concept for a features inventory process to be used by field staff. The resulting concept is adaptable for different asset classes (e.g. culverts, guardrail) and able to leverage existing DOT resources such as the videolog and LRS and our current technology platforms including Oracle and our GIS web infrastructure. The concept examined the feasibility of newly available technologies, such as mobile devices, while balancing ease of use in the field. Implementation and deployment costs were also important considerations in evaluating the success of the project. These project funds allowed the pilot to address the needs of two DOT districts. A report of findings was prepared, including recommendations for a full deployment of a field data collection.

Maintenance and Design of Steel Abutment Piles in Iowa Bridges, TR-622, 2014

Soil consolidation and erosion caused by roadway runoff have exposed the upper portions of steel piles at the abutments of numerous bridges, leaving them susceptible to accelerated corrosion rates due to the abundance of moisture, oxygen, and chlorides at these locations. This problem is compounded by the relative inaccessibility of abutment piles for close-up inspection and repair. The objective of this study was to provide bridge owners with recommendations for effective methods of addressing corrosion of steel abutment piles in existing and future bridges A review of available literature on the performance and protection of steel piles exposed to a variety of environments was performed. Eight potential coating systems for use in protecting existing and/or new piles were selected and subjected to accelerated corrosion conditions in the laboratory. Two surface preparation methods were evaluated in the field and three coating systems were installed on three piles at an existing bridge where abutment piles had been exposed by erosion. In addition, a passive cathodic protection (CP) system using sacrificial zinc anodes was tested in the laboratory. Several trial flowable mortar mixes were evaluated for use in conjunction with the CP system. For existing abutment piles, application of a protective coating system is a promising method of mitigating corrosion. Based on its excellent performance in accelerated corrosion conditions in the laboratory on steel test specimens with SSPC-SP3, -SP6, and -SP10 surface preparations, glass flake polyester is recommended for use on existing piles. An alternative is epoxy over organic zinc rich primer. Surface preparation of existing piles should include abrasive blast cleaning to SSPC-SP6. Although additional field testing is needed, based on the results of the laboratory testing, a passive CP system could provide an effective means of protecting piles in existing bridges when combined with a pumped mortar used to fill voids between the abutment footing and soil. The addition of a corrosion inhibitor to the mortar appears to be beneficial. For new construction, shop application of thermally sprayed aluminum or glass flake polyester to the upper portion of the piles is recommended.

Rapid Improvement and Maintenance of the Lipid Profile After Roux-en-Y Gastric Bypass (RYGBP)

Background: Dyslipidemia, a major component of the metabolic syndrome and an important cardiovascular risk factor, is one of the commonest comorbidity associated with morbid obesity. The aim of this paper is to show that RYGBP markedly improves dyslipidemia and that this improvement maintains over time. Patients and Methods: Prospectively updated databank for bariatric patients. Patients undergoing RYGBP have yearly blood tests during follow-up. The results for lipids at one to five years were compared with preoperative values. Results: The mean excess BMI loss after one and five years was 77,9 % and 72,3%respectively. After one year, there was a significant reduction of the mean total cholesterol, LDL-cholesterol, total cholesterol/HDL ratio and triglyceride values, which maintained up to five years, and an increase of the HDL fraction, which progressed until five years. The proportion of patients with abnormal values decreased from 24,3 to 6,2% for total cholesterol, from 45,1 to 11,7 %for HDL, from 53,3 to 21,9 for LDL, and from 40,5 to 10 % for triglycerides, with no significant change between three and five years, despite some weight regain. Conclusions: RYGBP rapidly improves all components of dyslipidemia, and thereby reduces the overall cardiovascular risk in operated patients.