Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes.

BACKGROUND: 2013 AHA/ACC guidelines on the treatment of cholesterol advised to tailor high-intensity statin after ACS, while previous ATP-III recommended titration of statin to reach low-density lipoprotein cholesterol (LDL-C) targets. We simulated the impact of this change of paradigm on the achievement of recommended targets. METHODS: Among a prospective cohort study of consecutive patients hospitalized for ACS from 2009 to 2012 at four Swiss university hospitals, we analyzed 1602 patients who survived one year after recruitment. Targets based on the previous guidelines approach was defined as (1) achievement of LDL-C target < 1.8 mmol/l, (2) reduction of LDL-C ≥ 50% or (3) intensification of statin in patients who did not reach LDL-C targets. Targets based on the 2013 AHA/ACC guidelines approach was defined as the maximization of statin therapy at high-intensity in patients aged ≤75 years and moderate- or high-intensity statin in patients >75 years. RESULTS: 1578 (99%) patients were prescribed statin at discharge, with 1120 (70%) at high-intensity. 1507 patients (94%) reported taking statin at one year, with 909 (57%) at high-intensity. Among 482 patients discharged with sub-maximal statin, intensification of statin was only observed in 109 patients (23%). 773 (47%) patients reached the previous LDL-C targets, while 1014 (63%) reached the 2013 AHA/ACC guidelines targetsone year after ACS (p value < 0.001). CONCLUSION: The application of the new 2013 AHA/ACC guidelines criteria would substantially increase the proportion of patients achieving recommended lipid targets one year after ACS. Clinical trial number, NCT01075868.

Review of targeted small business procurement activities for the year ended June 30, 2014

Review of targeted small business procurement activities for the year ended June 30, 2014

Discordances in the application of different criteria for quantification of paediatric abdominal obesity: an analysis of two Swiss studies.

Several definitions of paediatric abdominal obesity have been proposed but it is unclear whether they lead to similar results. We assessed the prevalence of abdominal obesity using five different waist circumference-based definitions and their agreement with total body fat (TBF) and abdominal fat (AF). Data from 190 girls and 162 boys (Ballabeina), and from 134 girls and 113 boys (Kinder-Sportstudie, KISS) aged 5-11 years were used. TBF was assessed by bioimpedance (Ballabeina) or dual energy X-ray absorption (KISS). On the basis of the definition used, the prevalence of abdominal obesity varied between 3.1 and 49.4% in boys, and 4.7 and 55.5% in girls (Ballabeina), and between 1.8 and 36.3% in boys and 4.5 and 37.3% in girls (KISS). Among children considered as abdominally obese by at least one definition, 32.0 (Ballabeina) and 44.7% (KISS) were considered as such by at least two (out of five possible) definitions. Using excess TBF or AF as reference, the areas under the receiver operating curve varied between 0.577 and 0.762 (Ballabeina), and 0.583 and 0.818 (KISS). We conclude that current definitions of abdominal obesity in children lead to wide prevalence estimates and should not be used until a standard definition can be proposed.

Segmentation of foot and ankle complex based on kinematic criteria.

Although various foot models were proposed for kinematics assessment using skin makers, no objective justification exists for the foot segmentations. This study proposed objective kinematic criteria to define which foot joints are relevant (dominant) in skin markers assessments. Among the studied joints, shank-hindfoot, hindfoot-midfoot and medial-lateral forefoot joints were found to have larger mobility than flexibility of their neighbour bonesets. The amplitude and pattern consistency of these joint angles confirmed their dominancy. Nevertheless, the consistency of the medial-lateral forefoot joint amplitude was lower. These three joints also showed acceptable sensibility to experimental errors which supported their dominancy. This study concluded that to be reliable for assessments using skin markers, the foot and ankle complex could be divided into shank, hindfoot, medial forefoot, lateral forefoot and toes. Kinematics of foot models with more segments must be more cautiously used.

Time-Dependent Specificity of Immunopathologic (C4d-CD68) and Histologic Criteria of Antibody-Mediated Rejection for Donor-Specific Antibodies and Allograft Dysfunction in Heart Transplantation.

BACKGROUND: In heart transplantation, antibody-mediated rejection (AMR) is diagnosed and graded on the basis of immunopathologic (C4d-CD68) and histopathologic criteria found on endomyocardial biopsies (EMB). Because some pathologic AMR (pAMR) grades may be associated with clinical AMR, and because humoral responses may be affected by the intensity of immunosuppression during the first posttransplantation year, we investigated the incidence and positive predictive values (PPV) of C4d-CD68 and pAMR grades for clinical AMR as a function of time. METHODS: All 564 EMB from 40 adult heart recipients were graded for pAMR during the first posttransplantation year. Clinical AMR was diagnosed by simultaneous occurrence of pAMR on EMB, donor specific antibodies and allograft dysfunction. RESULTS: One patient demonstrated clinical AMR at postoperative day 7 and one at 6 months (1-year incidence 5%). C4d-CD68 was found on 4,7% EMB with a "decrescendo" pattern over time (7% during the first 4 months vs. 1.2% during the last 8 months; P < 0.05). Histopathologic criteria of AMR occurred on 10.3% EMB with no particular time pattern. Only the infrequent (1.4%) pAMR2 grade (simultaneous histopathologic and immunopathologic markers) was predictive for clinical AMR, particularly after the initial postoperative period (first 4 months and last 8 months PPV = 33%-100%; P < 0.05). CONCLUSION: In the first posttransplantation year, AMR immunopathologic and histopathologic markers were relatively frequent, but only their simultaneous occurrence (pAMR2) was predictive of clinical AMR. Furthermore, posttransplantation time may modulate the occurrence of C4d-CD68 on EMB and thus the incidence of pAMR2 and its relevance to the diagnosis of clinical AMR.

Criteria for the Evaluation and Disposition of Low-Traffic-Count Secondary Roads, HR-139, 1969

The State of Iowa has too many roads. Although ranking thirty-fourth in population, twenty-fifth in area, and twentieth in motor vehicle registration, it ranks seventh in the nation in miles of rural roads. In 1920 when Iowa's rural population was 1,528,000, there were 97,440 miles of secondary roads. In 1960 with rural population down 56 percent to 662,000, there were 91,000 miles of secondary roads--a 7 percent decrease. The question has been asked: "Who are these 'service roads' serving?" This excess mileage tends to dissipate road funds at a critical time of increasing public demand for better and safer roads.

The gendering of excellence through quality criteria: the case of the SNSF Professorships in Switzerland

The Swiss National Science Foundation Professorships Programme is presented as a scientific programme that aims to promote outstanding young scholars to professorial positions. Academic excellence is presented as the main selection criterion. The emphasis put on the research portfolio and on the age of the candidates means that the beneficiaries of these professorships put forward an image of excellence that is more embedded in data-based sciences than in the humanities and social sciences, thus strengthening the domination of a sector scientific activity essentially occupied by men over the sector that has opened up more widely to women. This paper aims to deconstruct the criteria of academic excellence as they appear in this programme and to show that what seem quality criteria are in fact inspired by a specific androcentric model. These biases tend to undermine the gender equality aims of the programme.

Development of Object-Oriented Design and Specifications for Iowa DOT and Urban Standards: Phase I, TR-487, 2004

Currently, individuals including designers, contractors, and owners learn about the project requirements by studying a combination of paper and electronic copies of the construction documents including the drawings, specifications (standard and supplemental), road and bridge standard drawings, design criteria, contracts, addenda, and change orders. This can be a tedious process since one needs to go back and forth between the various documents (paper or electronic) to obtain information about the entire project. Object-oriented computer-aided design (OO-CAD) is an innovative technology that can bring a change to this process by graphical portrayal of information. OO-CAD allows users to point and click on portions of an object-oriented drawing that are then linked to relevant databases of information (e.g., specifications, procurement status, and shop drawings). The vision of this study is to turn paper-based design standards and construction specifications into an object-oriented design and specification (OODAS) system or a visual electronic reference library (ERL). Individuals can use the system through a handheld wireless book-size laptop that includes all of the necessary software for operating in a 3D environment. All parties involved in transportation projects can access all of the standards and requirements simultaneously using a 3D graphical interface. By using this system, users will have all of the design elements and all of the specifications readily available without concerns of omissions. A prototype object-oriented model was created and demonstrated to potential users representing counties, cities, and the state. Findings suggest that a system like this could improve productivity to find information by as much as 75% and provide a greater sense of confidence that all relevant information had been identified. It was also apparent that this system would be used by more people in construction than in design. There was also concern related to the cost to develop and maintain the complete system. The future direction should focus on a project-based system that can help the contractors and DOT inspectors find information (e.g., road standards, specifications, instructional memorandums) more rapidly as it pertains to a specific project.

Examination of Curing Criteria for Cold In-Place Recycling, TR-553, 2008

Cold In-Place Recycling (CIR) has been used widely in rehabilitating the rural highways because it improves a long-term pavement performance. A CIR layer is normally covered by a hot mix asphalt (HMA) overlay in order to protect it from water ingress and traffic abrasion and obtain the required pavement structure and texture. Curing is the term currently used for the period of time that a CIR layer should remain exposed to drying conditions before an HMA overlay is placed. The industry standard for curing time is 10 days to 14 days or a maximum moisture content of 1.5 percent, which appear to be very conservative. When the exposed CIR layer is required to carry traffic for many weeks before the wearing surface is placed, it increases the risk of a premature failure in both CIR layer and overlay. This study was performed to explore technically sound ways to identify minimum in-place CIR properties necessary to permit placement of the HMA overlay. To represent the curing process of CIR pavement in the field construction, three different laboratory curing procedures were examined: 1) uncovered, 2) semi-covered and 3) covered specimens. The indirect tensile strength of specimens in all three curing conditions did not increase during an early stage of curing but increased during a later stage of curing usually when the moisture content falls below 1.5%. Dynamic modulus and flow number increased as curing time increased and moisture contents decreased. For the same curing time, CIR-foam specimens exhibited the higher tensile strength and less moisture content than CIR-emulsion. The laboratory test results concluded that the method of curing temperature and length of the curing period significantly affect the properties of the CIR mixtures. The moisture loss index was developed to predict the moisture condition in the field and, in the future, this index be calibrated with the measurements of temperature and moisture of a CIR layer in the field.

Examination of Curing Criteria for Cold In-Place Recycling Phase 2: Measuring Temperature, Moisture, Deflection and Distress from CIR Test Section, TR-590, 2009

The previous research performed laboratory experiments to measure the impacts of the curing on the indirect tensile strength of both CIR-foam and CIR-emulsion mixtures. However, a fundamental question was raised during the previous research regarding a relationship between the field moisture content and the laboratory moisture content. Therefore, during this research, both temperature and moisture conditions were measured in the field by embedding the sensors at a midpoint and a bottom of the CIR layer. The main objectives of the research are to: (1) measure the moisture levels throughout a CIR layer and (2) develop a moisture loss index to determine the optimum curing time of CIR layer before HMA overlay. To develop a set of moisture loss indices, the moisture contents and temperatures of CIR-foam and CIR-emulsion layers were monitored for five months. Based on the limited field experiment, the following conclusions are derived: 1. The moisture content of the CIR layer can be monitored accurately using the capacitance type moisture sensor. 2. The moisture loss index for CIR layers is a viable tool in determining the optimum timing for an overlay without measuring actual moisture contents. 3. The modulus back-calculated based on the deflection measured by FWD seemed to be in a good agreement with the stiffness measured by geo-gauge. 4. The geo-gauge should be considered for measuring the stiffness of CIR layer that can be used to determine the timing of an overlay. 5. The stiffness of CIR-foam layer increased as a curing time increased and it seemed to be more influenced by a temperature than moisture content. The developed sets of moisture loss indices based on the field measurements will help pavement engineers determine an optimum timing of an overlay without continually measuring moisture conditions in the field using a nuclear gauge.

Examination of Curing Criteria for Cold In-Place Recycling (Phase 3: Calibration of Moisture Loss Indices and Development of Stiffness Gain Model), TR-609, 2011

In the previous study, moisture loss indices were developed based on the field measurements from one CIR-foam and one CIR-emulsion construction sites. To calibrate these moisture loss indices, additional CIR construction sites were monitored using embedded moisture and temperature sensors. In addition, to determine the optimum timing of an HMA overlay on the CIR layer, the potential of using the stiffness of CIR layer measured by geo-gauge instead of the moisture measurement by a nuclear gauge was explored. Based on the monitoring the moisture and stiffness from seven CIR project sites, the following conclusions are derived: 1. In some cases, the in-situ stiffness remained constant and, in other cases, despite some rainfalls, stiffness of the CIR layers steadily increased during the curing time. 2. The stiffness measured by geo-gauge was affected by a significant amount of rainfall. 3. The moisture indices developed for CIR sites can be used for predicting moisture level in a typical CIR project. The initial moisture content and temperature were the most significant factors in predicting the future moisture content in the CIR layer. 4. The stiffness of a CIR layer is an extremely useful tool for contractors to use for timing their HMA overlay. To determine the optimal timing of an HMA overlay, it is recommended that the moisture loss index should be used in conjunction with the stiffness of the CIR layer.

Inheritance pattern and selection criteria for resistance to soybean cyst nematode races 3 and 9

The objective of this work was to determine soybean resistance inheritance to Heterodera glycines Ichinohe (soybean cyst nematode - SCN) races 3 and 9, as well as to evaluate the efficiency of direct and indirect selection in a soybean population of 112 recombinant inbred lines (RIL) derived from the resistant cultivar Hartwig. The experiment was conducted in a completely randomized design, in Londrina, PR, Brazil. The estimated narrow-sense heritabilities for resistance to races 3 and 9 were 80.67 and 77.97%. The genetic correlation coefficient (r g = 0.17; p<0.01) shows that some genetic components of resistance to these two races are inherited together. The greatest genetic gain by indirect selection was obtained to race 9, selecting to race 3 due to simpler inheritance of resistance to race 9 and not because these two races share common resistance genes. The resistance of cultivar Hartwig to races 3 and 9 is determined by 4 and 2 genes, respectively. One of these genes confers resistance to both races, explaining a fraction of the significant genetic correlation found between resistance to these SCN races. The inheritance pattern described indicates that selection for resistance to SCN must be performed for each race individually.

Biased diffusion in confined media: Test of the Fick-Jacobs approximation and validity criteria

We study biased, diffusive transport of Brownian particles through narrow, spatially periodic structures in which the motion is constrained in lateral directions. The problem is analyzed under the perspective of the Fick-Jacobs equation, which accounts for the effect of the lateral confinement by introducing an entropic barrier in a one-dimensional diffusion. The validity of this approximation, based on the assumption of an instantaneous equilibration of the particle distribution in the cross section of the structure, is analyzed by comparing the different time scales that characterize the problem. A validity criterion is established in terms of the shape of the structure and of the applied force. It is analytically corroborated and verified by numerical simulations that the critical value of the force up to which this description holds true scales as the square of the periodicity of the structure. The criterion can be visualized by means of a diagram representing the regions where the Fick-Jacobs description becomes inaccurate in terms of the scaled force versus the periodicity of the structure.

Iowa Department of Administrative Services Central Procurement Enterprise (CPE) Policy and Procedures Manual, December 2013

Report on a review of the Central Procurement Enterprise (CPE) of the Iowa Department of Administrative Services for the period July 1, 2009 through March 31, 2013