Standardizing the diagnosis of inhalation injury using a descriptive score based on mucosal injury criteria.

INTRODUCTION: Inhalation injury is an important determinant of outcome in patients with major burns. However the diagnostic criteria remain imprecise, preventing objective comparisons of published data. The aims were to evaluate the utility of an inhalation score based on mucosal injury, while assessing separately the oro-pharyngeal sphere (ENT) and tracheobronchial tree (TB) in patients admitted to the ICU with a suspicion of inhalation injury. METHODS: Prospective observational study in 100 patients admitted with suspicion of inhalation injury among 168 consecutive burn admissions to the ICU of a university hospital. Inclusion criteria, endoscopic airway assessment during the first hours. ENT/TB lesion grading was 1: oedema, hyperemia, hypersecretion, 2: bullous mucosal detachment, erosion, exudates, 3: profound ulcers, necrosis. RESULTS: Of the 100 patients (age 42±17 years, burns 23±19%BSA), 79 presented an ENT inhalation injury ≥ENT1 (soot present in 24%): 36 had a tracheobronchial extension, 33 having a grade ≥TB1. Burned vibrissae: 10 patients "without" suffered ENT injury, while 6 patients "with" had no further lesions. Length of mechanical ventilation was strongly associated with the first 24 hrs' fluid resuscitation volume (p<0.0001) and the presence of inhalation injury (p=0.03), while the ICU length of stay was correlated with the %BSA. Soot was associated with prolonged mechanical ventilation (p=0.0115). There was no extubation failure. CONCLUSIONS: The developed inhalation score was simple to use, providing a unified language, and drawing attention to upper airway involvement. Burned vibrissae and suspected history proved to be insufficient diagnostic criteria. Further studies are required to validate the score in a larger population.

The book that gave to Iowa its name : a reprint,1935

This reprint of the book that gave to Iowa its name was published by the State Historical Society of Iowa in commemoration of the travels and explorations of Albert M. Lea in the Iowa country in 1835 while serving as Lieutenant in the First United States Dragoons.

Atlas-manuel d'anatomie descriptive du corps humain / par le Dr A. Prodhomme,...

Collection : Atlas-manuels de médecine

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.

Bridge Rail and Approach Railing for Low-Volume Roads in Iowa, TR-592, 2010

Bridge rail and approach guardrails provide safety to drivers by shielding more hazardous objects and redirecting vehicles to the roadway. However, guardrail can increase both the initial cost and maintenance cost of a bridge, while adding another object that may be struck by vehicles. Most existing low volume road (LVR) bridges in the state of Iowa are currently indicated to not possess bridge rail meeting “current acceptable standards”. The primary objective of the research summarized in this report was to provide the nations bridge and approach rail state of practice and perform a state wide crash analysis on bridge rails and approach guardrails on LVR bridges in Iowa. In support of this objective, the criteria and guidelines used by other bridge owners were investigated, non-standard and innovative bridge and approach guardrails for LVR’s were investigated, and descriptive, statistical and economical analyses were performed on a state wide crash analysis. The state wide crash analysis found the overall number of crashes at/on the more than 17,000+ inventoried and non-inventoried LVR bridges in Iowa was fewer than 350 crashes over an eight year period, representing less than 0.1% of the statewide reportable crashes. In other words, LVR bridge crashes are fairly rare events. The majority of these crashes occurred on bridges with a traffic volume less than 100 vpd and width less than 24 ft. Similarly, the majority of the LVR bridges possess similar characteristics. Crash rates were highest for bridges with lower traffic volumes, narrower widths, and negative relative bridge widths (relative bridge width is defined as: bridge width minus roadway width). Crash rate did not appear to be effected by bridge length. Statistical analysis confirmed that the frequency of vehicle crashes was higher on bridges with a lower width compared to the roadway width. The frequency of crashes appeared to not be impacted by weather conditions, but crashes may be over represented at night or in dark conditions. Statistical analysis revealed that crashes that occurred on dark roadways were more likely to result in major injury or fatality. These findings potentially highlight the importance of appropriate delineation and signing. System wide, benefit-cost (B/C) analyses yielded very low B/C ratios for statewide bridge rail improvements. This finding is consistent with the aforementioned recommendation to address specific sites where safety concerns exist.

The ambiguous disruption of gender-role expectations in the law and the lady name

The main purpose of this research project is to analyse the major female figures in Wilkie Collins' work of fiction The Law and the Lady, in relation to the times in which the novel was produced and the situation of women in the Victorian era. After taking into account the major events of the life of the author, as well as the sociohistorical conditions of the Victorian period, I try to reach conclusions about whether the author challenges gender-role expectations, presenting the readers with a new form of femininity, of if, on the contrary, he preserves and maintains a conservative, traditional perspective of femininity and female conventions proper to the established parameters of the times in which he lived. Keywords:

Evaluación del estándar SQL:1999 respecto a las características orientadas al objeto que soporta y su implementación a los SGBD object-relational

Memoria de TFC en el que se analiza el estándar SQL:1999 y se compara con PostgreeSQL y Oracle.

Culture in infancy : an account of a way the object "sculpts" early development.

The
 aim
 of
 this
 paper
 is
 to
 bring
 into
 consideration
 a
 way
 of
 studying
 culture
 in
 infancy.
 An
 emphasis 
is 
put 
on
 the
 role 
that 
the 
material 
object 
plays 
in 
early 
interactive
 processes. 
Accounted
 as
 a
 cultural
 artefact,
 the
 object
 is
 seen
 as
 a
 fundamental
 element
 within
 triadic
 mother‐object‐ infant
 interactions
 and
 is
 believed
 to
 be
 a
 driving
 force
 both
 for
 communicative
 and
 cognitive
 development.
 In
 order
 to
 reconsider
 the
 importance
 of
 the
 object
 in
 child
 development
 and
 to
 present
 an 
approach
 of 
studying
object
 construction,
accounts 
in 
literature 
on 
early 
communication
 development
 and
 the
 importance
 of
 the
 object
 are
 reviewed
 and
 discussed
 under
 the
 light
 of
 the
 cultural 
specificity 
of 
the 
material 
object.


Driving under drugs in Switzerland : a descriptive cross-sectional study

Objectives: Many drugs, both illicit or for medication, are known to influence driving abilities and increase risks of accidents. We explored the prevalence of psychoactive substances in a random sample of drivers in Switzerland. Methods: Saliva samples from 1078 random drivers were collected at 24 different locations in Western Switzerland from October 2006 to April 2008 for complete toxicological analysis using liquid chromatography/tandem mass spectrometry. Results: Provisional results are available for 437 drivers. 6.2% (CI95% 4.1 to 8.9) were under the influence of illicit drugs and 8.7% under psychoactive medication (CI95% 6.2 to 11.7). 37 drivers (8.5%) were under the influence of alcohol of which 14 (3.2%) were above 0.8 mg/L. 21 drivers (4.8%) were under the combined influence of more than one psychoactive substance; however only 4 drivers (0.9%) were under both the influence of medication and alcohol. Looking more specifically at illicit substances, 22 (5.0%) were positive to cocaine, 5 (1.1%) to cannabis, and 2 (0.5%) to amphetamines ; for psychoactive medication, 17 (3.9%) were positive to benzodiazepines, 16 (3.7%) to antidepressors, 7 (1.6%) to opiates, 7 (1.6%) to neuroleptics, and 3 (0.7%) to other substances influencing driving abilities. 17/21 drivers did not self-report their consumption of drugs whereas only 9/35 failed mentioning their medication. Men drivers were 3.2 times (CI95% 1.1 to 9.5) more likely to be under the influence of illicit drugs than women. Full results will be reported when laboratory data will be available in April. Conclusions: Driving under the influence of psychoactive substances is common. In Western Switzerland, prevention messages could focus on men, driving under medication or cocaine.