Quoi de neuf en chirurgie [Novelties in surgery in 2013?].

Multidisciplinary management of colorectal liver metastases allows an increase of about 20% in the resection rate of liver metastases. It includes chemotherapy, interventional radiology and surgery. In 2013, the preliminary results of the in-situ split of the liver associated with portal vein ligation (ALLPS) are promising with unprecedented mean hypertrophy up to 70% at day 9. However, the related morbidity of this procedure is about 40% and hence should be performed in the setting of study protocol only. For pancreatic cancer, the future belongs to the use of adjuvant and neo adjuvant therapies in order to increase the resection rate. Laparoscopic and robot-assisted surgery is still in evolution with significant benefits in the reduction of cost, hospital stay, and postoperative morbidity. Finally, enhanced recovery pathways (ERAS) have been validated for colorectal surgery and are currently assessed in other fields of surgery like HPB and upper GI surgery.

Agreed upon procedures report on the Iowa Sheep and Wool Promotion Board for the period July 1, 2009 through June 30, 2011

Agreed upon procedures report on the Iowa Sheep and Wool Promotion Board for the period July 1, 2009 through June 30, 2011

Agreed upon procedures report on the six Library Service Areas in the State of Iowa for the period July 1, 2010 through June 30, 2011

Agreed upon procedures report on the six Library Service Areas in the State of Iowa for the period July 1, 2010 through June 30, 2011

Agreed upon procedures report on the Lee County Narcotics Task Force for the period July 1, 2010 through May 31, 2012

Agreed upon procedures report on the Lee County Narcotics Task Force for the period July 1, 2010 through May 31, 2012

Report on applying agreed-upon procedures of Kossuth Connections, Algona, Iowa, and the Iowa Commission on Volunteer Services within the Iowa Department of Economic Development, now known as the Iowa Economic Development Authority, for the period October 2010 through June 2011

Report on applying agreed-upon procedures of Kossuth Connections, Algona, Iowa, and the Iowa Commission on Volunteer Services within the Iowa Department of Economic Development, now known as the Iowa Economic Development Authority, for the period October 2010 through June 2011

Testing Guide for Implementing Concrete Paving Quality Control Procedures, March 2008

Construction of portland cement concrete pavements is a complex process. A small fraction of the concrete pavements constructed in the United States over the last few decades have either failed prematurely or exhibited moderate to severe distress. In an effort to prevent future premature failures, 17 state transportation agencies pooled their resources, and a pooled fund research project, Material and Construction Optimization for Prevention of Premature Pavement Distress in PCC Pavements, was undertaken in 2003. Its purpose was to evaluate existing quality control tests, and then select and advance the state-of-the-practice of those tests most useful for optimizing concrete pavements during mix design, mix verification, and construction. This testing guide is one product of that project. The guide provides three recommended testing schemes (Levels A, B, and C, depending on a pavement’s design life and traffic volumes, etc.) that balance the costs of testing with the risk of failure for various project types. The recommended tests are all part of a comprehensive suite of tests described in detail in this guide.

Development of LRFD Procedures for Bridge Pile Foundations in Iowa Final Report, June 2010

For well over 100 years, the Working Stress Design (WSD) approach has been the traditional basis for geotechnical design with regard to settlements or failure conditions. However, considerable effort has been put forth over the past couple of decades in relation to the adoption of the Load and Resistance Factor Design (LRFD) approach into geotechnical design. With the goal of producing engineered designs with consistent levels of reliability, the Federal Highway Administration (FHWA) issued a policy memorandum on June 28, 2000, requiring all new bridges initiated after October 1, 2007, to be designed according to the LRFD approach. Likewise, regionally calibrated LRFD resistance factors were permitted by the American Association of State Highway and Transportation Officials (AASHTO) to improve the economy of bridge foundation elements. Thus, projects TR-573, TR-583 and TR-584 were undertaken by a research team at Iowa State University’s Bridge Engineering Center with the goal of developing resistance factors for pile design using available pile static load test data. To accomplish this goal, the available data were first analyzed for reliability and then placed in a newly designed relational database management system termed PIle LOad Tests (PILOT), to which this first volume of the final report for project TR-573 is dedicated. PILOT is an amalgamated, electronic source of information consisting of both static and dynamic data for pile load tests conducted in the State of Iowa. The database, which includes historical data on pile load tests dating back to 1966, is intended for use in the establishment of LRFD resistance factors for design and construction control of driven pile foundations in Iowa. Although a considerable amount of geotechnical and pile load test data is available in literature as well as in various State Department of Transportation files, PILOT is one of the first regional databases to be exclusively used in the development of LRFD resistance factors for the design and construction control of driven pile foundations. Currently providing an electronically organized assimilation of geotechnical and pile load test data for 274 piles of various types (e.g., steel H-shaped, timber, pipe, Monotube, and concrete), PILOT (http://srg.cce.iastate.edu/lrfd/) is on par with such familiar national databases used in the calibration of LRFD resistance factors for pile foundations as the FHWA’s Deep Foundation Load Test Database. By narrowing geographical boundaries while maintaining a high number of pile load tests, PILOT exemplifies a model for effective regional LRFD calibration procedures.

Development of LRFD Procedures for Bridge Pile Foundations in Iowa: Volume I: An Electronic Database for PIle LOad Tests, September 2011

• Examine current pile design and construction procedures used by the Iowa Department of Transportation (DOT). • Recommend changes and improvements to these procedures that are consistent with available pile load test data, soils information, and bridge design practice recommended by the Load and Resistance Factor Design (LRFD) approach.

Development of LRFD Procedures for Bridge Pile Foundations in Iowa: Volume II: Field Testing of Steel Piles in Clay, Sand, and Mixed Soils and Data Analysis, September 2011

In response to the mandate on Load and Resistance Factor Design (LRFD) implementations by the Federal Highway Administration (FHWA) on all new bridge projects initiated after October 1, 2007, the Iowa Highway Research Board (IHRB) sponsored these research projects to develop regional LRFD recommendations. The LRFD development was performed using the Iowa Department of Transportation (DOT) Pile Load Test database (PILOT). To increase the data points for LRFD development, develop LRFD recommendations for dynamic methods, and validate the results ofLRFD calibration, 10 full-scale field tests on the most commonly used steel H-piles (e.g., HP 10 x 42) were conducted throughout Iowa. Detailed in situ soil investigations were carried out, push-in pressure cells were installed, and laboratory soil tests were performed. Pile responses during driving, at the end of driving (EOD), and at re-strikes were monitored using the Pile Driving Analyzer (PDA), following with the CAse Pile Wave Analysis Program (CAPWAP) analysis. The hammer blow counts were recorded for Wave Equation Analysis Program (WEAP) and dynamic formulas. Static load tests (SLTs) were performed and the pile capacities were determined based on the Davisson’s criteria. The extensive experimental research studies generated important data for analytical and computational investigations. The SLT measured loaddisplacements were compared with the simulated results obtained using a model of the TZPILE program and using the modified borehole shear test method. Two analytical pile setup quantification methods, in terms of soil properties, were developed and validated. A new calibration procedure was developed to incorporate pile setup into LRFD.

Agreed-upon procedures report of the Iowa Economic Development Authority for the quarter ended March 31, 2012

Agreed-upon procedures report of the Iowa Economic Development Authority for the quarter ended March 31, 2012

Neuromonitoring after major neurosurgical procedures.

Postoperative care of major neurosurgical procedures is aimed at the prevention, detection and treatment of secondary brain injury. This consists of a series of pathological events (i.e. brain edema and intracranial hypertension, cerebral hypoxia/ischemia, brain energy dysfunction, non-convulsive seizures) that occur early after the initial insult and surgical intervention and may add further burden to primary brain injury and thus impact functional recovery. Management of secondary brain injury requires specialized neuroscience intensive care units (ICU) and continuous advanced monitoring of brain physiology. Monitoring of intracranial pressure (ICP) is a mainstay of care and is recommended by international guidelines. However, ICP monitoring alone may be insufficient to detect all episodes of secondary brain insults. Additional invasive (i.e. brain tissue PO2, cerebral microdialysis, regional cerebral blood flow) and non-invasive (i.e. transcranial doppler, near-infrared spectroscopy, EEG) brain monitoring devices might complement ICP monitoring and help clinicians to target therapeutic interventions (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Several independent studies demonstrate such multimodal approach may optimize patient care after major neurosurgical procedures. The aim of this review is to evaluate some of the available monitoring systems and summarize recent important data showing the clinical utility of multimodal neuromonitoring for the management of main acute neurosurgical conditions, including traumatic brain injury, subarachnoid hemorrhage and stroke.

Iowa Autism Council By-Laws and Operating Procedures, Revised 2012

These By-laws and Operating Procedures are designed to guide the membership and work of the Iowa Autism Council. The Iowa Autism Council is a collaborative resource that envisions its role as an advocate for children and adults living with Autism Spectrum Disorder (autism and Asperger's and other conditions represented on the autism spectrum) and their families. As such, it is committed to representing individuals with diverse and changing educational needs. Iowa Autism Council (IAC) shall have, and will perform, functions and duties as specified by law. Responsibilities include offering advice, consultation, and recommendations to Governor Culver and the Iowa legislature regarding matters concerning the ASD population. The role of the Council members is to advise, not advocate, for an individual position. Advise means to inform, counsel, recommend, suggest or guide. To advocate means to plead for your case or position, to favor an individual case or argument. The advisory Council is to provide advice, based on facts and good judgment.

Variability between laboratories performing coagulation tests with identical platforms: a nationwide evaluation study.

BACKGROUND: While the assessment of analytical precision within medical laboratories has received much attention in scientific enquiry, the degree of as well as the sources causing variation between them remains incompletely understood. In this study, we quantified the variance components when performing coagulation tests with identical analytical platforms in different laboratories and computed intraclass correlations coefficients (ICC) for each coagulation test. METHODS: Data from eight laboratories measuring fibrinogen twice in twenty healthy subjects with one out of 3 different platforms and single measurements of prothrombin time (PT), and coagulation factors II, V, VII, VIII, IX, X, XI and XIII were analysed. By platform, the variance components of (i) the subjects, (ii) the laboratory and the technician and (iii) the total variance were obtained for fibrinogen as well as (i) and (iii) for the remaining factors using ANOVA. RESULTS: The variability for fibrinogen measurements within a laboratory ranged from 0.02 to 0.04, the variability between laboratories ranged from 0.006 to 0.097. The ICC for fibrinogen ranged from 0.37 to 0.66 and from 0.19 to 0.80 for PT between the platforms. For the remaining factors the ICC's ranged from 0.04 (FII) to 0.93 (FVIII). CONCLUSIONS: Variance components that could be attributed to technicians or laboratory procedures were substantial, led to disappointingly low intraclass correlation coefficients for several factors and were pronounced for some of the platforms. Our findings call for sustained efforts to raise the level of standardization of structures and procedures involved in the quantification of coagulation factors.

Agreed upon procedures report on the Department of Human Services' compliance with Chapter 249J.22 of the Code of Iowa for the year ended June 30, 2012

Agreed upon procedures report on the Department of Human Services' compliance with Chapter 249J.22 of the Code of Iowa for the year ended June 30, 2012