The alligator and its allies, by Albert M. Reese ... with 62 figures and 28 plates.

copy 1

Male Gender and Arterial Hypertension are Plaque Predictors at Coronary Computed Tomography Angiography

Background: Systemic Arterial Hypertension (SAH) is one of the main risk factors for Coronary Artery Disease (CAD), in addition to male gender. Differences in coronary artery lesions between hypertensive and normotensive individuals of both genders at the Coronary Computed Tomography Angiography (CCTA) have not been clearly determined. Objective: To Investigate the calcium score (CS), CAD extent and characteristics of coronary plaques at CCTA in men and women with and without SAH. Methods: Prospective cross-sectional study of 509 patients undergoing CCTA for CAD diagnosis and risk stratification, from November 2011 to December 2012, at Instituto de Cardiologia Dante Pazzanese. Individuals were stratified according to gender and subdivided according to the presence (HT +) or absence (HT-) of SAH. Results: HT+ women were older (62.3 ± 10.2 vs 57.8 ± 12.8, p = 0.01). As for the assessment of CAD extent, the HT+ individuals of both genders had significant CAD, although multivessel disease is more frequent in HT + men. The regression analysis for significant CAD showed that age and male gender were the determinant factors of multivessel disease and CS ≥ 100. Plaque type analysis showed that SAH was a predictive risk factor for partially calcified plaques (OR = 3.9). Conclusion: Hypertensive men had multivessel disease more often than women. Male gender was a determinant factor of significant CAD, multivessel disease, CS ≥ 100 and calcified and partially calcified plaques, whereas SAH was predictive of partially calcified plaques.

Home Childcarer Approval Scheme Application Form HCC1 (PDF 62.3KB)

Home Childcarer Approval Scheme Application Form HCC1

Friday Facts, July 9, 2010, Vol. 62

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

Validation of a clinical prediction score for ruling out coronary heart disease in primary care patients with chest pain.

Background: A patient's chest pain raises concern for the possibility of coronary heart disease (CHD). An easy to use clinical prediction rule has been derived from the TOPIC study in Lausanne. Our objective is to validate this clinical score for ruling out CHD in primary care patients with chest pain. Methods: This secondary analysis used data collected from a oneyear follow-up cohort study attending 76 GPs in Germany. Patients attending their GP with chest pain were questioned on their age, gender, duration of chest pain (1-60 min), sternal pain location, pain increases with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the curve (ROC), sensitivity and specificity of the Lausanne CHD score were calculated for patients with full data. Results: 1190 patients were included. Full data was available for 509 patients (42.8%). Missing data was not related to having CHD (p = 0.397) or having a cardiovascular risk factor (p = 0.275). 76 (14.9%) were diagnosed with a CHD. Prevalence of CHD were respectively of 68/344 (19.8%), 2/62 (3.2%), 6/103 (5.8%) in the high, intermediate and low risk category. ROC was of 72.9 (CI95% 66.8; 78.9). Ruling out patients with low risk has a sensitivity of 92.1% (CI95% 83.0; 96.7) and a specificity of 22.4% (CI95% 18.6%; 26.7%). Conclusion: The Lausanne CHD score shows reasonably good sensitivity and can be used to rule out coronary events in patients with chest pain. Patients at risk of CHD for other rarer reasons should nevertheless also be investigated.

Council Bluffs Interstate System Improvements Project Pottawatomie County, Iowa and Douglas County, Nebraska Project Number: IM-029-3(62)54-13-78, November 2004

The Iowa Department of Transportation (Iowa DOT), Nebraska Department of Roads (NDOR), and the Federal Highway Administration (FHWA) are proposing to improve the interstate system around Council Bluffs with improvements extending across the Missouri River on I-80 to east of the I-480 interchange in Omaha, Nebraska, see Figure 1-1. The study considers long-term, broad-based transportation improvements along I-80, I-29, and I-480, including approximately 18 mainline miles of interstate and 14 interchanges (3 system1, 11 service), that would add capacity and correct functional issues along the mainline and interchanges and upgrade the I-80 Missouri River Crossing. These improvements, once implemented, would bring the segments of I-80 and I-29 up to current engineering standards and modernize the roadway to accommodate future traffic needs. In 2001, Iowa DOT and FHWA initiated the Council Bluffs Interstate System (CBIS) Improvements Project. The agencies concluded that the environmental study process would be conducted in two stages; that is, a tiered approach would be applied. The project is being conducted pursuant to the National Environmental Policy Act (NEPA) regulations issued by the Council on Environmental Quality (CEQ), 40 Code of Federal Regulations (CFR) Part 1502.20, and FHWA 23 CFR Part 771.111, that permit tiering for large, complex NEPA studies. Tier 1 is an examination of the overall interstate system improvement needs, including a clear explanation of the area’s transportation needs, a study of alternatives to satisfy them, and broad consideration of potential environmental and social impacts. The Tier 1 evaluation is at a sufficient level of engineering and environmental detail to assist decision makers in selecting a preferred transportation strategy. Tier 1 includes preparation of a draft and final Environmental Impact Statement (EIS) that would disclose the potential environmental and social effects (evaluated at a planning level that considers a variety of conceptual designs) of the proposed improvements. The final EIS will conclude with a Record of Decision (ROD) that states the preferred plan for improvements to be implemented. Essentially, the Tier 1 document will establish the planning framework for the needed improvements. Because the scope of the overall system improvements is large, the interstate improvements would be implemented as a series of individual projects that fit into the overall planning framework. The Tier 1 Area of Potential Impact, which is discussed in detail in Section 4 is an alternative that considers a combination of the most reasonable concepts that have been developed, buffered by approximately 100 or more feet to ensure that any Tier 2 design modifications would remain inside the outer boundary.

Record of Decision Council Bluffs Interstate System (I-29, I-80 and I-480) Improvements Project TIER 1 Environmental Impact Statement Council Bluffs, Iowa to Omaha, Nebraska FHWA-IA- EIS-04-01F Project Number: IM-029-3(62)54—13-78 Submitted Pursuant to 42 USC 4332(2)(c) and 49 USC 303, October 2008

The Federal Highway Administration (FHWA) approves the selection of the Reconstruction of All or Part of the Interstate (Construction Alternative) as the Preferred Alternative to provide improvements to the interstate system in the Omaha/Council Bluffs metropolitan area, extending across the Missouri River on Interstate 80 to east of the Interstate 480 interchange in Omaha, Nebraska. The study considered long-term, broad-based transportation improvements along Interstate I-29 (I-29), I-80, and I-480, including approximately 18 mainline miles of interstate and 14 interchanges (3 system, 11 service), that would add capacity and correct functional issues along the mainline and interchanges and upgrade the I-80 Missouri River Crossing. FHWA also approves the decisions to provide full access between West Broadway and I-29, design the I-80/I-29 overlap section as a dual-divided freeway, and locating the new I-80 Missouri River Bridge north of the existing bridge. Improvements to the interstate system, once implemented, would bring the segments of I-80 and I-29 (see Figure 1) up to current engineering standards and accommodate future traffic needs. This Record of Decision (ROD) concludes Tier 1 of the Council Bluffs Interstate System (CBIS) Improvements Project. Tier 1 included an examination of the area’s transportation needs, a study of alternatives to satisfy them, and broad consideration of potential environmental and social impacts. The Tier 1 evaluation consisted of a sufficient level of engineering and environmental detail to assist decision makers in selecting a preferred transportation strategy. During Tier 1 a Draft EIS (FHWA-IA- EIS-04-01D) was developed which was approved by FHWA, Iowa DOT, and Nebraska Department of Roads (NDOR) in November 2004 with comments accepted through March 15, 2005. The Draft EIS summarized the alternatives that were considered to address the transportation needs around Council Bluffs; identified reconstruction of all or part of the interstate, the “Construction Alternative,” as the Preferred Alternative; identified three system-level decisions that needed to be made at the Tier 1 level; and invited comment on the issues. The Final EIS (FHWA-IA- EIS-04-01F) further documented the Construction Alternative as the Preferred Alternative and identified the recommended decisions for the three system level decisions that needed to be made in Tier 1. This ROD defines the Selected Alternative determined in the Tier 1 studies.

Use of Longitudinal Subdrains in the 3R Program, HR-509, Progress Report #2, 1981

The main consideration for base construction under the pavement, in the design of Iowa's interstate, was structural capacity. The material was dense graded with the aim of supporting the pavement and distributing the load as it is transferred to the underlying grade. The drainage characteristics of the base was apparently not given adequate consideration. On jointed portland cement concrete pavement, the water that is trapped immediately beneath the pavement causes severe problems. The traffic causes rapid movement of the water resulting in the hydraulic pressures or "pumping" (movement and redeposit of base fine material), further resulting in faulting between individual slabs. The objective of this evaluation is to determine if longitudinal subdrains are effective in preventing or reducing pumping, faulting and related deterioration. Results suggest that, based upon the flow from the outlets observed during periodic checks and evidence of water flow at the outlets, it appears that to date the subdrains are effective in draining the subbase and subgrade. Because of the limited data available at this time, however, the pavement condition and faulting results are inconclusive.

Investigation of the Loss of Prestress in Prestressed Concrete Beams due to Steam Curing, HR-62, 1961

Mass production of prestressed concrete beams is facilitated by the accelerated curing of the concrete. The ·method most commonly used for this purpose is steam curing at atmospheric pressure. This requires concrete temperatures as high as 150°F. during the curing period. Prestressing facilities in Iowa are located out of doors. This means that during the winter season the forms are set and the steel cables are stressed at temperatures as low as 0°F. The thermal expansion of the prestressing cables should result in a reduction of the stress which was placed in them at the lower temperature. If the stress is reduced in the cables, then the amount of prestress ultimately transferred to the concrete may be less than the amount for which the beam was designed. Research project HR-62 was undertaken to measure and explain the difference between the initial stress placed in the cables and the actual stress which is eventually transferred to the concrete. The project was assigned to the Materials Department Laboratory under the general supervision of the Testing Engineer, Mr. James W. Johnson. A small stress bed complete with steam curing facilities was set up in the laboratory, and prestressed concrete beams were fabricated under closely controlled conditions. Measurements were made to determine the initial stress in the steel and the final stress in the concrete. The results of these tests indicate that there is a general loss of prestressing force in excess of that caused by elastic shortening of the concrete. The exact amount of the loss and the identification of the factors involved could not be determined from this limited investigation.

Use of Longitudinal Subdrains in the 3R Program, Progress Report 1, HR-509, 1980

The main consideration for base construction under the pavement, in the design of Iowa's interstate, was structural capacity. The material was dense graded with the aim of supporting the pavement and distributing the load as it is transferred to the underlying grade. The drainage characteristics of the base was apparently not given adequate consideration. On jointed portland cement concrete pavement, the water that is trapped immediately beneath the pavement causes severe problems. The traffic causes rapid movement of the water resulting in the hydraulic pressures or "pumping" (movement and redeposit of base fine material), further resulting in faulting between individual slabs. The objective of this evaluation is to determine if longitudinal subdrains are effective in preventing or reducing pumping, faulting and related deterioration. Results suggest that, based upon the flow from the outlets observed during periodic checks and evidence of water flow at the outlets, it appears that to date the subdrains are effective in draining the subbase and subgrade. Because of the limited data available at this time, however, the pavement condition and faulting results are inconclusive.