Epidemiology and new developments in the diagnosis of prosthetic joint infection.

Although prosthetic joint infection (PJI) is a rare event after arthroplasty, it represents a significant complication that is associated with high morbidity, need for complex treatment, and substantial healthcare costs. An accurate and rapid diagnosis of PJI is crucial for treatment success. Current diagnostic methods in PJI are insufficient with 10-30% false-negative cultures. Consequently, there is a need for research and development into new methods aimed at improving diagnostic accuracy and speed of detection. In this article, we review available conventional diagnostic methods for the diagnosis of PJI (laboratory markers, histopathology, synovial fluid and periprosthetic tissue cultures), new diagnostic methods (sonication of implants, specific and multiplex PCR, mass spectrometry) and innovative techniques under development (new laboratory markers, microcalorimetry, electrical method, reverse transcription [RT]-PCR, fluorescence in situ hybridization [FISH], biofilm microscopy, microarray identification, and serological tests). The results of highly sensitive diagnostic techniques with unknown specificity should be interpreted with caution. The organism identified by a new method may represent a real pathogen that was unrecognized by conventional diagnostic methods or contamination during specimen sampling, transportation, or processing. For accurate interpretation, additional studies are needed, which would evaluate the long-term outcome (usually >2 years) with or without antimicrobial treatment. It is expected that new rapid, accurate, and fully automatic diagnostic tests will be developed soon.

Ponctions et infiltrations articulaires [Arthrocentesis and joint infiltration]

Cet article se veut être un condensé des bases nécessaires à la pratique d'une ponction et, ou infiltration articulaire, des indications principales aux complications potentielles en passant par la description de la procédure et de ses contre-indications. La ponction du genou fait l'objet d'une description plus détaillée. Les données permettant de justifier une façon particulière de procéder ont spécifiquement été recherchées dans la littérature (Cochrane et Medline, termes de recherche : arthrocentesis ; joint aspiration). Le détail de ces données, comme par exemple le résultat d'études, ne trouve pas sa place dans ce résumé mais fait l'objet d'une publication à part. What should be known in order to practice safely a joint aspiration and/or infiltration is summarized in the following article. This summary includes various aspects, such as the indications and contraindications, the procedure itself, and the possible complications. The arthrocentesis of the knee is described in more details. Data in support of a specific modus operandi have been searched for in Cochrane and Pubmed (key words: arthrocentesis, joint aspiration). Only the conclusions of this research are exposed in this summary. A more comprehensive article will be published

05036-013 Joint Drainage District 1-10 Fnial Report

Install new tile system to eliminate the use of 20 agricultural drainage wells (ADW) that have been ruled by EPA to be "vunerable to spills from manure lagoons, direct discharges from septic tanks and accidental releases of materails used in farming". The project includes a tile system that will provide an outlet for all the tile connected to the ADWs and close all 20 ADWs in the drainage district. The pipe ranges in size from 42" to 8" in diameter and approximately 48,000 lineal feet to be installed.

Eighty-Sixth General Assembly Joint Rules of the House and Senate

Eighty-Sixth General Assembly Joint Rules of the House and Senate (House Concurrent Resolution 6), House adopted 2-3-2015, Senate adopted 2-4-2015

Eighty-Sixth General Assembly Joint Rules Governing Lobbyists (House Concurrent Resolution 7) House Adopted 2-3-2015, Senate Adopted 2-4-2015, February 5, 2015

Eighty-Sixth General Assembly Joint Rules Governing Lobbyists (House Concurrent Resolution 7) House Adopted 2-3-2015, Senate Adopted 2-4-2015

Camp Dodge Joint Maneuver Training, February 10, 2012

Th e Warrior Ready is an offi cial publication authorized under the provisions of AR 360-1. It is published electronically by the Iowa National Guard State Public Aff airs Offi ce on a monthly basis. News and opinions expressed in this publication are not necessarily those of the Adjutant General of Iowa, the National Guard, or the Department of Defense.

Laboratory Investigation of Bridge Strip Seal Joint Termination Details, SPR RB08-014, 2016

Bridge expansion joints, if not properly designed, constructed, and maintained, often lead to the deterioration of critical substructure elements. Strip seal expansion joints consisting of a steel extrusion and neoprene gland are one type of expansion joint and are commonly used by the Iowa Department of Transportation (DOT). Strip seal expansion joints are susceptible to tears and pull outs that allow water, chlorides, and debris to infiltrate the joint, and subsequently the bearings below. One area of the strip seal that is particularly problematic is where it terminates at the interface between the deck and the barrier rail. The Iowa DOT has noted that the initial construction quality of the current strip seal termination detail is not satisfactory, nor ideal, and a need exists for re-evaluation and possibly re-design of this detail. Desirable qualities of a strip seal termination detail provide a seal that is simple and fast to construct, facilitate quick gland removal and installation, and provide a reliable, durable barrier to prevent chloride-contaminated water from reaching the substructure. To meet the objectives of this research project, several strip seal termination details were evaluated in the laboratory. Alternate termination details may not only function better than the current Iowa DOT standard, but are also less complicated to construct, facilitating better quality control. However, uncertainties still exist regarding the long-term effects of using straight-through details, with or without the dogleg, that could not be answered in the laboratory in the short time frame of the research project.

Comparison of cannabinoid concentrations in oral fluid and whole blood between occasional and regular cannabis smokers prior to and after smoking a cannabis joint.

A cross-over controlled administration study of smoked cannabis was carried out on occasional and heavy smokers. The participants smoked a joint (11 % Δ9-tetrahydrocannabinol (THC)) or a matching placebo on two different occasions. Whole blood (WB) and oral fluid (OF) samples were collected before and up to 3.5 h after smoking the joints. Pharmacokinetic analyses were obtained from these data. Questionnaires assessing the subjective effects were administered to the subjects during each session before and after the smoking time period. THC, 11-hydroxy-THC (11-OH-THC) and 11-nor-9-carboxy-THC (THCCOOH) were analyzed in the blood by gas chromatography or liquid chromatography (LC)-tandem mass spectrometry (MS/MS). The determination of THC, THCCOOH, cannabinol (CBN), and Δ9-tetrahydrocannabinolic acid A (THC-A) was carried out on OF only using LC-MS/MS. In line with the widely accepted assumption that cannabis smoking results in a strong contamination of the oral cavity, we found that THC, and also THC-A, shows a sharp, high concentration peak just after smoking, with a rapid decrease in these levels within 3 h. No obvious differences were found between both groups concerning THC median maximum concentrations measured either in blood or in OF; these levels were equal to 1,338 and 1,041 μg/L in OF and to 82 and 94 μg/L in WB for occasional and heavy smokers, respectively. The initial WB THCCOOH concentration was much higher in regular smokers than in occasional users. Compared with the occasional smokers, the sensation of confusion felt by the regular smokers was much less while the feeling of intoxication remained almost unchanged.

Joint physical-MAC layer design of the broadcast channel protocol in adhoc networks

Broadcast transmission mode in ad hoc networks is critical to manage multihop routing or providing medium accesscontrol (MAC)-layer fairness. In this paper, it is shown that ahigher capacity to exchange information among neighbors may beobtained through a physical-MAC cross-layer design of the broadcastprotocol exploiting signal separation principles. Coherentdetection and separation of contending nodes is possible throughtraining sequences which are selected at random from a reducedset. Guidelines for the design of this set are derived for a lowimpact on the network performance and the receiver complexity.

Joint array combining and MLSE for single-user receivers in multipath Gaussian multiuser channels

The well-known structure of an array combiner along with a maximum likelihood sequence estimator (MLSE) receiveris the basis for the derivation of a space-time processor presentinggood properties in terms of co-channel and intersymbol interferencerejection. The use of spatial diversity at the receiver front-endtogether with a scalar MLSE implies a joint design of the spatialcombiner and the impulse response for the sequence detector. Thisis faced using the MMSE criterion under the constraint that thedesired user signal power is not cancelled, yielding an impulse responsefor the sequence detector that is matched to the channel andcombiner response. The procedure maximizes the signal-to-noiseratio at the input of the detector and exhibits excellent performancein realistic multipath channels.

Positive time-frequency distributions based on joint marginal constraints

This correspondence studies the formulation of members ofthe Cohen-Posch class of positive time-frequency energy distributions.Minimization of cross-entropy measures with respect to different priorsand the case of no prior or maximum entropy were considered. It isconcluded that, in general, the information provided by the classicalmarginal constraints is very limited, and thus, the final distributionheavily depends on the prior distribution. To overcome this limitation,joint time and frequency marginals are derived based on a "directioninvariance" criterion on the time-frequency plane that are directly relatedto the fractional Fourier transform.

Kosteuden ja neliömassan mittaaminen kartonkikoneen viiraosalla

Diplomityön tavoitteena oli selvittää spraytärkkelyksen ja eri kerrosten liitossakeuksien vaikutusta kartongin palstautumislujuuteen ja formaatioon. Työn teon aikana viiraosille hankittiin gammasäteilyllä toimivat kosteusmittarit. Työssä haettiin keinoja varmentaa mit-tausten luotettavuus kartonkikoneella, jonka nopeudet ja tuotteiden neliömassat vaihtelevat suuresti. Työn loppuvaiheessa aloitettiin mittareiden toiminnan parantaminen. Spraytärk-kelyksen annostelua parannettiin ja annostelulle rakennettiin suhdesäätö. Tärkkisumun aiheuttamia haittoja vähennettiin lisäämällä spraytärkkelysputkien yhteyteen tärkkelys-tippoja poistavia imupalkkeja. Tämän diplomityön kirjallisuusosan tavoitteena oli tarkastella taivekartonkia tuotteena ja sen kilpailukyvyn kannalta tärkeitä ominaisuuksia. Kilpailukyvyn kannalta tärkeään palstautumislujuuteen sekä taivutusjäykkyyteen kiinnitettiin huomiota niiden toisistaan riippuvuuksien vuoksi. Spraytärkkelyksen käyttö riittävän palstautumislujuuden varmistajana ja spraytärkkelyksen määrän hallinta olivat kirjallisuusosassa mukana. Liitossakeuksien hallinta gammasäteilyä hyödyntävien NDC-mittareiden avulla oli toinenpääalue. Kirjallisuusosassa on viitattu myös tehtaalta saatuihin kokemusperäisiin tietoihin. Tämän työn kokeellisessa osassa selvitettiin InkeroistenKartonkitehtaan Kartonkikone 4:a. ja sillä suoritettuja spraytärkkelyskokeita. Liitoskosteuksia selvitettiin pääosin aiempien mittausten ja kokemusten perusteella.

Effect of meal ingestion on liver stiffness in patients with cirrhosis and portal hypertension.

BACKGROUND AND AIMS: Liver stiffness is increasingly used in the non-invasive evaluation of chronic liver diseases. Liver stiffness correlates with hepatic venous pressure gradient (HVPG) in patients with cirrhosis and holds prognostic value in this population. Hence, accuracy in its measurement is needed. Several factors independent of fibrosis influence liver stiffness, but there is insufficient information on whether meal ingestion modifies liver stiffness in cirrhosis. We investigated the changes in liver stiffness occurring after the ingestion of a liquid standard test meal in this population. METHODS: In 19 patients with cirrhosis and esophageal varices (9 alcoholic, 9 HCV-related, 1 NASH; Child score 6.9±1.8), liver stiffness (transient elastography), portal blood flow (PBF) and hepatic artery blood flow (HABF) (Doppler-Ultrasound) were measured before and 30 minutes after receiving a standard mixed liquid meal. In 10 the HVPG changes were also measured. RESULTS: Post-prandial hyperemia was accompanied by a marked increase in liver stiffness (+27±33%; p<0.0001). Changes in liver stiffness did not correlate with PBF changes, but directly correlated with HABF changes (r = 0.658; p = 0.002). After the meal, those patients showing a decrease in HABF (n = 13) had a less marked increase of liver stiffness as compared to patients in whom HABF increased (n = 6; +12±21% vs. +62±29%,p<0.0001). As expected, post-prandial hyperemia was associated with an increase in HVPG (n = 10; +26±13%, p = 0.003), but changes in liver stiffness did not correlate with HVPG changes. CONCLUSIONS: Liver stiffness increases markedly after a liquid test meal in patients with cirrhosis, suggesting that its measurement should be performed in standardized fasting conditions. The hepatic artery buffer response appears an important factor modulating postprandial changes of liver stiffness. The post-prandial increase in HVPG cannot be predicted by changes in liver stiffness.

Official Positions for FRAX® clinical regarding prior fractures from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

The 2010 Position Development Conference addressed four questions related to the impact of previous fractures on 10-year fracture risk as calculated by FRAX(®). To address these questions, PubMed was searched on the keywords "fracture, epidemiology, osteoporosis." Titles of retrieved articles were reviewed for an indication that risk for future fracture was discussed. Abstracts of these articles were reviewed for an indication that one or more of the questions listed above was discussed. For those that did, the articles were reviewed in greater detail to extract the findings and to find additional past work and citing works that also bore on the questions. The official positions and the supporting literature review are presented here. FRAX(®) underestimates fracture probability in persons with a history of multiple fractures (good, A, W). FRAX(®) may underestimate fracture probability in individuals with prevalent severe vertebral fractures (good, A, W). While there is evidence that hip, vertebral, and humeral fractures appear to confer greater risk of subsequent fracture than fractures at other sites, quantification of this incremental risk in FRAX(®) is not possible (fair, B, W). FRAX(®) may underestimate fracture probability in individuals with a parental history of non-hip fragility fracture (fair, B, W). Limitations of the methodology include performance by a single reviewer, preliminary review of the literature being confined to titles, and secondary review being limited to abstracts. Limitations of the evidence base include publication bias, overrepresentation of persons of European descent in the published studies, and technical differences in the methods used to identify prevalent and incident fractures. Emerging topics for future research include fracture epidemiology in non-European populations and men, the impact of fractures in family members other than parents, and the genetic contribution to fracture risk.