Detecting and measuring deprivation in primary care: development, validity and reliability of a self-reported questionnaire - the DiPCare-Q

Background: General practitioners play a central role in taking deprivation into consideration when caring for patients in primary care. Validated questions to identify deprivation in primary-care practices are still lacking. For both clinical and research purposes, this study therefore aims to develop and validate a standardized instrument measuring both material and social deprivation at an individual level. Methods: The Deprivation in Primary Care Questionnaire (DiPCare-Q) was developed using qualitative and quantitative approaches between 2008 and 2011. A systematic review identified 199 questions related to deprivation. Using judgmental item quality, these were reduced to 38 questions. Two focus groups (primary-care physicians, and primary-care researchers), structured interviews (10 laymen), and think aloud interviews (eight cleaning staff) assured face validity. Item response theory analysis was then used to derive the DiPCare-Q index using data obtained from a random sample of 200 patients who were to complete the questionnaire a second time over the phone. For construct and criterion validity, the final 16 questions were administered to a random sample of 1,898 patients attending one of 47 different private primary-care practices in western Switzerland (validation set) along with questions on subjective social status (subjective SES ladder), education, source of income, welfare status, and subjective poverty. Results: Deprivation was defined in three distinct dimensions (table); material deprivation (eight items), social deprivation (five items) and health deprivation (three items). Item consistency was high in both the derivation (KR20 = 0.827) and the validation set (KR20 = 0.778). The DiPCare-Q index was reliable (ICC = 0.847). For construct validity, we showed the DiPCare-Q index to be correlated to patients' estimation of their position on the subjective SES ladder (rs = 0.539). This position was correlated to both material and social deprivation independently suggesting two separate mechanisms enhancing the feeling of deprivation. Conclusion: The DiPCare-Q is a rapid, reliable and validated instrument useful for measuring both material and social deprivation in primary care. Questions from the DiPCare-Q are easy to use when investigating patients' social history and could improve clinicians' ability to detect underlying social distress related to deprivation.

Measuring brain perfusion with intravoxel incoherent motion (IVIM): Initial clinical experience.

PURPOSE: To evaluate the feasibility of intravoxel incoherent motion (IVIM) perfusion measurements in the brain with currently available imaging systems. MATERIALS AND METHODS: We acquired high in-plane resolution (1.2 × 1.2 mm(2) ) diffusion-weighted images with 16 different values of b ranging from 0 to 900 s/mm(2) , in three orthogonal directions, on 3T systems with a 32-multichannel receiver head coil. IVIM perfusion maps were extracted by fitting a double exponential model of signal amplitude decay. Regions of interest were drawn in pathological and control regions, where IVIM perfusion parameters were compared to the corresponding dynamic susceptibility contrast (DSC) parameters. RESULTS: Hyperperfusion was found in the nonnecrotic or cystic part of two histologically proven glioblastoma multiforme and in two histologically proven glioma WHO grade III, as well as in a brain metastasis of lung adenocarcinoma, in a large meningioma, and in a case of ictal hyperperfusion. A monoexponential decay was found in a territory of acute ischemia, as well as in the necrotic part of a glioblastoma. The IVIM perfusion fraction f correlated well with DSC CBV. CONCLUSION: Our initial report suggests that high-resolution brain perfusion imaging is feasible with IVIM in the current clinical setting. J. Magn. Reson. Imaging 2014;39:624-632. © 2013 Wiley Periodicals, Inc.

Consumer Advisory: The Drive to Destroy: Removing data from computer hard drives, storage devices & wireless phones, June 2014

The Attorney General’s Consumer Protection Division receives hundreds of calls and consumer complaints every year. Follow these tips to avoid unexpected expense and disappointments. This record is about: The Drive to Destroy: Removing data from computer hard drives, storage devices & wireless phones

Evaluation of Air Pollution Control Devices for Asphalt Pavement Recycling Operations, HR-188, Progress Report, 1977

This report discusses the asphalt pavement recycling project designated Project HR-188 in Kossuth County, Iowa. Specific objectives were: (a) to determine the effectiveness of drum mixing plant modifications designed to control air pollution within limits specified by the Iowa Department of Environmental Quality; (b) to assess the impact of varying the proportions of recycled and virgin aggregates, (c) to assess the impact of varying the production rate of the plant, and (d) to assess the impact of varying the mixing temperature. The discussion includes information on the proposed use of research funds, project location and description, the project planning conference, plan development, bid letting, asphalt plant configuration, actual plant operation, why this method is successful, probable process limitations, pollution results, recycled pavement test results, and the cost of virgin vs. recycled asphalt pavements.

Portable School Stop Signs and Other Non-Uniform School Stop Control Devices, HR-190, 1978

Portable (roll-out) stop signs are used at school crossings in over 300 cities in Iowa. Their use conforms to the Code of Iowa, although it is not consistent with the provisions of the Manual on Uniform Traffic Control Devices adopted for nationwide application. A survey indicated that most users in Iowa believe that portable stop signs provide effective protection at school crossings, and favor their continued use. Other non-uniform signs that fold or rotate to display a STOP message only during certain hours are used at school crossings in over 60 cities in Iowa. Their use does not conform to either the Code of Iowa or the Manual on Uniform Traffic Control Devices. Users of these devices also tend to favor their continued use. A survey of other states indicated that use of temporary devices similar to those used in Iowa is not generally sanctioned. Some unsanctioned use apparently occurs in several states, however. A different type of portable stop sign for school crossings is authorized and widely used in one state. Portable stop signs similar to those used in Iowa are authorized in another state, although their use is quite limited. A few reports in the literature reviewed for this research discussed the use of portable stop signs. The authors of these reports uniformly recommended against the use of portable or temporary traffic control devices. Various reasons for this recommendation were given, although data to support the recommendation were not offered. As part of this research, field surveys were conducted at 54 locations in 33 communities where temporary stop control devices were in use at school crossings. Research personnel observed the obedience to stop control and measured the vehicular delay incurred. Stopped delay averaged 1.89 seconds/entering vehicle. Only 36.6 percent of the vehicles were observed to come to a complete stop at the study locations controlled by temporary stop control devices. However, this level of obedience does not differ from that observed at intersections controlled by permanent stop signs. Accident experience was compiled for 76 intersections in 33 communities in Iowa where temporary stop signs were used and, for comparative purposes, at 76 comparable intersections having other forms of control or operating without stop control. There were no significant differences in accident experience An economic analysis of vehicle operating costs, delay costs, and other costs indicated that temporary stop control generated costs only about 12 percent as great as permanent stop control for a street having a school crossing. Midblock pedestrian-actuated signals were shown to be cost effective in comparison with temporary stop signs under the conditions of use assumed. Such signals could be used effectively at a number of locations where temporary stop signs are being used. The results of this research do not provide a basis for recommending that use of portable stop signs be prohibited. However, erratic patterns of use of these devices and inadequate designs suggest that improved standards for their use are needed. Accordingly, nine recommendations are presented to enhance the efficiency of vehicular flow at school crossings, without causing a decline in the level of pedestrian protection being afforded.

A Feasibility Study on Embedded Micro-Electromechanical Sensors and Systems (MEMS) for Monitoring Highway Structures, TR-575, 2011

Micro-electromechanical systems (MEMS) provide vast improvements over existing sensing methods in the context of structural health monitoring (SHM) of highway infrastructure systems, including improved system reliability, improved longevity and enhanced system performance, improved safety against natural hazards and vibrations, and a reduction in life cycle cost in both operating and maintaining the infrastructure. Advancements in MEMS technology and wireless sensor networks provide opportunities for long-term continuous, real-time structural health monitoring of pavements and bridges at low cost within the context of sustainable infrastructure systems. The primary objective of this research was to investigate the use of MEMS in highway structures for health monitoring purposes. This study focused on investigating the use of MEMS and their potential applications in concrete through a comprehensive literature review, a vendor survey, and a laboratory study, as well as a small-scale field study. Based on the comprehensive literature review and vendor survey, the latest information available on off-the-shelf MEMS devices, as well as research prototypes, for bridge, pavement, and traffic applications were synthesized. A commercially-available wireless concrete monitoring system based on radio-frequency identification (RFID) technology and off-the-shelf temperature and humidity sensors were tested under controlled laboratory and field conditions. The test results validated the ability of the RFID wireless concrete monitoring system in accurately measuring the temperature both inside the laboratory and in the field under severe weather conditions. In consultation with the project technical advisory committee (TAC), the most relevant MEMS-based transportation infrastructure research applications to explore in the future were also highlighted and summarized.

Measuring the diurnal pattern of leaf hyponasty and growth in Arabidopsis - a novel phenotyping approach using laser scanning

Plants forming a rosette during their juvenile growth phase, such as Arabidopsis thaliana (L.) Heynh., are able to adjust the size, position and orientation of their leaves. These growth responses are under the control of the plants circadian clock and follow a characteristic diurnal rhythm. For instance, increased leaf elongation and hyponasty - defined here as the increase in leaf elevation angle - can be observed when plants are shaded. Shading can either be caused by a decrease in the fluence rate of photosynthetically active radiation (direct shade) or a decrease in the fluence rate of red compared with far-red radiation (neighbour detection). In this paper we report on a phenotyping approach based on laser scanning to measure the diurnal pattern of leaf hyponasty and increase in rosette size. In short days, leaves showed constitutively increased leaf elevation angles compared with long days, but the overall diurnal pattern and the magnitude of up and downward leaf movement was independent of daylength. Shade treatment led to elevated leaf angles during the first day of application, but did not affect the magnitude of up and downward leaf movement in the following day. Using our phenotyping device, individual plants can be non-invasively monitored during several days under different light conditions. Hence, it represents a proper tool to phenotype light- and circadian clock-mediated growth responses in order to better understand the underlying regulatory genetic network.

Problems of Bridge Supporting and Expansion Devices and an Experimental Comparison of the Dynamic Behavior of Rigid and Elastomeric Bearings, HR-105, 1965

The design of satisfactory supporting and expansion devices for highway bridges is a problem which has concerned bridge design engineers for many years. The problems associated with these devices have been emphasized by the large number of short span bridges required by the current expanded highway program of expressways and interstate highways. The initial objectives of this investigation were: (1) To review and make a field study of devices used for the support of bridge superstructures and for provision of floor expansion; (2) To analyze the forces or factors which influence the design and behavior of supporting devices and floor expansion systems; and (3) To ascertain the need for future research particularly on the problems of obtaining more economical and efficient supporting and expansion devices, and determining maximum allowable distance between such devices. The experimental portion was conducted to evaluate one of the possible simple and economical solutions to the problems observed in the initial portion. The investigation reported herein is divided into four major parts or phases as follows: (1) A review of literature; (2) A survey by questionnaire of design practice of a number of state highway departments and consulting firms; (3) Field observation of existing bridges; and, (4) An experimental comparison of the dynamic behavior of rigid and elastomeric bearings.

Measuring potentially avoidable hospital readmissions.

The objectives of this study were to develop a computerized method to screen for potentially avoidable hospital readmissions using routinely collected data and a prediction model to adjust rates for case mix. We studied hospital information system data of a random sample of 3,474 inpatients discharged alive in 1997 from a university hospital and medical records of those (1,115) readmitted within 1 year. The gold standard was set on the basis of the hospital data and medical records: all readmissions were classified as foreseen readmissions, unforeseen readmissions for a new affection, or unforeseen readmissions for a previously known affection. The latter category was submitted to a systematic medical record review to identify the main cause of readmission. Potentially avoidable readmissions were defined as a subgroup of unforeseen readmissions for a previously known affection occurring within an appropriate interval, set to maximize the chance of detecting avoidable readmissions. The computerized screening algorithm was strictly based on routine statistics: diagnosis and procedures coding and admission mode. The prediction was based on a Poisson regression model. There were 454 (13.1%) unforeseen readmissions for a previously known affection within 1 year. Fifty-nine readmissions (1.7%) were judged avoidable, most of them occurring within 1 month, which was the interval used to define potentially avoidable readmissions (n = 174, 5.0%). The intra-sample sensitivity and specificity of the screening algorithm both reached approximately 96%. Higher risk for potentially avoidable readmission was associated with previous hospitalizations, high comorbidity index, and long length of stay; lower risk was associated with surgery and delivery. The model offers satisfactory predictive performance and a good medical plausibility. The proposed measure could be used as an indicator of inpatient care outcome. However, the instrument should be validated using other sets of data from various hospitals.

Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions

Dual-energy X-ray absorptiometry (DXA) is commonly used in the care of patients for diagnostic classification of osteoporosis, low bone mass (osteopenia), or normal bone density; assessment of fracture risk; and monitoring changes in bone density over time. The development of other technologies for the evaluation of skeletal health has been associated with uncertainties regarding their applications in clinical practice. Quantitative ultrasound (QUS), a technology for measuring properties of bone at peripheral skeletal sites, is more portable and less expensive than DXA, without the use of ionizing radiation. The proliferation of QUS devices that are technologically diverse, measuring and reporting variable bone parameters in different ways, examining different skeletal sites, and having differing levels of validating data for association with DXA-measured bone density and fracture risk, has created many challenges in applying QUS for use in clinical practice. The International Society for Clinical Densitometry (ISCD) 2007 Position Development Conference (PDC) addressed clinical applications of QUS for fracture risk assessment, diagnosis of osteoporosis, treatment initiation, monitoring of treatment, and quality assurance/quality control. The ISCD Official Positions on QUS resulting from this PDC, the rationale for their establishment, and recommendations for further study are presented here.

The VAD connection : connecting ventricular assist devices to the aorta in silico

Les systèmes d'assistance ventriculaire sont apparus durant la dernière décade comme une approche thérapeutique efficace du traitement de l'insuffisance cardiaque terminale, en particulier dans le contexte de manque de donneurs d'organes. Néanmoins, et ceci malgré les progrès techniques majeurs, les taux de complications restent élevés et sont en partie liés à la configuration géométrique, en particulier le site d'implantation de la cannule de sortie à l'aorte thoracique. Bien que l'anastomose à l'aorte descendante permette une chirurgie moins invasive, les bénéfices de cette technique sont toujours controversés, comparée à la méthode standard de l'aorte ascendante, en raison du risque thrombo-embolique possiblement augmenté et des modifications hémodynamiques induites au niveau de l'arc aortique. Dans ce travail, nous comparons in silico en terme de débit et pression les deux possibilités anastomotiques. Nous développons un réseau de modèles mathématiques unidimensionnels, et l'appliquons à diverses situations cliniques, pour différents stades d'insuffisance cardiaque et de vitesses de rotation de la machine. Les données initiales sont obtenues grâce à un modèle OD (c'est-à-dire qui dépend uniquement du temps mais pas de l'espace) du système cardiovasculaire comprenant une assistance circulatoire, validé avec des données cliniques. Les simulations réalisées montrent que les deux méthodes sont similaires, en terme de débit et courbes de pression, ceci pour tous les cas cliniques étudiés. Ces résultats numériques soutiennent la possibilité d'utiliser la technique d'anastomose à l'aorte thoracique descendante, permettant une chirurgie moins invasive. Sur un plan plus fondamental, le système cardiovasculaire peut être simulé par le biais de multiples modèles de niveau de complexité différents, au prix d'un coût computationnel toujours plus élevé. Nous évaluons les avantages de modèles géométriques à plusieurs échelles (uni- et tridimensionnelle) avec données provenant de patients, comparés à des modèles simplifiés. Les résultats montrent que ces modèles de dimensions hétérogènes apportent un bénéfice important en terme de ressources de calcul, tout en conservant une précision acceptable. En conclusion, ces résultats encourageant montrent la relevance des études numériques dans le domaine médical, tant sur le plan fondamental et la compréhension des mécanismes physiopathologiques, que sur le plan applicatif et le développement de nouvelles thérapeutiques.

Dynamic Speed Feedback Signs, 2014

Dynamic speed feedback sign (DSFS) systems are traffic control devices that are programmed to provide a message to drivers exceeding a certain speed thresh¬old. A DSFS system typically consists of a speed-measuring device, which may be loop detectors or radar, and a message sign that displays feedback to drivers who exceed a predetermined speed threshold. The feedback may be the driver’s actual speed, a message like “SLOW DOWN,” or activation of a warning device such as beacons or a curve warning sign. For more on this topic by these authors, see also "Evaluation of Dynamic Speed Feedback Signs on Curves: A National Demonstration Project": http://www.trb.org/main/blurbs/172092.aspx

Alkali Content of Fly Ash – Measuring and Testing Strategies for Compliance, TR-628, 2015

Sodium and potassium are the common alkalis present in fly ash. Excessive amounts of fly ash alkalis can cause efflorescence problems in concrete products and raise concern about the effectiveness of the fly ash to mitigate alkali-silica reaction (ASR). The available alkali test, which is commonly used to measure fly ash alkali, takes approximately 35 days for execution and reporting. Hence, in many instances the fly ash has already been incorporated into concrete before the test results are available. This complicates the job of the fly ash marketing agencies and it leads to disputes with fly ash users who often are concerned with accepting projects that contain materials that fail to meet specification limits. The research project consisted of a lab study and a field study. The lab study focused on the available alkali test and how fly ash alkali content impacts common performance tests (mortar-bar expansion tests). Twenty-one fly ash samples were evaluated during the testing. The field study focused on the inspection and testing of selected, well documented pavement sites that contained moderately reactive fine aggregate and high-alkali fly ash. A total of nine pavement sites were evaluated. Two of the sites were control sites that did not contain fly ash. The results of the lab study indicated that the available alkali test is prone to experimental errors that cause poor agreement between testing labs. A strong (linear) relationship was observed between available alkali content and total alkali content of Class C fly ash. This relationship can be used to provide a quicker, more precise method of estimating the available alkali content. The results of the field study failed to link the use of high-alkali fly ash with the occurrence of ASR in the various concrete sites. Petrographic examination of the pavement cores indicated that Wayland sand is an ASR-sensitive aggregate. This was in good agreement with Iowa DOT field service records. It was recommended that preventative measures should be used when this source of sand is used in concrete mixtures.