Traumatologie de la personne âgée : une urgence nutritionnelle ? [Elderly orthopedic patients: Is nutritional support needed?]

La fracture de hanche chez la personne âgée reste un problème de santé publique. Elle est la conséquence d'une chute neuf fois sur dix et survient chez des personnes fragilisées par une ostéoporose, une sarcopénie, une dénutrition. Dans un service de traumatologie, la dénutrition protéino-énergétique est fréquente. Présente dès l'admission chez environ un patient sur deux, elle va souvent s'aggraver pendant le séjour hospitalier et favoriser la survenue de complications. Une prise en charge nutritionnelle doit impliquer une équipe multidisciplinaire qu'il faut coordonner. Elle doit être envisagée précocement pendant le séjour hospitalier et privilégier la voie orale. L'assistance nutritionnelle sous forme de CNO a prouvé son efficacité dans la réduction de la morbidité postopératoire. Son impact sur la mortalité, sur le pronostic fonctionnel et social reste discuté. Il faudra attendre l'étude de nouvelles cohortes dans lesquelles la compliance au traitement est nettement améliorée avant de conclure de manière définitive.

Iowa Vocational Rehabilitation Services Performance Plan, FY 2013

Agency Performance Plan, Iowa Vocational Rehabilitation Services

Iowa Vocational Rehabilitation Services Strategic Plan, 2011-2014

This report outlines the strategic plan for Iowa Vocational Rehabilitation Services including, goals and mission.

Protective effects of maternal nutritional supplementation with lactoferrin on growth and brain metabolism.

Background:Intrauterine growth restriction (IUGR) is a major risk factor for both perinatal and long-term morbidity. Bovine lactoferrin (bLf) is a major milk glycoprotein considered as a pleiotropic functional nutrient. The impact of maternal supplementation with bLf on IUGR-induced sequelae, including inadequate growth and altered cerebral development, remains unknown.Methods:IUGR was induced through maternal dexamethasone infusion (100 μg/kg during last gestational week) in rats. Maternal supplementation with bLf (0.85% in food pellet) was provided during both gestation and lactation. Pup growth was monitored, and Pup brain metabolism and gene expression were studied using in vivo (1)H NMR spectroscopy, quantitative PCR, and microarray in the hippocampus at postnatal day (PND)7.Results:Maternal bLf supplementation did not change gestational weight but increased the birth body weight of control pups (4%) with no effect on the IUGR pups. Maternal bLf supplementation allowed IUGR pups to recover a normalized weight at PND21 (weaning) improving catch-up growth. Significantly altered levels of brain metabolites (γ-aminobutyric acid, glutamate, N-acetylaspartate, and N-acetylaspartylglutamate) and transcripts (brain-derived neurotrophic factor (BDNF), divalent metal transporter 1 (DMT-1), and glutamate receptors) in IUGR pups were normalized with maternal bLf supplementation.Conclusion:Our data suggest that maternal bLf supplementation is a beneficial nutritional intervention able to revert some of the IUGR-induced sequelae, including brain hippocampal changes.

Pipe Rehabilitation with Polyethylene Pipe Liners, HR-370, 2003

Corroded, deteriorated, misaligned, and distorted drainage pipes can cause a serious threat to a roadway. Normal practice is to remove and replace the damaged drainage structure. An alternative method of rehabilitating these structures is to slip line them with a polyethylene liner. Twelve drainage structures were slip lined with polyethylene liners during 1994 in Iowa. Two types of liners installed were "Culvert Renew" and "Snap-Tite." It was found that the liners could be easily installed by most highway, county, and city maintenance departments. The liners restore the flow and increase the service life of the original drainage structure. The liners were found to be cost competitive compared with the removal and replacement of the existing drainage structure. Slip lining has the largest economic benefit when the roadway is paved, the culvert is under a deep fill, or traffic volumes are high. The annular space between the original pipe and the liner was filled with flowable mortar. Care should be taken to properly brace and grout the annular space between the liner and the culvert to avoid deformation of the liner.

Manual for Evaluation, Rehabilitation and Strengthening of Low Volume Bridges, HR-323, 1993

This report contains an evaluation and design manual for strengthening and replacing low volume steel stringer and timber stringer bridges. An advisory panel consisting of county and municipal engineers provided direction for the development of the manual. NBI bridge data, along with results from questionnaires sent to county and municipal engineers were used to formulate the manual. Types of structures shown to have the greatest need for cost-effective strengthening methods are steel stringer and timber stringer bridges. Procedures for strengthening these two types of structures have been developed. Various types of replacement bridges have also been included so that the most cost effective solution for a deficient bridge may be obtained. The key results of this study is an extensive compilation, which can be used by county engineers, of the most effective techniques for strengthening deficient existing bridges. The replacement bridge types included have been used in numerous low volume applications in surrounding states, as well as in Iowa. An economic analysis for determining the cost-effectiveness of the various strengthening methods and replacement bridges is also an important part of the manual. Microcomputer spreadsheet software for several of the strengthening methods, types of replacement bridges and for the economic analysis has been developed, documented and presented in the manual. So the manual, Chp. 3 of the final report, can be easily located, blue divider pages have been inserted to delineate the manual from the rest of the report.

Bridge Deck Rehabilitation Rebonding a Delaminated PCC Overlay By Epoxy Injection, HR-1036, 1989

The Iowa demonstration project to promote the rehabilitation of bridge deck concrete by rebonding delaminations with injected epoxy is a 150 ft x 150 ft high truss bridge on Iowa route No. 210 over Indian Creek near Maxwell in Story County (Service level D, AADT-730, Inventory Rating HS-16.9, Operating Rating HS-25). The objective of this study was to evaluate the effectiveness of repairing a delaminated bridge deck by epoxy injection, specifically a bridge deck with a delaminated portland cement concrete overlay. Observations noted during the project lead to the following conclusions: The delaminations rebonded with epoxy have remained solid through five years. The percentage of delamination has stayed essentially the same for both the epoxy injected and non-repaired areas. Epoxy injection appears to be a practical, cost effective alternative to other forms of deck rehabilitation when undertaken at the proper time. Cost effectiveness would reduce dramatically if delayed until breakouts have occurred. On the other hand it would be a slow, labor intensive process if undertaken too early when delaminations are small.

Variations on the nutritional status of eucalypt as influenced by the genetic material and age of tree

The Diagnosis and Recommendation System (DRIS) was applied to eucalypt trees (hybrids of Eucalyptus grandis x E. urophylla) with different ages and growing under different environmental conditions for three different clones. The basic data were obtained from 1,986 trees of commercial stands cultivated in the states of Espírito Santo and south Bahia, Brazil. The DRIS indices were calculated using the Beaufils' Range formula and grouped according to the Nutrient Application Potential Response method. The objective of this paper was to evaluate the N, P and Ca status in eucalypt trees, regarding the tree ages and genetic materials. The DRIS indices discriminated differences in the nutritional status of the trees, both in relation to age and the genetic materials (clones). The results indicated that the deficiency of N and Ca tended to decrease with tree age, whereas the P deficiency tended to increase. Furthermore, of the three evaluated clones, those numbered 00014 and 00034 showed opposite trends regarding to N, P, and Ca nutrition, and the clone numbered 00021, in general, presented the highest degree of unbalanced nutrition of N, P and Ca.

Nutritional diagnosis of Norway spruce stands growing on drained peatlands using foliar analysis

Tiivistelmä: Ojitettujen suokuusikoiden ravinnetarpeen määritys neulasanalyysillä

Pipe Rehabilitation with Polyethylene Pipe Liners, HR-370, Construction Report, 1995

Corroded, deteriorated, misaligned, and distorted drainage pipes can cause a serious threat to a roadway. Normal practice is to remove and replace the damaged drainage structure. An alternative method of rehabilitating these structures is to slip line them with a polyethylene liner. Twelve drainage structures were slip lined with polyethylene liners during 1994 in Iowa. Two types of liners installed were "Culvert Renew" and "Snap-Tite". It was found that the liners could be easily installed by most highway, county, and city maintenance departments. The liners restore the flow and increase the service life of the original drainage structure. The liners were found to be cost competitive with the removal and replacement of the existing drainage structure. Slip lining has the largest economic benefit when the roadway is paved, the culvert is under a deep fill, or traffic volumes are high. The annular space between the original pipe and the liner was filled with flowable mortar. Care should be taken to properly brace and grout the annular space between the liner and the culvert.

Nutritional status in commercial currant fields

Selostus: Herukkaviljelmien ravinnetila

Evaluation of Appropriate Maintenance, Repair and Rehabilitation Methods for Iowa Bridges, TR-429, 2003

Most states, including Iowa, have a significant number of substandard bridges. This number will increase significantly unless some type of preventative maintenance is employed. Both the Iowa Department of Transportation and Iowa counties have successfully employed numerous maintenance, repair and rehabilitation (MR&R) strategies for correcting various types of deficiencies. However, successfully employed MR&R procedures are often not systematically documented or defined for those involved in bridge maintenance. This study addressed the need for a standard bridge MR&R manual for Iowa with emphasis for secondary road applications. As part of the study, bridge MR&R activities that are relevant to the state of Iowa have been systematically categorized into a manual, in a standardized format. Where pertinent, design guidelines have been presented. Material presented in this manual is divided into two major categories: 1) Repair and Rehabilitation of Bridge Superstructure Components, and 2) Repair and Rehabilitation of Bridge Substructure Components. There are multiple subcategories within both major categories that provide detailed information. Some of the detailed information includes step-by-step procedures for accomplishing MR&R activities, material specifications and detailed drawings where available. The source of information contained in the manual is public domain technical literature and information provided by Iowa County Engineers. A questionnaire was sent to all 99 counties in Iowa to solicit information and the research team personally solicited input from many Iowa counties as a follow-up to the questionnaire.

Predictors of physiotherapy and occupational therapy use two years after a vocational rehabilitation for orthopaedic trauma

Introduction.- Health care utilization is an important field of our economy. Nevertheless a minority of cases induce the majority of costs. For instance, in the setting of accident insurance, the most expensive 5% of all injured cases involve 80% of the health care costs. Although physiotherapy and occupational therapy consist of only a small proportion of these costs, it is nevertheless important to evaluate the factors that predict its use in order to improve services (i.e. allocation of resources to those who need them and benefit most).Patients and methods.- In this longitudinal prospective study, the cohort consisted of 2156 consecutively included patients with orthopaedic problems attending the clinique Romande de réadaptation (CRR) at Sion for inpatient rehabilitation after a work, traffic or leisure related injury. Two years after discharge, a questionnaire regarding the use of different health cares was send to the patients (1502 patients returned their questionnaires). The aim of this study was to calculate, with a logistic multivariate model, in-patient hospitalized for orthopaedic problems, the variables that mostly predict physiotherapy use 2 years after discharge.Results.- The full multivariate model contains 46 predictors. The use of physiotherapy and occupational therapy was significantly predicted in this multivariate model by the following predictors: Patients with a spinal problem (OR 1.51 versus lower-extremity problem, 95% CI 1.01 to 2.27), a disability pension (OR 1.69, 95% CI 1.09 to 2.60), patients with sports activities (OR 1.56, 95% CI 1.26 to 1.94), patients with longer stay at the rehabilitation clinic (OR 1.22 per week, 95% CI 1.05 to 1.41), women (OR 1.64, 95% CI 1.09 to 2.48) and those consulting a psychiatrist (OR 1.66, 95% CI 1.06 to 2.60).Discussion.- In this prospective study with a 2-year follow-up, different factors predicted the use of physiotherapy and occupational therapy after an injury. Further studies are needed to clarify the impact of these factors for the health care utilization and the strategies, which would allow to improve allocation of available resources.

INTERMED predicts non-return to work in an occupational rehabilitation setting for individuals with orthopaedic trauma-part 2

Introduction.- The model presented in part I (19 predictors) had good predictive values for non-return to work 2 years after vocational rehabilitation for orthopaedic trauma. However, the number of predictors is high for the detection of patients at risk in a clinic. For example, the INTERMED for itself consists of 20 questions and needs 20 minutes to be filled in. For this reason, the aim of this study was to compare the predictive value of different models for the prediction of non-return to work.Patients and methods.- In this longitudinal prospective study, the cohort consisted of 2156 included inpatients with orthopaedic trauma attending a rehabilitation hospital after a work, traffic, sport or leisure related injury. Two years after discharge, 1502 patients returned a questionnaire regarding return to work. We compared the area under the receiver-operator-characteristics curve (ROC) between different models: INTERMED total score, the 4 partial INTERMED scores, the items of the most predictive partial score; with or without confounders.Results.- The ROC for the total score of the INTERMED plus the five confounders of the of the part one (qualified work, speaking French, lesion of upper extremity, education and age) was 0.72. The sole partial INTERMED score to predict return to work was the social sub score. The ROC for the five items of the latter sub score of the INTERMED was 0.69. The ROC for the five items of the social subscale of the INTERMED combined with five predictors was 0.73. This was significantly better than the use of only the five items from INTERMED alone (delta 0.034; 95% CI 0.017 to .050). The model presented in part I (INTERMED total score plus 18 predictors) was not significantly better than the five items INTERMED social score plus five confounders.Discussion.- The use of a model with ten variables (INTERMED social five items plus five confounders) has good predictive value to detect patients not returning to work after vocational rehabilitation after orthopaedic trauma. The parsimony of this model facilitates its use in a clinic for the detection of patients at risk.