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

The best indirect evidence that increased bone turnover contributes to fracture risk is the fact that most of the proven therapies for osteoporosis are inhibitors of bone turnover. The evidence base that we can use biochemical markers of bone turnover in the assessment of fracture risk is somewhat less convincing. This relates to natural variability in the markers, problems with the assays, disparity in the statistical analyses of relevant studies and the independence of their contribution to fracture risk. More research is clearly required to address these deficiencies before biochemical markers might contribute a useful independent risk factor for inclusion in FRAX(®).

Aortic root rupture: implications of catheter-guided aortic valve replacement.

PURPOSE OF REVIEW: The safety and efficiency of trans catheter aortic valve implantation (TAVI) has been clearly demonstrated. In high-risk patients, the number of procedures is constantly increasing and in western European countries this procedure is employed in more than 30% of isolated aortic valve replacements. The literature, however, focusing on perioperative aortic root (AoR) rupture is rather limited to just a few reports. The aim of this review is to analyze the pathophysiology of AoR rupture during TAVI, stressing the implications of the morphology of the AoR for this devastating complication. RECENT FINDINGS: Currently, perioperative AoR rupture ranges between 0.5 and 1.5% during TAVI, with almost 100% mortality. Recently, valve oversizing and balloon dilatation in a calcified and small AoR were considered as the most important predictive factors for this complication. SUMMARY: The most fragile unit of the AoR is its anchoring substrate to the ostium of the left ventricle. This membranous structure is not involved in the degenerative process leading to aortic valve stenosis. Due to the TAVI and/or balloon dilatation of the calcium stationed on the three leaflets and their attachment, a lesion may result on this structure. And, as a consequence, there is rupture of the AoR.

A randomised controlled clinical trial and gait analysis of fixed- and mobile-bearing total knee replacements with a five-year follow-up.

This study compared the outcome of total knee replacement (TKR) in adult patients with fixed- and mobile-bearing prostheses during the first post-operative year and at five years' follow-up, using gait parameters as a new objective measure. This double-blind randomised controlled clinical trial included 55 patients with mobile-bearing (n = 26) and fixed-bearing (n = 29) prostheses of the same design, evaluated pre-operatively and post-operatively at six weeks, three months, six months, one year and five years. Each participant undertook two walking trials of 30 m and completed the EuroQol questionnaire, Western Ontario and McMaster Universities osteoarthritis index, Knee Society score, and visual analogue scales for pain and stiffness. Gait analysis was performed using five miniature angular rate sensors mounted on the trunk (sacrum), each thigh and calf. The study population was divided into two groups according to age (≤ 70 years versus > 70 years). Improvements in most gait parameters at five years' follow-up were greater for fixed-bearing TKRs in older patients (> 70 years), and greater for mobile-bearing TKRs in younger patients (≤ 70 years). These findings should be confirmed by an extended age controlled study, as the ideal choice of prosthesis might depend on the age of the patient at the time of surgery.

Audit report on the Iowa Water Pollution Control Works Financing Program and the Iowa Drinking Water Facilities Financing Program, joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2014

Audit report on the Iowa Water Pollution Control Works Financing Program and the Iowa Drinking Water Facilities Financing Program, joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2014

Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

Risk factors for fracture can be purely skeletal, e.g., bone mass, microarchitecture or geometry, or a combination of bone and falls risk related factors such as age and functional status. The remit of this Task Force was to review the evidence and consider if falls should be incorporated into the FRAX® model or, alternatively, to provide guidance to assist clinicians in clinical decision-making for patients with a falls history. It is clear that falls are a risk factor for fracture. Fracture probability may be underestimated by FRAX® in individuals with a history of frequent falls. The substantial evidence that various interventions are effective in reducing falls risk was reviewed. Targeting falls risk reduction strategies towards frail older people at high risk for indoor falls is appropriate. This Task Force believes that further fracture reduction requires measures to reduce falls risk in addition to bone directed therapy. Clinicians should recognize that patients with frequent falls are at higher fracture risk than currently estimated by FRAX® and include this in decision-making. However, quantitative adjustment of the FRAX® estimated risk based on falls history is not currently possible. In the long term, incorporation of falls as a risk factor in the FRAX® model would be ideal.

Transverse Joint Sealing with Various Sealants, HR-203, 1983

Iowa's first portland cement concrete pavement was constructed in 1904 in the City of LeMars. A portion of that pavement served traffic until 1974 at which time it was resurfaced. The first rural Iowa pee pavement (16' wide, 6" to 7" thick) was constructed under the direction of the Iowa State Highway Commission in 1913. Some of Iowa's early pavements had transverse joints at 25-foot spacings. At that time, joint spacings across the nation ranged from 24 to 100 ft. There have been many changes in joint design over the years with some pavements being constructed without transverse joints. Joint spacing on Iowa primary pavements has generally remained around 20 feet with this spacing having been adopted as an Iowa standard in 1954. Until 1978 it was common to specify a 40-foot joint spacing on secondary pavements. The performance of the pavements with joint spacings greater than 20 feet, and in some cases no contraction joints, generated a 1955 research project on joint spacing. This project was 16 miles long containing sections without contraction joints and sections with joints sawed at intervals of 20, 50 and 80 feet. Approximately half of the sawed joints were left unsealed. The results of this research supported the 20-foot spacing, but were inconclusive regarding the benefits of sealing. One of the desired characteristics of joint sealing material is that it should act as a moisture barrier and prevent the intrusion of surface water. It was generally accepted from past experience that the hot poured type joint seals did not provide this effective moisture barrier.

Transverse Joint Sealing with Improved Sealers, HR-276, 1991

Concern about premature joint sealant failures occurring in portland cement concrete (PCC) pavements gave impetus to initiating this research project. Eight sealants, including three silicone sealants, were evaluated and tested in the lab as well as incorporated in approximately 700 joints in the field and evaluated over a six-year period. The preliminary data show that among the silicone sealants, Dow Corning 888 rated the highest. However, this was rated third overall behind the W. R. Meadows cold-applied Sof Seal and Crafco #231 hot pour sealants. The W. R. Meadows and Crafco sealants cost approximately 30 percent and 50 percent less to furnish and place than the Dow Corning product. All joint sealants will continue to be evaluated.

Cardiac motion estimation by joint alignment of tagged MRI sequences

Image registration has been proposed as an automatic method for recovering cardiac displacement fields from Tagged Magnetic Resonance Imaging (tMRI) sequences. Initially performed as a set of pairwise registrations, these techniques have evolved to the use of 3D+t deformation models, requiring metrics of joint image alignment (JA). However, only linear combinations of cost functions defined with respect to the first frame have been used. In this paper, we have applied k-Nearest Neighbors Graphs (kNNG) estimators of the -entropy (H ) to measure the joint similarity between frames, and to combine the information provided by different cardiac views in an unified metric. Experiments performed on six subjects showed a significantly higher accuracy (p < 0.05) with respect to a standard pairwise alignment (PA) approach in terms of mean positional error and variance with respect to manually placed landmarks. The developed method was used to study strains in patients with myocardial infarction, showing a consistency between strain, infarction location, and coronary occlusion. This paper also presentsan interesting clinical application of graph-based metric estimators, showing their value for solving practical problems found in medical imaging.

On-pump fibrillating heart mitral valve replacement with the SAPIEN? XT transcatheter heart valve.

In some high-risk patients, standard mitral valve replacement can represent a challenging procedure, requiring a risky extensive decalcification of the annulus. In particular, high-risk redo patients and patients with a previously implanted transcatheter aortic valve, who develop calcific mitral disease, would benefit from the development of new, minimally invasive, transcatheter or hybrid techniques for mitral valve replacement. In particular, mixing transcatheter valve therapies and well-established minimally invasive techniques for mitral replacement or repair can help in decreasing the surgical risk and the technical complexity. Thus, placing transcatheter, balloon-expandable Sapien? XT stent-valves in calcified, degenerated mitral valves through a right thoracotomy, a left atriotomy and on an on-pump fibrillating heart, represents an attractive alternative to standard surgery in redo patients, in patients with concomitant transcatheter aortic stent-valves in place and in patients with a high-risk profile. We describe this hybrid technique in detail.

Pressure Relief and Other Joint Rehabilitation Techniques, HR-1042, 1987

A study of four major concrete pavement joint rehabilitation techniques has been conducted, including: pressure relief joints, full-depth repairs, partial-depth repairs and joint resealing. The products of this research include the following for each technique: a summary of published research, detailed documentation of the design and performance of the 36 projects, conclusions and recommendations of the state highway engineers panel, "Design and Construction Guidelines" and "Guide Specifications." The latter two products are prepared for use by state highway agencies. The results of this study are based upon a review of literature, extensive field surveys and analysis of 36 rehabilitation projects, and the experience of an expert panel of state highway engineers.

Longitudinal Joint Forming in PCC Pavements, MLR-00-05, Construction Report, 2003

In conventional construction practices, a longitudinal joint is sawed in a PCC (Portland Cement Concrete) pavement to control concrete shrinkage cracking between two lanes of traffic. Sawing a joint in hardened concrete is an expensive and time consuming operation. The longitudinal joint is not a working joint (in comparison to a transverse joint) as it is typically tied with a tie bar at 30 inch spacing. The open joint reservoir, left by the saw blade, typically is filled or sealed with a durable crack sealant to keep incompressibles and water from getting into the joint reservoir. An experimental joint forming knife has been developed. It is installed under the paving machine to form the longitudinal joint in the wet concrete as a part of the paving process. Through this research method, forming a very narrow longitudinal joint during the paving process, two conventional paving operations can be eliminated. Joint forming eliminates the need of the joint sawing operation in the hard concrete, and as the joint that is formed does not leave a wide-open reservoir, but only a hairline crack, it does not need the joint filling or sealing operation. Therefore, the two conventional longitudinal joint sawing and sealing operations are both being eliminated by this innovation. A laboratory scale prototype joint forming knife was built and tested, initially forming joints in small concrete beams. The results were positive so the method was proposed for field testing. Initial field tests were done in the construction season of 2001, limited to one paving contractor. A number of modifications were made to the knife throughout the field tests. About 3000 feet of longitudinal joint was formed in 2001. Additional testing was done in the 2002 construction season, working with the same contractor. About 150,000 feet of longitudinal joint was formed in 2002. Evaluations of the formed joints were done to determine longitudinal joint hairline crack development rate and appearance. Additional tests will be done in the next construction season to improve or perfect the longitudinal joint forming technique.

Demonstration Project using Railroad Flatcars for Low-Volume Road Bridges, TR-444, 2003

The use of Railroad Flatcars (RRFCs) as the superstructure on low-volume county bridges has been investigated in a research project conducted by the Bridge Engineering Center at Iowa State University. These bridges enable county engineers to replace old, inadequate county bridge superstructures for less than half the cost and in a shorter construction time than required for a conventional bridge. To illustrate their constructability, adequacy, and economy, two RRFC demonstration bridges were designed, constructed, and tested: one in Buchanan County and the other in Winnebago County. The Buchanan County Bridge was constructed as a single span with 56-ft-long flatcars supported at their ends by new, concrete abutments. The use of concrete in the substructure allowed for an integral abutment at one end of the bridge with an expansion joint at the other end. Reinforced concrete beams (serving as longitudinal connections between the three adjacent flatcars) were installed to distribute live loads among the RRFCs. Guardrails and an asphalt milling driving surface completed the bridge. The Winnebago County Bridge was constructed using 89-ft-long flatcars. Preliminary calculations determined that they were not adequate to span 89 ft as a simple span. Therefore, the flatcars were supported by new, steel-capped piers and abutments at the RRFCs' bolsters and ends, resulting in a 66-ft main span and two 10-ft end spans. Due to the RRFC geometry, the longitudinal connections between adjacent RRFCs were inadequate to support significant loads; therefore, transverse, recycled timber planks were utilized to effectively distribute live loads to all three RRFCs. A gravel driving surface was placed on top of the timber planks, and a guardrail system was installed to complete the bridge. Bridge behavior predicted by grillage models for each bridge was validated by strain and deflection data from field tests; it was found that the engineered RRFC bridges have live load stresses significantly below the AASHTO Bridge Design Specification limits. To assist in future RRFC bridge projects, RRFC selection criteria were established for visual inspection and selection of structurally adequate RRFCs. In addition, design recommendations have been developed to simplify live load distribution calculations for the design of the bridges. Based on the results of this research, it has been determined that through proper RRFC selection, construction, and engineering, RRFC bridges are a viable, economic replacement system for low-volume road bridges.

Evaluation of Transverse Joint Forming Methods for PCC Pavement, TR-532, 2006

The members of the Iowa Concrete Paving Association, the National Concrete Pavement Technology Center Research Committee, and the Iowa Highway Research Board commissioned a study to examine alternative ways of developing transverse joints in portland cement concrete pavements. The present study investigated six separate variations of vertical metal strips placed above and below the dowels in conventional baskets. In addition, the study investigated existing patented assemblies and a new assembly developed in Spain and used in Australia. The metal assemblies were placed in a new pavement and allowed to stay in place for 30 days before the Iowa Department of Transportation staff terminated the test by directing the contractor to saw and seal the joints. This report describes the design, construction, testing, and conclusions of the project.