Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.

Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.

Effect of phosphorus and potassium on yield and on agronomical characteristics of cotton

With the objective of studying the effect of increasing phosphorus and potassium doses on the agronomical and technological characteristics of the cotton (Gossypium hirsutum L.), cultivar IAC 20, an experiment was carried out during 1994/95 on a Red-Dark Latossol at the Embrapa-Centro de Pesquisa Agropecuária do Oeste (CPAO) in Ponta Porã, MS, Brazil. A randomized bloch design was used in a 3 x 5 factorial arrangement with four replications. The doses were 30, 60 and 90 kg ha-1 of P2O5, applied as triple superphosphate, and 0, 30, 60, 90 and 120 kg ha-1 of K2O as KCl. The K2O doses used had a significant influence on the seed cotton yield, plant height and weight of 100 seeds and of bolls.

Evaluation of Cover Aggregate Stripping Characteristics, HR-182, 1979

The purpose of Research Project HR-182 was to identify those aggregate types which would perform satisfactorily as seal coat aggregates. Aggregates were chosen from across the State to represent the various types normally encountered and were used with two different types of binder bitumens. A water spray treatment was also included to simulate the effects of rainfall. The evaluation was based upon aggregate retention. Due to the influence of unexpected variables upon the field samples, the laboratory data are reliable for only the most general observations. Namely, that gravels as a group appear to be retained better than carbonates and rain-fall shortly after seal coat placement can affect aggregate retention. The subsequent field observations and analysis of skid resistance data permit the following conclusions: 1. Aggregate retention is influenced by lithologic type with the gravels, quartzite, haydite, dolomites, and medium grained limestones performing best. 2. Aggregate retention is not influenced by binder bitumen type. 3. Friction values of seal coats are influ-enced by aggregate retention and/or lithologic type. The following recommendations have been determined: The aggregate used for cover aggregate/seal coat projects should be Type 4 or better skid resistance as identified in Iowa DOT Materials Instructional Memorandum T-203. This will result in maximizing the possibility of good aggregate retention and skid resistance.

Characteristics and early and long-term outcome in patients with acute ischemic stroke and low ejection fraction.

OBJECTIVES: We assessed the clinical characteristics of patients with acute ischemic stroke (AIS) with left ventricular ejection fraction (EF) ≤ 35% and investigated the association of low EF with early and long-term outcome. METHODS: A total of 2439 patients of the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) were selected. Demographics, risk factors, pre-stroke treatment, and clinical, radiological and metabolic variables in patients with and without low EF were compared. Functional independence (modified Rankin Score ≤ 2) and mortality were recorded 1 week up to 12 months from admission. RESULTS: Low EF patients (n=119) were more commonly men, older, had higher rates of coronary artery disease and atrial fibrillation (AF), and more frequent pretreatment with anticoagulants, antiplatelets and antihypertensive agents. On admission, they presented with higher stroke severity and had lower values of systolic blood pressure, higher heart rate, and worse estimated glomerular filtration rate. Stroke-related disability and death rates were higher in low EF patients during follow-up (19.5% vs. 7.8% at 1 week, and 36.1% vs. 16.5% at 12 months). Increasing age, stroke severity, and AF were independent predictors of one-year mortality in these patients while prior use of statins had a favorable effect on early mortality. CONCLUSIONS: AIS in patients with low EF is associated with older age, cardiac comorbidities, and more severe clinical presentation. Low EF can identify a subset of AIS patients at high risk of early and long-term functional disability and mortality.

Acute opiate overdose: characteristics of 190 consecutive cases.

AIMS: To characterize the population of drug users consulting the Emergency Room (ER) of a university hospital with acute opiate overdose (AOO) and to assess rate of referral to specialized treatment programme. DESIGN: Survey of a 12-month sample of AOO patients. MEASUREMENTS: Medical and psychosocial features of the drug users, details of emergency treatment and referral by a mobile resuscitation team (SMUR) and the ER of our hospital (CHUV-Lausanne, Switzerland). In addition fatal AOO cases were collected by the Institute of Forensic Medicine (IFM) during the same period. FINDINGS: One hundred and eighty-four cases of AOO (134 patients) were treated. The files of the IFM detailed six additional deceased cases. This population of drug users was characterized by an over-representation of men (73%), by young age (27.4 years), by a high rate of multi-drugs use (90%) and by a high rate of multiple previous overdoses (2.6). Average length of stay was 20.1 hours but 41% of cases stayed less than 8 hours. Only one patient was readmitted within an 8-hour period. When discharged, 78% returned home. Unexpectedly, 67% of patients were not referred to any therapeutic programme for drug addiction. CONCLUSION: This study shows the low mortality of AOO when treated but also demonstrates the need to improve psychosocial evaluation and referral of drug addicts admitted with AOO.

Evaluation of Cohesion and Swell Characteristics of Asphalt Treated Base Mixtures, R-223, 1968

This study was undertaken to evaluate the suitability of various stones which play an important role in the properties of compacted mixtures in asphalt treated bases. The determination of the effect of water temperature on the cohesion of the mixes is investigated. A number of stones were prepared for the test. Attention is paid to the particular source of stone with the corresponding test results. A preliminary study of the effect of lime when added to mixed aggregate was also conducted. The purpose of this study is to provide needed information on the cohesive characteristics of asphalt treated bases using a wide range of stones. This study is also to evaluate the suitability of the various stone sources.

Determination of the Optimum Base Characteristics for Pavements, TR-482, 2004

In recent years, it has become apparent that the design and maintenance of pavement drainage extends the service life of pavements. Most pavement structures now incorporate subsurface layers. Part of the function of these subsurface layers is to drain away excess water, which can be extremely deleterious to the life of the pavement. To assure the effectiveness of such drainage layers after they have been spread and compacted, simple, rapid, in-situ permeability and stability testing and end-result specification are needed. This report includes conclusions and recommendations related to four main study objectives: (1) Determine the optimal range for in-place stability and in-place permeability based on Iowa aggregate sources; (2) Evaluate the feasibility of an air permeameter for determining the permeability of open and well-graded drainage layers in situ; (3) Develop reliable end-result quality control/quality assurance specifications for stability and permeability; and (4) Refine aggregate placement and construction methods to optimize uniformity.

Characteristics of Chemical Treated Roadway Surfaces, HR-33, 1963

Iowa Highway Commission Project HR-33, "Characteristics of Chemically Treated Roadway Surfaces", was investigated at the Iowa Engineering Experiment Station under Project 375-S. The purpose of the project as originally proposed was to study the physical and chemical characteristics of chemically treated roadway surfaces. All chemical treatments were to be included, but only sodium chloride and calcium chloride treated roadways were investigated. The uses of other types of chemical treatment were not discovered until recently, notably spent sulfite liquor and a commercial additive. Costs of stabilized secondary roads in Hamilton County averaged $4300.00 per mile even though remanent soil-aggregate material was used. The cost of similar roads in Franklin County was $4400.00 per mile. The Franklin County road surfaces were constructed entirely from materials that were hauled to the road site. Costs in Butler County were a little over $3000.00 per mile some eight years ago. Chemical investigations indicate that calcium chloride and sodium chloride are lost through leaching. Approximately 95 percent of the sodium chloride appears to have been lost, and nearly 65 percent of the calcium chloride has disappeared. The latter value may be much in error since surface dressings of calcium chloride are commonly used and have not been taken into account. Clay contents of the soil-aggregate-chemical stabilized roads range from about 6 to ll percent, averaging 8 or 9 percent. The thicknesses of stabilized mats are usually 2 to 4 inches, with in-place densities ranging from 130 to 145 pcf. Generally the densities found in sodium chloride stabilized roads were slightly higher than those found in the calcium chloride stabilized roads.

An Evaluation of Cover Aggregate Stripping Characteristics, Progress Report, HR-182, 1977

The increasing use of seal coats for surface restoration and the concurrent increase in failures of such treatments prompted the current research. Field observations indicated that certain aggregate types seemed to be more susceptible to failure, including stripping and disintegration. The research was thus designed to try to identify those aggregate types which would perform satisfactorily under normal conditions.

Determination of Asphalt Content and Characteristics of Bituminous Paving Mixtures, MLR-88-11, 1988

Due to the hazardous nature of chemical asphalt extraction agents, nuclear gauges have become an increasingly popular method of determining the asphalt content of a bituminous mix. This report details the results of comparisons made between intended, tank stick, extracted, and nuclear asphalt content determinations. A total of 315 sets of comparisons were made on samples that represented 110 individual mix designs and 99 paving projects. All samples were taken from 1987 construction projects. In addition to the comparisons made, seventeen asphalt cement samples were recovered for determination of penetration and viscosity. Results were compared to similar tests performed on the asphalt assurance samples in an attempt to determine the amount of asphalt hardening that can be expected due to the hot mix process. Conclusions of the report are: 1. Compared to the reflux extraction procedure, nuclear asphalt content gauges determine asphalt content of bituminous mixes with much greater accuracy and comparable precision. 2. As a means for determining asphalt content, the nuclear procedure should be used as an alternate to chemical extractions whenever possible. 3. Based on penetration and viscosity results, softer grade asphalts undergo a greater degree 'of hardening due to hot mix processing than do harder grades, and asphalt viscosity changes caused by the mixing process are subject to much more variability than are changes in penetration. 4. Based on changes in penetration and viscosity, the Thin Film Oven Test provides a reasonable means of estimating how much asphalt hardening can be anticipated due to exposure to the hot mix processing environment.

Valganciclovir in adult solid organ transplant recipients: pharmacokinetic and pharmacodynamic characteristics and clinical interpretation of plasma concentration measurements.

Valganciclovir and ganciclovir are widely used for the prevention of cytomegalovirus (CMV) infection in solid organ transplant recipients, with a major impact on patients' morbidity and mortality. Oral valganciclovir, the ester prodrug of ganciclovir, has been developed to enhance the oral bioavailability of ganciclovir. It crosses the gastrointestinal barrier through peptide transporters and is then hydrolysed into ganciclovir. This review aims to describe the current knowledge of the pharmacokinetic and pharmacodynamic characteristics of this agent, and to address the issue of therapeutic drug monitoring. Based on currently available literature, ganciclovir pharmacokinetics in adult solid organ transplant recipients receiving oral valganciclovir are characterized by bioavailability of 66 +/- 10% (mean +/- SD), a maximum plasma concentration of 3.1 +/- 0.8 mg/L after a dose of 450 mg and of 6.6 +/- 1.9 mg/L after a dose of 900 mg, a time to reach the maximum plasma concentration of 3.0 +/- 1.0 hours, area under the plasma concentration-time curve values of 29.1 +/- 5.3 mg.h/L and 51.9 +/- 18.3 mg.h/L (after 450 mg and 900 mg, respectively), apparent clearance of 12.4 +/- 3.8 L/h, an elimination half-life of 5.3 +/- 1.5 hours and an apparent terminal volume of distribution of 101 +/- 36 L. The apparent clearance is highly correlated with renal function, hence the dosage needs to be adjusted in proportion to the glomerular filtration rate. Unexplained interpatient variability is limited (18% in apparent clearance and 28% in the apparent central volume of distribution). There is no indication of erratic or limited absorption in given subgroups of patients; however, this may be of concern in patients with severe malabsorption. The in vitro pharmacodynamics of ganciclovir reveal a mean concentration producing 50% inhibition (IC(50)) among CMV clinical strains of 0.7 mg/L (range 0.2-1.9 mg/L). Systemic exposure of ganciclovir appears to be moderately correlated with clinical antiviral activity and haematotoxicity during CMV prophylaxis in high-risk transplant recipients. Low ganciclovir plasma concentrations have been associated with treatment failure and high concentrations with haematotoxicity and neurotoxicity, but no formal therapeutic or toxic ranges have been validated. The pharmacokinetic parameters of ganciclovir after valganciclovir administration (bioavailability, apparent clearance and volume of distribution) are fairly predictable in adult transplant patients, with little interpatient variability beyond the effect of renal function and bodyweight. Thus ganciclovir exposure can probably be controlled with sufficient accuracy by thorough valganciclovir dosage adjustment according to patient characteristics. In addition, the therapeutic margin of ganciclovir is loosely defined. The usefulness of systematic therapeutic drug monitoring in adult transplant patients therefore appears questionable; however, studies are still needed to extend knowledge to particular subgroups of patients or dosage regimens.

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome.

BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. METHODS: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. RESULTS: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤ 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. CONCLUSIONS: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.