Diagnosis and management of chronic obstructive pulmonary disease: the swiss guidelines: official guidelines of the Swiss Respiratory Society.

The new Swiss Chronic Obstructive Pulmonary Disease (COPD) Guidelines are based on a previous version, which was published 10 years ago. The Swiss Respiratory Society felt the need to update the previous document due to new knowledge and novel therapeutic developments about this prevalent and important disease. The recommendations and statements are based on the available literature, on other national guidelines and, in particular, on the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. Our aim is to advise pulmonary physicians, general practitioners and other health care workers on the early detection and diagnosis, prevention, best symptomatic control, and avoidance of COPD as well as its complications and deterioration.

Phase-field approach to spatial perturbations in normal Saffman-Taylor fingers

We make a numerical study of the effect that spatial perturbations have in normal Saffman-Taylor fingers driven at constant pressure gradients. We use a phase field model that allows for spatial variations in the Hele-Shaw cell. We find that, regardless of the specific way in which spatial perturbations are introduced, a lateral instability develops on the sides of the propagating Saffman-Taylor finger. Moreover, the instability exists regardless of the intensity of spatial perturbations in the cell as long as the perturbations are felt by the finger tip. If, as the finger propagates, the spatial perturbations felt by the tip change, the instability is nonperiodic. If, as the finger propagates, the spatial perturbations felt by the tip are persistent, the instability developed is periodic. In the later case, the instability is symmetrical or asymmetrical depending on the intensity of the perturbation.

Pain and beliefs after musuloskeletal trauma: Complex relationships during the first year of rehabilitation

Introduction.- Pain and beliefs have an influence on the patient's course in rehabilitation and their relationships are complex. The aim of this study was to understand the relationships between pain at admission and the evolution of beliefs during rehabilitation as well as the relationships between pain and beliefs one year after rehabilitation.Patients and methods.- Six hundred and thirty-one consecutive patients admitted in rehabilitation after musculoskeletal trauma, were included and assessed at admission, at discharge and one year after discharge. Pain was measured by VAS (Visual Analogical Scale) and beliefs by judgement on Lickert scales. Four kinds of beliefs were evaluated: fear of a severe origin of pain, fear of movement, fear of pain and feeling of distress (loss of control). The association between pain and beliefs was assessed by logistic regressions, adjusted for gender, age, native language, education and bio-psycho-social complexity.Results.- At discharge, 44% of patients felt less distressed by pain, 34% are reinsured with regard to their fear of a severe origin of pain, 38% have less fear of pain and 33% have less fear of movement. The higher the pain at admission, the higher the probability that the distress diminished, this being true up to a threshold (70 mm/100) beyond which there was a plateau. At one year, the higher the pain, the more dysfunctional the fears.Discussion.- The relationships between pain and beliefs are complex and may change all along rehabilitation. During hospitalization, one could hope that the patient would be reinsured and would gain self-control again, if pain does not exceed a certain threshold. After one year, high pain increases the risk of dysfunctional beliefs. For clinical practice, these data suggest to think in terms of the more accessible "entrance door", act against pain and/or against beliefs, adpated to each patient.

La "satisfaction" du médecin lors d'une première consultation diffère-t-elle selon l'origine du patient? Une étude prospective. [Does physician's satisfaction with an initial consultation differ according to the patient's origin? A prospective study].

Difficulties in the doctor-patient relationship may arise because of differences in socio-cultural background. The aim of this study was to evaluate the doctors' satisfaction in an ambulatory care setting when confronted with 3 different cultural groups (Swiss, foreign residents, refugees) and to review some preconceived ideas. Actually, the foreign population did not consult more often in emergencies than the Swiss population, nor did it present more frequently with somatizations in first interview. However, the doctors felt globally less satisfied with the refugees than with the other patients, mainly because of communication difficulties and therefore a less satisfying doctor-patient relationship. Nevertheless, the doctors felt they had the same diagnostic accuracy in the 3 groups. Studies on the satisfaction of primary care doctors are important, because the quality of the doctor-patient relationship directly influences the quality of medical care.

Wind Monitoring of the Saylorville and Red Rock Reservoir Bridges with Remote, Cellular-Based Notifications, May 2012

Following a high wind event on January 24, 2006, at least five people claimed to have seen or felt the superstructure of the Saylorville Reservoir Bridge in central Iowa moving both vertically and laterally. Since that time, the Iowa Department of Transportation (DOT) contracted with the Bridge Engineering Center at Iowa State University to design and install a monitoring system capable of providing notification of the occurrence of subsequent high wind events. In subsequent years, a similar system was installed on the Red Rock Reservoir Bridge to provide the same wind monitoring capabilities and notifications to the Iowa DOT. The objectives of the system development and implementation are to notify personnel when the wind speed reaches a predetermined threshold such that the bridge can be closed for the safety of the public, correlate structural response with wind-induced response, and gather historical wind data at these structures for future assessments. This report describes the two monitoring systems, their components, upgrades, functionality, and limitations, and results from one year of wind data collection at both bridges.

Assessment of driving capability through the use of clinical and psychomotor tests in relation to blood cannabinoids levels following oral administration of 20 mg dronabinol or of a cannabis decoction made with 20 or 60 mg Delta9-THC.

Delta(9)-Tetrahydrocannabinol (THC) is frequently found in the blood of drivers suspected of driving under the influence of cannabis or involved in traffic crashes. The present study used a double-blind crossover design to compare the effects of medium (16.5 mg THC) and high doses (45.7 mg THC) of hemp milk decoctions or of a medium dose of dronabinol (20 mg synthetic THC, Marinol on several skills required for safe driving. Forensic interpretation of cannabinoids blood concentrations were attempted using the models proposed by Daldrup (cannabis influencing factor or CIF) and Huestis and coworkers. First, the time concentration-profiles of THC, 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) (active metabolite of THC), and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) in whole blood were determined by gas chromatography-mass spectrometry-negative ion chemical ionization. Compared to smoking studies, relatively low concentrations were measured in blood. The highest mean THC concentration (8.4 ng/mL) was achieved 1 h after ingestion of the strongest decoction. Mean maximum 11-OH-THC level (12.3 ng/mL) slightly exceeded that of THC. THCCOOH reached its highest mean concentration (66.2 ng/mL) 2.5-5.5 h after intake. Individual blood levels showed considerable intersubject variability. The willingness to drive was influenced by the importance of the requested task. Under significant cannabinoids influence, the participants refused to drive when they were asked whether they would agree to accomplish several unimportant tasks, (e.g., driving a friend to a party). Most of the participants reported a significant feeling of intoxication and did not appreciate the effects, notably those felt after drinking the strongest decoction. Road sign and tracking testing revealed obvious and statistically significant differences between placebo and treatments. A marked impairment was detected after ingestion of the strongest decoction. A CIF value, which relies on the molar ratio of main active to inactive cannabinoids, greater than 10 was found to correlate with a strong feeling of intoxication. It also matched with a significant decrease in the willingness to drive, and it matched also with a significant impairment in tracking performances. The mathematic model II proposed by Huestis et al. (1992) provided at best a rough estimate of the time of oral administration with 27% of actual values being out of range of the 95% confidence interval. The sum of THC and 11-OH-THC blood concentrations provided a better estimate of impairment than THC alone. This controlled clinical study points out the negative influence on fitness to drive after medium or high dose oral THC or dronabinol.

Evaluation of Dense Bridge Floor Concrete Using High Range Water Reducer, May 1983

The objectives of this research project are: (1) To determine the feasibility of proportioning, mixing, placing and finishing a dense portland cement concrete in a bridge floor using conventional mixing, placing and finishing equipment. (2) To determine the economics, longevity, maintenance performance and protective qualities of a dense portland cement concrete bridge floor when using a high rangewater reducing admixture. The purpose of a high range water reducing admixture is to produce a dense, high quality concrete at a low water-cement ratio witj adequate workability. A low water-cement ratio contributes greatly to increased strength. The normal 7 day strength of untreated concrete would be expected i n 3 days using a superplasticizer. A dense concrete also has the desirable properties of excellent durability and reduced permeability. It is felt that a higher quality, denser, higher strength portland cement concrete can be produced and placed, using conventional equipment, by the addition of a high range water reducing admixture. Such a dense concrete, w i t h a water/cement ratio of approximately 0.30 to 0.35, would be expected to be much less permeable and thus retard the intrusion of chloride. With care and attention given to obtaining the design cover over steel (2% inches clear), it i s hoped that protection for the design life of the structure will be obtained. Evaluation of this experimental concrete bridge floor included chloride content and delamination testing of the concrete floor five years after construction. A comparitive evaluation o f a control section o f concrete without the water reducing admixture was conducted. Other items o f comparison include workability during construction, strength, density, water-cement ratio and chloride penetration.

Wind Monitoring of the Saylorville and Red Rock Reservoir Bridges with Remote, Cellular-Based Notifications, May 2012

Following high winds on January 24, 2006, at least five people claimed to have seen or felt the superstructure of the Saylorville Reservoir Bridge in central Iowa moving both vertically and laterally. Since that time, the Iowa Department of Transportation (DOT) contracted with the Bridge Engineering Center at Iowa State University to design and install a monitoring system capable of providing notification of the occurrence of subsequent high winds. Although measures were put into place following the 2006 event at the Saylorville Reservoir Bridge, knowledge of the performance of this bridge during high wind events was incomplete. Therefore, the Saylorville Reservoir Bridge was outfitted with an information management system to investigate the structural performance of the structure and the potential for safety risks. In subsequent years, given the similarities between the Saylorville and Red Rock Reservoir bridges, a similar system was added to the Red Rock Reservoir Bridge southeast of Des Moines. The monitoring system developed and installed on these two bridges was designed to monitor the wind speed and direction at the bridge and, via a cellular modem, send a text message to Iowa DOT staff when wind speeds meet a predetermined threshold. The original intent was that, once the text message is received, the bridge entrances would be closed until wind speeds diminish to safe levels.

Programme latin de don d'organes (PLDO): une initiative efficace pour augmenter les dons d'organes en Suisse [Latin organ donation programme (LODP): an effective initiative to increase organ donation in Switzerland].

The 1st federal transplant law was enforced in July 2007 with the obligation to promote quality and efficiency in the procedures for organ and tissue donation for transplantation. The Latin organ donation programme (LODP) created in 2008 aims to develop organ donation in 17 public hospitals in 7 Latin cantons, covering 2.2 million people; 29% of the Swiss population. The implementation of various effective measures by the LODP enabled the increase in the number of donors by 70% between 2008 and 2010, with four organs procured per donor; greatly exceeding the European average of three. The results show that LODP has successfully professionalised the system and we can only hope that similar organisations will be put into place throughout Switzerland.

Geophagia secondary to anaemia in a rich country?

Case Report: A 19 year old female, originally from Cameroon, residentin Switzerland for 10 years, consults for chronic fatigue, constipationand menorrhagia. Clinical examination reveals pain in the iliac fossa,laboratory tests show an iron deficiency anaemia with a hemoglobinof 74 g/l (N: 117-157) and a ferritin less than 3 μg/l (N: 30-300).Gynecological aetiology is strongly suspected.Findings: The dietary history reveals a high intake of African chalkcalled "Mabel" in Lingala, for which she has a craving with criteria forsubstance dependence according to the Diagnostic and StatisticalManual IV. Eating non-food products is called "PICA" and the eatingof earth "geophagia". It is often assumed by the patient that geophagiaoffers nutritional virtues of the earth, and that the land would act asantitoxic, anti-emetic, immune-stimulant, strengthen the intestinalbarrier and be rich in calcium, iron and many nutrients. But insteadgeophagia causes anemia, iron chelation, heavy metal poisoningand significant constipation or obstruction.Management: The patient, following our advice, stopped ingestingchalk. Parenteral iron substitution of ferric carboxymaltose 1000 mgstopped the craving, and resolved her subjective state of fatigue andher haemoglobin normalized to 140 g/l. The menorrhagia resolved withhormone replacement and the constipation subsequently disappeared.Discussion: Our patient was suffering from iron deficiency resulting ina craving for non-food products in this case the earth. We advisepractitioners to systematically ask the question in patients of Africanand South American origin by using synonyms for the word "Mabel"(African chalk, kaolin, Kalaba, calabash chalk, calabash Stone, Kaolin,hurdle, or clay Nzu). A simple question can sometimes avoid costlyinvestigations. The ferrous replacement intravenously can probably stopthe practice of geophagy faster. Finally, we must remember that thispractice is underestimated and rarely expressed by patients as it isoften felt to be a shameful practice.

Heat Dissipation and Crack Control in Massive Concrete at the Burlington Bridge, MLR-94-1, 1995

The large concrete placements at the Burlington Bridge were expected to cause great temperature differentials within the individual placements. In an attempt to reduce cracking due to the large temperature differentials, the Iowa Department of Transportation required that contractors continuously monitor the temperatures and temperature differentials in the concrete placement to assure that the temperature differentials did not exceed 35 deg F. It was felt that if temperature differentials remained below 35 deg F, cracking would be minimized. The following is a summary of the background of the project, and what occurred during individual concrete placements. The following conclusions were drawn: 1) Side temperatures are cooler and more greatly affected by ambient air temperatures; 2) When the 35 deg F limit was exceeded, it was almost exclusively the center to side differential; 3) The top temperature increases substantially when a new pour is placed; 4) The use of ice and different cement types did seem to affect the overall temperature gain and the amount of time taken for any one placement to reach a peak, but did not necessarily prevent the differentials from exceeding the 35 deg F limit, nor prevent cracking in any placement; and 5) Larger placements have a greater tendency to exceed the differential limit.

Screening for post-traumatic stress disorder (PTSD) in a psychiatric emergency setting

Background and Objectives: (i) to assess the prevalence of PTSD in a psychiatric emergency setting by means of a diagnostic instrument and to compare it with PTSD-prevalence of a clinically evaluated, historical sample; and (ii) to assess psychiatric residents' perception of the systematic use of this diagnostic instrument. Methods: A consecutive sample of patients (N = 403) evaluated for a psychiatric emergency was assessed with the module J (PTSD) of the MINI, the historical sample (N = 350), assessed by chart review, consisted of consecutive patients of the same setting evaluated one year prior to the study period. Residents' perceptions were assessed by means of a focus group. Results: While in only 0.57% of the historical sample (N = 350) a diagnosis of PTSD was recorded, 20.3% (N = 64) of the patients assessed with the diagnostic instrument (N = 316) qualified for a diagnosis of PTSD. Higher prevalence rates were observed in refugees and those without legal residency status (50%); patients from countries with a recent history of war (47.1%); those with four (44.4%) or three psychiatric co-morbidities (35.3%); migrants (29.8%) and patients without professional income (25%). Residents felt that the systematic use of the tool was not adequate in the psychiatric emergency setting for various reasons (e.g.: not suitable for a first or single consultation, negative impact on the clinical evaluation). Conclusions: The study confirms that PTSD is underdiagnosed in the psychiatric emergency setting. To improve the situation, targeted screening or educational and institutional strategies are needed.

Children left behind during immigration: repercussions on the mental health of Latin-American mothers and fathers

Emigrating and having to leave children behind may be a risk factor for the mental health of immigrants. This study aimed to compare the psychological symptoms reported by immigrants mothers and fathers who took their children with them with those who left their children behind. The sample comprised 213 Latin American immigrants (123 women and 90 men). The results showed that mothers who did not have children with them reported more psychological symptoms than those who did. Few differences were observed in the case of fathers, except that those who had their children with them reported more symptoms related with somatization. After controlling for possible confounding variables ('time since immigration', ·having a job', 'legal status', and social support') it is concluded that for mothers not being accompanied by own's children explains the largest proportion of the psychological synptoms analyzed, although the time since immigration also accounts for some of the variance in the case of depressive sympthomatology and general distress. It is likely that the despair and frustation felt by mothers grows as time goes on and they remain unable to reunite the family. These results may be useful in terms of designing prevention and intervention programs with immigrants mothers.

Evaluation Study of Pit Run Gravel Asphalt Treated Base Mixtures with Various Percentages of Crushed Limestone, R-217, 1968

In November of 1966, an investigation of the rigid Class I asphalt treated base specification, requiring 70 per cent crushed limestone, was initiated. It was felt that it might be possible to modify the need for crushed particles, in the construction of basis on heavy duty roads, at a savings, by using more local materials, without sacrificing strength and/or durability. This is a short study on typical sources of pit run gravel, with various percentages of limestone. It is conducted with an eye open to the possibility that our specifications may be modified. The possibility that further investigation may be desirable is not ignored.

Dynamics of Highway Bridges, HR-67, 1961

The AASHO specifications for highway bridges require that in designing a bridge, the live load must be multiplied by an impact factor for which a formula is given, dependent only upon the length of the bridge. This formula is a result of August Wohler's tests on fatigue in metals, in which he determined that metals which are subjected to large alternating loads will ultimately fail at lower stresses than those which are subjected only to continuous static loads. It is felt by some investigators that this present impact factor is not realistic, and it is suggested that a consideration of the increased stress due to vibrations caused by vehicles traversing the span would result in a more realistic impact factor than now exists. Since the current highway program requires a large number of bridges to be built, the need for data on dynamic behavior of bridges is apparent. Much excellent material has already been gathered on the subject, but many questions remain unanswered. This work is designed to investigate further a specific corner of that subject, and it is hoped that some useful light may be shed on the subject. Specifically this study hopes to correlate, by experiment on a small scale test bridge, the upper limits of impact utilizing a stationary, oscillating load to represent axle loads moving past a given point. The experiments were performed on a small scale bridge which is located in the basement of the Iowa Engineering Experiment Station. The bridge is a 25 foot simply supported span, 10 feet wide, supported by four beams with a composite concrete slab. It is assumed that the magnitude of the predominant forcing function is the same as the magnitude of the dynamic force produced by a smoothly rolling load, which has a frequency determined by the passage of axles. The frequency of passage of axles is defined as the speed of the vehicle divided by the axle spacing. Factors affecting the response of the bridge to this forcing function are the bridge stiffness and mass, which determine the natural frequency, and the effects of solid damping due to internal structural energy dissipation.