Changes in lung function during an extreme mountain ultramarathon.

This study aimed to assess the effects of an extreme mountain ultramarathon (MUM, 330 km, 24,000 D+) on lung function. Twenty-nine experienced male ultramarathon runners performed longitudinally [before (pre), during (mid), and immediately after (post) a MUM] a battery of pulmonary function tests. The tests included measurements of forced vital capacity, forced expiratory volume in 1 s, peak flow, inspiratory capacity, and maximum voluntary ventilation in 12 s (MVV12). A significant reduction in the running speed was observed (-43.0% between pre-mid and mid-post; P < 0.001). Expiratory function declined significantly at mid (P < 0.05) and at post (P < 0.05). A similar trend was observed for inspiratory function (P < 0.05). MVV12 declined at mid (P < 0.05) and further decreased at post (P < 0.05). Furthermore, there are significant negative correlations between performance time and MVV12 pre-race (R = -0.54, P = 0.02) as well as changes in MVV12 between pre- and post-race (R = -0.53, P = 0.009). It is concluded that during an extreme MUM, a continuous decline in pulmonary function was observed, likely attributable to the high levels of ventilation required during this MUM in a harsh mountainous environment.

The Beck Cognitive Insight Scale in outpatients with psychotic disorders: further evidence from a French-speaking sample.

OBJECTIVE: The Beck Cognitive Insight Scale (BCIS) evaluates patients' self-report of their ability to detect and correct misinterpretation. Our study aims to confirm the factor structure and the convergent validity of the original scale in a French-speaking environment. METHOD: Outpatients (n = 158) suffering from schizophrenia or schizoaffective disorders fulfilled the BCIS. The 51 patients in Montpellier were equally assessed with the Positive and Negative Syndrome Scale (PANSS) by a psychiatrist who was blind of the BCIS scores. RESULTS: The fit indices of the confirmatory factor analysis validated the 2-factor solution reported by the developers of the scale with inpatients, and in another study with middle-aged and older outpatients. The BCIS composite index was significantly negatively correlated with the clinical insight item of the PANSS. CONCLUSIONS: The French translation of the BCIS appears to have acceptable psychometric properties and gives additional support to the scale, as well as cross-cultural validity for its use with outpatients suffering from schizophrenia or schizoaffective disorders. The correlation between clinical and composite index of cognitive insight underlines the multidimensional nature of clinical insight. Cognitive insight does not recover clinical insight but is a potential target for developing psychological treatments that will improve clinical insight.

Physical activity and energy expenditure in rheumatoid arthritis patients and matched controls.

OBJECTIVES: To compare daily energy expenditure between RA patients and matched controls, and to explore the relationship between daily energy expenditure or sedentariness and disease-related scores. METHODS: One hundred and ten patients with RA and 440 age- and sex-matched controls were included in this study. Energy expenditure was assessed using the validated physical activity (PA) frequency questionnaire. Disease-related scores included disease activity (DAS-28), functional status (HAQ), pain visual analogue scale (VAS) and fatigue VAS. Total energy expenditure (TEE) and the amount of energy spent in low- (TEE-low), moderate- (TEE-mod) and high-intensity (TEE-high) PAs were calculated. Sedentariness was defined as expending <10% of TEE in TEE-mod or TEE-high activities. Between-group comparisons were computed using conditional logistic regression. The effect of disease-related scores on TEE was investigated using linear regression. RESULTS: TEE was significantly lower for RA patients compared with controls [2392 kcal/day (95% CI 2295, 2490) and 2494  kcal/day (2446, 2543), respectively, P = 0.003]. A significant difference was found between groups in TEE-mod (P = 0.015), but not TEE-low (P = 0.242) and TEE-high (P = 0.146). All disease-related scores were significantly poorer in sedentary compared with active patients. TEE was inversely associated with age (P < 0.001), DAS-28 (P = 0.032) and fatigue VAS (P = 0.029), but not with HAQ and pain VAS. CONCLUSION: Daily energy expenditure is significantly lower in RA patients compared with matched controls, mainly due to less moderate-intensity PAs performed. Disease activity and fatigue are important contributing factors. These points need to be addressed if promoting PA in RA patients is a health goal. Trial registration. ClinicalTrials.gov, http://clinicaltrials.gov, NCT01228812.

Integration of local-scale hydrological and regional-scale geophysical based on a nonlinear Bayesian sequential simulation approach

Significant progress has been made with regard to the quantitative integration of geophysical and hydrological data at the local scale. However, extending the corresponding approaches to the regional scale represents a major, and as-of-yet largely unresolved, challenge. To address this problem, we have developed a downscaling procedure based on a non-linear Bayesian sequential simulation approach. The basic objective of this algorithm is to estimate the value of the sparsely sampled hydraulic conductivity at non-sampled locations based on its relation to the electrical conductivity, which is available throughout the model space. The in situ relationship between the hydraulic and electrical conductivities is described through a non-parametric multivariate kernel density function. This method is then applied to the stochastic integration of low-resolution, re- gional-scale electrical resistivity tomography (ERT) data in combination with high-resolution, local-scale downhole measurements of the hydraulic and electrical conductivities. Finally, the overall viability of this downscaling approach is tested and verified by performing and comparing flow and transport simulation through the original and the downscaled hydraulic conductivity fields. Our results indicate that the proposed procedure does indeed allow for obtaining remarkably faithful estimates of the regional-scale hydraulic conductivity structure and correspondingly reliable predictions of the transport characteristics over relatively long distances.

Strengthening of Existing Continuous Composite Bridges, HR-287, 1987

Research was conducted to investigate the potential of strengthening continuous bridges by post-tensioning. The study included the following: a literature review, selection and rating of a prototype continuous composite bridge, tests of a one-third-scale continuous composite bridge model, finite element analysis of the bridge model, and tests of a full-scale composite beam mockup for a negative moment region. The study results indicated that the strengthening of continuous, composite bridges is feasible. The primary objective in applyig the post-tensioning should be to provide moments opposite to those produced by live and dead loads. Longitudinal distribution of that post-tensioning always must be considered if only exterior or only interior beams are post-tensioned. Testing and finite element analysis showed that post-tensioning of positive moment regions with straight tendons was more effective than post-tensioning negative moment regions with straight tendons. Changes in tension in tendons may be either beneficial or detrimental when live loads are applied to a strengthened bridge and thus must be carefully considered in design.

Design Manual for Strengthening Single-Span Composite Bridges by Post-Tensioning Part 3, HR-238, 1985

The authors have post-tensioned and monitored two Iowa bridges and have field tested the post-tensioning of a composite bridge in Florida. In order to provide the practical post-tensioning distribution factors given in this manual, the authors developed a finite element model of a composite bridge and checked the model against a one-half scale laboratory bridge and two actual composite bridges, one of which had a 45 deg skew. Following a brief discussion of this background research, this manual explains the use of elastic, composite beam and bridge section properties, the distribution fractions for symmetrically post-tensioned exterior beams, and a method for computing the strength of a post-tensioned beam. Also included is a design example for a typical, 51.25-ft (15.62-m) span, four-beam composite bridge. Moments for Iowa Department of Transportation rating trucks, H 20 and HS 20 trucks, have been tabulated for design convenience and are included in the appendix.

Composite Precast Prestressed Concrete Bridge Slabs, HR-310, 1991

Precast prestressed concrete panels have been used as subdecks in bridge construction in Iowa and other states. To investigate the performance of these types of composite slabs at locations adjacent to abutment and pier diaphragms in skewed bridges, a research prcject which involved surveys of design agencies and precast producers, field inspections of existing bridges, analytical studies, and experimental testing was conducted. The survey results from the design agencies and panel producers showed that standardization of precast panel construction would be desirable, that additional inspections at the precast plant and at the bridge site would be beneficial, and that some form of economical study should be undertaken to determine actual cost savings associated with composite slab construction. Three bridges in Hardin County, Iowa were inspected to observe general geometric relationships, construction details, and to note the visual condition of the bridges. Hairline cracks beneath several of the prestressing strands in many of the precast panels were observed, and a slight discoloration of the concrete was seen beneath most of the strands. Also, some rust staining was visible at isolated locations on several panels. Based on the findings of these inspections, future inspections are recommended to monitor the condition of these and other bridges constructed with precast panel subdecks. Five full-scale composite slab specimens were constructed in the Structural Engineering Laboratory at Iowa State University. One specimen modeled bridge deck conditions which are not adjacent to abutment or pier diaphragms, and the other four specimens represented the geometric conditions which occur for skewed diaphragms of 0, 15, 30, and 40 degrees. The specimens were subjected to wheel loads of service and factored level magnitudes at many locations on the slab surface and to concentrated loads which produced failure of the composite slab. The measured slab deflections and bending strains at both service and factored load levels compared reasonably well with the results predicted by simplified Finite element analyses of the specimens. To analytically evaluate the nominal strength for a composite slab specimen, yield-line and punching shear theories were applied. Yield-line limit loads were computed using the crack patterns generated during an ultimate strength test. In most cases, these analyses indicated that the failure mode was not flexural. Since the punching shear limit loads in most instances were close to the failure loads, and since the failure surfaces immediately adjacent to the wheel load footprint appeared to be a truncated prism shape, the probable failure mode for all of the specimens was punching shear. The development lengths for the prestressing strands in the rectangular and trapezoidal shaped panels was qualitatively investigated by monitoring strand slippage at the ends of selected prestressing strands. The initial strand transfer length was established experimentally by monitoring concrete strains during strand detensioning, and this length was verified analytically by a finite element analysis. Even though the computed strand embedment lengths in the panels were not sufficient to fully develop the ultimate strand stress, sufficient stab strength existed. Composite behavior for the slab specimens was evaluated by monitoring slippage between a panel and the topping slab and by computation of the difference in the flexural strains between the top of the precast panel and the underside of the topping slab at various locations. Prior to the failure of a composite slab specimen, a localized loss of composite behavior was detected. The static load strength performance of the composite slab specimens significantly exceeded the design load requirements. Even with skew angles of up to 40 degrees, the nominal strength of the slabs did not appear to be affected when the ultimate strength test load was positioned on the portion of each slab containing the trapezoidal-shaped panel. At service and factored level loads, the joint between precast panels did not appear to influence the load distribution along the length of the specimens. Based on the static load strength of the composite slab specimens, the continued use of precast panels as subdecks in bridge deck construction is recommended.

Increased tender point counts before and after total hip arthroplasty are associated with poorer outcomes but are not individually predictive.

In a prospective study, total hip arthroplasty (THA) patients were assessed preoperatively and postoperatively (n = 95) to determine if tender points (TPs) are associated with poor THA outcomes. Patients with high follow-up TP counts had higher visual analog scale (VAS) for pain and sleep, higher follow-up Western Ontario and McMaster Universities Arthritis Index (pain, stiffness, function), lower Health Assessment Questionnaire, Harris Hip, and Short Form 36 (physical functioning, bodily pain, physical component summary) scores. High follow-up TP were associated with increased pain, pain not relieved by surgery, poor function, and poor sleep. Visual analog scale pain and sleep, Short Form 36 (physical functioning, bodily pain), Western Ontario and McMaster Universities Arthritis Index, Health Assessment Questionnaire, and Harris hip scores improved significantly after THA; TP scores did not. Higher preoperative TP were predictive of higher follow-up TP but were poorly predictive of poor outcome measures after surgery in individual patients, suggesting that preoperative TPs are contraindicative for THA.

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.

Treatment of extended skin defects with autologous composite cultured skin grafts in a patient with epidermolysis bullosa

Rationale: The purpose of this article is to demonstrate the use of homologous culture cells in treating an advanced coccon formation of the hand and three extended squamous cell carcinomas of the lower and upper limb in a patient with recessive dystrophic epidermolysis bullosa. The preparation and application of these cells in the operation room are being described. Methods: A number of surgical approaches have been described to correct these deformities in order to improve function.We propose a new therapeutic approach of treating loss of motion and independent digital function as well as coverage of large skin defects in a patient with recessive dystrophic epidermolysis bullosa by using autologous culture cells. Surgical treatment of these patients is really difficult because of the existing skin fragility. Furthermore, surgical wounds do not easily heal because of recurrent blisters and erosions as well as due to the patients' poor nutricial status. Results: We report our experience of mutiple extended cutaneous squamous cell carcinomas arising in our patient which were successfully managed using autologous composite cultured skin grafts. The cocoon hand deformity was also treated with the limb becoming functional. Conclusion: The use of autologous keratinocytes and fibroblasts in epidermolysis bullosa is hereby outlined for the fist time.

Feasibility Study of Dynamic Overload and Ultimate Load Tests of Full-Scale Highway Bridges, HR-160, 1973

As a result of the construction of the Saylorville Dam and Reservoir on the Des Moines River, six highway bridges are scheduled for removal. Five of these are old high-truss single-lane bridges, each bridge having several simple spans. The other bridge is a fairly modern (1955) double 4-span continuous beam-and-slab composite highway bridge. The availability of these bridges affords an unusual opportunity for study of the behavior of full-scale bridges. Because of the magnitude of the potential testing program, a feasibility study was initiated and the results are presented in this two-part final report. Part I summarizes the findings and Part II presents the supporting detailed information.

Exploring the proposed DSM-5 diagnostic threshold and severity scale for the alcohol use disorder

Aims :¦Several studies have questioned the validity of separating the diagnosis of alcohol abuse from that of alcohol dependence, and the DSM-5 task force has proposed combining the criteria from these two diagnoses to assess a single category of alcohol use disorders (AUD). Furthermore, the DSM-5 task force has proposed including a new 2-symptom threshold and a severity scale based on symptom counts for the AUD diagnosis. The current study aimed to examine these modifications in a large population-based sample.¦Method :¦Data stemmed from an adult sample (N=2588 ; mean age 51.3 years (s.d.: 0.2), 44.9% female) of current and lifetime drinkers from the PsyCoLaus study, conducted in the Lausanne area in Switzerland. AUDs and validating variables were assessed using a semi-structured diagnostic interview for the assessment of alcohol¦and other major psychiatric disorders. First, the adequacy of the proposed 2- symptom threshold was tested by comparing threshold models at each possible cutoff and a linear model, in relation to different validating variables. The model with the smallest Akaike Criterion Information (AIC) value was established as the best¦model for each validating variable. Second, models with varying subsets of individual AUD symptoms were created to assess the associations between each symptom and the validating variables. The subset of symptoms with the smallest AIC value was established as the best subset for each validator.¦Results :¦1) For the majority of validating variables, the linear model was found to be the best fitting model. 2) Among the various subsets of symptoms, the symptoms most frequently associated with the validating variables were : a) drinking despite having knowledge of a physical or psychological problem, b) having had a persistent desire or unsuccessful efforts to cut down or control drinking and c) craving. The¦least frequent symptoms were : d) drinking in larger amounts or over a longer period than was intended, e) spending a great deal of time in obtaining, using or recovering from alcohol use and f) failing to fulfill major role obligations.¦Conclusions :¦The proposed DSM-5 2-symptom threshold did not receive support in our data. Instead, a linear AUD diagnosis was supported with individuals receiving an increasingly severe AUD diagnosis. Moreover, certain symptoms were more frequently associated with the validating variables, which suggests that these¦symptoms should be considered as more severe.

An operator formulation of the multiscale finite-volume method with correction function

The multiscale finite-volume (MSFV) method has been derived to efficiently solve large problems with spatially varying coefficients. The fine-scale problem is subdivided into local problems that can be solved separately and are coupled by a global problem. This algorithm, in consequence, shares some characteristics with two-level domain decomposition (DD) methods. However, the MSFV algorithm is different in that it incorporates a flux reconstruction step, which delivers a fine-scale mass conservative flux field without the need for iterating. This is achieved by the use of two overlapping coarse grids. The recently introduced correction function allows for a consistent handling of source terms, which makes the MSFV method a flexible algorithm that is applicable to a wide spectrum of problems. It is demonstrated that the MSFV operator, used to compute an approximate pressure solution, can be equivalently constructed by writing the Schur complement with a tangential approximation of a single-cell overlapping grid and incorporation of appropriate coarse-scale mass-balance equations.

Saccharomyces cerevisiae Dmc1 and Rad51 Proteins Preferentially Function with Tid1 and Rad54 Proteins, Respectively, to Promote DNA Strand Invasion during Genetic Recombination.

The Saccharomyces cerevisiae Dmc1 and Tid1 proteins are required for the pairing of homologous chromosomes during meiotic recombination. This pairing is the precursor to the formation of crossovers between homologs, an event that is necessary for the accurate segregation of chromosomes. Failure to form crossovers can have serious consequences and may lead to chromosomal imbalance. Dmc1, a meiosis-specific paralog of Rad51, mediates the pairing of homologous chromosomes. Tid1, a Rad54 paralog, although not meiosis-specific, interacts with Dmc1 and promotes crossover formation between homologs. In this study, we show that purified Dmc1 and Tid1 interact physically and functionally. Dmc1 forms stable nucleoprotein filaments that can mediate DNA strand invasion. Tid1 stimulates Dmc1-mediated formation of joint molecules. Under conditions optimal for Dmc1 reactions, Rad51 is specifically stimulated by Rad54, establishing that Dmc1-Tid1 and Rad51-Rad54 function as specific pairs. Physical interaction studies show that specificity in function is not dictated by direct interactions between the proteins. Our data are consistent with the hypothesis that Rad51-Rad54 function together to promote intersister DNA strand exchange, whereas Dmc1-Tid1 tilt the bias toward interhomolog DNA strand exchange.

Use of the Cognitive Performance Scale (CPS) to detect cognitive impairment in the acute care setting: concurrent and predictive validity.

The Cognitive Performance Scale (CPS) was initially designed to assess cognition in long term care residents. Subsequently, the CPS has also been used among in-home, post-acute, and acute care populations even though CPS' clinimetric performance has not been studied in these settings. This study aimed to determine CPS agreement with the Mini Mental Status Exam (MMSE) and its predictive validity for institutionalization and death in a cohort (N=401) of elderly medical inpatients aged 75 years and over. Medical, physical and mental status were assessed upon admission. The same day, the patient's nurse completed the CPS by interview. Follow-up data were gathered from the central billing system (nursing home stay) and proxies (death). Cognitive impairment was present in 92 (23%) patients according to CPS (score >or= 2). Agreement with MMSE was moderate (kappa 0.52, P<.001). Analysis of discordant results suggested that cognitive impairment was overestimated by the CPS in dependent patients with comorbidities and depressive symptoms, and underestimated in older ones. During follow-up, subjects with abnormal CPS had increased risks of death (adjusted hazard ratio (adjHR) 1.7, 95% CI 1.0-2.8, P=.035) and institutionalization (adjHR 2.7, 95% CI 1.3-5.3, P=.006), independent of demographic, health and functional status. Interestingly, subjects with abnormal CPS were at increased risk of death only if they also had abnormal MMSE. The CPS predicted death and institutionalization during follow-up, but correlated moderately well with the MMSE. Combining CPS and MMSE provided additional predictive information, suggesting that domains other than cognition are assessed by professionals when using the CPS in elderly medical inpatients.