A cost study of common surface finish systems for steel structures

This paper presents part of a study aimed at finding a suitable, yet cost-effective, surface finish for a steel structure subject to the car washing environment and corrosive chemicals. The initial, life cycle and average equivalent annual (AEAC) costs for surface finishing methods were calculated for a steel structure using the LCCC algorithm developed by American Galvanizers Association (AGA). The cost study consisted of 45 common surface finish systems including: hot-dip galvanization (HDG), metallization, acrylic, alkyd and epoxy as well as duplex coatings such as epoxy zinc and inorganic zinc (IOZ). The results show that initial, life cycle and AEAC costs for hot dip galvanization are the lowest among all the other methods, followed by coal tar epoxy painting. The annual average cost of HDG for this structure was estimated about €0.22/m2, while the other cost-effective alternatives were: IOZ, polyurea, epoxy waterborne and IOZ/epoxy duplex coating.

Wear of PEEK-Ti6Al4V systems under micro-abrasion and linear sliding conditions

Dissertação de mestrado integrado em Engenharia Biomédica

Monitorização do risco de dificuldades de aprendizagem específicas na leitura de alunos do 2.º ao 4.ºano no contexto do modelo de resposta à intervenção

Dissertação de mestrado em Educação Especial (área de especialização em Dificuldades de Aprendizagem Específicas)

Subgroup analyses in randomised controlled trials: cohort study on trial protocols and journal publications

OBJECTIVE: To investigate the planning of subgroup analyses in protocols of randomised controlled trials and the agreement with corresponding full journal publications. DESIGN: Cohort of protocols of randomised controlled trial and subsequent full journal publications. SETTING: Six research ethics committees in Switzerland, Germany, and Canada. DATA SOURCES: 894 protocols of randomised controlled trial involving patients approved by participating research ethics committees between 2000 and 2003 and 515 subsequent full journal publications. RESULTS: Of 894 protocols of randomised controlled trials, 252 (28.2%) included one or more planned subgroup analyses. Of those, 17 (6.7%) provided a clear hypothesis for at least one subgroup analysis, 10 (4.0%) anticipated the direction of a subgroup effect, and 87 (34.5%) planned a statistical test for interaction. Industry sponsored trials more often planned subgroup analyses compared with investigator sponsored trials (195/551 (35.4%) v 57/343 (16.6%), P<0.001). Of 515 identified journal publications, 246 (47.8%) reported at least one subgroup analysis. In 81 (32.9%) of the 246 publications reporting subgroup analyses, authors stated that subgroup analyses were prespecified, but this was not supported by 28 (34.6%) corresponding protocols. In 86 publications, authors claimed a subgroup effect, but only 36 (41.9%) corresponding protocols reported a planned subgroup analysis. CONCLUSIONS: Subgroup analyses are insufficiently described in the protocols of randomised controlled trials submitted to research ethics committees, and investigators rarely specify the anticipated direction of subgroup effects. More than one third of statements in publications of randomised controlled trials about subgroup prespecification had no documentation in the corresponding protocols. Definitive judgments regarding credibility of claimed subgroup effects are not possible without access to protocols and analysis plans of randomised controlled trials.

A single LC-tandem mass spectrometry method for the simultaneous determination of 14 antimalarial drugs and their metabolites in human plasma.

Among the various determinants of treatment response, the achievement of sufficient blood levels is essential for curing malaria. For helping us at improving our current understanding of antimalarial drugs pharmacokinetics, efficacy and toxicity, we have developed a liquid chromatography-tandem mass spectrometry method (LC-MS/MS) requiring 200mul of plasma for the simultaneous determination of 14 antimalarial drugs and their metabolites which are the components of the current first-line combination treatments for malaria (artemether, artesunate, dihydroartemisinin, amodiaquine, N-desethyl-amodiaquine, lumefantrine, desbutyl-lumefantrine, piperaquine, pyronaridine, mefloquine, chloroquine, quinine, pyrimethamine and sulfadoxine). Plasma is purified by a combination of protein precipitation, evaporation and reconstitution in methanol/ammonium formate 20mM (pH 4.0) 1:1. Reverse-phase chromatographic separation of antimalarial drugs is obtained using a gradient elution of 20mM ammonium formate and acetonitrile both containing 0.5% formic acid, followed by rinsing and re-equilibration to the initial solvent composition up to 21min. Analyte quantification, using matrix-matched calibration samples, is performed by electro-spray ionization-triple quadrupole mass spectrometry by selected reaction monitoring detection in the positive mode. The method was validated according to FDA recommendations, including assessment of extraction yield, matrix effect variability, overall process efficiency, standard addition experiments as well as antimalarials short- and long-term stability in plasma. The reactivity of endoperoxide-containing antimalarials in the presence of hemolysis was tested both in vitro and on malaria patients samples. With this method, signal intensity of artemisinin decreased by about 20% in the presence of 0.2% hemolysed red-blood cells in plasma, whereas its derivatives were essentially not affected. The method is precise (inter-day CV%: 3.1-12.6%) and sensitive (lower limits of quantification 0.15-3.0 and 0.75-5ng/ml for basic/neutral antimalarials and artemisinin derivatives, respectively). This is the first broad-range LC-MS/MS assay covering the currently in-use antimalarials. It is an improvement over previous methods in terms of convenience (a single extraction procedure for 14 major antimalarials and metabolites reducing significantly the analytical time), sensitivity, selectivity and throughput. While its main limitation is investment costs for the equipment, plasma samples can be collected in the field and kept at 4 degrees C for up to 48h before storage at -80 degrees C. It is suited to detecting the presence of drug in subjects for screening purposes and quantifying drug exposure after treatment. It may contribute to filling the current knowledge gaps in the pharmacokinetics/pharmacodynamics relationships of antimalarials and better define the therapeutic dose ranges in different patient populations.

Therapeutic Drug Monitoring of the new targeted anticancer agents imatinib, nilotinib, dasatinib, sunitinib, sorafenib and lapatinib by LC tandem mass spectrometry.

The treatment of some cancer patients has shifted from traditional, non-specific cytotoxic chemotherapy to chronic treatment with molecular targeted therapies. Imatinib mesylate, a selective inhibitor of tyrosine kinases (TKIs) is the most prominent example of this new era and has opened the way to the development of several additional TKIs, including sunitinib, nilotinib, dasatinib, sorafenib and lapatinib, in the treatment of various hematological malignancies and solid tumors. All these agents are characterized by an important inter-individual pharmacokinetic variability, are at risk for drug interactions, and are not devoid of toxicity. Additionally, they are administered for prolonged periods, anticipating the careful monitoring of their plasma exposure via Therapeutic Drug Monitoring (TDM) to be an important component of patients' follow-up. We have developed a liquid chromatography-tandem mass spectrometry method (LC-MS/MS) requiring 100 microL of plasma for the simultaneous determination of the six major TKIs currently in use. Plasma is purified by protein precipitation and the supernatant is diluted in ammonium formate 20 mM (pH 4.0) 1:2. Reverse-phase chromatographic separation of TKIs is obtained using a gradient elution of 20 mM ammonium formate pH 2.2 and acetonitrile containing 1% formic acid, followed by rinsing and re-equilibration to the initial solvent composition up to 20 min. Analyte quantification, using matrix-matched calibration samples, is performed by electro-spray ionization-triple quadrupole mass spectrometry by selected reaction monitoring detection using the positive mode. The method was validated according to FDA recommendations, including assessment of extraction yield, matrix effects variability (<9.6%), overall process efficiency (87.1-104.2%), as well as TKIs short- and long-term stability in plasma. The method is precise (inter-day CV%: 1.3-9.4%), accurate (-9.2 to +9.9%) and sensitive (lower limits of quantification comprised between 1 and 10 ng/mL). This is the first broad-range LC-MS/MS assay covering the major currently in-use TKIs. It is an improvement over previous methods in terms of convenience (a single extraction procedure for six major TKIs, reducing significantly the analytical time), sensitivity, selectivity and throughput. It may contribute to filling the current knowledge gaps in the pharmacokinetics/pharmacodynamics relationships of the latest TKIs developed after imatinib and better define their therapeutic ranges in different patient populations in order to evaluate whether a systematic TDM-guided dose adjustment of these anticancer drugs could contribute to minimize the risk of major adverse reactions and to increase the probability of efficient, long lasting, therapeutic response.

Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.

BACKGROUND: Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia. METHODS: Patient records of conscious adult trauma victims transported by our air rescue helicopter service over 10 yr were reviewed retrospectively. Oligoanalgesia was defined as a numeric rating scale (NRS) >3 at hospital admission. Multilevel logistic regression analysis was used to predict oligoanalgesia, accounting first for patient case-mix, and then physician-level clustering. The intraclass correlation was expressed as the median odds ratio (MOR). RESULTS: A total of 1202 patients and 77 physicians were included in the study. NRS at the scene was 6.9 (1.9). The prevalence of oligoanalgesia was 43%. Physicians had a median of 5.7 yr (inter-quartile range: 4.2-7.5) of post-graduate training and 27% were female. In our multilevel analysis, significant predictors of oligoanalgesia were: no analgesia [odds ratio (OR) 8.8], National Advisory Committee for Aeronautics V on site (OR 4.4), NRS on site (OR 1.5 per additional NRS unit >4), female physician (OR 2.0), and years of post-graduate experience [>4.0 to ≤5.0 (OR 1.3), >3.0 to ≤4.0 (OR 1.6), >2.0 to ≤3.0 (OR 2.6), and ≤2.0 yr (OR 16.7)]. The MOR was 2.6, and was statistically significant. CONCLUSIONS: Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.

Volutrauma activates the clotting cascade in the newborn but not adult rat.

Coagulopathy and alveolar fibrin deposition are common in sick neonates and attributed to the primary disease, as opposed to their ventilatory support. Hypothesizing that high tidal volume ventilation activates the extrinsic coagulation pathway, we air ventilated newborn and adult rats at low (10 ml/kg) or high (30 ml/kg) tidal volume and compared them with age-matched nonventilated controls. Blood was collected at the end of the experiment for measurement of clot time, tissue factor, and other coagulation factor content. Similar measurements were obtained from lung lavage material. The newborn clot time (44+/-1) was lower and plasma tissue factor content higher (103.4+/-0.4) than adults (88+/-4 s and 26.6+/-1.4 units; P<0.01). High, but not low, tidal volume ventilation of newborns for as little as 15 min significantly reduced clot time and increased plasma tissue factor content (P<0.01). High volume ventilation increased plasma factor Xa (0.1+/-0.1 to 1.6+/-0.4 nM; P<0.01) and thrombin (1.3+/-0.2 to 2.2+/-0.4 nM; P<0.05) and decreased antithrombin (0.12+/-0.01 to 0.05+/-0.01; P<0.01) in the newborn. Lung lavage material of high volume-ventilated newborns showed increased (P<0.01) factor Xa and thrombin. No changes in these parameters were observed in adult rats that were high volume ventilated for up to 90 min. Compared with adults, newborn rats have a greater propensity for volutrauma-activated intravascular coagulation. These data suggest that mechanical ventilation promotes neonatal thrombosis via lung tissue factor release.

Assimilation process in a psychotherapy with a client presenting schizoid personality disorder

The assimilation of problematic experiences has been studied as change processes in psychotherapies of different client populations. Several theory-building case studies using the assimilation model have shown how important a meaning bridge is in such change processes. In a client presenting schizoid personality disorder the creation of meaning as an affect-evoking process may be a particularly important stage in the change process. The present case study aims to apply the assimilation model to a psychotherapy process with a highly disturbed client and focuses on the creation of a meaning bridge in the process. Moreover, the assimilation analysis focuses on the effect of an external person, i.e. the partner or the therapist, when responding to the client's unassimilated problematic experiences. Their effects on the client's assimilation processes are discussed.

Directrius per a l'accessibilitat al contingut web, versió 1.0

Aquestes directrius expliquen com fer que el contingut web sigui accessible a persones amb discapacitats i s'adrecen a creadors de contingut (autors de pàgines web o dissenyadors de llocs web) i a creadors d'eines d'autor. L'objectiu principal d'aquestes directrius és promoure l'accessibilitat. Tanmateix, l'aplicació de les directrius facilitarà l'accés al contingut a tot tipus d'usuari, sigui quin sigui l'agent d'usuari usat (navegador web, navegador de veu, telèfon mòbil, ordinador de cotxe, etc.) o les condicions de l'entorn de consulta (entorns sorollosos, espais mal il·luminats, entorns en què no es poden usar les mans, etc.). L'aplicació d'aquestes directrius també ajudarà els usuaris a trobar la informació d'una manera més ràpida dins el web. Les directrius no pretenen desincentivar l'ús d'imatges, vídeo, etc., sinó que expliquen com fer que el contingut multimèdia sigui més accessible a una àmplia audiència.Aquest és un document de referència per a uns principis d'accessibilitat i idees de disseny. Algunes de les estratègies comentades tracten d'aspectes relatius a la internacionalització del web i a l'accés des de terminals mòbils. Tanmateix, el document se centra en l'accessibilitat i no tracta exhaustivament dels aspectes relacionats amb altres activitats del W3C. Si voleu més informació sobre aquests temes podeu consultar les pàgines inicials W3C Mobile Access Activity (per a l'accés des de terminals mòbils) i W3C Internationalization Activity (per als aspectes d'internacionalització).Aquest document està pensat per a ser estable en el temps i, per tant, no dóna informació específica sobre si els navegadors funcionen o no amb una determinada tecnologia, ja que aquesta informació varia molt ràpidament. Aquesta informació es pot trobar al web de la Web Accessibility Initiative ,WAI, (Iniciativa d'Accessibilitat Web) [WAI-UA-SUPPORT].Aquest document inclou un annex que organitza tots els punts de verificació ordenats per tema i per prioritat. Els punts de l'annex estan enllaçats a les respectives definicions en el document. Els temes recollits en l'annex inclouen les imatges, el contingut multimèdia, les taules, els marcs, els formularis i els scripts. L'annex es presenta en forma de taula o com a simple llista.Un document a part, amb el títol Techniques for Web Content Accessibility Guidelines 1.0 (Tècniques per a les directrius per a l'accessibilitat al contingut web, versió 1.0) ([TECHNIQUES]) explica com posar a la pràctica els punts citats fins aquí. El document de tècniques explica cada punt amb més detalls i dóna exemples usant el llenguatge d'etiquetatge d'hipertext (HTML), fulls d'estil en cascada (CSS), el llenguatge d'integració multimèdia sincronitzada (SMIL) o el llenguatge d'etiquetatge matemàtic (MathML). Aquest document també inclou tècniques per a provar o validar una pàgina web i un índex dels elements i atributs HTML amb les tècniques que els usen. El document de tècniques està pensat per a seguir de prop els canvis tecnològics i es preveu que s'actualitzi més sovint que les directrius.Nota: Algunes de les característiques descrites en les directrius no estan encara implementades en tots els navegadors o eines multimèdia; en concret pot ser que no es puguin utilitzar funcions noves d'HTML 4.0, de CSS1 o CSS2.Les Directrius per a l'accessibilitat al contingut web, versió 1.0 són part d'una col·lecció de directrius sobre accessibilitat publicades per la Web Accessibility Initiative, WAI (Iniciativa d'Accessibilitat Web). La col·lecció comprèn User Agent Accessibility Guidelines (Directrius d'accessibilitat per a agents d'usuari) [WAI-USERAGENT] i Authoring Tool Accessibility Guidelines (Directrius d'accessibilitat per a eines d'autor [WAI-AUTOOLS].

Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes.

BACKGROUND: Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting the doctor to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. OBJECTIVES: To evaluate the effects of reminders automatically generated through a computerized system and delivered on paper to healthcare professionals on processes of care (related to healthcare professionals' practice) and outcomes of care (related to patients' health condition). SEARCH METHODS: For this update the EPOC Trials Search Co-ordinator searched the following databases between June 11-19, 2012: The Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Library (Economics, Methods, and Health Technology Assessment sections), Issue 6, 2012; MEDLINE, OVID (1946- ), Daily Update, and In-process; EMBASE, Ovid (1947- ); CINAHL, EbscoHost (1980- ); EPOC Specialised Register, Reference Manager, and INSPEC, Engineering Village. The authors reviewed reference lists of related reviews and studies.  SELECTION CRITERIA: We included individual or cluster-randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals on processes and/or outcomes of care. DATA COLLECTION AND ANALYSIS: Review authors working in pairs independently screened studies for eligibility and abstracted data. We contacted authors to obtain important missing information for studies that were published within the last 10 years. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median absolute improvement and interquartile range (IQR) in process adherence across included studies using the primary outcome or median outcome as representative outcome. MAIN RESULTS: In the 32 included studies, computer-generated reminders delivered on paper to healthcare professionals achieved moderate improvement in professional practices, with a median improvement of processes of care of 7.0% (IQR: 3.9% to 16.4%). Implementing reminders alone improved care by 11.2% (IQR 6.5% to 19.6%) compared with usual care, while implementing reminders in addition to another intervention improved care by 4.0% only (IQR 3.0% to 6.0%) compared with the other intervention. The quality of evidence for these comparisons was rated as moderate according to the GRADE approach. Two reminder features were associated with larger effect sizes: providing space on the reminder for provider to enter a response (median 13.7% versus 4.3% for no response, P value = 0.01) and providing an explanation of the content or advice on the reminder (median 12.0% versus 4.2% for no explanation, P value = 0.02). Median improvement in processes of care also differed according to the behaviour the reminder targeted: for instance, reminders to vaccinate improved processes of care by 13.1% (IQR 12.2% to 20.7%) compared with other targeted behaviours. In the only study that had sufficient power to detect a clinically significant effect on outcomes of care, reminders were not associated with significant improvements. AUTHORS' CONCLUSIONS: There is moderate quality evidence that computer-generated reminders delivered on paper to healthcare professionals achieve moderate improvement in process of care. Two characteristics emerged as significant predictors of improvement: providing space on the reminder for a response from the clinician and providing an explanation of the reminder's content or advice. The heterogeneity of the reminder interventions included in this review also suggests that reminders can improve care in various settings under various conditions.

Chemical and mineralogical changes in a Brazilian Rhodic Paleudult under different land use and managements

Changes in land use and management can affect the dynamic equilibrium of soil systems and induce chemical and mineralogical alterations. This study was based on two long-term experiments (10 and 27 years) to evaluate soil used for no-tillage maize cultivation, with and without poultry litter application (NTPL and NTM), and with grazed native pasture fertilized with cattle droppings (GrP), on the chemical and mineralogical characteristics of a Rhodic Paleudult in Southern Brazil, in comparison with the same soil under native grassland (NGr). In the four treatments, soil was sampled from the 0.0-2.5 and 2.5-5.0 cm layers. In the air-dried fine soil (ADFS) fraction (∅ < 2 mm), chemical characteristics of solid and liquid phases and the specific surface area (SSA) were evaluated. The clay fraction (∅ < 0.002 mm) in the 0.0-2.5 cm layer was analyzed by X-ray diffraction (XRD) after treatments for identification and characterization of 2:1 clay minerals. Animal waste application increased the total organic C concentration (COT) and specific surface area (SSA) in the 0.0-2.5 cm layer. In comparison to NGr, poultry litter application (NTPL) increased the concentrations of Ca and CECpH7, while cattle droppings (GrP) increased the P and K concentrations. In the soil solution, the concentration of dissolved organic C was positively related with COT levels. With regard to NGr, the soil use with crops (NTM and NTPL) had practically no effect on the chemical elements in solution. On the other hand, the concentrations of most chemical elements in solution were higher in GrP, especially of Fe, Al and Si. The Fe and Al concentrations in the soil iron oxides were lower, indicating reductive/complexive dissolution of crystalline forms. The X-ray diffraction (XRD) patterns of clay in the GrP environment showed a decrease in intensity and reflection area of the 2:1 clay minerals. This fact, along with the intensified Al and Si activity in soil solution indicate dissolution of clay minerals in soil under cattle-grazed pasture fertilized with animal droppings.

Evauation of Recycled Asphalt Concrete Pavements: Final Report for Kossuth County, Iowa, HR-1888, February 1980

After some success with a small asphalt pavement recycling project in 1975, Kossuth County, Iowa programmed a much larger undertaking during the 1976 construction season. The work performed in 1975 indicated that a quality product could be produced with some modifications to conventional equipment. As anticipated , the major problem encountered was the excessive air pollution created during the heating and mixing process. As part of its 1976 road program, Kossuth County developed plans for recycling sixteen miles of existing asphalt pavements using the "hot mix" recycling process. One project, ten miles in length, was selected by the Federal Highway Authority as part of "Demonstration Project No. 39, Recycling Asphalt Pavements." The FHWA provided a $29,500 grant t o the project to be used for project testing and evaluation. Cooperation and input into the work proposed for 1976 was received from many sources. The people and organizations contributing were the Federal Highway Authority, the Iowa Department of Environmental Quality, the Federal Environmental Protection Agency, several contractors, and personnel from the Kossuth County Engineer's Office.

Investigation of Field Corrosion Performance and Bond/Development Length of Galvanized Reinforcing Steel, TR-666, 2014

In reinforced concrete systems, ensuring that a good bond between the concrete and the embedded reinforcing steel is critical to long-term structural performance. Without good bond between the two, the system simply cannot behave as intended. The bond strength of reinforcing bars is a complex interaction between localized deformations, chemical adhesion, and other factors. Coating of reinforcing bars, although sometimes debated, has been commonly found to be an effective way to delay the initiation of corrosion in reinforced concrete systems. For many years, the standard practice has been to coat reinforcing steel with an epoxy coating, which provides a barrier between the steel and the corrosive elements of water, air, and chloride ions. Recently, there has been an industry-led effort to use galvanizing to provide the protective barrier commonly provided by traditional epoxy coatings. However, as with any new structural product, questions exist regarding both the structural performance and corrosion resistance of the system. In the fall of 2013, Buchanan County, Iowa constructed a demonstration bridge in which the steel girders and all internal reinforcing steel were galvanized. The work completed in this project sought to understand the structural performance of galvanized reinforcing steel as compared to epoxy-coated steel and to initiate a long-term corrosion monitoring program. This work consisted of a series of controlled laboratory tests and the installation of a corrosion monitoring system that can be observed for years in the future. The results of this work indicate there is no appreciable difference between the bond strength of epoxy-coated reinforcing steel and galvanized reinforcing steel. Although some differences were observed, no notable difference in either peak load, slip, or failure mode could be identified. Additionally, a long-term monitoring system was installed in this Buchanan County bridge and, to date, no corrosion activity has been identified.