997 resultados para Rehabilitation solutions


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Based on previous National Bridge Inventory data, the state of Iowa has nearly 20,000 bridges on low-volume roads (LVRs). Thus, these bridges are the responsibility of the county engineers. Of the bridges on the county roads, 24 percent are structurally deficient and 5 percent are functionally obsolete. A large number of the older bridges on the LVRs are built on timber piling with timber back walls. In many cases, as timber abutments and piers age, the piling and back wall planks deteriorate at a rate faster than the bridge superstructure. As a result, a large percentage of the structurally deficient bridges on LVRs are classified as such because of the condition of the timber substructure elements. As funds for replacing bridges decline and construction costs increase, effective rehabilitation and strengthening techniques for extending the life of the timber substructures in bridges with structurally sound superstructures has become even more important. Several counties have implemented various techniques to strengthen/repair damaged piling, however, there is minimal data documenting the effectiveness of these techniques. There are numerous instances where cracked and failed pilings have been repaired. However, there are no experimental data on the effectiveness of the repairs or on the percentage of load transferred from the superstructure to the sound pile below. To address the research needs, a review and evaluation of current maintenance and rehabilitation methods was completed. Additionally, a nationwide survey was conducted to learn the methods used beyond Iowa. Field investigation and live-load testing of bridges with certain Iowa methods was completed. Lastly, laboratory testing of new strengthening and rehabilitation methods was performed.

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Special investigation of the University of Iowa Health Care, Department of Orthopaedics and Rehabilitation, for the period July 1, 1999 through December 31, 2014

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Bridge deck and substructure deterioration due to the corrosive effects of deicing chemicals on reinforcing steel is a problem facing many transportation agencies. The main concern is protection of older bridges with uncoated reinforcing steel. Many different methods have been tried over the past years to repair bridge decks. The Iowa system of bridge deck rehabilitation has proven to be very effective. It consists of scarifying the deck surface, removing any deteriorated concrete, and overlaying with low slump dense concrete. Another rehabilitation method that has emerged is cathodic protection. It has been used for many years in the protection of underground pipelines and in 1973 was first installed on a bridge deck. Cathodic protection works by applying an external source of direct current to the embedded reinforcing steel, thereby changing the electrochemical process of corrosion. The corroding steel, which is anodic, is protected by changing it to a cathodic state. The technology involved in cathodic protection as applied to bridge decks has improved over the last 12 years. One company marketing new technology in cathodic protection systems is Raychem Corporation of Menlo Park, California. Their system utilizes a Ferex anode mesh that distributes the impressed direct current over the deck surface. Ferex mesh was selected because it seemed readily adaptable to the Iowa system of bridge deck rehabilitation. The bridge deck would be scarified, deteriorated concrete removed, Ferex anode mesh installed, and overlaid with low slump dense concrete. The Federal Highway Administration (FHWA) promotes cathodic protection under Demonstration Project No. 34, "Cathodic Protection for Reinforced Concrete Bridge Decks."

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Introduction¦Surgery for chronic low back pain (CLBP) is a controversial topic. One randomized controlled¦trial (RCT) showed superiority of surgery to physiotherapy only, whereas two more RCTs¦failed to show that surgery was better than multidisciplinary rehabilitation including cognitive¦intervention. The latter is therefore regarded as the golden standard of conservative¦treatment and in our unit it is whenever possible offered to patients prior to lumbar surgery¦for CLBP.¦The objective of this study was to compare results of lumbar surgery between one group of¦patients who failed to improve despite such rehabilitation and a second group of patients who¦underwent surgery following usual conservative therapies. Our hypothesis is that patients¦who failed such a comprehensive treatment would respond poorly to surgery.¦Patients and Methods¦43 patients (age 41.2±8.1 years, number of men 20) were operated between 2003 and 2009¦by a single surgeon for CLBP due to degenerative disc disease (36) or isthmic¦spondylolisthesis (7). Patients with sciatica or neurological abnormalities were excluded.¦Seventeen (40%) patients were operated having failed to improve following the¦aforementioned rehabilitation programme (Surgery following rehabilitation group) whereas¦the remaining 26 (60%) were operated having failed to improve with physiotherapy of varying¦intensity (Surgery following physiotherapy group). Oswestry disability index (ODI) pre¦operatively and at 2 years following surgery was prospectively evaluated. Fisher's exact test¦was used to compare groups.¦Results¦At two years following surgery, with an average follow up of 22 month, a 15 points ODI¦improvement was achieved for 9 (53%) patients of the surgery following rehabilitation group¦and in 15 (58%) patients of the surgery following physiotherapy group (p=1.0). A 50% ODI¦improvement was observed for 6 (35%) and 12 (46%) patients respectively (p=0.54).¦Discussion¦The main finding of this study was that surgery following failed multidisciplinary rehabilitation¦yields similar results to those of patients who only received usual physiotherapy treatment for¦CLBP prior to surgery. But surprisingly we found that it is possible with surgery to improve¦the quality of life of those CLBP sufferers who failed to respond to a comprehensive¦rehabilitation program and with a similar success rate to those reported in other series.¦But rehabilitation should still be offered as a treatment option in all CLBP patients prior to¦surgery, given that it is devoid of complications and that it will spare the need of surgery to a¦significant proportion of CLBP patients while not compromising surgical results in the¦remaining subjects who failed to improve.

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This research project investigated the effects of concentrated brines of magnesium chloride, calcium chloride, sodium chloride, and calcium magnesium acetate on portland cement concrete. Although known to be effective at deicing and anti-icing, the deleterious effects these chemicals may have on concrete have not been well documented. As a result of this research, it was determined that there is significant evidence that magnesium chloride and calcium chloride chemically interact with hardened portland cement paste in concrete resulting in expansive cracking, increased permeability, and a significant loss in compressive strength. Although the same effects were not seen with sodium chloride brines, it was shown that sodium chloride brines have the highest rate of ingress into hardened concrete. This latter fact is significant with respect to corrosion of embedded steel. The mechanism for attack of hardened cement paste varies with deicer chemical but in general, a chemical reaction between chlorides and cement hydration products results in the dissolution of the hardened cement paste and formation of oxychloride phases, which are expansive. The chemical attack of the hardened cement paste is significantly reduced if supplementary cementitious materials are included in the concrete mixture. Both coal fly ash and ground granulated blast furnace slag were found to be effective at mitigating the chemical attack caused by the deicers tested. In the tests performed, ground granulated blast furnace slag performed better as a mitigation strategy as compared to coal fly ash. Additionally, siloxane and silane sealants were effective at slowing the ingress of deicing chemicals into the concrete and thereby reducing the observed distress. In general, the siloxane sealant appeared to be more effective than the silane, but both were effective and should be considered as a maintenance strategy.

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OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

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This research project investigated the effects of concentrated brines of magnesium chloride, calcium chloride, sodium chloride, and calcium magnesium acetate on portland cement concrete. Although known to be effective at deicing and anti-icing, the deleterious effects these chemicals may have on concrete have not been well documented. As a result of this research, it was determined that there is significant evidence that magnesium chloride and calcium chloride chemically interact with hardened portland cement paste in concrete resulting in expansive cracking, increased permeability, and a significant loss in compressive strength. Although the same effects were not seen with sodium chloride brines, it was shown that sodium chloride brines have the highest rate of ingress into hardened concrete. This latter fact is significant with respect to corrosion of embedded steel. The mechanism for attack of hardened cement paste varies with deicer chemical but in general, a chemical reaction between chlorides and cement hydration products results in the dissolution of the hardened cement paste and formation of oxychloride phases, which are expansive. The chemical attack of the hardened cement paste is significantly reduced if supplementary cementitious materials are included in the concrete mixture. Both coal fly ash and ground granulated blast furnace slag were found to be effective at mitigating the chemical attack caused by the deicers tested. In the tests performed, ground granulated blast furnace slag performed better as a mitigation strategy as compared to coal fly ash. Additionally, siloxane and silane sealants were effective at slowing the ingress of deicing chemicals into the concrete and thereby reducing the observed distress. In general, the siloxane sealant appeared to be more effective than the silane, but both were effective and should be considered as a maintenance strategy.

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Problem solving (including insight, divergent thinking) seems to rely on the right hemisphere (RH). These functions are difficult to assess behaviorally. We propose anagram resolution as a suitable paradigm. University students (n=32) performed three tachistoscopic lateralized visual half-field experiments (stimulus presentation 150ms). In Experiment 1, participants recalled four-letter strings. Subsequently, participants provided solutions for four-letter anagrams (one solution in Experiment 2; two solutions in Experiment 3). Additionally, participants completed a schizotypy questionnaire (O-LIFE). Results showed a right visual field advantage in Experiment 1 and 2, but no visual field advantage in Experiment 3. In Experiment 1, increasing positive schizotypy associated with a RH performance shift. Problem solving seems to require increasingly the RH when facing several rather than one solution. This result supports previous studies on the RH's role in remote associative, metaphor and discourse processing. The more complex language requirements, the less personality traits seem to matter.

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Objective: To investigate the relationship between falls efficacy at admission and functional status reported one month after discharge from post-acute rehabilitation in a cohort of elderly patients. Methods: Participants were elderly patients admitted to postacute rehabilitation in an academic geriatric facility. Data on demographics and affective status were collected upon admission; functional status and gait speed were measured at admission and at discharge; self-reported functional status and history of falls since discharge were collected one month after discharge (follow-up). Falls efficacy was measured using the Fall Efficacy Scale, that assesses confidence in performing 12 activities of daily living without falling (range 0 to 100, higher score indicating higher confidence). Patients were classified using the median FES score at baseline (95) as cut-off to divide the population into "confident" and "fearful" groups. Results: Participants' (N=180, mean age 81.3±7.1 years, 75.6% women) mean FES score was 92.3±8.7 at baseline (range 60-100). Basic ADL score averaged 3.5±1.6 at baseline, 4.7±1.3 at discharge, and 5.5±0.7 at follow-up (self-reported). Baseline FES score was positively correlated with basic ADL at follow-up (rho=0.35, p<.001). At follow-up, 58.7% of the patients were fully independent in basic ADL, this proportion being significantly higher in confident than fearful patients (70.7% vs 42.4%, p<.001). Compared to confident patients, those fearful had significantly lower odds (OR 0.3, 95%CI 0.2-0.6, p<.001) to report full independence at follow-up. This relationship remained (adjOR = 0.4, 95%CI 0.2-0.8, p=.01) after controlling for demographics, baseline gait speed, depressive symptoms, functional status at discharge, and history of falls since discharge. Conclusion: In this cohort of older rehab patients, poor falls efficacy at admission was associated with lower function reported one month after discharge even after controlling for initial mobility performance and functional status at discharge. Further studies should determine whether interventions aiming at falls efficacy improvement will also result in improved function in fearful subjects undergoing rehabilitation.

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"MotionMaker (TM)" is a stationary programmable test and training system for the lower limbs developed at the 'Ecole Polytechnique Federale de Lausanne' with the 'Fondation Suisse pour les Cybertheses'.. The system is composed of two robotic orthoses comprising motors and sensors, and a control unit managing the trans-cutaneous electrical muscle stimulation with real-time regulation. The control of the Functional Electrical Stimulation (FES) induced muscle force necessary to mimic natural exercise is ensured by the control unit which receives a continuous input from the position and force sensors mounted on the robot. First results with control subjects showed the feasibility of creating movements by such closed-loop controlled FES induced muscle contractions. To make exercising with the MotionMaker (TM) safe for clinical trials with Spinal Cord Injured (SCI) volunteers, several original safety features have been introduced. The MotionMaker (TM) is able to identify and manage the occurrence of spasms. Fatigue can also be detected and overfatigue during exercise prevented.

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The primary objective of this project is to develop a design manual that would aid the county or municipal engineer in making structurally sound bridge strengthening or replacement decisions. The contents of this progress report are related only to Phase I of the study and deal primarily with defining the extent of the bridge problem in Iowa. In addition, the types of bridges to which the manual should be directed have been defined.

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The objective of this work was to evaluate the effects of alkaline solution marinades on the characteristics of pork subjected to post-mortem pH decrease in pig muscle. The pH of carcasses was measured in a commercial slaughterhouse (n = 526), 45 min after slaughtering (pH45) and, then, the carcasses were divided into the groups with pH45<5.7 or pH45>5.7. Ten samples of the longissimus dorsi muscles of each group were collected and distributed in an entirely randomized design, in a 2x4 factorial arrangement, with two conditions (pH45<5.7 or pH45>5.7), and four marinade solutions: TC, no marinade; TM1, sodium bicarbonate and sodium chloride; TM2, sodium tripolyphosphate and sodium chloride; TM3, sodium bicarbonate, sodium tripolyphosphate and sodium chloride. There was no interaction between pH45 of the meat and the marinade treatments. Meat with pH45<5.7 showed higher values for lightness, and for purge loss (PL), exudate loss (EL), cooking loss (CL) and shear force (SF). Marinating increased the pH, reduced the lightness, EL, CL and SF, and improved tenderness, juiciness and flavor of meat. Marinades with solutions containing chloride, bicarbonate, and sodium tripolyphosphate are effective in the improvement of pork quality, making physical characteristics of marinated meat similar to those of fresh pork, as a consequence of accelerated postmortem glycolysis.