898 resultados para recommendation
Resumo:
The erosive capacity of rainfall can be expressed by an index and knowing it allows recommendation of soil management and conservation practices to reduce water erosion. The objective of this study was to calculate various indices of rainfall erosivity in Lages, Santa Catarina, Brazil, identify the best one, and discover its temporal distribution. The study was conducted at the Center of Agricultural and Veterinary Sciences, Lages, Santa Catarina, using daily rainfall charts from 1989 to 2012. Using the computer program Chuveros , 107 erosivity indices were obtained, which were based on maximum intensity in 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 70, 80, 90, 100, 110, 120, 135, 150, 165, 180, 210, and 240 min of duration and on the combination of these intensities with the kinetic energy obtained by the equations of Brown & Foster, Wagner & Massambani, and Wischmeier & Smith. The indices of the time period from 1993 to 2012 were correlated with the respective soil losses from the standard plot of the Universal Soil Loss Equation (USLE) in order to select the erosivity index for the region. Erosive rainfall accounted for 83 % of the mean annual total volume of 1,533 mm. The erosivity index (R factor) of rainfall recommended for Lages is the EI30, whose mean annual value is 5,033 MJ mm ha-1 h-1, and of this value, 66 % occurs from September to February. Mean annual erosivity has a return period estimated at two years with a 50 % probability of occurrence.
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Background and Aims: The three anti-TNF agents infliximab (IFX), adalimumab (ADA) andcertolizumab pegol (CZP) have demonstrated similar efficacy in induction and maintenanceof response and remission in Crohn's disease (CD) treatment. Given the comparability ofthese drugs, patient's preferences may influence the choice of the product. However, dataon patient's preferences for choosing anti-TNF agents are lacking. We therefore aimed toassess the CD patient's appraisal to select the drug of his choice and to identify factorsguiding this decision.Methods: A prospective survey among anti-TNF-naive CD patientswas performed. Patients were provided a description of the three anti-TNF agents focusingon indication, application mode (s.c. vs. i.v.), application time intervals, setting of application(hospital vs. private practice vs. patient's home), average time to apply the medication permonth, typical side effects, and the scientific evidence of efficacy and safety available for everydrug. Patients answered a questionnaire consisting of 17 questions, covering demographic,disease-specific, and medication data.Results: Hundred patients (47f/53m, mean age 45±16years) completed the questionnaire. Disease duration was <1year in 7%, 1-5 years in 31%,and >5 years in 62% of patients. Disease location was ileal in 33%, colonic in 40%, andileocolonic in 27%. Disease phenotype was inflammatory in 68%, stenosing in 29%, andinternally fistulizing in 3% of patients. Additionally, 20% had perianal fistulizing disease.Patients were already treated with the following drugs: mesalamines 61%, budesonide 44%,prednisone 97%, thiopurines 78%, methotrexate 16%. In total, 30% had already heardabout IFX, 20% about ADA, and 11% about CZP. Thirty-six percent voted for treatmentwith ADA, 28% for CZP, and 25% for IFX, whereas 11% were undecided. The followingfactors influenced the patient's decision for choosing a specific anti-TNF drug (severalanswers possible): side effects 76%, physician's recommendation 66%, application mode54%, efficacy experience 52%, time to spend for therapy 27%, patient's recommendations21%, interactions with other medications 12%. The single most important factor for choosinga specific anti-TNF was (1 answer): side effect profile 35%, physician's recommendation22%, efficacy experience 21%, application mode 13%, patient's recommendations 5%, timespent for therapy 3%, interaction with other medications 1%.Conclusions: The majority ofpatients preferred anti-TNF syringes to infusions. The safety profile of the drugs and thephysician's recommendation are major factors influencing the patient's choice for a specificanti-TNF drug. Patient's issues about safety and lifestyle habits should be taken into accountwhen prescribing specific anti-TNF formulations.
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This Tier 2 Environmental Assessment (EA) presents the results of studies and analyses conducted to determine the potential impacts of proposed improvements in Segment 3 of the Council Bluffs Interstate System (CBIS) in the Council Bluffs metropolitan area. This document is tiered to the Tier 1 Draft and Final Environmental Impact Statements (EIS) that evaluated impacts of the overall CBIS Improvements Project, which includes five segments of independent utility1 This EA on Segment 3 of the Project is divided into the following sections: and encompasses 18 mainline miles of Interstate and 14 interchanges along Interstate 80 (I-80), Interstate 29 (I-29), and Interstate 480 (I-480). More information about the tiering process is found below under Project Background. • Section 1 provides background information on the Project and discusses the relationship between the earlier Tier 1 EIS and this Tier 2 EA. It also discusses the proposed action and the area studied, the purpose of the Project, and the need for the Project based on transportation problems that currently exist or are expected in the future. • Section 2, Alternatives, identifies the range of alternatives considered for Segment 3 to address the transportation problems identified in Section 1. It also identifies the alternatives retained for further study in this EA and the preferred Segment 3 alternative. • Section 3, Affected Environment and Environmental Consequences, describes the general environment for each resource affected by the proposed improvements. It also describes the potential environmental impacts of the Segment 3 Project and methods to avoid, minimize, and mitigate impacts. • Section 4, Disposition, lists the agencies and organizations that will receive copies of this EA and the locations at which this EA will be available for public review. • Section 5, Comments and Coordination, summarizes the agency coordination and public involvement efforts in conjunction with the Segment 3 Project. • Section 6, Conclusion and Recommendation, summarizes resource impacts. • Section 7, References, lists the sources cited in this EA. For Segment 3, the Federal Highway Administration (FHWA) and Iowa Department of Transportation (Iowa DOT) determined that an EA is the appropriate level of Tier 2 study to comply with the National Environmental Policy Act (NEPA) requirements. The primary purpose of an EA is to clearly establish the significance of a project’s environmental impacts. That analysis is included in this document.
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ABSTRACT Univariate methods for diagnosing nutritional status such as the sufficiency range and the critical level for garlic crops are very susceptible to the effects of dilution and accumulation of nutrients. Therefore, this study aimed to establish bivariate and multivariate norms for this crop using the Diagnosis and Recommendation Integrated System (DRIS) and Nutritional Composition Diagnosis (CND), respectively. The criteria used were nutritional status and the sufficiency range, and then the diagnoses were compared. The study was performed in the region of Alto Paranaíba, MG, Brazil, during the crop seasons 2012 and 2013. Samples comprised 99 commercial fields of garlic, cultivated with the cultivar “Ito” and mostly established in Latossolo Vermelho-Amarelo Distrófico (Oxisol). Copper and K were the nutrients with the highest number of fields diagnosed as limiting by lack (LF) and limiting by excess (LE), respectively. The DRIS method presented greater tendency to diagnose LF, while the CND tended towards LE. The sufficiency range of both methods presented narrow ranges in relation to those suggested by the literature. Moreover, all ranges produced by the CND method provided narrower ranges than the DRIS method. The CND method showed better performance than DRIS in distinguishing crop yield covered by different diagnoses. Turning to the criterion of evaluation, the study found that nutritional status gave a better performance than sufficiency range in terms of distinguishing diagnoses regarding yield.
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The quadrennial need study was developed to assist in identifying county highway financial needs (construction, rehabilitation, maintenance, and administration) and in the distribution of the road use tax fund (RUTF) among the counties in the state. During the period since the need study was first conducted using HWYNEEDS software, between 1982 and 1998, there have been large fluctuations in the level of funds distributed to individual counties. A recent study performed by Jim Cable (HR-363, 1993), found that one of the major factors affecting the volatility in the level of fluctuations is the quality of the pavement condition data collected and the accuracy of these data. In 1998, the Center for Transportation Research and Education researchers (Maze and Smadi) completed a project to study the feasibility of using automated pavement condition data collected for the Iowa Pavement Management Program (IPMP) for the paved county roads to be used in the HWYNEEDS software (TR-418). The automated condition data are objective and also more current since they are collected in a two year cycle compared to the 10-year cycle used by HWYNEEDS right now. The study proved the use of the automated condition data in HWYNEEDS would be feasible and beneficial in educing fluctuations when applied to a pilot study area. In another recommendation from TR-418, the researchers recommended a full analysis and investigation of HWYNEEDS methodology and parameters (for more information on the project, please review the TR-418 project report). The study reported in this document builds on the previous study on using the automated condition data in HWYNEEDS and covers the analysis and investigation of the HWYNEEDS computer program methodology and parameters. The underlying hypothesis for this study is thatalong with the IPMP automated condition data, some changes need to be made to HWYNEEDS parameters to accommodate the use of the new data, which will stabilize the process of allocating resources and reduce fluctuations from one quadrennial need study to another. Another objective of this research is to investigate the gravel roads needs and study the feasibility of developing a more objective approach to determining needs on the counties gravel road network. This study identifies new procedures by which the HWYNEEDS computer program is used to conduct the quadrennial needs study on paved roads. Also, a new procedure will be developed to determine gravel roads needs outside of the HWYNEED program. Recommendations are identified for the new procedures and also in terms of making changes to the current quadrennial need study. Future research areas are also identified.
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This investigation was initiated to determine the causes of a rutting problem that occurred on Interstate 80 in Adair County. 1-80 from Iowa 25 to the Dallas County line was opened to traffic in November, 1960. The original pavement consisted of 4-1/2" of asphalt cement concrete over 12" of rolled stone base and 12" of granular subbase. A 5-1/2" overlay of asphalt cement concrete was placed in 1964. In 1970-1972, the roadway was resurfaced with 3" of asphalt cement concrete. In 1982, an asphalt cement concrete inlay, designed for a 10-year life, was placed in the eastbound lane. The mix designs for all courses met or exceeded all current criteria being used to formulate job mixes. Field construction reports indicate .that asphalt usage, densities, field voids and filler bitumen determinations were well within specification limits on a very consistent basis. Field laboratory reports indicate that laboratory voids for the base courses were within the prescribed limits for the base course and below the prescribed limits for the surface course. Instructional memorandums do indicate that extreme caution should be exercised when the voids are at or near the lower limits and traffic is not minimal. There is also a provision that provides for field voids controlling when there is a conflict between laboratory voids and field voids. It appears that contract documents do not adequately address the directions that must be taken when this conflict arises since it can readily be shown that laboratory voids must be in the very low or dangerous range if field voids are to be kept below the maximum limit under the current density specifications. A rut depth survey of January, 1983, identified little or no rutting on this section of roadway. Cross sections obtained in October, 1983, identified rutting which ranged from 0 to 0.9" with a general trend of the rutting to increase from a value of approximately 0.3" at MP 88 to a rut depth of 0.7" at MP 98. No areas of significant rutting were identified in the inside lane. Structural evaluation with the Road Rater indicated adequate structural capacity and also indicated that the longitudinal subdrains were functioning properly to provide adequate soil support values. Two pavement sections taken from the driving lane indicated very little distortion in the lower 7" base course. Essentially all of the distortion had occurred in the upper 2" base course and the 1..;1/2" surface course. Analysis of cores taken from this section of Interstate 80 indicated very little densification of either the surface or the upper or lower base courses. The asphalt cement content of both the Type B base courses and the Type A surface course were substantially higher than the intended asphalt cement content. The only explanation for this is that the salvaged material contained a greater percent of asphalt cement than initial extractions indicated. The penetration and viscosity of the blend of new asphalt cement and the asphalt cement recovered from the salvaged material were relatively close to that intended for this project. The 1983 ambient temperatures were extremely high from June 20 through September 10. The rutting is a result of a combination of adverse factors including, (1) high asphalt content, (2) the difference between laboratory and field voids, (3) lack of intermediate sized crushed particles, (4) high ambient temperatures. The high asphalt content in the 2" upper base course produced an asphalt concrete mix that did not exhibit satisfactory resistance to deformation from heavy loading. The majority of the rutting resulted from distortion of the 2" upper base lift. Heater planing is recommended as an interim corrective action. Further recommendation is to design for a 20-year alternative by removing 2-1/2" of material from the driving lane by milling and replacing with 2-1/2" of asphalt concrete with improved stability. This would be .followed by placing 1-1/2" of high quality resurfacing on the entire roadway. Other recommendations include improved density and stability requirements for asphalt concrete on high traffic roadways.
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Disorders of language, spatial perception, attention, memory, calculation and praxis are a frequent consequence of acquired brain damage [in particular, stroke and traumatic brain injury (TBI)] and a major determinant of disability. The rehabilitation of aphasia and, more recently, of other cognitive disorders is an important area of neurological rehabilitation. We report here a review of the available evidence about effectiveness of cognitive rehabilitation. Given the limited number and generally low quality of randomized clinical trials (RCTs) in this area of therapeutic intervention, the Task Force considered, besides the available Cochrane reviews, evidence of lower classes which was critically analysed until a consensus was reached. In particular, we considered evidence from small group or single cases studies including an appropriate statistical evaluation of effect sizes. The general conclusion is that there is evidence to award a grade A, B or C recommendation to some forms of cognitive rehabilitation in patients with neuropsychological deficits in the post-acute stage after a focal brain lesion (stroke, TBI). These include aphasia therapy, rehabilitation of unilateral spatial neglect (ULN), attentional training in the post-acute stage after TBI, the use of electronic memory aids in memory disorders, and the treatment of apraxia with compensatory strategies. There is clearly a need for adequately designed studies in this area, which should take into account specific problems such as patient heterogeneity and treatment standardization.
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Develop, in conjunction with the regional planning affiliations and metropolitan planning organizations and other stakeholder groups, a process to exchange STP federal funds for Primary Highway System funds for the purpose of reducing the number of small projects that have to meet onerous federal requirements. In order to implement this recommendation, legislative action is required to eliminate the restriction on using Primary Road Fund revenue on local jurisdiction roadways in exchange for a portion of their federal STP funding. This past session, Iowa DOT worked with legislators to introduce a bill in both the House and the Senate to eliminate this Code restriction. Bills were discussed at the subcommittee level in both the House and Senate but did not proceed because of the need to have further discussions with impacted parties. Prior to next session, discussions will occur amongst all impacted parties to reach consensus on how this recommendation could be implemented. With that consensus in place prior to next session, it is anticipated that the bills can be reintroduced next session.
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Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency. Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era. Fluconazole remains the first line of therapy for both oropharyngeal candidiasis and oesophageal candidiasis and should be preferred to itraconazole oral solution (or capsules when not available) due to fewer side effects. For patients who still present with fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results in addition to the optimization of HAART when feasible. For vaginal candidiasis, topical therapy is preferred.
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BACKGROUND: This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol. METHODS: Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. RESULTS: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (quality of evidence and recommendations according to the GRADE system). CONCLUSIONS: Based on the evidence available for each item of the multimodal perioperative-care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery.
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First-degree atrio-ventricular (AV) block is defined as a PR interval longer than 200 ms. If too long, it can become clinically relevant and may mimic a pacemaker syndrome. We report the case of a young woman with a long PR interval, probably congenital, with episodes of syncope and dizziness since childhood. Pseudo-pacemaker syndrome is rare and is a Class IIa recommendation for a pacemaker implantation. A dual-chamber pacemaker was implanted and short AV delay was programmed, with rapid clinical improvement.
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The objective of this project was to use a Global Positioning System (GPS) to determine the aerial camera location and orientation that best facilitated mapping done from aerial photographs without any ground control. Four test flights were conducted. The first test flight was performed in June 1993 at St. Louis, with the objective of testing the multiantenna concept using two antenna on the aircraft. The second test in August 1993 was conducted over the Iowa State University (ISU) campus at Ames. This flight evaluated the use of GPS for pinpoint navigation. The third test flight over St. Louis was flown in October 1993, with four antenna on aircraft; its objective was to evaluate the 3DF GPS receiver and the antenna locations. On the basis of the results of these three tests, a final test flight over the Mustang Project area in Ames and the ISU campus was conducted in June 1994. Analysis of these data showed that airborne GPS can be used (1) in pinpoint navigation with an accuracy of 25 m or better, (2) to determine the location of the camera nodal point with an accuracy of 10 cm or better, and (3) to determine the orientation angles of the camera with an accuracy of 0.0001 radians or better. In addition, the exterior orientation elements determined by airborne GPS can be used to rectify aerial photos, to produce orthophotos, and in direct stereo plotting. Further research is recommended in these areas to maximize the use of airborne GPS. The report is organized in the following chapters: (1) Introduction; (2) Photogrammetry and Kinematic GPS; (3) Analysis of First Test; (4) Analysis of Second Test; (5) Analysis of Third Test; (6) Analysis of Final Test; (7) Applications of Airborne GPS; and (8) Conclusion and Recommendation.
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The Diagnosis and Recommendation System (DRIS) was applied to eucalypt trees (hybrids of Eucalyptus grandis x E. urophylla) with different ages and growing under different environmental conditions for three different clones. The basic data were obtained from 1,986 trees of commercial stands cultivated in the states of Espírito Santo and south Bahia, Brazil. The DRIS indices were calculated using the Beaufils' Range formula and grouped according to the Nutrient Application Potential Response method. The objective of this paper was to evaluate the N, P and Ca status in eucalypt trees, regarding the tree ages and genetic materials. The DRIS indices discriminated differences in the nutritional status of the trees, both in relation to age and the genetic materials (clones). The results indicated that the deficiency of N and Ca tended to decrease with tree age, whereas the P deficiency tended to increase. Furthermore, of the three evaluated clones, those numbered 00014 and 00034 showed opposite trends regarding to N, P, and Ca nutrition, and the clone numbered 00021, in general, presented the highest degree of unbalanced nutrition of N, P and Ca.
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ABSTRACT: BACKGROUND: Individual counselling, pharmacotherapy, and group therapy are evidence-based interventions that help patients stop smoking. Acupuncture, hypnosis, and relaxation have no demonstrated efficacy on smoking cessation, whereas self-help material may only have a small benefit. The purpose of this study is to assess physicians' current clinical practice regarding smokers motivated to stop smoking. METHODS: The survey included 3385 Swiss primary care physicians. Self-reported use of nine smoking cessation interventions was scored. One point was given for each positive answer about practicing interventions with demonstrated efficacy, i.e. nicotine replacement therapy, bupropion, counselling, group therapy, and smoking cessation specialist. No points were given for the recommendation of acupuncture, hypnosis, relaxation, and self-help material. Multivariable logistic analysis was performed to identify factors associated with a good practice score, defined as >1. RESULTS: The response rate was 55%. Respondents were predominately over the age of 40 years (88%), male (79%), and resided in urban areas (74%). Seventeen percent reported being smokers. Most of the physicians prescribed nicotine replacement therapy (84%), bupropion (65%), or provided counselling (70%). A minority of physicians recommended acupuncture (26%), hypnosis (8%), relaxation (7%), or self-help material (24%). A good practice score was obtained by 85% of respondents. Having attended a smoking cessation training program was the only significant predictor of a good practice score (odds ratio: 6.24 , 95% CI 1.95-20.04). CONCLUSION: The majority of respondents practice recommended smoking cessation interventions. However, there is room for improvement and implementing an evidence-based smoking cessation-training program could provide additional benefit.
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The concrete admixture Ipanex (Registered trademark) manufactured by IPA Systems Inc. was submitted to the Iowa Department of Transportation (Iowa DOT) New Products Committee on April 15, 1998. The New Products Committee requested that the Iowa DOT Materials Laboratory evaluate the durability, corrosion inhibiting and concrete permeability reduction effects of this admixture. This report is intended to present the results of testing in Iowa DOT materials laboratories, review a Pennsylvania State University report, as well as review the IPA Systems Inc. marketing literature. The objective is to provide the New Products Committee with a recommendation concerning approval of this product based on the information gathered. The portland cement concrete admixture Ipanex (Registered trademark) did not show any significant benefit in terms of improvement in areas of permeability, chloride resistance and strength in the testing performed at the Iowa DOT. The literature and reports reviewed did not provide enough credible evidence to refute this conclusion. Additionally, the benefits ascribed to this product can be more economically achieved using other currently available products such as slag and silica fume. The recommendation is that this product not be approved for use on State projects in Iowa.