The effect of continuous positive airway pressure on total cerebral blood flow in healthy awake volunteers.

PURPOSE: Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea. However, the physiologic impact of CPAP on cerebral blood flow (CBF) is not well established. Ultrasound can be used to estimate CBF, but there is no widespread accepted protocol. We studied the physiologic influence of CPAP on CBF using a method integrating arterial diameter and flow velocity (FV) measurements obtained for each vessel supplying blood to the brain. METHODS: FV and lumen diameter of the left and right internal carotid, vertebral, and middle cerebral arteries were measured using duplex Doppler ultrasound with and without CPAP at 15 cm H(2)O, applied in a random order. Transcutaneous carbon dioxide (PtcCO(2)), heart rate (HR), blood pressure (BP), and oxygen saturation were monitored. Results were compared with a theoretical prediction of CBF change based on the effect of partial pressure of carbon dioxide on CBF. RESULTS: Data were obtained from 23 healthy volunteers (mean ± SD; 12 male, age 25.1 ± 2.6 years, body mass index 21.8 ± 2.0 kg/m(2)). The mean experimental and theoretical CBF decrease under CPAP was 12.5 % (p < 0.001) and 11.9 % (p < 0.001), respectively. The difference between experimental and theoretical CBF reduction was not statistically significant (3.84 ± 79 ml/min, p = 0.40). There was a significant reduction in PtcCO(2) with CPAP (p = <0.001) and a significant increase in mean BP (p = 0.0017). No significant change was observed in SaO(2) (p = 0.21) and HR (p = 0.62). CONCLUSION: Duplex Doppler ultrasound measurements of arterial diameter and FV allow for a noninvasive bedside estimation of CBF. CPAP at 15 cm H(2)O significantly decreased CBF in healthy awake volunteers. This effect appeared to be mediated predominately through the hypocapnic vasoconstriction coinciding with PCO(2) level reduction. The results suggest that CPAP should be used cautiously in patients with unstable cerebral hemodynamics.

Three-dimensional black-blood cardiac magnetic resonance coronary vessel wall imaging detects positive arterial remodeling in patients with nonsignificant coronary artery disease.

BACKGROUND: Direct noninvasive visualization of the coronary vessel wall may enhance risk stratification by quantifying subclinical coronary atherosclerotic plaque burden. We sought to evaluate high-resolution black-blood 3D cardiovascular magnetic resonance (CMR) imaging for in vivo visualization of the proximal coronary artery vessel wall. METHODS AND RESULTS: Twelve adult subjects, including 6 clinically healthy subjects and 6 patients with nonsignificant coronary artery disease (10% to 50% x-ray angiographic diameter reduction) were studied with the use of a commercial 1.5 Tesla CMR scanner. Free-breathing 3D coronary vessel wall imaging was performed along the major axis of the right coronary artery with isotropic spatial resolution (1.0x1.0x1.0 mm(3)) with the use of a black-blood spiral image acquisition. The proximal vessel wall thickness and luminal diameter were objectively determined with an automated edge detection tool. The 3D CMR vessel wall scans allowed for visualization of the contiguous proximal right coronary artery in all subjects. Both mean vessel wall thickness (1.7+/-0.3 versus 1.0+/-0.2 mm) and wall area (25.4+/-6.9 versus 11.5+/-5.2 mm(2)) were significantly increased in the patients compared with the healthy subjects (both P<0.01). The lumen diameter (3.6+/-0.7 versus 3.4+/-0.5 mm, P=0.47) and lumen area (8.9+/-3.4 versus 7.9+/-3.5 mm(2), P=0.47) were similar in both groups. CONCLUSIONS: Free-breathing 3D black-blood coronary CMR with isotropic resolution identified an increased coronary vessel wall thickness with preservation of lumen size in patients with nonsignificant coronary artery disease, consistent with a "Glagov-type" outward arterial remodeling. This novel approach has the potential to quantify subclinical disease.

Report on the Iowa Law Enforcement Academy for the year ended June 30, 2011

Report on the Iowa Law Enforcement Academy for the year ended June 30, 2011

The aggregate claims distribution of a life insurance portfolio with a pairwise positive dependence structure

The individual life model has always been considered as the one closest to the real situation of the total claims of a life insurance portfolio. It only makes the ¿nearly inevitable assumption¿ of independence of the lifelenghts of insured persons in the portfolio. Many clinical studies, however, have demonstrated positive dependence of paired lives such as husband and wife. In our opinion, it won¿t be unrealistic expecting a considerable number of married couples in any life insurance portfolio (e.g. life insurance contracts formalized at the time of signing a mortatge) and these dependences materially increase the values for the stop-loss premiums associated to the aggregate claims of the portfolio. Since the stop-loss order is the order followed by any risk averse decison maker, the simplifying hypothesis of independence constitute a real financial danger for the company, in the sense that most of their decisions are based on the aggregated claims distribution. In this paper, we will determine approximations for the distribution of the aggregate claims of a life insurance portfolio with some married couples and we will describe how to make safe decisions when we don¿t know exactly the dependence structure between the risks in each couple. Results in this paper are partly based on results in Dhaene and Goovaerts (1997)

Harassment in Education: It's Against the Law, 2011

Harassment is illegal in all areas protected by Iowa Code Chapter 216. This includes education, employment, public accommodations, credit and housing. Acts of harassment take place every day in schools across the country. Frequently these acts, even if reported to administration, are dismissed as harmless, as "kids will be kids," or as "no big deal." Many people do not realize that harassment that interferes with a person's educational progress is illegal, just as it is illegal in the workplace.

What the Law Requires Accessible Multi-family Housing in Iowa, Janaury 2001

For people with disabilities, however, housing options have been limited. Today, state and federal laws are changing this. Who will benefit? All of us. For “accessibility” is an issue that, at one time or another, affects us all. This is true whether _ temporarily or permanently _ we use wheelchairs, need grab bars, cannot climb stairs, require easy-to-reach shelves, or rely on easy-to-navigate living spaces. The primary purpose of accessible housing law is to prevent discrimination against people with disabilities, but the end result is a living environment that is more usable for everyone. For example, both the very young and the very old will find an accessible dwelling more comfortable. People with temporary limitations due to injury or illness will find it easier to live in. Such a home will be more welcoming to guests with disabilities.

Sexual Orientation Gender Indentity, and Iowa's Safe Schools Law, 2007

Another recently enacted law is the Iowa Safe Schools Law. Effective September 1, 2007, Iowa Code Chapter 280 requires both public and private schools to establish policies prohibiting harassment and bullying against students by employees, school volunteers, or other students. Sexual Orientation and Gender identity are covered under the Safe Schools Law. Students may now seek remedies under both Chapter 216 and Chapter 280.

Sexual Orientation & Gender Indentity: A Housing Provider’s Guide to Iowa Law Compliance, 2007

Effective July 1, 2007, the Iowa Civil Rights Act (Iowa Code Chapter 216) was expanded to add sexual orientation and gender identity to the list of protected classes. It is now ILLEGAL in Iowa to discriminate against a person because of his/her sexual orientation or gender identity.

Sexual Orientation & Gender Identity: A Public Accommodations Provider’s Guide to Iowa Law, 2007

Effective July 1, 2007, the Iowa Civil Rights Act (Iowa Code Chapter 216) was expanded to add sexual orientation and gender identity to the list of protected classes. It is now ILLEGAL in Iowa to discriminate against a person because of his/her sexual orientation or gender identity.

The impact of fasting on the interpretation of triglyceride levels for predicting myocardial infarction risk in HIV-positive individuals: the D:A:D study.

We assessed whether fasting modifies the prognostic value of these measurements for the risk of myocardial infarction (MI). Analyses used mixed effect models and Poisson regression. After confounders were controlled for, fasting triglyceride levels were, on average, 0.122 mmol/L lower than nonfasting levels. Each 2-fold increase in the latest triglyceride level was associated with a 38% increase in MI risk (relative rate, 1.38; 95% confidence interval, 1.26-1.51); fasting status did not modify this association. Our results suggest that it may not be necessary to restrict analyses to fasting measurements when considering MI risk.

School Bus Safety Study: Kadyn’s Law, December 2012

In 2012, the Iowa legislature passed a bill for an act relating to school bus safety, including providing penalties for failure to obey school bus warning lamps and stop signal arms, providing for a school bus safety study and administrative remedies, and making an appropriation. The bill, referred to as Iowa Senate File (SF) 2218 or “Kadyn’s Law,” became effective March 16, 2012. A multiagency committee addressed three specific safety study elements of Kadyn’s Law as follows: * Use of cameras mounted on school buses to enhance the safety of children riding the buses and aid in enforcement of motor vehicle laws pertaining to stop-arm violations * Feasibility of requiring school children to be picked up and dropped off on the side of the road on which their home is located * Inclusion of school bus safety as a priority in driver training curriculum This report summarizes the findings for each of these topics.