Médecine d'urgence [Emergency medicine: updates 2013].

New evidences published this year are susceptible to change the management of several medical emergencies. Combined antiplatelet therapy might be beneficial for the management of TIA or minor stroke and rapid blood pressure lowering might improve the outcome in patients with intracerebral hemorrhage. A restrictive red cell transfusion strategy is indicated in case of upper digestive bleeding and coagulation factors concentrates are superior to fresh frozen plasma for urgent warfarin reversal. Prolonged systemic steroid therapy is not warranted in case of acute exacerbation of BPCO, and iterative physiotherapy is not beneficial after acute whiplash. Finally, family presence during cardiopulmonary resuscitation may reduce post-traumatic stress disorder among relatives.

Agreed-upon procedures report on the City of Cambridge, Iowa for the period August 1, 2013 through July 31, 2014

Agreed-upon procedures report on the City of Cambridge, Iowa for the period August 1, 2013 through July 31, 2014

Agreed-upon procedures report on the City of Gilman, Iowa for the period September 1, 2013 through August 31, 2014

Agreed-upon procedures report on the City of Gilman, Iowa for the period September 1, 2013 through August 31, 2014

Agreed-upon procedures report on the City of Mount Ayr, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Mount Ayr, Iowa for the period July 1, 2013 through June 30, 2014

Investigation of Rapid Thermal Analysis Procedures for Prediction of the Service Life of PCCP Carbonate Coarse Aggregate, HR-337, 1993

The major objective of this research project was to use thermal analysis techniques in conjunction with x-ray analysis methods to identify and explain chemical reactions that promote aggregate related deterioration in portland cement concrete. Twenty-two different carbonate aggregate samples were subjected to a chemical testing scheme that included: • bulk chemistry (major, minor and selected trace elements) • bulk mineralogy (minor phases concentrated by acid extraction) • solid-solution in the major carbonate phases • crystallite size determinations for the major carbonate phases • a salt treatment study to evaluate the impact of deicer salts Test results from these different studies were then compared to information that had been obtained using thermogravimetric analysis techniques. Since many of the limestones and dolomites that were used in the study had extensive field service records it was possible to correlate many of the variables with service life. The results of this study have indicated that thermogravimetric analysis can play an important role in categorizing carbonate aggregates. In fact, with modern automated thermal analysis systems it should be possible to utilize such methods on a quality control basis. Strong correlations were found between several of the variables that were monitored in this study. In fact, several of the variables exhibited significant correlations to concrete service life. When the full data set was utilized (n = 18), the significant correlations to service life can be summarized as follows ( a = 5% level): • Correlation coefficient, r, = -0.73 for premature TG loss versus service life. • Correlation coefficient, r, = 0.74 for relative crystallite size versus service life. • Correlation coefficient, r, = 0.53 for ASTM C666 durability factor versus service life. • Correlation coefficient, r, = -0.52 for acid-insoluble residue versus service life. Separation of the carbonate aggregates into their mineralogical categories (i.e., calcites and dolomites) tended to increase the correlation coefficients for some specific variables (r sometimes approached 0.90); however, the reliability of such correlations was questionable because of the small number of samples that were present in this study.

Elgard Cathodic Protection System, HR-553, 1995

Following is the Operations Manual for the Pennsylvania Ave Bridge over I-235 located in Des Moines, Iowa, which was installed from July 1992 to October 1992. The project uses ELGARD™ 210 Anode Mesh and is divided into 3 zones. Periodic data collection and/or inspection of the cathodic protection system is required to insure proper operation and a long life. This Operation Manual contains a schedule, operation procedures, operation log forms, a rectifier panel drawing, and pertinent reference matenal. Operation procedures and operating records are contained in the body of the manual, while blank operation forms, as built drawings, and pertinent reference material are contained in the appendices.

Awareness of HIV Testing Guidelines Is Low among Swiss Emergency Doctors: A Survey of Five Teaching Hospitals in French-Speaking Switzerland.

BACKGROUND: In Switzerland, 30% of HIV-infected individuals are diagnosed late. To optimize HIV testing, the Swiss Federal Office of Public Health (FOPH) updated 'Provider Induced Counseling and Testing' (PICT) recommendations in 2010. These permit doctors to test patients if HIV infection is suspected, without explicit consent or pre-test counseling; patients should nonetheless be informed that testing will be performed. We examined awareness of these updated recommendations among emergency department (ED) doctors. METHODS: We conducted a questionnaire-based survey among 167 ED doctors at five teaching hospitals in French-Speaking Switzerland between 1(st) May and 31(st) July 2011. For 25 clinical scenarios, participants had to state whether HIV testing was indicated or whether patient consent or pre-test counseling was required. We asked how many HIV tests participants had requested in the previous month, and whether they were aware of the FOPH testing recommendations. RESULTS: 144/167 doctors (88%) returned the questionnaire. Median postgraduate experience was 6.5 years (interquartile range [IQR] 3; 12). Mean percentage of correct answers was 59 ± 11%, senior doctors scoring higher (P=0.001). Lowest-scoring questions pertained to acute HIV infection and scenarios where patient consent was not required. Median number of test requests was 1 (IQR 0-2, range 0-10). Only 26/144 (18%) of participants were aware of the updated FOPH recommendations. Those aware had higher scores (P=0.001) but did not perform more HIV tests. CONCLUSIONS: Swiss ED doctors are not aware of the national HIV testing recommendations and rarely perform HIV tests. Improved recommendation dissemination and adherence is required if ED doctors are to contribute to earlier HIV diagnoses.

Agreed-upon procedures report on the City of Lacona, Iowa for the period December 1, 2013 through November 30, 2014

Agreed-upon procedures report on the City of Lacona, Iowa for the period December 1, 2013 through November 30, 2014

Agreed-upon procedures report on the City of Lansing, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Lansing, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Armstrong, Iowa for the period October 1, 2013 through September 30, 2014

Agreed-upon procedures report on the City of Armstrong, Iowa for the period October 1, 2013 through September 30, 2014

Stabilization Procedures to Mitigate Edge Rutting for Granular Shoulders - Phase II, TR-591, 2011

A multifaceted investigation was undertaken to develop recommendations for methods to stabilize granular road shoulders with the goal of mitigating edge ruts. Included was reconnaissance of problematic shoulder locations, a laboratory study to develop a method to test for changes in granular material stability when stabilizing agents are used, and the construction of three sets of test sections under traffic at locations with problematic granular shoulders. Full results of this investigation are included in this report and its appendices. This report also presents conclusions and recommendations based on the study results.

Agreed-upon procedures report on the City of Hills, Iowa for the period October 1, 2013 through September 30, 2014

Agreed-upon procedures report on the City of Hills, Iowa for the period October 1, 2013 through September 30, 2014

Agreed-upon procedures report on the City of Kelley, Iowa for the period November 1, 2013 through October 31, 2014

Agreed-upon procedures report on the City of Kelley, Iowa for the period November 1, 2013 through October 31, 2014

Agreed-upon procedures report on the City of Tiffin, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Tiffin, Iowa for the period July 1, 2013 through June 30, 2014