Innovations in hypoxic training

Athletes seem compelled to include some forms of altitude training in their preparation expecting additional performance gains compared to equivalent training at sea-level. For the general population, altitude training often only consists in spending weeks at altitude to enhance red blood cell production, hemoglobin mass and thus oxygen delivery to the muscles. Over the past two decades, intermittent hypoxic training (IHT), that is, a method where athletes live at or near sea-level but train in hypobaric hypoxia (HH, real altitude) or normobaric hypoxia (NH, simulated altitude) was shown to induce exclusive adaptations directly at the muscular level that may support performance improvements. Our work first demonstrated significant differences between exposure and exercise in HH vs. NH that may help disentangling hypoxia and hypobaria for athletes or mountaineers who use NH to prepare for altitude competitions or expeditions. Second, we produced a comprehensive review of the strikingly poor and controversial benefits of IHT for performance enhancement in team or racket sports. Using evidence of peripheral muscular adaptations with the recruitment of fast-twitch fibers playing a major role, we then developed and assessed the potential of a new training method in hypoxia based on the repetitions of "all-out" sprints interspersed with incomplete recovery periods, the so called "repeated sprint training in hypoxia" (RSH). We have consequently shown RSH to delay fatigue when sprints with incomplete recoveries are repeated until exhaustion both in cycling and cross-country ski double poling. We definitely outlined RSH as a promising training strategy and proposed new studies to judge the efficacy of RSH in team sports and determine the specific mechanisms that may enhance team game results. In conclusion, our work allowed updating the panorama over the contemporary hypoxic training possibilities. It provides an overview of the current scientific knowledge about intermittent hypoxic training and repeated sprint training in hypoxia (RSH). This will benefit athletes and teams in intermittent sports looking to include a hypoxic stimulus to their training to gain a specific competitive edge.

Development of a pediatric eosinophilic esophagitis activity index (ped-EEsAI): International experts propose dysphagia, whitish exudates on endoscopy , and intraepithelial eosinophili count as major items related to EoE activity

Background and Aims: The international EEsAI study group aims to develop, validate and evaluate the first pediatric EoE activity index (ped-EEsAI). We report on results of phase 1, which aims to generate candidate items. Methods: This study involves 3 phases: (1) item generation, (2) index derivation and testing on a first patient cohort, and (3) validation in a second cohort. In phase 1, item generation, weighting and reduction are achieved through a Delphi process with an international EoE expert group. The experts proposed and ranked candidate items on a 7-point Likert scale (0 = no, 6 = perfect relationship with EoE activity). Results: 23 international EoE experts proposed and ranked 39 items (20 clinical, 6 endoscopic, 8 histologic, 5 laboratory items). Rank order for clinical items: dysphagia related to food consistencies (median 5, range 2-6), severity of dysphagia (5, 3-6), frequency of dysphagia episodes (5, 3-6), regurgitation and vomiting (4, 2-5), response to dietary restrictions (4, 1-6); endoscopic items: whitish exudates (5, 3-6), furrowing (4, 3-6), corrugated rings (4, 2-6), linear shearing (4, 2-6), strictures (3, 2-6); histologic items: intraepithelial eosinophil count (5, 4-6), lamina propria fibrosis (3, 2-6), basal layer enlargement (3, 1-5); laboratory items: % blood eosinophils (3, 0-5). Conclusions: These items will now be reduced in further Delphi rounds, tested on a cohort of 100 pediatric EoE patients and validated in a second independent cohort, resulting in a robust, broadly accepted disease activity index for use in clinical trials and daily care.

Public health education in Europe: old and new challenges

The purpose of this article is to discuss some of the current challenges faced by European schools of public health. Perhaps most remarkable on the continent is the diversity, the magnitude, and the rapidity of the developments in public health education since the Second World War. This article discusses its evolution, its main characteristics and the underlying rationale with several examples. Further, it addresses specific aspects of the future development, namely the collaboration of academic schools with practice-oriented institutions, as well as the interactions between the constituent disciplines of public health. The Bologna process on post-graduate education in Europe has had an important impact on the overall design of most schools. There is a willingness to develop public health in each country of the European region and there is a need to develop common strategies to reach high standards in teaching, training and researching in all disciplines related to public health.

The future of patient safety: Surgical trainees accept virtual reality as a new training tool.

BACKGROUND: The use of virtual reality (VR) has gained increasing interest to acquire laparoscopic skills outside the operating theatre and thus increasing patients' safety. The aim of this study was to evaluate trainees' acceptance of VR for assessment and training during a skills course and at their institution. METHODS: All 735 surgical trainees of the International Gastrointestinal Surgery Workshop 2006-2008, held in Davos, Switzerland, were given a minimum of 45 minutes for VR training during the course. Participants' opinion on VR was analyzed with a standardized questionnaire. RESULTS: Fivehundred-twenty-seven participants (72%) from 28 countries attended the VR sessions and answered the questionnaires. The possibility of using VR at the course was estimated as excellent or good in 68%, useful in 21%, reasonable in 9% and unsuitable or useless in 2%. If such VR simulators were available at their institution, most course participants would train at least one hour per week (46%), two or more hours (42%) and only 12% wouldn't use VR. Similarly, 63% of the participants would accept to operate on patients only after VR training and 55% to have VR as part of their assessment. CONCLUSION: Residents accept and appreciate VR simulation for surgical assessment and training. The majority of the trainees are motivated to regularly spend time for VR training if accessible.

Structural Analysis and Overlay Design of Pavements Using the Road Rater, MLR-84-3, 1986

In recent years the Iowa DOT has shifted emphasis from the construction of new roads to the maintenance and preservation of existing highways. A need has developed for analyzing pavements structurally to select the correct rehabilitation strategy and to properly design a pavement overlay if necessary. This need has been fulfilled by Road Rater testing which has been used successfully on all types of pavements to evaluate pavement and subgrade conditions and to design asphaltic concrete overlays. The Iowa Road Rater Design Method has been simplified so that it may be easily understood and used by the widely diverse groups of individuals which may be involved in pavement restoration and management. Road Rater analysis techniques have worked well to date and have been verified by pavement coring, soils sampling and testing, and pavement removal by block sampling. Void detection testing has also been performed experimentally in Iowa, and results indicate that the Road Rater can be used to locate pavement voids and that Road Rater analysis techniques are reasonably accurate. The success of Road Rater research and development has made deflection test data one of the most important pavement management inputs.

Iowa Strategy for Homeland Security and Emergency Management 2009-2014, August 31, 2009

Address sustainability in all efforts. Sustainability should be at the core of all levels of homeland security and emergency management effort in Iowa. Capabilities need to be built for the long term, and without a sustainability plan in place, projects can quickly deplete uncertain levels of funding. Utilize an all-hazards methodology. Developing capabilities that are effective during a variety of disaster and emergency scenarios represents sound planning and resource management. Enhance capabilities through joint planning, training and exercise. Effective capabilities developed through coordinated planning efforts and an ongoing joint training and exercising program to ensure sustainment of prepared response. Utilize a collaborative approach to build capability. We will utilize whatever partnerships are necessary to build capability in the most effective manner possible. Regional partnerships have been, and will continue to be, in the forefront of the State of Iowa’s efforts to build and enhance capability. Enhance statewide capabilities. Whenever possible, we will identify and augment existing resources to provide statewide capability during a disaster or terrorist attack. Awareness, outreach and education. Open communication is critical to the success of any initiative. All projects implemented will have awareness, education and outreach components to ensure that all stakeholders are informed as to their responsibilities, capabilities and access. Information sharing and a common operating picture. The timely exchange of critical/actionable information is imperative to the success of every operation. The identification of a common operating picture allows decision makers to make informed decisions based on a unified understanding of the events around them.

The effect of exercise, alcohol or both combined on health and physical performance.

Alcohol (ethanol) is consumed on a daily basis by a large fraction of the population, and in many countries, light-to-moderate alcohol consumption is considered as an integral part of the diet. Although the relationship between alcohol intake and obesity is controversial, regular consumption of alcohol, through its effects in suppressing fat oxidation, is regarded as a risk factor for weight gain, increased abdominal obesity and hypertriglyceridemia. Indeed, alcohol taken with a meal leads to an increase in postprandial lipemia-an effect on postprandial metabolism that is opposite to that observed with exercise. Furthermore, although regular exercise training and/or a preprandial exercise session reduce postprandial lipemia independently of alcohol ingestion, the exercise-induced reduction in postprandial lipemia is nonetheless less pronounced when alcohol is also consumed with the meal. Whether or not alcohol influences exercise and sport performance remains contradictory. It is believed that alcohol has deleterious effects on the performance, although it may contribute to reduce pain and anxiety. The alcohol effects on sports performance depend on the type and dosage of alcohol, acute vs chronic administration, the alcohol elimination rate as well as the type of exercise.

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.

New perspectives in the use of ink evidence in forensic science: Part III: Operational applications and evaluation.

The research reported in this series of article aimed at (1) automating the search of questioned ink specimens in ink reference collections and (2) at evaluating the strength of ink evidence in a transparent and balanced manner. These aims require that ink samples are analysed in an accurate and reproducible way and that they are compared in an objective and automated way. This latter requirement is due to the large number of comparisons that are necessary in both scenarios. A research programme was designed to (a) develop a standard methodology for analysing ink samples in a reproducible way, (b) comparing automatically and objectively ink samples and (c) evaluate the proposed methodology in forensic contexts. This report focuses on the last of the three stages of the research programme. The calibration and acquisition process and the mathematical comparison algorithms were described in previous papers [C. Neumann, P. Margot, New perspectives in the use of ink evidence in forensic science-Part I: Development of a quality assurance process for forensic ink analysis by HPTLC, Forensic Sci. Int. 185 (2009) 29-37; C. Neumann, P. Margot, New perspectives in the use of ink evidence in forensic science-Part II: Development and testing of mathematical algorithms for the automatic comparison of ink samples analysed by HPTLC, Forensic Sci. Int. 185 (2009) 38-50]. In this paper, the benefits and challenges of the proposed concepts are tested in two forensic contexts: (1) ink identification and (2) ink evidential value assessment. The results show that different algorithms are better suited for different tasks. This research shows that it is possible to build digital ink libraries using the most commonly used ink analytical technique, i.e. high-performance thin layer chromatography, despite its reputation of lacking reproducibility. More importantly, it is possible to assign evidential value to ink evidence in a transparent way using a probabilistic model. It is therefore possible to move away from the traditional subjective approach, which is entirely based on experts' opinion, and which is usually not very informative. While there is room for the improvement, this report demonstrates the significant gains obtained over the traditional subjective approach for the search of ink specimens in ink databases, and the interpretation of their evidential value.

Demonstration and Field Evaluation of Alternative Portland Cement Concrete Pavement Reinforcement Materials, HR-1069, 2003

Transverse joints are placed in portland cement concrete pavements to control the development of random cracking due to stresses induced by moisture and thermal gradients and restrained slab movement. These joints are strengthened through the use of load transfer devices, typically dowel bars, designed to transfer load across the joint from one pavement slab to the next. Epoxy coated steel bars are the materials of choice at the present time, but have experienced some difficulties with resistance to corrosion from deicing salts. The research project investigated the use of alternative materials, dowel size and spacing to determine the benefits and limitations of each material. In this project two types of fiber composite materials, stainless steel solid dowels and epoxy coated dowels were tested for five years in side by side installation in a portion of U.S. 65 near Des Moines, Iowa, between 1997 and 2002. The work was directed at analyzing the load transfer characteristics of 8-in. vs. 12-in. spacing of the dowels and the alternative dowel materials, fiber composite (1.5- and 1.88-in. diameter) and stainless steel (1.5-in. diameter), compared to typical 1.5-in. diameter epoxy-coated steel dowels placed on 12-in. spacing. Data were collected biannually within each series of joints and variables in terms of load transfer in each lane (outer wheel path), visual distress, joint openings, and faulting in each wheel path. After five years of performance the following observations were made from the data collected. Each of the dowel materials is performing equally in terms of load transfer, joint movement and faulting. Stainless steel dowels are providing load transfer performance equal to or greater than epoxy-coated steel dowels at the end of five years. Fiber reinforced polymer (FRP) dowels of the sizes and materials tested should be spaced no greater than 8 in. apart to achieve comparable performance to epoxy coated dowels. No evidence of deterioration due to road salts was identified on any of the products tested. The relatively high cost of stainless steel solid and FRP dowels was a limitation at the time of this study conclusion. Work is continuing with the subject materials in laboratory studies to determine the proper shape, spacing, chemical composition and testing specification to make the FRP and stainless (clad or solid) dowels a viable alternative joint load transfer material for long lasting portland cement concrete pavements.

Design Guide for Improved Quality of Roadway Subgrades and Subbases, TR-525, 2008

The performance of a pavement depends on the quality of its subgrade and subbase layers; these foundational layers play a key role in mitigating the effects of climate and the stresses generated by traffic. Therefore, building a stable subgrade and a properly drained subbase is vital for constructing an effective and long lasting pavement system. This manual has been developed to help Iowa highway engineers improve the design, construction, and testing of a pavement system’s subgrade and subbase layers, thereby extending pavement life. The manual synthesizes current and previous research conducted in Iowa and other states into a practical geotechnical design guide [proposed as Chapter 6 of the Statewide Urban Design and Specifications (SUDAS) Design Manual] and construction specifications (proposed as Section 2010 of the SUDAS Standard Specifications) for subgrades and subbases. Topics covered include the important characteristics of Iowa soils, the key parameters and field properties of optimum foundations, embankment construction, geotechnical treatments, drainage systems, and field testing tools, among others.

Changes in running mechanics and spring-mass behaviour during a 5-km time trial.

Research into the biomechanical manifestation of fatigue during exhaustive runs is increasingly popular but additional understanding of the adaptation of the spring-mass behaviour during the course of strenuous, self-paced exercises continues to be a challenge in order to develop optimized training and injury prevention programs. This study investigated continuous changes in running mechanics and spring-mass behaviour during a 5-km run. 12 competitive triathletes performed a 5-km running time trial (mean performance: ̴17 min 30 s) on a 200 m indoor track. Vertical and anterior-posterior ground reaction forces were measured every 200 m by a 5-m long force platform system, and used to determine spring-mass model characteristics. After a fast start, running velocity progressively decreased (- 11.6%; P<0.001) in the middle part of the race before an end spurt in the final 400-600 m. Stride length (- 7.4%; P<0.001) and frequency (- 4.1%; P=0.001) decreased over the 25 laps, while contact time (+ 8.9%; P<0.001) and total stride duration (+ 4.1%; P<0.001) progressively lengthened. Peak vertical forces (- 2.0%; P<0.01) and leg compression (- 4.3%; P<0.05), but not centre of mass vertical displacement (+ 3.2%; P>0.05), decreased with time. As a result, vertical stiffness decreased (- 6.0%; P<0.001) during the run, whereas leg stiffness changes were not significant (+ 1.3%; P>0.05). Spring-mass behaviour progressively changes during a 5-km time trial towards deteriorated vertical stiffness, which alters impact and force production characteristics.

Iowa Strategy for Homeland Security and Emergency Management 2015-2017, October 1, 2014

Address sustainability in all efforts. Sustainability should be at the core of all levels of homeland security and emergency management effort in Iowa. Capabilities need to be built for the long term, and without a sustainability plan in place, projects can quickly deplete uncertain levels of funding. Utilize an all-hazards methodology. Developing capabilities that are effective during a variety of disaster and emergency scenarios represents sound planning and resource management. Enhance capabilities through joint planning, training and exercise. Effective capabilities developed through coordinated planning efforts and an ongoing joint training and exercising program to ensure substantiate of prepared response. Utilize a collaborative approach to build capability. We will utilize whatever partnerships are necessary to build capability in the most effective manner possible. Regional partnerships have been, and will continue to be, in the forefront of the State of Iowa’s efforts to build and enhance capability. Enhance statewide capabilities. Whenever possible, we will identify and augment existing resources to provide statewide capability during a disaster or terrorist attack. Awareness, outreach and education. Open communication is critical to the success of any initiative. All projects implemented will have awareness, education and outreach components to ensure that all stakeholders are informed as to their responsibilities, capabilities and access. Information sharing and a common operating picture. The timely exchange of critical/actionable information is imperative to the success of every operation. The identification of a common operating picture allows decision makers to make informed decisions based on a unified understanding of the events around them.

Comparison of Roadway Roughness Derived from LIDAR and SFM 3D Point Clouds, HR-3001, 2015

This report describes a short-term study undertaken to investigate the potential for using dense three-dimensional (3D) point clouds generated from light detection and ranging (LIDAR) and photogrammetry to assess roadway roughness. Spatially continuous roughness maps have potential for the identification of localized roughness features, which would be a significant improvement over traditional profiling methods. This report specifically illustrates the use of terrestrial laser scanning (TLS) and photogrammetry using a process known as structure from motion (SFM) to acquire point clouds and illustrates the use of these point clouds in evaluating road roughness. Five roadway sections were chosen for scanning and testing: three gravel road sections, one portland cement concrete (PCC) section, and one asphalt concrete (AC) section. To compare clouds obtained from terrestrial laser scanning and photogrammetry, the coordinates of the clouds for the same section on the same date were matched using open source computer code. The research indicates that the technologies described are very promising for evaluating road roughness. The major advantage of both technologies is the large amount of data collected, which allows the evaluation of the full surface. Additional research is needed to further develop the use of dense 3D point clouds for roadway assessment.

Health consultation : Des Moines (Ex) Ordnance Site Landfill and Lagoon Complex Prairie Trail Development Site [Ankeny] (2012)

The Prairie Trail Development Area is located in the southern portion of Ankeny, Iowa. This development area is located in an area that was formally occupied by the Des Moines Ordnance Plant. The Des Moines Ordnance Plant was constructed for the production and testing of small arms munitions for use during World War II. The Landfill and Lagoon Complex was utilized for disposal of wastes from the ordnance plant and also from various entities that utilized the site property until 1991. The United States Environmental Protection Agency (EPA) is verseeing the cleanup of the Landfill and Lagoon Complex. A portion of the remainder of the site property had been used for burning of scrap explosives, the storage and disposal of chemicals, a disposal pond, testing of products, and various munitions manufacturing activities. The Iowa Department of Natural Resources (IDNR) is overseeing the cleanup of this remaining portion of the site property. The Iowa Department of Public Health has been contacted by residents within the Prairie Trail Development Area and by individuals that have an interest in relocating to the Prairie Trail Development Area. These residents are concerned with any environmental contamination that will be left after site remedial activities are completed. These residents want to know if any remaining environmental contamination will adversely impact their health or the health of their families.