Indicateurs sécurité en obstétrique : une étude Delphi [Patient safety indicators for obstetrics: a Delphi based study]

OBJECTIVE: Clinical indicators are increasingly used to assess safety of patient care. In obstetrics, only a few indicators have been validated to date and none is used across specialties. The purpose of this study was to identify and assess for face and content validity a group of safety indicators that could be used by anaesthetists, obstetricians and neonatologists involved in labour and delivery units. MATERIALS AND METHODS: We first conducted a systematic review of the literature to identify potential measures. Indicators were then validated by a panel of 30 experts representing all specialties working in labour and delivery units. We used the Delphi method, an iterative questionnaire-based consensus seeking technique. Experts determined on a 7-point Likert scale (1=most representative/7=less representative) the soundness of each indicator as a measure of safety and their possible association with errors and complications caused by medical management. RESULTS: We identified 44 potential clinical indicators from the literature. Following the Delphi process, 13 indicators were considered as highly representative of safety during obstetrical care (mean score</=2.3). Experts ranked 6 of these indicators as being strongly associated to potential errors and complications. CONCLUSIONS: We identified and validated for face and content, a group of six clinical indicators to measure potentially preventable iatrogenic complications in labour and delivery units.

CLIL Materials in Chemistry and English: Iodometric Titrations

Content and Language Integrated Learning (CLIL)Materials in Chemistry and English following the principles of CLIL / Content-based Instruction and Task-based Learning

Artificial-Intelligence-Based Optimization of the Management of Snow Removal Assets and Resources Final Report, October 2002

Geographic information systems (GIS) and artificial intelligence (AI) techniques were used to develop an intelligent snow removal asset management system (SRAMS). The system has been evaluated through a case study examining snow removal from the roads in Black Hawk County, Iowa, for which the Iowa Department of Transportation (Iowa DOT) is responsible. The SRAMS is comprised of an expert system that contains the logical rules and expertise of the Iowa DOT’s snow removal experts in Black Hawk County, and a geographic information system to access and manage road data. The system is implemented on a mid-range PC by integrating MapObjects 2.1 (a GIS package), Visual Rule Studio 2.2 (an AI shell), and Visual Basic 6.0 (a programming tool). The system could efficiently be used to generate prioritized snowplowing routes in visual format, to optimize the allocation of assets for plowing, and to track materials (e.g., salt and sand). A test of the system reveals an improvement in snowplowing time by 1.9 percent for moderate snowfall and 9.7 percent for snowstorm conditions over the current manual system.

MRI-based prostate brachytherapy seed localization.

A magnetic resonance imaging (MRI) pulse sequence and a corresponding image processing algorithm to localize prostate brachytherapy seeds during or after therapy are presented. Inversion-Recovery with ON-resonant water suppression (IRON) is an MRI methodology that generates positive contrast in regions of magnetic field susceptibility, as created by prostate brachytherapy seeds. Phantoms comprising of several materials found in brachytherapy seeds were created to assess the usability of the IRON pulse sequence for imaging seeds. Resulting images show that seed materials are clearly visible with high contrast using IRON, agreeing with theoretical predictions. A seed localization algorithm to process IRON images demonstrates the potential of this imaging technique for seed localization and dosimetry.

MEPDG Work Plan Task No. 5: Characterization of Unbound Materials (Soils/Aggregates) for Mechanistic-Empirical Pavement Design Guide, 2009

The resilient modulus (MR) input parameters in the Mechanistic-Empirical Pavement Design Guide (MEPDG) program have a significant effect on the projected pavement performance. The MEPDG program uses three different levels of inputs depending on the desired level of accuracy. The primary objective of this research was to develop a laboratory testing program utilizing the Iowa DOT servo-hydraulic machine system for evaluating typical Iowa unbound materials and to establish a database of input values for MEPDG analysis. This was achieved by carrying out a detailed laboratory testing program designed in accordance with the AASHTO T307 resilient modulus test protocol using common Iowa unbound materials. The program included laboratory tests to characterize basic physical properties of the unbound materials, specimen preparation and repeated load triaxial tests to determine the resilient modulus. The MEPDG resilient modulus input parameter library for Iowa typical unbound pavement materials was established from the repeated load triaxial MR test results. This library includes the non-linear, stress-dependent resilient modulus model coefficients values for level 1 analysis, the unbound material properties values correlated to resilient modulus for level 2 analysis, and the typical resilient modulus values for level 3 analysis. The resilient modulus input parameters library can be utilized when designing low volume roads in the absence of any basic soil testing. Based on the results of this study, the use of level 2 analysis for MEPDG resilient modulus input is recommended since the repeated load triaxial test for level 1 analysis is complicated, time consuming, expensive, and requires sophisticated equipment and skilled operators.

New insight on bio-sensing by nano-fabricated memristors

We report here on a new insight for bio- sensing based on the memristive effect of functional- ized Schottky-barrier memristive silicon nanowire in dry environment. The device concept is discussed. Elec- trical measurements confirm the bio-detection by the narrowing of the memristive Ids − Vds hysteresis upon interaction of antigen with antibody-functionalized nanowire.

GIS-based debris flow source and runout susceptibility assessment from DEM data - a case study in NW Nicaragua

In October 1998, Hurricane Mitch triggered numerous landslides (mainly debris flows) in Honduras and Nicaragua, resulting in a high death toll and in considerable damage to property. The potential application of relatively simple and affordable spatial prediction models for landslide hazard mapping in developing countries was studied. Our attention was focused on a region in NW Nicaragua, one of the most severely hit places during the Mitch event. A landslide map was obtained at 1:10 000 scale in a Geographic Information System (GIS) environment from the interpretation of aerial photographs and detailed field work. In this map the terrain failure zones were distinguished from the areas within the reach of the mobilized materials. A Digital Elevation Model (DEM) with 20 m×20 m of pixel size was also employed in the study area. A comparative analysis of the terrain failures caused by Hurricane Mitch and a selection of 4 terrain factors extracted from the DEM which, contributed to the terrain instability, was carried out. Land propensity to failure was determined with the aid of a bivariate analysis and GIS tools in a terrain failure susceptibility map. In order to estimate the areas that could be affected by the path or deposition of the mobilized materials, we considered the fact that under intense rainfall events debris flows tend to travel long distances following the maximum slope and merging with the drainage network. Using the TauDEM extension for ArcGIS software we generated automatically flow lines following the maximum slope in the DEM starting from the areas prone to failure in the terrain failure susceptibility map. The areas crossed by the flow lines from each terrain failure susceptibility class correspond to the runout susceptibility classes represented in a runout susceptibility map. The study of terrain failure and runout susceptibility enabled us to obtain a spatial prediction for landslides, which could contribute to landslide risk mitigation.

Permeability of Granular Subbase Materials, MLR-90-4, 1991

The purpose of this research was to evaluate the materials Iowa uses as a granular subbase and to determine if it provides adequate drainage. Numerous laboratory and in-situ tests were conducted on the materials currently being used in Iowa. The follow conclusions can be made based on the test results: 1. The crushed concrete that is used as a subbase material has a relatively low permeability compared to many other materials used by other states. 2. Further research and tests are needed to find the necessary parameters for crushed concrete to make sure it is providing its optimum drainage and preventing premature damage of the pavement. 3. We have definitely made improvements in drainage in the past few months, but there are many areas that we can improve on that will increase the permeability of this material and insure that the pavement system is safe from premature damage due to water. The current gradation specification for granular subbase material at the start of this study was: Sieve # % Passing 1” 100 #8 10-35 #50 0-15 #200 0-6

CLIL Materials in Chemistry and English: Iodometric Titrations

Content and Language Integrated Learning (CLIL)Materials in Chemistry and English following the principles of CLIL / Content-based Instruction and Task-based Learning

Minimum VMA in HMA Based on Gradation and Volumetric Properties, MLR-95-7, 1996

The use of voids in the mineral aggregate (VMA) criteria for proper mix design of hot mix asphalt (HMA) mixtures is a time honored and fairly successful tool. Recent developments in the field of asphalt mix design have encouraged the use of mixtures with a coarse aggregate structure to resist the affect of heavy traffic loads. By using the equations presented, which account for both aggregate gradation and the volumetric properties of the materials, the mix designer is able to judge the proper VMA requirement for each unique blend of materials. By applying the new equations, the most economical mix may be selected without great risk of reduced durability. Supporting data from field application is presented to illustrate the use of the equations.

Performance Based Specifications, TR-403, 1998

The goal in highway construction and operation has shifted from method based specifications to specifications relating desired performance attributes to materials, mix designs, and construction methods. Shifting from method specifications to performance based specifications can work as an incentive or disincentive for the contractor to improve performance or extend pavement life. This literature search was directed at a review of existing portland cement concrete performance specification development, and the criteria that can effectively measure pavement performance. The criteria identified in the literature include concrete strength, slab thickness, air content, initial smoothness, water-cement ratio, unit weight, and slump. A description of each criterion, along with the advantages, disadvantages, and test methods for each are identified. Also included are the results from a survey that was sent out to various state, federal, and trade agencies. The responses indicated that 53% currently use or are developing a performance based specification program. Of the 47% of agencies that do not use a performance based specification program, over 34% indicated that they would consider a similar program. The most commonly measured characteristics include thickness, strength, smoothness, and air content. Lastly recommendations and conclusions are made regarding other factors that affect pavement performance and a proposed second phase of the research is suggested. The research team suggests that a regional expert task group be formed to identify performance levels and criteria. The results of that effort will guide the research team in the development of new or revised specifications.

Correlation of Locally-Based Performance of Asphalts with their Physicochemical Parameters, Task 1 Report, HR-298, 1988

This is the first report of 6 tasks to be performed in an effort to establish locally-based quality and performance criteria for asphalts, and ultimately to develop performance-related specifications based on simple physicochemical methods. Three of the most promising chemical methods (high performance liquid chromatography (HPLC), thermal analysis, and X-ray diffraction were selected to analyze 4 different types of samples. The results will indicate the fundamental asphalt property variables that directly affect the field performance in Iowa. The details of the materials and procedures employed are described, and the results of the tests are presented.

Histopathological evaluation of root canal filling materials for primary teeth

This study aimed to assess the response of apical and periapical tissues of dogs¿ teeth after root canal filling with different materials. Forty roots from dogs¿ premolars were prepared biomechanically and assigned to 4 groups filled with: Group I: commercial calcium hydroxide and polyethylene glycol-based paste (Calen®) thickened with zinc oxide; Group II: paste composed of iodoform, Rifocort® and camphorated amonochlorophenol; Group III: zinc oxide-eugenol cement; Group IV: sterile saline. After 30 days, the samples were subjected to histological processing. The histopathological findings revealed that in Groups I and IV the apical and periapical regions exhibited normal appearance, with large number of fibers and cells and no resorption of mineralized tissues. In Group II, mild inflammatory infiltrate and mild edema were observed, with discrete fibrogenesis and bone resorption. Group III showed altered periapical region and thickened periodontal ligament with presence of inflammatory cells and edema. It may be concluded that the Calen paste thickened with zinc oxide yielded the best tissue response, being the most indicated material for root canal filling of primary teeth with pulp vitality.

Minimal analytical characterization of engineered nanomaterials needed for hazard assessment in biological matrices.

Abstract This paper presents the outcomes from a workshop of the European Network on the Health and Environmental Impact of Nanomaterials (NanoImpactNet). During the workshop, 45 experts in the field of safety assessment of engineered nanomaterials addressed the need to systematically study sets of engineered nanomaterials with specific metrics to generate a data set which would allow the establishment of dose-response relations. The group concluded that international cooperation and worldwide standardization of terminology, reference materials and protocols are needed to make progress in establishing lists of essential metrics. High quality data necessitates the development of harmonized study approaches and adequate reporting of data. Priority metrics can only be based on well-characterized dose-response relations derived from the systematic study of the bio-kinetics and bio-interactions of nanomaterials at both organism and (sub)-cellular levels. In addition, increased effort is needed to develop and validate analytical methods to determine these metrics in a complex matrix.

Pharmacogenetics-based population pharmacokinetic analysis of etravirine in HIV-1 infected individuals.

OBJECTIVES: Etravirine (ETV) is metabolized by cytochrome P450 (CYP) 3A, 2C9, and 2C19. Metabolites are glucuronidated by uridine diphosphate glucuronosyltransferases (UGT). To identify the potential impact of genetic and non-genetic factors involved in ETV metabolism, we carried out a two-step pharmacogenetics-based population pharmacokinetic study in HIV-1 infected individuals. MATERIALS AND METHODS: The study population included 144 individuals contributing 289 ETV plasma concentrations and four individuals contributing 23 ETV plasma concentrations collected in a rich sampling design. Genetic variants [n=125 single-nucleotide polymorphisms (SNPs)] in 34 genes with a predicted role in ETV metabolism were selected. A first step population pharmacokinetic model included non-genetic and known genetic factors (seven SNPs in CYP2C, one SNP in CYP3A5) as covariates. Post-hoc individual ETV clearance (CL) was used in a second (discovery) step, in which the effect of the remaining 98 SNPs in CYP3A, P450 cytochrome oxidoreductase (POR), nuclear receptor genes, and UGTs was investigated. RESULTS: A one-compartment model with zero-order absorption best characterized ETV pharmacokinetics. The average ETV CL was 41 (l/h) (CV 51.1%), the volume of distribution was 1325 l, and the mean absorption time was 1.2 h. The administration of darunavir/ritonavir or tenofovir was the only non-genetic covariate influencing ETV CL significantly, resulting in a 40% [95% confidence interval (CI): 13-69%] and a 42% (95% CI: 17-68%) increase in ETV CL, respectively. Carriers of rs4244285 (CYP2C19*2) had 23% (8-38%) lower ETV CL. Co-administered antiretroviral agents and genetic factors explained 16% of the variance in ETV concentrations. None of the SNPs in the discovery step influenced ETV CL. CONCLUSION: ETV concentrations are highly variable, and co-administered antiretroviral agents and genetic factors explained only a modest part of the interindividual variability in ETV elimination. Opposing effects of interacting drugs effectively abrogate genetic influences on ETV CL, and vice-versa.