Postoperative delirium. Part 2: detection, prevention and treatment.

To target pharmacological prevention, instruments giving an approximation of an individual patient's risk of developing postoperative delirium are available. In view of the variable clinical presentation, identifying patients in whom prophylaxis has failed (that is, who develop delirium) remains a challenge. Several bedside instruments are available for the routine ward and ICU setting. Several have been shown to have a high specificity and sensitivity when compared with the standard definitions according to DSM-IV-TR and ICD-10. The Confusion Assessment Method (CAM) and a version specifically developed for the intensive care setting (CAM-ICU) have emerged as a standard. However, alternatives allowing grading of the severity of delirium are also available. In many units, the approach to delirium follows a three-step strategy. Initially, non-pharmacological multicomponent strategies are used for primary prevention. As a second step, pharmacological prophylaxis may be added. Perioperative administration of haloperidol has been shown to reduce the severity, but not the incidence, of delirium. Perioperative administration of atypical antipsychotics has been shown to reduce the incidence of delirium in specific groups of patients. In patients with delirium, both symptomatic and causal treatment of delirium need to be considered. So far symptomatic treatment of delirium is primarily based on antipsychotics. Currently, cholinesterase inhibitors cannot be recommended and the data on dexmedetomidine are inconclusive. With the exception of alcohol-withdrawal delirium, there is no role for benzodiazepines in the treatment of delirium. It is unclear whether treating delirium prevents long-term sequelae.

Developing a Simple and Rapid Test for Monitoring the Heat Evolution of Concrete Mixtures for Both Laboratory and Field Applications, January 2006

Various test methods exist for measuring heat of cement hydration; however, most current methods require expensive equipment, complex testing procedures, and/or extensive time, thus not being suitable for field application. The objectives of this research are to identify, develop, and evaluate a standard test procedure for characterization and quality control of pavement concrete mixtures using a calorimetry technique. This research project has three phases. Phase I was designed to identify the user needs, including performance requirements and precision and bias limits, and to synthesize existing test methods for monitoring the heat of hydration, including device types, configurations, test procedures, measurements, advantages, disadvantages, applications, and accuracy. Phase II was designed to conduct experimental work to evaluate the calorimetry equipment recommended from the Phase I study and to develop a standard test procedure for using the equipment and interpreting the test results. Phase II also includes the development of models and computer programs for prediction of concrete pavement performance based on the characteristics of heat evolution curves. Phase III was designed to study for further development of a much simpler, inexpensive calorimeter for field concrete. In this report, the results from the Phase I study are presented, the plan for the Phase II study is described, and the recommendations for Phase III study are outlined. Phase I has been completed through three major activities: (1) collecting input and advice from the members of the project Technical Working Group (TWG), (2) conducting a literature survey, and (3) performing trials at the CP Tech Center’s research lab. The research results indicate that in addition to predicting maturity/strength, concrete heat evolution test results can also be used for (1) forecasting concrete setting time, (2) specifying curing period, (3) estimating risk of thermal cracking, (4) assessing pavement sawing/finishing time, (5) characterizing cement features, (6) identifying incompatibility of cementitious materials, (7) verifying concrete mix proportions, and (8) selecting materials and/or mix designs for given environmental conditions. Besides concrete materials and mix proportions, the configuration of the calorimeter device, sample size, mixing procedure, and testing environment (temperature) also have significant influences on features of concrete heat evolution process. The research team has found that although various calorimeter tests have been conducted for assorted purposes and the potential uses of calorimeter tests are clear, there is no consensus on how to utilize the heat evolution curves to characterize concrete materials and how to effectively relate the characteristics of heat evolution curves to concrete pavement performance. The goal of the Phase II study is to close these gaps.

Boson-boson mixtures and triplet correlations

The hypernetted-chain formalism for boson-boson mixtures described by an extended Jastrow correlated wave function is derived, taking into account elementary diagrams and triplet correlations. The energy of an ideal boson 3He-4He mixture is computed for low values of the 3He concentration. The zero-3He-concentration limit provides a 3He chemical potential in good agreement with the experimental value, when a McMillan two-body correlation factor and the Lennard-Jones potential are adopted. If the Euler equations for the two-body correlation factors are solved in presence of triplet correlations, the agreement is again improved. At the experimental 4He equilibrium density, the 3He chemical potential turns out to be -2.58 K, to be compared with the experimental value, -2.79 K.

Molecular dynamics study of the longitudinal modes in disparate-mass binaryliquid mixtures.

A series of molecular dynamics simulations of simple liquid binary mixtures of soft spheres with disparate-mass particles were carried out to investigate the origin of the marked differences between the dynamic structure factors of some liquid binary mixtures such as the Li0.7Mg0.3 and Li0.8Pb0.2 alloys. It is shown that the facility for observing peaks associated with fast-propagating modes in the partial Li-Li dynamic structure factor of Li0.8Pb0.2 should be mainly attributed to the structure of this alloy, which is characterized by an incipient ABAB ordering as found in molten salts. The longitudinal dispersion relations at intermediate wave vectors obtained from the longitudinal current spectra are very similar for the two alloys and reflect the existence of both fast-and slow-propagating modes of kinetic character associated with light and heavy particles, respectively. The influence of the hardness of the repulsive potential cores as well as the composition of the mixture on the longitudinal collective modes is also discussed.

Task 4: Testing Iowa Portland Cement Concrete Mixtures for the AASHTO Mechanistic-Empirical Pavement Design Procedure, May 2008

The present research project was designed to identify the typical Iowa material input values that are required by the Mechanistic-Empirical Pavement Design Guide (MEPDG) for the Level 3 concrete pavement design. It was also designed to investigate the existing equations that might be used to predict Iowa pavement concrete for the Level 2 pavement design. In this project, over 20,000 data were collected from the Iowa Department of Transportation (DOT) and other sources. These data, most of which were concrete compressive strength, slump, air content, and unit weight data, were synthesized and their statistical parameters (such as the mean values and standard variations) were analyzed. Based on the analyses, the typical input values of Iowa pavement concrete, such as 28-day compressive strength (f’c), splitting tensile strength (fsp), elastic modulus (Ec), and modulus of rupture (MOR), were evaluated. The study indicates that the 28-day MOR of Iowa concrete is 646 + 51 psi, very close to the MEPDG default value (650 psi). The 28-day Ec of Iowa concrete (based only on two available data of the Iowa Curling and Warping project) is 4.82 + 0.28x106 psi, which is quite different from the MEPDG default value (3.93 x106 psi); therefore, the researchers recommend re-evaluating after more Iowa test data become available. The drying shrinkage (εc) of a typical Iowa concrete (C-3WR-C20 mix) was tested at Concrete Technology Laboratory (CTL). The test results show that the ultimate shrinkage of the concrete is about 454 microstrain and the time for the concrete to reach 50% of ultimate shrinkage is at 32 days; both of these values are very close to the MEPDG default values. The comparison of the Iowa test data and the MEPDG default values, as well as the recommendations on the input values to be used in MEPDG for Iowa PCC pavement design, are summarized in Table 20 of this report. The available equations for predicting the above-mentioned concrete properties were also assembled. The validity of these equations for Iowa concrete materials was examined. Multiple-parameters nonlinear regression analyses, along with the artificial neural network (ANN) method, were employed to investigate the relationships among Iowa concrete material properties and to modify the existing equations so as to be suitable for Iowa concrete materials. However, due to lack of necessary data sets, the relationships between Iowa concrete properties were established based on the limited data from CP Tech Center’s projects and ISU classes only. The researchers suggest that the resulting relationships be used by Iowa pavement design engineers as references only. The present study furthermore indicates that appropriately documenting concrete properties, including flexural strength, elastic modulus, and information on concrete mix design, is essential for updating the typical Iowa material input values and providing rational prediction equations for concrete pavement design in the future.

Quality Control/Quality Assurance Testing for Joint Density and Segregation of Asphalt Mixtures, TR-623, 2013

Longitudinal joint quality control/assurance is essential to the successful performance of asphalt pavements and it has received considerable amount of attention in recent years. The purpose of the study is to evaluate the level of compaction at the longitudinal joint and determine the effect of segregation on the longitudinal joint performance. Five paving projects with the use of traditional butt joint, infrared joint heater, edge restraint by milling and modified butt joint with the hot pinch longitudinal joint construction techniques were selected in this study. For each project, field density and permeability tests were made and cores from the pavement were obtained for in-lab permeability, air void and indirect tensile strength. Asphalt content and gradations were also obtained to determine the joint segregation. In general, this study finds that the minimum required joint density should be around 90.0% of the theoretical maximum density based on the AASHTO T166 method. The restrained-edge by milling and butt joint with the infrared heat treatment construction methods both create the joint density higher than this 90.0% limit. Traditional butt joint exhibits lower density and higher permeability than the criterion. In addition, all of the projects appear to have segregation at the longitudinal joint except for the edge-restraint by milling method.

Development of Performance Properties of Ternary Mixtures and Concrete Pavement Mixture Design and Analysis (MDA): Effect of Paste Quality on Fresh and Hardened Properties of Ternary Mixtures, TPF-5(117), 2012

The purpose of this study was to investigate the effect of cement paste quality on the concrete performance, particularly fresh properties, by changing the water-to-cementitious materials ratio (w/cm), type and dosage of supplementary cementitious materials (SCM), and airvoid system in binary and ternary mixtures. In this experimental program, a total matrix of 54 mixtures with w/cm of 0.40 and 0.45; target air content of 2%, 4%, and 8%; a fixed cementitious content of 600 pounds per cubic yard (pcy), and the incorporation of three types of SCMs at different dosages was prepared. The fine aggregate-to- total aggregate ratio was fixed at 0.42. Workability, rheology, air-void system, setting time, strength, Wenner Probe surface resistivity, and shrinkage were determined. The effects of paste variables on workability are more marked at the higher w/cm. The compressive strength is strongly influenced by the paste quality, dominated by w/cm and air content. Surface resistivity is improved by inclusion of Class F fly ash and slag cement, especially at later ages. Ternary mixtures performed in accordance with their ingredients. The data collected will be used to develop models that will be part of an innovative mix proportioning procedure.

Timing of primary growth harvest affects the yield and nutritive value of timothy-red clover mixtures

Selostus: Ensimmäisen sadon korjuuaika vaikuttaa timotein ja puna-apilan seosnurmen satoon ja rehuarvoon

A Laboratory Evaluation of Asphaltic Concrete Containing Asphadur, MLR-78-2, 1978

This report describes a laboratory evaluation of three asphaltic concrete, plant produced mixtures containing Asphadur. The mixtures represent a type A asphaltic concrete and two type B asphaltic concretes. The type A and one of the type B mixtures were used in pavements and will be evaluated later for durability and serviceability. The second type B mixture was made only for laboratory testing. In each instance, control batches of the same mixtures but without Asphadur were made for comparison. Type A is a high type asphaltic concrete, requires a minimum of 65 percent crushed particles and is generally used for higher traffic volume roads. Type B is used for intermediate or lower traffic volumes and requires a minimum of 30 percent crushed particles.

Evaluation of Asphalt Mix Permeability, MLR-90-2, 1992

Efforts to eliminate rutting on the Interstate system have resulted in 3/4 in. aggregate mixes, with 75 blow Marshall, 85% crushed aggregate mix designs. On a few of these projects paved in 1988-1989, water has appeared on the surfaces. Some conclusions have been reached by visual on-sight investigations that the water is coming from surface water, rain and melting snow gaining entry into the surface asphalt mixture, then coming back out in selected areas. Cores were taken from several Interstate projects and tested for permeability to investigate the surface water theory that supposedly happens with only the 3/4 in. mixtures. All cores were of asphalt overlays over portland cement concrete, except for the Clarke County project which is full depth AC. The testing consisted of densities, permeabilities, voids by high pressure airmeter (HPAM), extraction, gradations, AC content, and film thicknesses. Resilient modulus, indirect tensile and retained strengths after freeze/thaw were also done. All of the test results are about as expected. Permeabilities, the main reason for testing, ranged from 0.00 to 2.67 ft per day and averages less than 1/2 ft per day if the following two tests are disregarded. One test on each binder course came out to 15.24 ft/day, and a surface course at 13.78 ft/day but these are not out of supposedly problem projects.

Evaluation of Limestone Filler in Gravel Mixtures "Asphaltic Concrete", R-228, 1968

This study was designed to provide background information on asphaltic concrete mixtures peculiar to northwest Iowa. This background is necessary to provide the basis for future specifications. There were several projects let in 1967 involving l", 3/4" and 3/8" mixes of Type "B'' asphaltic concrete which specified in part, II Not less than 40% of the material passing the No. 200 sieve shall be pulverized limestone or mineral filler, but in no case shall the per cent of pulverized limestone or mineral filler passing the No. 200 sieve be less than 2%. No credit will be allowed for limestone in gravel - II Northwest Iowa has no suitable limestone or mineral filler locally available. As a result, this material has to be imported, raising the cost of the mix approximately twenty-five cents per ton. The purpose of this study, therefore, was designed to compare some original job mix samples with alternate mixes from the same local material, but without the addition of pulverized limestone or mineral filler. Since the filler from the crushed gravel does not have the same crushing characteristics or sieve analysis as the pulverized limestone or mineral filler, they could not be compared on an equal percentage basis. Therefore, the alternate mixes were made to conform to the following proposed specification, "No less than 40% of the material passing No. 200 sieve shall be pulverized limestone or mineral filler or a 100% crushed gravel, but in no case shall the per cent of pulverized limestone or mineral filler or a 100% crushed gravel passing the No. 200 sieve be less than 2%."

Bonded, Thin-Lift, Non-Reinforced Portland Cement Concrete Resurfacing, MLR-77-2, 1977

A research project involving 2, 3, 4, and 5 in. (5.1, 7.6, 10.2, and 12.7 cm) of bonded portland cement concrete (PCC) overlay on a 1.3 mile (2.1 km) PCC pavement was conducted in Clayton County, Iowa, during September 1977, centering on the following objectives: (1) Determine the mixing and proportioning procedures required in using a conventional, central mix proportioning plant to produce a dense PCC mixture using standard mixes with super water reducing admixtures; (2) Determine the economics, longevity and maintenance performance of a bonded, thin-lift, non-reinforced PCC resurfacing course using conventional procedures, equipment and concrete paving mixtures both with and without super water reducing admixtures; and (3) Determine if an adequate bond between the existing pavement and an overlay of thin-lift, dense, non-reinforced PCC can be obtained with only special surface cleaning and no surface removal or grinding. The conclusions are as follows: (1) Normal mixing equipment and proportioning procedures could be used using a conventional central-mix proportioning plant. This was successful when used with super water reducing admixtures. Only minor changes need be made in procedures and timing. (2) The time has been too short since the completion of the project to determine how the new pavement will perform, however, initially it appears that the method is economical and no reason is seen at this time why the life of the pavement should not be comparable to an all new pavement. (3) The initial test results show that bond strength, regardless of which method of cleaning is used, scarifying, sand blasting or water blasting, far exceed what is considered the minimum bond strength of 200 psi (1379 kPa) except where the paint stripes were intentionally left, thus showing that the paint must be removed. (4) It appears that either cement and water grout or sand, cement and water grout may be used and still obtain the required bond.

Determination of Asphalt Content and Characteristics of Bituminous Paving Mixtures, MLR-88-11, 1988

Due to the hazardous nature of chemical asphalt extraction agents, nuclear gauges have become an increasingly popular method of determining the asphalt content of a bituminous mix. This report details the results of comparisons made between intended, tank stick, extracted, and nuclear asphalt content determinations. A total of 315 sets of comparisons were made on samples that represented 110 individual mix designs and 99 paving projects. All samples were taken from 1987 construction projects. In addition to the comparisons made, seventeen asphalt cement samples were recovered for determination of penetration and viscosity. Results were compared to similar tests performed on the asphalt assurance samples in an attempt to determine the amount of asphalt hardening that can be expected due to the hot mix process. Conclusions of the report are: 1. Compared to the reflux extraction procedure, nuclear asphalt content gauges determine asphalt content of bituminous mixes with much greater accuracy and comparable precision. 2. As a means for determining asphalt content, the nuclear procedure should be used as an alternate to chemical extractions whenever possible. 3. Based on penetration and viscosity results, softer grade asphalts undergo a greater degree 'of hardening due to hot mix processing than do harder grades, and asphalt viscosity changes caused by the mixing process are subject to much more variability than are changes in penetration. 4. Based on changes in penetration and viscosity, the Thin Film Oven Test provides a reasonable means of estimating how much asphalt hardening can be anticipated due to exposure to the hot mix processing environment.

Evaluation of a multicomponent worksite health promotion program for cardiovascular risk factors-correcting for the regression towards the mean effect.

BACKGROUND: We assessed the impact of a multicomponent worksite health promotion program for0 reducing cardiovascular risk factors (CVRF) with short intervention, adjusting for regression towards the mean (RTM) affecting such nonexperimental study without control group. METHODS: A cohort of 4,198 workers (aged 42 +/- 10 years, range 16-76 years, 27% women) were analyzed at 3.7-year interval and stratified by each CVRF risk category (low/medium/high blood pressure [BP], total cholesterol [TC], body mass index [BMI], and smoking) with RTM and secular trend adjustments. Intervention consisted of 15 min CVRF screening and individualized counseling by health professionals to medium- and high-risk individuals, with eventual physician referral. RESULTS: High-risk groups participants improved diastolic BP (-3.4 mm Hg [95%CI: -5.1, -1.7]) in 190 hypertensive patients, TC (-0.58 mmol/l [-0.71, -0.44]) in 693 hypercholesterolemic patients, and smoking (-3.1 cig/day [-3.9, -2.3]) in 808 smokers, while systolic BP changes reflected RTM. Low-risk individuals without counseling deteriorated TC and BMI. Body weight increased uniformly in all risk groups (+0.35 kg/year). CONCLUSIONS: In real-world conditions, short intervention program participants in high-risk groups for diastolic BP, TC, and smoking improved their CVRF, whereas low-risk TC and BMI groups deteriorated. Future programs may include specific advises to low-risk groups to maintain a favorable CVRF profile.

Cross talk between 2,4-diacetylphloroglucinol-producing biocontrol pseudomonads on wheat roots.

The performance of Pseudomonas biocontrol agents may be improved by applying mixtures of strains which are complementary in their capacity to suppress plant diseases. Here, we have chosen the combination of Pseudomonas fluorescens CHA0 with another well-characterized biocontrol agent, P. fluorescens Q2-87, as a model to study how these strains affect each other's expression of a biocontrol trait. In both strains, production of the antimicrobial compound 2,4-diacetylphloroglucinol (DAPG) is a crucial factor contributing to the suppression of root diseases. DAPG acts as a signaling compound inducing the expression of its own biosynthetic genes. Experimental setups were developed to investigate whether, when combining strains CHA0 and Q2-87, DAPG excreted by one strain may influence expression of DAPG-biosynthetic genes in the other strain in vitro and on the roots of wheat. DAPG production was monitored by observing the expression of lacZ fused to the biosynthetic gene phlA of the respective strain. Dual-culture assays in which the two strains were grown in liquid medium physically separated by a membrane revealed that Q2-87 but not its DAPG-negative mutant Q2-87::Tn5-1 strongly induced phlA expression in a DeltaphlA mutant of strain CHA0. In the same way, phlA expression in a Q2-87 background was induced by DAPG produced by CHA0. When coinoculated onto the roots of wheat seedlings grown under gnotobiotic conditions, strains Q2-87 and CHA0, but not their respective DAPG-negative mutants, were able to enhance phlA expression in each other. In summary, we have established that two nonrelated pseudomonads may stimulate each other in the expression of an antimicrobial compound important for biocontrol. This interpopulation communication occurs in the rhizosphere, i.e., at the site of pathogen inhibition, and is mediated by the antimicrobial compound itself acting as a signal exchanged between the two pseudomonads.