986 resultados para Thérapies alternatives


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Iowa's public road system of 112,000 miles is one of the largest and the best in the nation. It represents a considerable financial investment of taxpayer revenues over the years. And, it requires a sustained investment to preserve an economical level of transport service into the future. In 1982, a Governor's Blue Ribbon Transportation Task Force evaluated the effectiveness of Iowa's entire transportation system. Four important Task Force recommendations dealt with public road administrative issues in Iowa. These issues were related to: 1. design criteria and levels of maintenance 2. consistency in the use of standards among jurisdictions 3. consolidation of maintenance operations at one jurisdictional level and 4. jurisdictional authority for roads. The issues formed the background for Research Project HR-265.

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Recent reports have indicated that 23.5% of the nation's highway bridges are structurally deficient and 17.7% are functionally obsolete. A significant number of these bridges are on the Iowa secondary road system where over 86% of the rural bridge management responsibilities are assigned to the counties. Some of the bridges can be strengthened or otherwise rehabilitated, but many more are in need of immediate replacement. In a recent investigation (HR-365 "Evaluation of Bridge Replacement Alternatives for the County Bridge System") several types of replacement bridges that are currently being used on low volume roads were identified. It was also determined that a large number of counties (69%) have the ability and are interested in utilizing their own forces to design and construct short span bridges. After reviewing the results from HR-365, the research team developed one "new" bridge replacement concept and a modification of a replacement system currently being used. Both of these bridge replacement alternatives were investigated in this study, the results of which are presented in two volumes. This volume (Volume 2) presents the results of Concept 2 - Modification of the Beam-in-Slab Bridge. Concept 1 - Steel Beam Precast Units is presented in Volume 1. Concept 2 involves various laboratory tests of the Beam-in-Slab bridge (BISB) currently being used by Benton County and several other Iowa counties. In this investigation, the behavior and strength of the BISB were determined; a new method of obtaining composite action between the steel beams and concrete was also tested. Since the Concept 2 bridge is primarily intended for use on low-volume roads, the system can be constructed with new or used beams. In the experimental part of the investigation, there were three types of laboratory tests: push-out tests, service and ultimate load tests of models of the BISB, and composite beam tests utilizing the newly developed shear connection. In addition to the laboratory tests, there was a field test in which an existing BISB was service load tested. An equation was developed for predicting the strength of the shear connection investigated; in addition, a finite element model for analyzing the BISB was also developed. Push-out tests were completed to determine the strength of the recently developed shear connector. A total of 36 specimens were tested, with variables such as hole diameter, hole spacing, presence of reinforcement, etc. being investigated. In the model tests of the BISB, two and four beam specimens [L=9,140 mm (30 ft)] were service load tested for behavior and load distribution data. Upon completion of these tests, both specimens were loaded to failure. In the composite beam tests, four beams, one with standard shear studs and three using the shear connection developed, were tested. Upon completion of the service load tests, all four beams were loaded to failure. The strength and behavior of the beams with the new shear connection were found to be essentially the same as that of the specimen with standard shear studs.

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Independence, respect, and equality are values important to all people. These values help define the concepts of autonomy (independence and freedom) and self-determination (the right to make decisions for one’s self). Because these rights are so valued in our society and are something that most of us would value for ourselves, the “least restrictive alternative” should always be considered before taking away a person’s civil and legal rights to make decisions for him or herself. The least restrictive alternative is an option, which allows a person to keep as much autonomy, and self-determination as possible while providing only the level of protection and supervision that is necessary. Some examples may include: representative payee for certain government benefit checks, joint bank accounts or advance directives for health care.

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This project continues the research which addresses the numerous bridge problems on the Iowa secondary road system. It is a continuation (Phase 2) of Project HR-382, in which two replacement alternatives (Concept 1: Steel Beam Precast Units and Concept 2: Modification of the Benton County Beam-in-Slab Bridge) were investigated. In previous research for concept 1, a precast unit bridge was developed through laboratory testing. The steel-beam precast unit bridge requires the fabrication of precast double-tee (PCDT) units, each consisting of two steel beams connected by a reinforced concrete deck. The weight of each PCDT unit is minimized by limiting the deck thickness to 4 in., which permits the units to be constructed off-site and then transported to the bridge site. The number of units required is a function of the width of bridge desired. Once the PCDT units are connected, a cast-in-place reinforced concrete deck is cast over the PCDT units and the bridge railing attached. Since the steel beam PCDT unit bridge design is intended primarily for use on low-volume roads, used steel beams can be utilized for a significant cost savings. In previous research for concept 2, an alternate shear connector (ASC) was developed and subjected to static loading. In this investigation, the ASC was subjected to cyclic loading in both pushout specimens and composite beam tests. Based on these tests, the fatigue strength of the ASC was determined to be significantly greater than that required in typical low volume road single span bridges. Based upon the construction and service load testing, the steel-beam precast unit bridge was successfully shown to be a viable low volume road bridge alternative. The construction process utilized standard methods resulting in a simple system that can be completed with a limited staff. Results from the service load tests indicated adequate strength for all legal loads. An inspection of the bridge one year after its construction revealed no change in the bridge's performance. Each of the systems previously described are relatively easy to construct. Use of the ASC rather than the welded studs significantly simplified the work, equipment, and materials required to develop composite action between the steel beams and the concrete deck.

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The goals of this project were to implement several stabilization methods for preventing or mitigating freeze-thaw damage to granular surfaced roads and identify the most effective and economical methods for the soil and climate conditions of Iowa. Several methods and technologies identified as potentially suitable for Iowa were selected from an extensive analysis of existing literature provided with Iowa Highway Research Board (IHRB) Project TR-632. Using the selected methods, demonstration sections were constructed in Hamilton County on a heavily traveled two-mile section of granular surfaced road that required frequent maintenance during previous thawing periods. Construction procedures and costs of the demonstration sections were documented, and subsequent maintenance requirements were tabulated through two seasonal freeze-thaw periods. Extensive laboratory and field tests were performed prior to construction, as well as before and after the two seasonal freeze-thaw periods, to monitor the performance of the demonstration sections. A weather station was installed at the project site and temperature sensors were embedded in the subgrade to monitor ground temperatures up to a depth of 5 ft and determine the duration and depths of ground freezing and thawing. An economic analysis was performed using the documented construction and maintenance costs, and the estimated cumulative costs per square yard were projected over a 20-year timeframe to determine break-even periods relative to the cost of continuing current maintenance practices. Overall, the sections with biaxial geogrid or macadam base courses had the best observed freeze-thaw performance in this study. These two stabilization methods have larger initial costs and longer break-even periods than aggregate columns, but counties should also weigh the benefits of improved ride quality and savings that these solutions can provide as excellent foundations for future paving or surface upgrades.

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Restrenyiment i teràpies alternatives i complementàries és la base de la intervenció en persones grans, sent el grup de població amb més incidència de patir restrenyiment. En elles s’hi atribueixen factors de risc força recurrents: immobilitat, polifarmàcia, dieta pobra en fibra, ingesta hídrica inadequada, etc. L’objectiu de la realització del treball és millorar el restrenyiment a través de l’aplicació de les teràpies alternatives i complementàries en persones grans institucionalitzades per tal d’aconseguir una millora del problema de salut i de la qualitat de vida mitjançant un tractament no farmacològic. El/la professional d’infermeria durà a terme la intervenció a partir d’un canvi en la dieta de la persona gran tot augment el seu contingut en fibra, potenciant la ingesta hídrica, l’aplicació de la fitoteràpia, la recomanació de la reflexologia podal, incrementar l’activitat física i la realització de tècniques de relaxació i de massatges abdominals per disminuir l’angoixa que aquest problema de salut genera a la persona i millorar el dolor abdominal que li comporta. El pla de cures d’infermeria es desenvoluparà en 12 setmanes consecutives en les quals s’aplicaran i s’avaluaran les diferents teràpies naturals de forma setmanal per poder observar l’evolució de la persona respecte a les activitats programades. Per últim, esmentar que durant tot el treball s’ha contrastat l’evidència científica de diversos autors especialitzats en el restrenyiment i en les teràpies alternatives i complementàries. La cerca de tota la informació s’ha realitzat a partir de diverses bases de dades tot aplicant els criteris d’inclusió i exclusió que m’han permès l’obtenció d’articles, llibres, guies i protocols vàlids per utilitzar-los i plasmar-los en el treball.

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The most important recent advance in the treatment of neovascular age-related macular degeneration (AMD) is the development of antivascular endothelial growth factor (anti-VEGF) therapeutic agents that preserve and improve visual acuity by arresting choroidal neovascular growth and reducing vascular permeability. Two anti-VEGF agents, ranibizumab and pegaptanib sodium, are currently approved by Swissmedic for the treatment of neovascular AMD. A third anti-VEGF agent, bevacizumab, is currently used as an off label treatment option for exsudative AMD. Other anti-VEGF agent strategies that have shown efficacy include among others, small interfering RNA agents to silence the VEGF gene and receptor and the fusion protein VEGF trap. Anti-VEGF therapies have been used successfully in the clinic, encouraging their use in the treatment of other neovascular and exudative eye diseases.

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The competitiveness comparison is carried out for merely electricity producing alternatives. In Finland, further construction of CHP (combined heat and power) power plants will continue and cover part of the future power supply deficit, but also new condensing power plant capacity will be needed. The following types of power plants are studied: - nuclear power plant, - coal-fired condensing power plant - combined cycle gas turbine plant, - peat-fired condensing power plant. - wood-fired condensing power plant - wind power plant The calculations have been made using the annuity method with a real interest rate of 5 % perannum and with a fixed price level as of March 2003. With the annual full load utilization time of 8000 hours the nuclear electricity would cost 23,7 ¤/MWh, the gas based electricity 32,3 ¤/MWh and coal based electricity 28,1 ¤/MWh. If the influence of emission trading is taken into account,the advantage of the nuclear power will still be improved. Inorder to study the impact of changes in the input data, a sensitivity analysis has been carried out. It reveals that the advantage of the nuclear power is quite clear. E.g. the nuclear electricity is rather insensitive tothe changes of the uranium price, whereas for natural gas alternative the rising trend of gas price causes the greatest risk.

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El present treball proposa l’addició d’un 10% de sal al pinso d’engreix d’11 vedells de la raça Parda de Montaña, com a sistema per limitar-ne el consum sense haver de fer ús de mà d’obra complementària ni de sistemes mecanitzats que en controlin la quantitat de consum. Aquest % de sal, pretén aconseguir una reducció en la palatabilitat del pinso de consum dels animals, aconseguint així uns menors valors d’ingestió de concentrat per un major consum de farratge. Aquesta relació quantitativa té com a objectiu, aconseguir la introducció d’aquests animals en el marc de la producció ecològica, que estableix una ràtio de consum de farratge vs concentrat de 60 : 40. El grup d’11 vedells, prèviament esmentat, és comparat amb una altre grup, també d’11 vedells i de la mateixa raça i edat, que són alimentats amb el mateix fenc d’alfals, però amb pinso convencional i no amb el complementat amb sal

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Le cancer de la vessie est le deuxième cancer urologique le plus fréquent dans le monde. La plupart des patients (75%) sont initialement diagnostiqués avec un cancer non musculo- invasif. Après résection trans-urétrale, ie traitement standard pour ce type de lésion chez les patients présentant un risque important de récidive/progression consiste en une série d'instillations intravésicales du Bacille de Calmette-Guerin (i.e. le vaccin BCG). Cependant cette "BCG thérapie" est associée à des effets secondaires non négligeables et s'avère inefficace dans 30% des cas, des limitations donc importantes qui soulignent la nécessité de développer des stratégies thérapeutiques alternatives. L'utilisation d'antigènes associés aux tumeurs (TAA) comme vaccin, combinée à une application locale d'immunostimulants sur le site tumoral, est une approche prometteuse en vue de maximiser les réponses immunitaires anti-tumorales localement. Nous montrons que la bactérie vivante atténuée Ty21a, issue du vaccin Vivotif® contre la fièvre typhoïde, peut être utilisée comme immunostimulant intravésical (IVES), mais ce uniquement dans le cas où la bactérie est en phase exponentielle de croissance (Vivotif exp). En effet, l'instillation IVES de Vivotif exp à la suite d'une vaccination par un TAA, un antigène mineur d'histocompatibilité mâle H-Y (Uty), permet d'augmenter de 15 fois le nombre de cellules T CD8 totales et spécifiques de l'antigène dans la vessie. Le recrutement des cellules T est TLR4-dépendent, ce qui suggère un rôle des lipopolysaccharides du Vivotif exp. Par ailleurs, en comparaison avec le contenu bactérien de la capsule de Vivotif, les bactéries en phase exponentielle de croissance permettent également une augmentation préférentielle des chemokines C5/C5a, CXCL1, CXCL2 et CXCL5 dans la vessie, mais pas du nombre de cellules T exprimant les récepteurs apparentés (C5aR et CXCR2). De plus, combiner la vaccination Uty avec le Vivotif exp en IVES permet d'améliorer la survie des souris présentant une tumeur orthotopique de la vessie exprimant l'antigène Uty (lignée tumorale murine MB49). Puisque pour certains cancers, aucun TAA - du moins exprimé à tous les stades tumoraux - n'est identifié, il est nécessaire de développer d'autres approches non vaccinales. Dans une deuxième partie de ce travail de thèse, nous avons donc investigué deux stratégies permettant d'induire une destruction des cellules tumorales, la thérapie génique par gène de suicide, d'une part, et la thérapie photodynamique dans le proche infrarouge (NIR-PDT), d'autre part. Pour appliquer ces thérapies, nous avons utilisé comme vecteur sûr et non toxique une forme non réplicative du virus du « Human Papillomavirus » (HPV) capable de "pseudo-infecter" préférentiellement les souris présentant des tumeurs vésicales (MB49). L'utilisation de pseudovirions (PsV) HPV portant comme gène suicide la thymidine kinase, une enzyme du virus de l'herpès simplex, suivi d'un traitement par la prodrogue Ganciclovir, permet de tuer 90% des cellules MB49 in-vitro ainsi que de ralentir significativement le développement des tumeurs vésicales in-vivo. Par ailleurs, l'emploi de particules pseudo- virales HPV couplées à la phtalocyanine IR700, un pigment photosensible présentant un pouvoir cytotoxique une fois activé, permet de tuer, après application d'une lumière dans le proche infrarouge, quasi 100% des cellules MB49 in-vitro et, plus important, de régresser des tumeurs in-vivo. De façon générale, ce travail de thèse présente des approches thérapeutiques innovantes et prometteuses pour le traitement des patients avec un cancer non musculo-invasif de la vessie. -- Bladder cancer is the second most common urological malignancy in the world. At initial diagnosis, non-muscle invasive bladder cancer (NMIBC) accounts for 75% of bladder cancer. The standard of care of NMIBC consists of intravesical (IVES) treatments with Bacillus- Calmette-Guerin (BCG) following transurethral resections of the lesions. However, repeated BCG treatments are associated with significant side effects and treatment failure may occur in 30% of the cases, underlying the necessity of alternative therapeutic strategies. The use of tumor-associated antigens (TAA) as vaccines followed by the local application of immunostimulants where the tumor resides is a promising approach to increase anti-tumor immune responses locally. We show that live attenuated Ty21a bacteria used from the vivotif® vaccine against typhoid fever can efficiently be used as IVES immunostimulant, only if bacteria are grown to exponential phase (Vivotif exp). In this condition, IVES immunostimulation after TAA vaccination with a minor histocompatibility male antigen HY (Uty) resulted in more than 15-fold increase of both vaccine-specific and total CD8-T cells in the bladder. T cell recruitment was mediated by TLR-4 suggesting that it was mainly mediated by lipopolysaccharides of Vivotif exp. In addition, these bacteria, as compared to the bacterial content of the vivotif capsule preferentially increased C5/C5a, CXCL1, CXCL2 and CXCL5 chemokines, but not the numbers of T cells expressing the cognate receptors (C5aR and CXCR2). Combination of IVES Vivotif exp with Uty vaccination improved survival of mice with pre-established orthotopic Uty-expressing MB49 murine bladder tumors, as compared to vaccination alone. As known TAA are not identified in all cancers, or not expressed in all stages of the tumor, we further investigated two potent approaches able of initiating tumor-cell destruction, suicide-gene therapy and near-infrared (NIR) photodynamic therapy (PDT). Towards a safe and non-toxic application of these therapies, we used Human Papillomavirus (HPV) replication-defective vectors that were able to preferentially pseudo-infect MB49-tumor bearing mice. HPV pseudovirions (PsV) carrying the Herpex-Simplex virus thymidine kinase suicide-gene followed by treatment with the prodrug Ganciclovir resulted in 90% of MB49 cell-death in-vitro and was able to significantly reduce bladder tumor growth in-vivo. Furthermore, HPV virus-like particles coupled to a NIR phtalocyanine dye, IR700 in combination with specific NIR light led to almost 100% of MB49 cell-death in-vitro and more interestingly, to bladder tumors shrinkage in-vivo. Overall, in this thesis, we offer promising therapeutic approaches for application in NMIBC patients.