Prevalence and costs of multinutrution in hospitalized patients; the PREDyCES study

Justificación y objetivos: El estudio PREDyCES® tuvo dos objetivos principales. Primero, analizar la prevalencia de desnutrición hospitalaria (DH) en España tanto al ingreso como al alta, y segundo, estimar sus costes asociados. Métodos: Estudio nacional, transversal, observacional, multicéntrico, en condiciones de práctica clínica habitual que evaluó la presencia de desnutrición hospitalaria al ingreso y al alta mediante el NRS-2002®. Una extensión del estudio analizó la incidencia de complicaciones asociadas a la desnutrición, el exceso de estancia hospitalaria y los costes sanitarios asociados a la DH. Resultados: La prevalencia de desnutrición observada según el NRS-2002® fue del 23.7%. El análisis multivariante mostró que la edad, el género, la presencia de enfermedad oncológica, diabetes mellitus, disfagia y la polimedicación fueron los factores principales que se asociaron a la presencia de desnutrición. La DH se asoció a un incremento de la estancia hospitalaria, especialmente en aquellos pacientes que ingresaron sin desnutrición y que presentaron desnutrición al alta (15.2 vs 8.0 días; p < 0.001), con un coste adicional asociado de 5.829€ por paciente. Conclusiones: Uno de cada cuatro pacientes en los hospitales españoles se encuentra desnutrido. Esta condición se asocia a un exceso de estancia hospitalaria y costes asociados, especialmente en pacientes que se desnutren durante su hospitalización. Se debería generalizar el cribado nutricional sistemático con el objetivo de implementar intervenciones nutricionales de conocida eficacia.

Performance of Various Thicknesses of Portland Cement Concrete, HR-9, 30 Year Report, 1981

If adequately designed and high quality material and good construction practices are used, portland cement concrete is very durable. This is demonstrated by the oldest pavement in Iowa (second oldest in the U.S.) paved in 1904, which performed well for 70 years without resurfacing. The design thickness is an important factor in both the performance and cost of pavement. The objective of this paper is to provide a 30-year performance evaluation of a pavement constructed to determine the required design thickness for low volume secondary roadways. In 1951 Greene County and the Iowa Highway Research Board of the Iowa Department of Transportation initiated a four-mile (6.4 km) demonstration project to evaluate thicknesses ranging from 4-1/2" (11.4 cm) to 6" (15.2 cm). The project, consisting of 10 research sections, was formed pavement placed on a gravel roadbed with very little preparation except for redistribution of the loose aggregate. Eight sections were non-reinforced except for centerline tie bars and no contraction joints were used. Mesh reinforcing and contraction joints spaced at 29' 7" (9.02 m) intervals were used in two 4-1/2" (11.4 cm) thick sections. The only air entrained section was non-reinforced. The pavement performed well over its 30-year life carrying a light volume of traffic and did not require major maintenance. There was substantial cracking with average slab length varying directly with thickness. The 4-1/2" (11.4 cm) thick non-air entrained, mesh-reinforced pavement with contraction joints has performed the best.

Populations with elevated mutation load do not benefit from the operation of sexual selection.

Theory predicts that if most mutations are deleterious to both overall fitness and condition-dependent traits affecting mating success, sexual selection will purge mutation load and increase nonsexual fitness. We explored this possibility with populations of mutagenized Drosophila melanogaster exhibiting elevated levels of deleterious variation and evolving in the presence or absence of male-male competition and female choice. After 60 generations of experimental evolution, monogamous populations exhibited higher total reproductive output than polygamous populations. Parental environment also affected fitness measures - flies that evolved in the presence of sexual conflict showed reduced nonsexual fitness when their parents experienced a polygamous environment, indicating trans-generational effects of male harassment and highlighting the importance of a common garden design. This cost of parental promiscuity was nearly absent in monogamous lines, providing evidence for the evolution of reduced sexual antagonism. There was no overall difference in egg-to-adult viability between selection regimes. If mutation load was reduced by the action of sexual selection in this experiment, the resultant gain in fitness was not sufficient to overcome the costs of sexual antagonism.

Evaluation of Recycled Rubber in Asphalt Cement Concrete - Field Testing, Final Report for HR-330, 330A, 330B, 330C, 330D, 2002

Roughly 242 million used tires are generated annually in the United States. Many of these tires end up being landfilled or stockpiled. The stockpiles are unsightly, unsanitary, and also collect water which creates the perfect breeding ground for mosquitoes, some of which carry disease. In an effort to reduce the number of used tire stockpiles the federal government mandated the use of recycled rubber in federally funded, state implemented department of transportation (DOT) projects. This mandate required the use of recycled rubber in 5% of the asphalt cement concrete (ACC) tonnage used in federally funded projects in 1994, increasing that amount by 5% each year until 20% was reached, and remaining at 20% thereafter. The mandate was removed as part of the appropriations process in 1994, after the projects in this research had been completed. This report covers five separate projects that were constructed by the Iowa Department Of Transportation (DOT) in 1991 and 1992. These projects had all had some form of rubber incorporated into their construction and were evaluated for 5 years. The conclusion of the study is that the pavements with tire rubber added performed essentially the same as conventional ACC pavement. An exception was the use of rubber chips in a surface lift. This performed better at crack control and worse with friction values than conventional ACC. The cost of the pavement with rubber additive was significantly higher. As a result, the benefits do not outweigh the costs of using this recycled rubber process in pavements in Iowa.

The underestimation of compliance to direct help requests explained by adaptive sampling

Helping behavior is any intentional behavior that benefits another living being or group (Hogg & Vaughan, 2010). People tend to underestimate the probability that others will comply with their direct requests for help (Flynn & Lake, 2008). This implies that when they need help, they will assess the probability of getting it (De Paulo, 1982, cited in Flynn & Lake, 2008) and then they will tend to estimate one that is actually lower than the real chance, so they may not even consider worth asking for it. Existing explanations for this phenomenon attribute it to a mistaken cost computation by the help seeker, who will emphasize the instrumental cost of “saying yes”, ignoring that the potential helper also needs to take into account the social cost of saying “no”. And the truth is that, especially in face-to-face interactions, the discomfort caused by refusing to help can be very high. In short, help seekers tend to fail to realize that it might be more costly to refuse to comply with a help request rather than accepting. A similar effect has been observed when estimating trustworthiness of people. Fetchenhauer and Dunning (2010) showed that people also tend to underestimate it. This bias is reduced when, instead of asymmetric feedback (getting feedback only when deciding to trust the other person), symmetric feedback (always given) was provided. This cause could as well be applicable to help seeking as people only receive feedback when they actually make their request but not otherwise. Fazio, Shook, and Eiser (2004) studied something that could be reinforcing these outcomes: Learning asymmetries. By means of a computer game called BeanFest, they showed that people learn better about negatively valenced objects (beans in this case) than about positively valenced ones. This learning asymmetry esteemed from “information gain being contingent on approach behavior” (p. 293), which could be identified with what Fetchenhauer and Dunning mention as ‘asymmetric feedback’, and hence also with help requests. Fazio et al. also found a generalization asymmetry in favor of negative attitudes versus positive ones. They attributed it to a negativity bias that “weights resemblance to a known negative more heavily than resemblance to a positive” (p. 300). Applied to help seeking scenarios, this would mean that when facing an unknown situation, people would tend to generalize and infer that is more likely that they get a negative rather than a positive outcome from it, so, along with what it was said before, people will be more inclined to think that they will get a “no” when requesting help. Denrell and Le Mens (2011) present a different perspective when trying to explain judgment biases in general. They deviate from the classical inappropriate information processing (depicted among other by Fiske & Taylor, 2007, and Tversky & Kahneman, 1974) and explain this in terms of ‘adaptive sampling’. Adaptive sampling is a sampling mechanism in which the selection of sample items is conditioned by the values of the variable of interest previously observed (Thompson, 2011). Sampling adaptively allows individuals to safeguard themselves from experiences they went through once and turned out to lay negative outcomes. However, it also prevents them from giving a second chance to those experiences to get an updated outcome that could maybe turn into a positive one, a more positive one, or just one that regresses to the mean, whatever direction that implies. That, as Denrell and Le Mens (2011) explained, makes sense: If you go to a restaurant, and you did not like the food, you do not choose that restaurant again. This is what we think could be happening when asking for help: When we get a “no”, we stop asking. And here, we want to provide a complementary explanation for the underestimation of the probability that others comply with our direct help requests based on adaptive sampling. First, we will develop and explain a model that represents the theory. Later on, we will test it empirically by means of experiments, and will elaborate on the analysis of its results.

Iowa DOT Evaluation of the PASCO Road Survey System, HR-539, 1987

The report compares and contrasts the automated PASCO method of pavement evaluation to the manual procedures used by the Iowa Department of Transportation (DOT) to evaluate pavement condition. Iowa DOT's use of IJK and BPR roadmeters and manual crack and patch surveys are compared to PASCO's use of 35-mm photography, artificial lighting and hairline projection, tracking wheels and lasers to measure ride, cracking and patching, rut depths, and roughness. The Iowa DOT method provides a Present Serviceability Index (PSI) value and PASCO provides a Maintenance Control Index (MCI). Seven sections of Interstate Highway, county roads and city streets, and one shoulder section were tested with different speeds of data collection, surface types and textures, and stop and start conditions. High correlation of results between the two methods in the measurement of roughness (0.93 for the tracking wheel and 0.84 for the laser method) were recorded. Rut depth correlations of 0.61 and cracking of 0.32 are attributed to PASCO's more comprehensive measurement techniques. A cost analysis of the data provided by both systems indicates that PASCO is capable of providing a comparable result with improved accuracy at a cost of $125-$150 or less per two-lane mile depending on survey mileage. Improved data collection speed, accuracy, and reliability, and a visible record of pavement condition for comparable costs are available. The PASCO system's ability to provide the data required in the Highway Pavement Distress Identification Manual, the Pavement Condition Rating Guide, and the Strategic Highway Research Program Long Term Pavement Performance (LTPP) Studies, is also outlined in the report.

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.

Evaluation of DuroTrim Vegetation Control Mats, HR-2090, 2002

The routine maintenance along Iowa's highways and roadways during the summer growing season is a time consuming and costly endeavor. Trimming around guardrail posts and delineator posts is especially costly due to the handwork required. Trimming costs account for approximately 50% of the shoulder mowing costs according to expense figures obtained from the Iowa Department of Transportation (DOT), Office of Maintenance. The FY 2001 statewide trimming costs for the Iowa DOT was approximately $430,000 ($305,000 labor, $125,000 equipment and materials). This product would be required to perform well for 9-21 years, on average, in order to recoup the cost of installation. This includes the durability of the product, but not the cost of repair due to traffic damage, snowplow and wing damage, or damage caused by mowing operations. Maintenance costs associated with vegetation creep over the mats and repair costs would extend the required service life. As a result of resource realignment, the Iowa DOT roadside maintenance policy, for FY 2003 and the future, will be to eliminate trimming around delineator posts unless the reflector is obstructed. This policy change will effectively eliminate the need for weed control mats due to the significant reduction in trimming. The use of the weed control mats could be justified in areas that are dangerous to maintenance workers such as guardrail installations in high traffic areas. Because the delineator posts are further from the edge of the traveled roadway, there is a reduced risk to the maintenance workforce while hand trimming. Because the DuroTrim Vegetation Control Mats appear to have performed adequately in the field trial, they could be considered for use, where safety conditions warrant. That use should be limited, however, due to the considerable initial cost and changes in Iowa DOT roadside maintenance policy. Application should be limited to instances where the use of the DuroTrim Vegetation Control Mats would have a significant impact on the safety of the roadside maintenance workers. The cost savings, due to the elimination of the trimming and mowing alone, is not enough to justify their use in most situations at their current cost. The test sections will continue to be monitored periodically so that approximate service life can be determined.

Field Evaluation of Electro-Reflective Measuring Apparatus (ERMA), MLR-81-01, 1981

The Electro-Reflective Measuring Apparatus (ERMA) was developed by the Minnesota Department of Highways in 1974 to measure the retro-reflective characteristics of pavement marking materials. Minnesota researchers recommended that due to the increased cost of pavement marking materials and reduced availability of these materials, ERMA can and should be used as a maintenance management tool to determine when painting is necessary rather than according to a fixed time schedule. The Iowa DOT Office of Materials built an ERMA device patterned after Minnesota's design in 1976. Subsequent efforts to calibrate and correlate this ERMA device to District Paint Foremen ratings proved unsuccessful, and ERMA modification or abandonment was recommended in 1979. Lyman Moothart, Materials Lab. Tech. 4, modified the ERMA device in 1980 and correlation attempts to District Paint Foremen ratings conducted in November 1980 have been moderately successful. A Paint/No Paint ERMA value has been established which will identify about 90% of the painting needs but will also include about 40% of the marking lines not needing repainting. The Office of Maintenance should establish a trial ERMA program to study the accuracy and potential cost savings of using ERMA to identify pavement marking needs.

Performance of Reinforcement Fabric Used Under Asphaltic Concrete Overlays, MLR-83-03, 1983

The 1982 cost of a two-inch asphaltic concrete overlay, with fabric, was an average of 85% of the cost of a three-inch overlay (see attached calculations). A structural number can be assigned to the extra inch of overlay, whereas it is doubtful that any number can be assigned to the fabric. The observations made on the projects in this report leave little reason to be optimistic on the use of fabrics under asphalt overlays. This is especially true of the Floyd, Dallas and Clarke county projects. A great amount of fabric is being used nationwide for this purpose, probably more from sales promotion than from actual documented performance. Full scale field testing is continuing each time a project is let utilizing fabric reinforcement under asphaltic concrete overlays. It has already become apparent that the use of fabrics in AC overlays is not always cost effective.

Randomized controlled study demonstrating failure of LPV/r monotherapy in HIV: the role of compartment and CD4-nadir.

BACKGROUND: Long-term side-effects and cost of HIV treatment motivate the development of simplified maintenance. Monotherapy with ritonavir-boosted lopinavir (LPV/r-MT) is the most widely studied strategy. However, efficacy of LPV/r-MT in compartments remains to be shown. METHODS: Randomized controlled open-label trial comparing LPV/r-MT with continued treatment for 48 weeks in treated patients with fully suppressed viral load. The primary endpoint was treatment failure in the central nervous system [cerebrospinal fluid (CSF)] and/or genital tract. Treatment failure in blood was defined as two consecutive HIV RNA levels more than 400 copies/ml. RESULTS: The trial was prematurely stopped when six patients on monotherapy (none in continued treatment-arm) demonstrated a viral failure in blood. At study termination, 60 patients were included, 29 randomized to monotherapy and 13 additional patients switched from continued treatment to monotherapy after 48 weeks. All failures occurred in patients with a nadir CD4 cell count below 200/microl and within the first 24 weeks of monotherapy. Among failing patients, all five patients with a lumbar puncture had an elevated HIV RNA load in CSF and four of six had neurological symptoms. Viral load was fully resuppressed in all failing patients after resumption of the original combination therapy. No drug resistant virus was found. The only predictor of failure was low nadir CD4 cell count (P < 0.02). CONCLUSION: Maintenance of HIV therapy with LPV/r alone should not be recommended as a standard strategy; particularly not in patients with a CD4 cell count nadir less than 200/microl. Further studies are warranted to elucidate the role of the central nervous system compartment in monotherapy-failure.

Reuse of Lime Sludge from Water Softening and Coal Combustion Byproducts, TR-459, 2004

Disposal of lime sludge remains a major challenge to cities in the Midwest. Disposal of lime sludge from water softening adds about 7-10% to the cost of water treatment. Having effective and safe options is essential for future compliance with the regulations of the State of Iowa and within budget restrictions. Dewatering and drying are essential to all reuse applications as this affects transportation costs and utility. Feasibility tests were conducted on some promising applications like SOx control in power generation facilities that burn coal, replacement of limestone as an ingredient in portland cement production, dust control on gravel roads, neutralization of industrial wastewater pH, and combination with fly ash or cement in construction fill applications. A detailed report and analysis of the construction fills application is presented in the second half of the report. A brief discussion of the results directly follows.

Field and Laboratory Evaluation of Precast Concrete Bridges, TR-440, 2001

Recent data compiled by the National Bridge Inventory revealed 29% of Iowa's approximate 24,600 bridges were either structurally deficient or functionally obsolete. This large number of deficient bridges and the high cost of needed repairs create unique problems for Iowa and many other states. The research objective of this project was to determine the load capacity of a particular type of deteriorating bridge – the precast concrete deck bridge – which is commonly found on Iowa's secondary roads. The number of these precast concrete structures requiring load postings and/or replacement can be significantly reduced if the deteriorated structures are found to have adequate load capacity or can be reliably evaluated. Approximately 600 precast concrete deck bridges (PCDBs) exist in Iowa. A typical PCDB span is 19 to 36 ft long and consists of eight to ten simply supported precast panels. Bolts and either a pipe shear key or a grouted shear key are used to join adjacent panels. The panels resemble a steel channel in cross-section; the web is orientated horizontally and forms the roadway deck and the legs act as shallow beams. The primary longitudinal reinforcing steel bundled in each of the legs frequently corrodes and causes longitudinal cracks in the concrete and spalling. The research team performed service load tests on four deteriorated PCDBs; two with shear keys in place and two without. Conventional strain gages were used to measure strains in both the steel and concrete, and transducers were used to measure vertical deflections. Based on the field results, it was determined that these bridges have sufficient lateral load distribution and adequate strength when shear keys are properly installed between adjacent panels. The measured lateral load distribution factors are larger than AASHTO values when shear keys were not installed. Since some of the reinforcement had hooks, deterioration of the reinforcement has a minimal affect on the service level performance of the bridges when there is minimal loss of cross-sectional area. Laboratory tests were performed on the PCDB panels obtained from three bridge replacement projects. Twelve deteriorated panels were loaded to failure in a four point bending arrangement. Although the panels had significant deflections prior to failure, the experimental capacity of eleven panels exceeded the theoretical capacity. Experimental capacity of the twelfth panel, an extremely distressed panel, was only slightly below the theoretical capacity. Service tests and an ultimate strength test were performed on a laboratory bridge model consisting of four joined panels to determine the effect of various shear connection configurations. These data were used to validate a PCDB finite element model that can provide more accurate live load distribution factors for use in rating calculations. Finally, a strengthening system was developed and tested for use in situations where one or more panels of an existing PCDB need strengthening.

Evidence of energy sparing in Gambian women during pregnancy: a longitudinal study using whole-body calorimetry.

Components of daily energy expenditure were measured serially by whole-body calorimetry in Gambian women before pregnancy and at 6, 12, 18, 24, 30, and 36 wk gestation. Weight gain was (mean +/- SD) 6.8 +/- 2.8 kg, fat deposition was 2.0 +/- 2.5 kg and lean tissue deposition was 5.0 +/- 2.5 kg. Basal metabolic rate (BMR) was depressed during the first 18 wk of gestation, causing total cumulative maintenance costs by week 36 to be 8.4 MJ. Individual responses to pregnancy correlated with changes in body mass (36 wk: delta BMR vs delta weight; r = 0.60, P < 0.01 delta BMR vs delta LBM; r = 0.62, P < 0.01). There was no significant increase in the cost of treadmill exercise (0% slope: F = 0.71, P = 0.64; 5% slope: F = 1.97, P = 0.10), 24-h energy expenditure (F = 0.72, P = 0.64), activity or diet-induced thermogenesis (F = 1.02, P = 0.43), during pregnancy in spite of body weight gain. Total metabolic costs over 36 wk were 144 MJ (fetus 43 MJ, fat deposition 92 MJ, cumulative maintenance costs 8.4 MJ). These were far lower than reported for well-nourished Western populations.

Improvement of walking speed prediction by accelerometry and altimetry, validated by satellite positioning.

Activity monitors based on accelerometry are used to predict the speed and energy cost of walking at 0% slope, but not at other inclinations. Parallel measurements of body accelerations and altitude variation were studied to determine whether walking speed prediction could be improved. Fourteen subjects walked twice along a 1.3 km circuit with substantial slope variations (-17% to +17%). The parameters recorded were body acceleration using a uni-axial accelerometer, altitude variation using differential barometry, and walking speed using satellite positioning (DGPS). Linear regressions were calculated between acceleration and walking speed, and between acceleration/altitude and walking speed. These predictive models, calculated using the data from the first circuit run, were used to predict speed during the second circuit. Finally the predicted velocity was compared with the measured one. The result was that acceleration alone failed to predict speed (mean r = 0.4). Adding altitude variation improved the prediction (mean r = 0.7). With regard to the altitude/acceleration-speed relationship, substantial inter-individual variation was found. It is concluded that accelerometry, combined with altitude measurement, can assess position variations of humans provided inter-individual variation is taken into account. It is also confirmed that DGPS can be used for outdoor walking speed measurements, opening up new perspectives in the field of biomechanics.