Tentative de suicide des adolescents: accueil, evaluation, orientation [Suicide attempt: encounter, evaluation, orientation].

Le suicide et les tentatives de suicide des adolescents sont des enjeux de santé publique majeurs. En s'appuyant sur le modèle de soins développé à Genève, nous décrivons les différents temps nécessaires pour accueillir, évaluer et orienter un adolescent pris dans un mouvement suicidaire. Un temps d'accueil et d'évaluation pédiatrique, puis un temps d'évaluation psychiatrique et enfin un temps d'orientation à l'issue duquel est proposée une prise en charge spécifique. En fonction des caractéristiques cliniques du jeune (impulsivité, symptomatologie anxio-dépressive...), de sa capacité d'engagement dans les soins et de la qualité des liens du réseau, la prise en charge sera soit ambulatoire intensive, soit hospitalière. Suicide and suicide attempts of adolescents are major public health issues. Based on a model of care developed in Geneva, we describe the conditions necessary to evaluate and guide a teenager trapped in a suicidal behavior. First of all, there must be some time dedicated to pediatric assessement followed by a psychiatric evaluation and finally, the adolescent can be oriented toward specific treatment. Depending on the clinical characteristics of the young adolescent and according to his willingness to engage himself in intensive follow-up (impulsivity, anxious?--depressive symptomatology...), cares will be given either as outpatient with close monitoring or inpatient.

Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland.

BACKGROUND: In 2004, complementary and alternative medicine (CAM) was offered by physicians in one-third of Swiss hospitals. Since then, CAM health policy has changed considerably. This study aimed to describe the present supply and use of CAM in hospitals in the French-speaking part of Switzerland, and to explore qualitatively the characteristics of this offer. METHODS: Between June 2011 and March 2012, a short questionnaire was sent to the medical directors of hospitals (n = 46), asking them whether CAM was offered, where and by whom. Then, a semi-directive interview was conducted with ten CAM therapists. RESULTS: Among 37 responses (return rate 80%), 19 medical directors indicated that their hospital offered at least one CAM and 18 reported that they did not. Acupuncture was the most frequently available CAM, followed by manual therapies, osteopathy and aromatherapy. The disciplines that offered CAM most frequently were rehabilitation, gynaecology and obstetrics, palliative care, psychiatry, and anaesthetics. In eight out of ten interviews, it appeared that the procedures for introducing a CAM in the hospital were not tightly supervised by the hospital and were mainly based on the goodwill of the therapists, rather than clinical/scientific evidence. CONCLUSION: The number of hospitals offering CAM in the French-speaking part of Switzerland seemed to have risen since 2004. The selection of a CAM to be offered in a hospital should be based on the same procedure of evaluation and validation as conventional therapy, and if the safety and efficiency of the CAM is evidence-based, it should receive the same resources as a conventional therapy.

Improving the Accuracy and Usability of Iowa Falling Weight Deflectometer Data, May 2013

This study aims to improve the accuracy and usability of Iowa Falling Weight Deflectometer (FWD) data by incorporating significant enhancements into the fully-automated software system for rapid processing of the FWD data. These enhancements include: (1) refined prediction of backcalculated pavement layer modulus through deflection basin matching/optimization, (2) temperature correction of backcalculated Hot-Mix Asphalt (HMA) layer modulus, (3) computation of 1993 AASHTO design guide related effective SN (SNeff) and effective k-value (keff ), (4) computation of Iowa DOT asphalt concrete (AC) overlay design related Structural Rating (SR) and kvalue (k), and (5) enhancement of user-friendliness of input and output from the software tool. A high-quality, easy-to-use backcalculation software package, referred to as, I-BACK: the Iowa Pavement Backcalculation Software, was developed to achieve the project goals and requirements. This report presents theoretical background behind the incorporated enhancements as well as guidance on the use of I-BACK developed in this study. The developed tool, I-BACK, provides more fine-tuned ANN pavement backcalculation results by implementation of deflection basin matching optimizer for conventional flexible, full-depth, rigid, and composite pavements. Implementation of this tool within Iowa DOT will facilitate accurate pavement structural evaluation and rehabilitation designs for pavement/asset management purposes. This research has also set the framework for the development of a simplified FWD deflection based HMA overlay design procedure which is one of the recommended areas for future research.

Improving the Accuracy and Usability of Iowa Falling Weight Deflectometer Data: Tech Transfer Summary, May 2013

This study aims to improve the accuracy and usability of Iowa Falling Weight Deflectometer (FWD) data by incorporating significant enhancements into the fully-automated software system for rapid processing of the FWD data. These enhancements include: (1) refined prediction of backcalculated pavement layer modulus through deflection basin matching/optimization, (2) temperature correction of backcalculated Hot-Mix Asphalt (HMA) layer modulus, (3) computation of 1993 AASHTO design guide related effective SN (SNeff) and effective k-value (keff ), (4) computation of Iowa DOT asphalt concrete (AC) overlay design related Structural Rating (SR) and kvalue (k), and (5) enhancement of user-friendliness of input and output from the software tool. A high-quality, easy-to-use backcalculation software package, referred to as, I-BACK: the Iowa Pavement Backcalculation Software, was developed to achieve the project goals and requirements. This report presents theoretical background behind the incorporated enhancements as well as guidance on the use of I-BACK developed in this study. The developed tool, I-BACK, provides more fine-tuned ANN pavement backcalculation results by implementation of deflection basin matching optimizer for conventional flexible, full-depth, rigid, and composite pavements. Implementation of this tool within Iowa DOT will facilitate accurate pavement structural evaluation and rehabilitation designs for pavement/asset management purposes. This research has also set the framework for the development of a simplified FWD deflection based HMA overlay design procedure which is one of the recommended areas for future research.

Instrumentation and Monitoring of Precast Bridge Approach Tied to an Integral Abutment Bridge in Bremer County, SPR 0000-005, 2010

Approach slab pavement at integral abutment (I-A) bridges are prone to settlement and cracking, which has been long recognized by the Iowa Department of Transportation (DOT). A commonly recommended solution is to integrally attach the approach slab to the bridge abutment. This study sought to supplement a previous project by instrumenting, monitoring, and analyzing the behavior of an approach slab tied to a integral abutment bridge. The primary objective of this investigation was to evaluate the performance of the approach slab. To satisfy the research needs, the project scope involved reviewing a similar previous study, implementing a health monitoring system on the approach slab, interpreting the data obtained during the evaluation, and conducting periodic visual inspections of the bridge and approach slab. Based on the information obtained from the testing, the following general conclusions were made: the integral connection between the approach slab and the bridge appears to function well with no observed distress at this location and no relative longitudinal movement measured between the two components; the measured strains in the approach slabs indicate a force exists at the expansion joint and should be taken into consideration when designing both the approach slab and the bridge and the observed responses generally followed an annual cyclic and/or short term cyclic pattern over time; the expansion joint at one side of the approach slab does not appear to be functioning as well as elsewhere; much larger frictional forces were observed in this study compared to the previous study.

Examination of Heterogeneous Crossing Sequences Between Toner and Rollerball Pen Strokes by Digital Microscopy and 3-D Laser Profilometry

The determination of line crossing sequences between rollerball pens and laser printers presents difficulties that may not be overcome using traditional techniques. This research aimed to study the potential of digital microscopy and 3-D laser profilometry to determine line crossing sequences between a toner and an aqueous ink line. Different paper types, rollerball pens, and writing pressure were tested. Correct opinions of the sequence were given for all case scenarios, using both techniques. When the toner was printed before the ink, a light reflection was observed in all crossing specimens, while this was never observed in the other sequence types. The 3-D laser profilometry, more time-consuming, presented the main advantage of providing quantitative results. The findings confirm the potential of the 3-D laser profilometry and demonstrate the efficiency of digital microscopy as a new technique for determining the sequence of line crossings involving rollerball pen ink and toner. With the mass marketing of laser printers and the popularity of rollerball pens, the determination of line crossing sequences between such instruments is encountered by forensic document examiners. This type of crossing presents difficulties with optical microscopic line crossing techniques involving ballpoint pens or gel pens and toner (1-4). Indeed, the rollerball's aqueous ink penetrates through the toner and is absorbed by the fibers of the paper, leaving the examiner with the impression that the toner is above the ink even when it is not (5). Novotny and Westwood (3) investigated the possibility of determining aqueous ink and toner crossing sequences by microscopic observation of the intersection before and after toner removal. A major disadvantage of their study resides in destruction of the sample by scraping off the toner line to see what was underneath. The aim of this research was to investigate the ways to overcome these difficulties through digital microscopy and three-dimensional (3-D) laser profilometry. The former was used as a technique for the determination of sequences between gel pen and toner printing strokes, but provided less conclusive results than that of an optical stereomicroscope (4). 3-D laser profilometry, which allows one to observe and measure the topography of a surface, has been the subject of a number of recent studies in this area. Berx and De Kinder (6) and Schirripa Spagnolo (7,8) have tested the application of laser profilometry to determine the sequence of intersections of several lines. The results obtained in these studies overcome disadvantages of other methods applied in this area, such as scanning electron microscope or the atomic force microscope. The main advantages of 3-D laser profilometry include the ease of implementation of the technique and its nondestructive nature, which does not require sample preparation (8-10). Moreover, the technique is reproducible and presents a high degree of freedom in the vertical axes (up to 1000 μm). However, when the paper surface presents a given roughness, if the pen impressions alter the paper with a depth similar to the roughness of medium, the results are not always conclusive (8). It becomes difficult in this case to distinguish which characteristics can be imputed to the pen impressions or the quality of the paper surface. This important limitation is assessed by testing different types of paper of variable quality (of different grammage and finishing) and the writing pressure. The authors will therefore assess the limits of 3-D laser profilometry technique and determine whether the method can overcome such constraints. Second, the authors will investigate the use of digital microscopy because it presents a number of advantages: it is efficient, user-friendly, and provides an objective evaluation and interpretation.

Development and Implementation of an Expert System for Forecasting Fog on US Highway 30 in Cedar Rapids, Iowa, HR-357, 1996

Several accidents, some involving fatalities, have occurred on U.S. Highway 30 near the Archer Daniels Midland Company (ADM) Corn Sweeteners plant in Cedar Rapids, Iowa. A contributing factor to many of these accidents has been the large amounts of water (vapor and liquid) emitted from multiple sources at ADM's facility located along the south side of the highway. Weather and road closure data acquired from IDOT have been used to develop a database of meteorological conditions preceding and accompanying closure of Highway 30 in Cedar Rapids. An expert system and a FORTRAN program were developed as aids in decision making with regard to closure of Highway 30 near the plant. The computer programs were used for testing, evaluation, and final deployment. Reports indicate the decision tools have been successfully implemented and were judged to be helpful in forecasting road closures and in reducing costs and personnel time in monitoring the roadway.

Iowa's CHLOE Profilometer Correlation Procedure, MLR-87-10, 1987

The Iowa DOT has been correlating its roadmeters to the CHLOE Profilometer since 1968. The same test method for the Present Serviceability Index (PSI) deduction from the pavement condition (crack and patch) survey has also been used since 1968. Resulting PSI measurements on the Interstate and Primary Highway Systems have had good continuity through the years due to these test procedures. A computer program called PSITREND has been developed to plot PSI versus year tested for every rural pavement section in the State of Iowa. PSITREND provides pavement performance trends which are very useful for prediction of rehabilitation needs and for evaluation of new designs or rehabilitation techniques. The PSITREND data base should be maintained through future years to expand on nineteen years of historical PSI test information already collected.

Appropriateness of colonoscopy in Europe (EPAGE II). Functional bowel disorders: pain, constipation and bloating.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of functional bowel symptoms, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of functional bowel symptoms was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: Much of the evidence for use of colonoscopy in evaluation of chronic abdominal pain, and/or constipation and/or abdominal bloating is modest. Major limitations include small numbers of patients and lack of adequate characterization of these patients. Large community-based follow-up studies are needed to enable better definition of the natural history of patients with functional bowel disorders. Guidelines stress that alarm features ("red flags"), such as rectal bleeding, anemia, weight loss, nocturnal symptoms, family history of colon cancer, age of onset > 50 years, and recent onset of symptoms should all lead to careful evaluation before a diagnosis of functional bowel disorder is made. EPAGE II assessed these symptoms by means of 12 clinical scenarios, rating colonoscopy as appropriate, uncertain and inappropriate in 42 % (5/12), 25 % (3/12), and 33 % (4/12) of these, respectively. CONCLUSIONS: Evidence to support the use of colonoscopy in the evaluation of patients with functional bowel disorders and no alarm features is lacking. These patients have no increased risk of colon cancer and thus advice on screening for this is not different from that for the general population. EPAGE II criteria, available online (http://www.epage.ch), consider colonoscopy appropriate in patients of > 50 years with chronic or new-onset bowel disturbances, but not in patients with isolated chronic abdominal pain.

Iowa DOT Library Services, Collection, & Technology Assessment, TR-670, 2014

Assesses the impact of library services on research projects, proposes methods to improve the impact of library services on research projects, assesses current library technology systems and proposes upgrades, assesses current library collection infrastructure and propose upgrades, especially in regards to collection damage from water or fire; ascertains patron interest in mobile technologies and suggest development based on interest.

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes.

The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coordinated by working group 4. There was a consensus that complete blocking of the seminal vesicles was not necessary, although sampling of the junction of the seminal vesicles and prostate was mandatory. There was consensus that sampling of the vas deferens margins was not obligatory. There was also consensus that muscular wall invasion of the extraprostatic seminal vesicle only should be regarded as seminal vesicle invasion. Categorization into types of seminal vesicle spread was agreed by consensus to be not necessary. For examination of lymph nodes, there was consensus that special techniques such as frozen sectioning were of use only in high-risk cases. There was no consensus on the optimal sampling method for pelvic lymph node dissection specimens, although there was consensus that all lymph nodes should be completely blocked as a minimum. There was also a consensus that a count of the number of lymph nodes harvested should be attempted. In view of recent evidence, there was consensus that the diameter of the largest lymph node metastasis should be measured. These consensus decisions will hopefully clarify the difficult areas of pathological assessment in radical prostatectomy evaluation and improve the concordance of research series to allow more accurate assessment of patient prognosis.

Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of iron-deficiency anemia (IDA) and hematochezia, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of IDA and hematochezia was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: IDA occurs in 2 %-5 % of adult men and postmenopausal women. Examination of both the upper and lower gastrointestinal tract is recommended in patients with iron deficiency. Colonoscopy for IDA yields one colorectal cancer (CRC) in every 9-13 colonoscopies. Hematochezia is a well-recognized alarm symptom and such patients are likely to be referred for colonoscopy. Colonoscopy is unanimously recommended in patients aged > or = 50. Diverticulosis, vascular ectasias, and ischemic colitis are common causes of acute lower gastrointestinal bleeding (LGIB); CRC is found in 0.2 %-11 % of the colonoscopies performed for LGIB. Most patients with scant hematochezia have an anorectal or a distal source of bleeding. The expert panel considered most clinical indications for colonoscopy as appropriate in the presence of IDA (58 %) or hematochezia (83 %). CONCLUSION: Despite the limitations of the published studies, guidelines unanimously recommend colonoscopy for the investigation of IDA and hematochezia in patients aged > or = 50 years. These indications were also considered appropriate by EPAGE II, as were indications in patients at low risk for CRC with no obvious cause of bleeding found during adequate previous investigations.

WISE: Women in Science and Engineering, Fall 2006

Women in Science and Engineering (WISE) Program is to expand and improve educational and professional opportunities for women in all fields of science, technology, engineering and math (STEM) by facilitating individual, institutional, and social change.

WISE: Women in Science and Engineering, Spring 2007

Women in Science and Engineering (WISE) Program is to expand and improve educational and professional opportunities for women in all fields of science, technology, engineering and math (STEM) by facilitating individual, institutional, and social change.

WISE: Women in Science and Engineering, Spring 2009

Women in Science and Engineering (WISE) Program is to expand and improve educational and professional opportunities for women in all fields of science, technology, engineering and math (STEM) by facilitating individual, institutional, and social change.