The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings

BACKGROUND: Previous published studies have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of nonmedical factors (ie, embodied in health care system design) as possible contributors to variations in colonoscopy performance. METHODS: Patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers in 11 western countries were used. Variability was captured through 2 performance outcomes (diagnostic yield and colonoscopy withdrawal time), jointly studied as dependent variables, using a multilevel 2-equation system. RESULTS: Results showed that open-access systems and high-volume colonoscopy centers were independently associated with a higher likelihood of detecting significant lesions and longer withdrawal durations. Fee for service (FFS) payment was associated with shorter withdrawal durations, and so had an indirect negative impact on the diagnostic yield. Teaching centers exhibited lower detection rates and longer withdrawal times. CONCLUSIONS: Our results suggest that gatekeeping colonoscopy is likely to miss patients with significant lesions and that developing specialized colonoscopy units is important to improve performance. Results also suggest that FFS may result in a lower quality of care in colonoscopy practice and highlight the fact that longer withdrawal times do not necessarily indicate higher quality in teaching centers.

Geomodelling of a fluvial system with semi-supervised support vector regression

Fluvial deposits are a challenge for modelling flow in sub-surface reservoirs. Connectivity and continuity of permeable bodies have a major impact on fluid flow in porous media. Contemporary object-based and multipoint statistics methods face a problem of robust representation of connected structures. An alternative approach to model petrophysical properties is based on machine learning algorithm ? Support Vector Regression (SVR). Semi-supervised SVR is able to establish spatial connectivity taking into account the prior knowledge on natural similarities. SVR as a learning algorithm is robust to noise and captures dependencies from all available data. Semi-supervised SVR applied to a synthetic fluvial reservoir demonstrated robust results, which are well matched to the flow performance

System-level Support for Mobile Ad hoc Communications: an Algorithmic & Practical Approach

A mobile ad hoc network (MANET) is a decentralized and infrastructure-less network. This thesis aims to provide support at the system-level for developers of applications or protocols in such networks. To do this, we propose contributions in both the algorithmic realm and in the practical realm. In the algorithmic realm, we contribute to the field by proposing different context-aware broadcast and multicast algorithms in MANETs, namely six-shot broadcast, six-shot multicast, PLAN-B and ageneric algorithmic approach to optimize the power consumption of existing algorithms. For each algorithm we propose, we compare it to existing algorithms that are either probabilistic or context-aware, and then we evaluate their performance based on simulations. We demonstrate that in some cases, context-aware information, such as location or signal-strength, can improve the effciency. In the practical realm, we propose a testbed framework, namely ManetLab, to implement and to deploy MANET-specific protocols, and to evaluate their performance. This testbed framework aims to increase the accuracy of performance evaluation compared to simulations, while keeping the ease of use offered by the simulators to reproduce a performance evaluation. By evaluating the performance of different probabilistic algorithms with ManetLab, we observe that both simulations and testbeds should be used in a complementary way. In addition to the above original contributions, we also provide two surveys about system-level support for ad hoc communications in order to establish a state of the art. The first is about existing broadcast algorithms and the second is about existing middleware solutions and the way they deal with privacy and especially with location privacy. - Un réseau mobile ad hoc (MANET) est un réseau avec une architecture décentralisée et sans infrastructure. Cette thèse vise à fournir un support adéquat, au niveau système, aux développeurs d'applications ou de protocoles dans de tels réseaux. Dans ce but, nous proposons des contributions à la fois dans le domaine de l'algorithmique et dans celui de la pratique. Nous contribuons au domaine algorithmique en proposant différents algorithmes de diffusion dans les MANETs, algorithmes qui sont sensibles au contexte, à savoir six-shot broadcast,six-shot multicast, PLAN-B ainsi qu'une approche générique permettant d'optimiser la consommation d'énergie de ces algorithmes. Pour chaque algorithme que nous proposons, nous le comparons à des algorithmes existants qui sont soit probabilistes, soit sensibles au contexte, puis nous évaluons leurs performances sur la base de simulations. Nous montrons que, dans certains cas, des informations liées au contexte, telles que la localisation ou l'intensité du signal, peuvent améliorer l'efficience de ces algorithmes. Sur le plan pratique, nous proposons une plateforme logicielle pour la création de bancs d'essai, intitulé ManetLab, permettant d'implémenter, et de déployer des protocoles spécifiques aux MANETs, de sorte à évaluer leur performance. Cet outil logiciel vise à accroître la précision desévaluations de performance comparativement à celles fournies par des simulations, tout en conservant la facilité d'utilisation offerte par les simulateurs pour reproduire uneévaluation de performance. En évaluant les performances de différents algorithmes probabilistes avec ManetLab, nous observons que simulateurs et bancs d'essai doivent être utilisés de manière complémentaire. En plus de ces contributions principales, nous fournissons également deux états de l'art au sujet du support nécessaire pour les communications ad hoc. Le premier porte sur les algorithmes de diffusion existants et le second sur les solutions de type middleware existantes et la façon dont elles traitent de la confidentialité, en particulier celle de la localisation.

Electronic Construction Collaboration System – Phase III, December 2011

This phase of the electronic collaboration project involved two major efforts: 1) implementation of AEC Sync (formerly known as Attolist), a web-based project management system (WPMS), on the Broadway Viaduct Bridge Project and the Iowa Falls Arch Bridge Project and 2) development of a web-based project management system for bridge and highway construction projects with less than $10 million in contract value. During the previous phase of this project (fiscal year 2010), the research team helped with the implementation process for AEC Sync and collected feedback from the Broadway Viaduct project team members before the start of the project. During the 2011 fiscal year, the research team collected the post-project surveys from the Broadway Viaduct project members and compared them to the pre-project survey results. The results of the AEC Sync implementation on the Broadway project were positive. The project members were satisfied with the performance of the AEC Sync software and how it facilitated document management and its transparency. In addition, the research team distributed, collected, and analyzed the pre-project surveys for the Iowa Falls Arch Bridge Project. The implementation of AEC Sync for the Iowa Falls Arch Bridge Project appears to also be positive, based on the pre-project surveys. The fourth phase of this electronic collaboration project involves the identification and implementation of a WPMS solution for smaller bridge and highway projects. The workflow for the shop drawing approval process for sign truss projects was documented and used to identify possible WPMS solutions. After testing and evaluating several WPMS solutions, Microsoft SharePoint Foundation’s site pages were selected to be pilot-tested on sign truss projects. Due to the limitation on the SharePoint license that the Iowa Department of Transportation (DOT) has, a file transfer protocol (FTP) site will be developed alongside this site to allow contractors to upload shop drawings to the Iowa DOT. The SharePoint site pages are expected to be ready for implementation during the 2012 calendar year.

Optimizing Cementious Content in Concrete Mixtures for Required Performance Final Report, January 2012

This research investigated the effects of changing the cementitious content required at a given water-to-cement ratio (w/c) on workability, strength, and durability of a concrete mixture. An experimental program was conducted in which 64 concrete mixtures with w/c ranging between 0.35 and 0.50, cementitious content ranging from 400 to 700 per cubic yard (pcy), and containing four different supplementary cementitious material (SCM) combinations were tested. The fine-aggregate to total-aggregate ratio was fixed at 0.42 and the void content of combined aggregates was held constant for all the mixtures. Fresh (i.e., slump, unit weight, air content, and setting time) and hardened properties (i.e., compressive strength, chloride penetrability, and air permeability) were determined. The hypothesis behind this study is that when other parameters are kept constant, concrete properties such as strength, chloride penetration, and air permeability will not be improved significantly by increasing the cement after a minimum cement content is used. The study found that about 1.5 times more paste is required than voids between the aggregates to obtain a minimum workability. Below this value, water-reducing admixtures are of no benefit. Increasing paste thereafter increased workability. In addition, for a given w/c, increasing cementitious content does not significantly improve compressive strength once the critical minimum has been provided. The critical value is about twice the voids content of the aggregate system. Finally, for a given w/c, increasing paste content increases chloride penetrability and air permeability.

Optimizing Cementitious Content in Concrete Mixtures for Required Performance Final Report, January 2012

This research investigated the effects of changing the cementitious content required at a given water-to-cement ratio (w/c) on workability, strength, and durability of a concrete mixture. An experimental program was conducted in which 64 concrete mixtures with w/c ranging between 0.35 and 0.50, cementitious content ranging from 400 to 700 per cubic yard (pcy), and containing four different supplementary cementitious material (SCM) combinations were tested. The fine-aggregate to total-aggregate ratio was fixed at 0.42 and the void content of combined aggregates was held constant for all the mixtures. Fresh (i.e., slump, unit weight, air content, and setting time) and hardened properties (i.e., compressive strength, chloride penetrability, and air permeability) were determined. The hypothesis behind this study is that when other parameters are kept constant, concrete properties such as strength, chloride penetration, and air permeability will not be improved significantly by increasing the cement after a minimum cement content is used. The study found that about 1.5 times more paste is required than voids between the aggregates to obtain a minimum workability. Below this value, water-reducing admixtures are of no benefit. Increasing paste thereafter increased workability. In addition, for a given w/c, increasing cementitious content does not significantly improve compressive strength once the critical minimum has been provided. The critical value is about twice the voids content of the aggregate system. Finally, for a given w/c, increasing paste content increases chloride penetrability and air permeability.

Performance of Strip Seals in Iowa Bridges, Project TR-437, January 2001

A pilot study was conducted on the premature failures of neoprene strip seals in expansion joints in Iowa bridges. In a relatively large number of bridges, strip seals have pulled out of the steel extrusions or otherwise failed well before the expected life span of the seal. The most serious consequence of a strip-seal failure is damage to the bridge substructure due to salt, water, and debris interacting with the substructure. A literature review was performed. Manufacturers’ specifications and recommendations, practices in the states bordering Iowa, and Iowa DOT design and installation guidelines were reviewed. Discussions were held with bridge contractors and the installation of a strip seal system was observed. Iowa DOT bridge databases were analyzed. A national survey was conducted on the use and performance of strip seals. With guidance from the Iowa DOT, twelve in-service bridges with strip-seal expansion joints were selected for detailed investigation. Effective bridge temperatures and corresponding expansion-joint openings were measured, DOT inspection reports were reviewed, and likely cause(s) of premature failures of strip seals were proposed. All of the seals used in the twelve bridges that had the most serious failures were in concrete girder bridges. Experimental results show that for a majority of these serious failures, the joint opening at 0° F predicted by the Iowa DOT design equations, the joint opening at 0° F extrapolated from the experimental data, or both, are larger than the movement rating of the strip seal specified on the bridge plans. Other likely causes of premature failures of seals in the twelve bridges include debris and ice in the seal cavity, a large skew and the corresponding decrease in the movement rating of the seal, improper installation, and improper setting of the initial gap.

Performance of a new gadolinium-based intravascular contrast agent in free-breathing inversion-recovery 3D coronary MRA.

In three-dimensional (3D) coronary magnetic resonance angiography (MRA), the in-flow contrast between the coronary blood and the surrounding myocardium is attenuated as compared to thin-slab two-dimensional (2D) techniques. The application of a gadolinium (Gd)-based intravascular contrast agent may provide an additional source of signal and contrast by reducing T(1blood) and supporting the visualization of more distal or branching segments of the coronary arterial tree. In six healthy adults, the left coronary artery (LCA) system was imaged pre- and postcontrast with a 0.075-mmol/kg bodyweight dose of the intravascular contrast agent B-22956. For imaging, an optimized free-breathing, navigator-gated and -corrected 3D inversion recovery (IR) sequence was used. For comparison, state-of-the-art baseline 3D coronary MRA with T(2) preparation for non-exogenous contrast enhancement was acquired. The combination of IR 3D coronary MRA, sophisticated navigator technology, and B-22956 allowed for an extensive visualization of the LCA system. Postcontrast, a significant increase in both the signal-to-noise ratio (SNR; 46%, P < 0.05) and contrast-to-noise ratio (CNR; 160%, P < 0.01) was observed, while vessel sharpness of the left anterior descending (LAD) artery and the left coronary circumflex (LCX) were improved by 20% (P < 0.05) and 18% (P < 0.05), respectively.

Bridge to life: the Lifebridge B2T extracorporeal life support system in an in vitro trial.

Extracorporeal life support systems (ECLS) have become common in cardiothoracic surgery, but are still "Terra Incognita" in other medical fields due to the fact that perfusion units are normally bound to cardiothoracic centres. The Lifebridge B2T is an ECLS that is meant to be used as an easy and fast-track extracorporeal cardiac support to provide short-term perfusion for the transport of a patient to a specialized centre. With the Lifebridge B2T it is now possible to provide extracorporeal bypass for patients in hospitals without a perfusion unit. The Lifebridge B2T was tested on three calves to analyze the handling, performance and security of this system. The Lifebridge B2T safely can be used clinically and can provide full extracorporeal support for patients in cardiac or pulmonary failure. Flows up to 3.9 +/- 0.2l/min were reached, with an inflow pressure of -103 +/- 13mmHg, using a 21Fr. BioMedicus (Medtronic, Minneapolis, MN, USA) venous cannula. The "Plug and Play" philosophy, with semi-automatic priming, integrated check-list, a long battery time of over two hours and instinctively designed user interface, makes this device very interesting for units with high-risk interventions, such as catheterisation labs. If a system is necessary in an emergency unit, the Lifebridge can provide a high security level, even in centres not acquainted with cardiopulmonary bypass.

Rewarding civil service performance through team bonuses : findings, analysis and recommendations

Performance-related pay within public organizations is continuing to spread. Although it can help to strengthen an entrepreneurial spirit in civil servants, its implementation is marred by technical, financial, managerial and cultural problems. This article identifies an added problem, namely the contradiction that exists between a managerial discourse that emphasizes the team and collective performance, on the one hand, and the use of appraisal and reward tools that are above all individual, on the other. Based on an empirical survey carried out within Swiss public organizations, the analysis shows that the team is currently rarely taken into account and singles out the principal routes towards an integrated system for the management and rewarding of civil servants.

Design Guide for Precast UHPC Waffle Deck Panel System, including Connections, June 2013

Abstract: As a part of an innovation project funded by the Federal Highway Administration (FHWA) Highways for LIFE program, a full-depth precast, ultra-high-performance concrete (UHPC) waffle deck panel and appropriate connections suitable for field implementation of waffle decks were developed. Following a successful full-scale validation test on a unit consisting of two panels with various types of connections under laboratory conditions, the waffle deck was installed successfully on a replacement bridge in Wapello County, Iowa. The subsequent load testing confirmed the desirable performance of the UHPC waffle deck bridge. Using the lessons from the completed project and outcomes from a series of simple and detailed finite element analyses of waffle decks, this report was developed to serve as a guide for broadening the design and installation of the UHPC waffle deck panel in new and existing bridges. Following an introduction to UHPC and waffle deck panels and a summary of completed work, this document presents information on waffle deck design, design of connections, redecking using waffle deck panels, and guidance on precast fabrication, construction, and installation of UHPC waffle deck panels.

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.

Analysis of Existing Work-Zone Devices with MASH Safety Performance Criteria, TPF-5(018), 2009

Crashworthy, work-zone, portable sign support systems accepted under NCHRP Report No. 350 were analyzed to predict their safety peformance according to the TL-3 MASH evaluation criteria. An analysis was conducted to determine which hardware parameters of sign support systems would likely contribute to the safety performance with MASH. The acuracy of the method was evaluated through full-scale crash testing. Four full-scale crash tests were conducted with a pickup truck. Two tall-mounted, sign support systems with aluminum sign panels failed the MASH criteria due to windshield penetration. One low-mounted system with a vinyl, roll-up sign panel failed the MASH criteria due to windshield and floorboard penetration. Another low-mounted system with an aluminum sign panel successfully met the MASH criteria. Four full-scale crash tests were conducted with a small passenger car. The low-mounted tripod system with an aluminum sign panel failed the MASH criteria due to windshield penetration. One low-mounted system with aluminum sign panel failed the MASH criteria due to excessive windshield deformation, and another similar system passed the MASH criteria. The low-mounted system with a vinyl, roll-up sign panel successfully met the MASH criteria. Hardware parameters of work-zone sign support systems that were determined to be important for failure with MASH include sign panel material, the height to the top of the mast, the presence of flags, sign-locking mechanism, base layout and system orientation. Flowcharts were provided to assist manufacturers when designing new sign support systems.

A comparison of the performance of modern screen-film and digital mammography systems.

This work compares the detector performance and image quality of the new Kodak Min-R EV mammography screen-film system with the Fuji CR Profect detector and with other current mammography screen-film systems from Agfa, Fuji and Kodak. Basic image quality parameters (MTF, NPS, NEQ and DQE) were evaluated for a 28 kV Mo/Mo (HVL = 0.646 mm Al) beam using different mAs exposure settings. Compared with other screen-film systems, the new Kodak Min-R EV detector has the highest contrast and a low intrinsic noise level, giving better NEQ and DQE results, especially at high optical density. Thus, the properties of the new mammography film approach those of a fine mammography detector, especially at low frequency range. Screen-film systems provide the best resolution. The presampling MTF of the digital detector has a value of 15% at the Nyquist frequency and, due to the spread size of the laser beam, the use of a smaller pixel size would not permit a significant improvement of the detector resolution. The dual collection reading technology increases significantly the low frequency DQE of the Fuji CR system that can at present compete with the most efficient mammography screen-film systems.

Iowa Natural Resources, Agency Performance Plan, FY2013

The work of the Department of Natural Resources impacts the lives of all Iowans. Iowans deserve a clean environment and quality natural areas for public use and enjoyment. This report reflects the progress made during fiscal year 2013 (FY13) toward our goals and provides information regarding the condition of our state’s natural resources and the effectiveness of our programs. In FY13, we continued to improve collaboration with other executive branch agencies. The DNR and DOT work very closely on the issuance of permits needed for road and bridge constructions, but recently we have also been working together to meet the administrative needs of the agencies. The DNR is working closely with the DOT to adopt an Electronic Records Management System used by the DOT. This system will improve accessibility to public documents and reduce the amount of paper files retained in storage. The DNR also continues to improve collaboration with other agencies, such as the Iowa Economic Development Authority as we work closely with them on business development in the state. The DNR strives to continually improve our customer service and how we can meet Iowan’s needs. As an example, the online reservation system for campground reservations has grown over the past eight years so that now 88% of the camping reservations are made online. The DNR continues to improve our online presence and accessibility. In FY13 the Iowa Legislature approved paying off the State’s bond debt used to construct Honey Creek Resort State Park. By removing this debt, the DNR will be able to focus more on the future of the Resort, rather than the past debt. Finally, in August of 2012, the DNR was faced with a tragic accident, where a seasonal parks employee died after rolling a mower into a lake. This incident has caused us to establish a Safety Program at the DNR and to review all of our departmental safety trainings, programs, and equipment. By focusing on our employee’s safety and well being, it is another way that we can demonstrate that at the DNR, our employees are our greatest asset.