Feasibility Study of Strengthening Existing Single Span Steel Beam Concrete Deck Bridges, June 1961

Iowa has the same problem that confronts most states in the United States: many bridges constructed more than 20 years ago either have deteriorated to the point that they are inadequate for original design loads or have been rendered inadequate by changes in design/maintenance standards or design loads. Inadequate bridges require either strengthening or posting for reduced loads. A sizeable number of single span, composite concrete deck - steel I beam bridges in Iowa currently cannot be rated to carry today's design loads. Various methods for strengthening the unsafe bridges have been proposed and some methods have been tried. No method appears to be as economical and promising as strengthening by post-tensioning of the steel beams. At the time this research study was begun, the feasibility of posttensioning existing composite bridges was unknown. As one would expect, the design of a bridge-strengthening scheme utilizing post-tensioning is quite complex. The design involves composite construction stressed in an abnormal manner (possible tension in the deck slab), consideration of different sizes of exterior and interior beams, cover-plated beams already designed for maximum moment at midspan and at plate cut-off points, complex live load distribution, and distribution of post-tensioningforces and moments among the bridge beams. Although information is available on many of these topics, there is miminal information on several of them and no information available on the total design problem. This study, therefore, is an effort to gather some of the missing information, primarily through testing a half-size bridge model and thus determining the feasibility of strengthening composite bridges by post-tensioning. Based on the results of this study, the authors anticipate that a second phase of the study will be undertaken and directed toward strengthening of one or more prototype bridges in Iowa.

Effect of a governmentally-led physical activity program on motor skills in young children attending child care centers: a cluster randomized controlled trial.

OBJECTIVE: To assess the effect of a governmentally-led center based child care physical activity program (Youp'la Bouge) on child motor skills.Patients and methods: We conducted a single blinded cluster randomized controlled trial in 58 Swiss child care centers. Centers were randomly selected and 1:1 assigned to a control or intervention group. The intervention lasted from September 2009 to June 2010 and included training of the educators, adaptation of the child care built environment, parental involvement and daily physical activity. Motor skill was the primary outcome and body mass index (BMI), physical activity and quality of life secondary outcomes. The intervention implementation was also assessed. RESULTS: At baseline, 648 children present on the motor test day were included (age 3.3 +/- 0.6, BMI 16.3 +/- 1.3 kg/m2, 13.2% overweight, 49% girls) and 313 received the intervention. Relative to children in the control group (n = 201), children in the intervention group (n = 187) showed no significant increase in motor skills (delta of mean change (95% confidence interval: -0.2 (-0.8 to 0.3), p = 0.43) or in any of the secondary outcomes. Not all child care centers implemented all the intervention components. Within the intervention group, several predictors were positively associated with trial outcomes: 1) free-access to a movement space and parental information session for motor skills 2) highly motivated and trained educators for BMI 3) free-access to a movement space and purchase of mobile equipment for physical activity (all p < 0.05). CONCLUSION: This "real-life" physical activity program in child care centers confirms the complexity of implementing an intervention outside a study setting and identified potentially relevant predictors that could improve future programs.Trial registration: Trial registration number: clinical trials.gov NCT00967460 http://clinicaltrials.gov/ct2/show/NCT00967460.

Deciding the sale of a life policy in the viatical market: Implications on individual welfare

[cat] En aquest article, es presenta un model econòmic que permet determinar la venda o no d'una pòlissa de vida (total o en part) per part d'un assegurat malalt terminal en el mercat dels viatical settlements. Aquest mercat va aparèixer a finals de la dècada dels 80 a conseqüència de l'epidèmia de la SIDA. Actualment, representa una part del mercat dels life settlements. Les pòlisses que es comercialitzen en el mercat dels viaticals són aquelles on l'assegurat és malalt terminal amb una esperança de vida de dos anys o menys. El model és discret i considera només dos períodes (anys), ja que aquesta és la vida residual màxima que contempla el mercat. L'agent posseix una riquesa inicial que ha de repartir entre consum i herència. S'introdueix en primer lloc la funció d'utilitat esperada del decisor i, utilitzant programació dinàmica, es dedueix l'estratègia que reporta una utilitat més gran (no vendre/vendre (en part) la pòlissa en el moment zero/vendre (en part) la pòlissa en el moment ú). L'òptim depèn del preu de la pòlissa venuda i de paràmetres personals de l'individu. Es troba una expressió analítica per l'estratègia òptima i es realitza un anàlisi de sensibilitat.

2009-2010 Juvenile Court Services School Liaison Program Data, July 2010

Data are provided to CJJP through statistical summary forms completed by the JCSLs. Because forms are completed only when meaningful contact between a student and a liaison takes place, only a portion of the total population served is reported. Meaningful contact is defined as having at least five contacts within a 60-day period (at any point during the academic year) regarding at least one of the referral reasons supplied on the form. Data are entered into a web-based application by the liaisons and retrieved electronically by CJJP via the internet. Service information is submitted and uploaded only at the end of the academic year.

Géopatrimoines des trois Chablais. Identification et valorisation des témoins glaciaires

Cette recherche s'applique aux témoins glaciaires des Chablais dans quatre de leurs dimensions : géopatrimoine, connaissance objective, inventaire de géosites et valorisation. Elle est organisée sur le canevas d'un processus de patrimonialisation auquel elle participe et qu'elle interroge à la fois. En 2009, débutait le projet 123 Chablais, pour une durée de quatre ans. Il concernait l'ensemble du territoire chablaisien, réparti sur deux pays (France et Suisse) et trois entités administratives (département de la Haute-Savoie, cantons de Vaud et du Valais). Ce projet, élaboré dans le cadre du programme Interreg IV France-Suisse, avait pour but de dynamiser le développement économique local en s'appuyant sur les patrimoines régionaux. Le géopatrimoine, identifié comme une de ces ressources, faisait donc l'objet de plusieurs actions, dont cette recherche. En parallèle, le Chablais haut-savoyard préparait sa candidature pour rejoindre l'European Geopark Network (EGN). Son intégration, effective dès 2012, a fait de ce territoire le cinquième géoparc français du réseau. Le Geopark du Chablais fonde son identité géologique sur l'eau et la glace, deux thématiques intimement liées aux témoins glaciaires. Dans ce contexte d'intérêt pour le géopatrimoine local et en particulier pour le patrimoine glaciaire, plusieurs missions ont été assignées à cette recherche qui devait à la fois améliorer la connaissance objective des témoins glaciaires, inventorier les géosites glaciaires et valoriser le patrimoine glaciaire. Le premier objectif de ce travail était d'acquérir une vision synthétique des témoins glaciaires. Il a nécessité une étape de synthèse bibliographique ainsi que sa spatialisation, afin d'identifier les lacunes de connaissance et la façon dont ce travail pouvait contribuer à les combler. Sur cette base, plusieurs méthodes ont été mises en oeuvre : cartographie géomorphologique, reconstitution des lignes d'équilibre glaciaires et datations de blocs erratiques à l'aide des isotopes cosmogéniques produits in situ. Les cartes géomorphologiques ont été élaborées en particulier dans les cirques et vallons glaciaires. Les datations cosmogéniques ont été concentrées sur deux stades du glacier du Rhône : le Last Local Glacial Maximum (LLGM) et le stade de Monthey. Au terme de cette étape, les spécificités du patrimoine glaciaire régional se sont révélées être 1) une grande diversité de formes et des liens étroits avec différents autres processus géomorphologiques ; 2) une appartenance des témoins glaciaires à dix grandes étapes de la déglaciation du bassin lémanique. Le second objectif était centré sur le processus d'inventaire des géosites glaciaires. Nous avons mis l'accent sur la sélection du géopatrimoine en développant une approche basée sur deux axes (temps et espace) identifiés dans le volet précédent et avons ainsi réalisé un inventaire à thèmes, composé de 32 géosites. La structure de l'inventaire a également été explorée de façon à intégrer des critères d'usage de ces géosites. Cette démarche, soutenue par une réflexion sur les valeurs attribuées au géopatrimoine et sur la façon d'évaluer ces valeurs, nous a permis de mettre en évidence le point de vue anthropo - et scientifico - centré qui prévaut nettement dans la recherche européenne sur le géopatrimoine. L'analyse des résultats de l'inventaire a fait apparaître quelques caractéristiques du patrimoine glaciaire chablaisien, discret, diversifié, et comportant deux spécificités exploitables dans le cadre d'une médiation scientifique : son statut de « berceau de la théorie glaciaire » et ses liens étroits avec des activités de la vie quotidienne, en tant que matière première, support de loisir ou facteur de risque. Cette recherche a débouché sur l'élaboration d'une exposition itinérante sur le patrimoine glaciaire des Chablais. Ce produit de valorisation géotouristique a été conçu pour sensibiliser la population locale à l'impact des glaciers sur son territoire. Il présente une série de sept cartes de stades glaciaires, encadrées par les deux mêmes thématiques, l'histoire de la connaissance glaciaire d'une part, les témoins glaciaires et la société, d'autre part. -- This research focuses on glacial witnesses in the Chablais area according to four dimensions : geoheritage, objective knowledge, inventory and promotion of geosites. It is organized on the model of an heritage's process which it participates and that it questions both. In 2009, the project 123 Chablais started for a period of four years. It covered the entire chablaisien territory spread over two countries and three administrative entities (département of Haute-Savoie, canton of Vaud, canton of Valais). This project, developed in the framework of the Interreg IV France-Switzerland program, aimed to boost the local development through regional heritage. The geoheritage identified as one of these resources, was therefore the subject of several actions, including this research. In parallel, the French Chablais was preparing its application to join the European Geopark Network (EGN). Its integration, effective since 2012, made of this area the fifth French Geopark of the network. The Chablais Geopark geological identity was based on water and ice, two themes closely linked to the glacial witnesses. In this context of interest for the regional geoheritage and especially for the glacial heritage, several missions have been assigned to this research which should improve objective knowledge of glacial witnesses, inventory and assess glacial geosites. The objective knowledge's component was to acquire a synthetic vision of the glacial witnesses. It required a first bibliography synthesis step in order to identify gaps in knowledge and how this work could help to fill them. On this basis, several methods have been implemented: geomorphological mapping, reconstruction of the equilibrium-line altitude and dating of glacial erratic blocks using cosmogenic isotopes produced in situ. Geomorphological maps have been developed especially in glacial cirques and valleys. Cosmogenic datings were concentrated on two stages of the Rhone glacier: the Last Local Glacial Maximum (LLGM) and « the stage of Monthey ». After this step, the specificities of the regional glacial heritage have emerged to us as 1) a wide variety of forms and links to various other geomorphological processes; 2) belonging of glacial witnesses to ten major glacial stages of Léman Lake's deglaciation. In the inventory of glacial geosites component we focused on the selection of geoheritage. We developed an approach based on two axes (time and space) identified in the preceding components. We obtained a thematic inventory, consisting of 32 geosites. The structure of the inventory was also explored in the aim to integrate use criteria of geosites. This approach, supported by a thought on the values attributed to the geoheritage and how to assess these values allowed us to highlight the point of view much anthropological - and scientific -centered prevailing in the European research on geoheritage. The analysis of the inventory's results revealed some characteristics of chablaisien glacial heritage, discrete, diverse, and with two features exploitable in the context of a scientific mediation: its status as « cradle of the glacial theory » and its close links with activities of daily life, as raw material, leisure support and risk factor. This research leads to the development of a traveling exhibition on the glacial heritage of the Chablais area. It presents a series of seven glacial stage's cards, framed by the two themes mentioned above: « history of glacial knowledge » and « glacial witnesses and society ».

Analysis of joint laxity after total ankle arthroplasty: cadaver study.

BACKGROUND: Clinical results of total ankle arthroplasty with early designs were disappointing. Recently-developed ankle prostheses have good mid-term results; however, limited information is available regarding effects of total ankle arthroplasty on ankle laxity. METHODS: Eight cadaveric lower extremities were tested with a custom device which enabled measurement of multi-axial forces, moments, and displacement during applied axial, shear, and rotational loading. Tests consisted of anterior-posterior and medial-lateral translation and internal-external rotation of the talus relative to the tibia during axial loads on the tibia simulating body weight (700 N) and an unloaded condition (5 N). Tests were performed in neutral, dorsiflexion, and plantarflexion. Laxity was determined for the intact ankle, and following insertion of an unconstrained total ankle implant, comparing load-displacement curve. FINDINGS: Laxity after total ankle arthroplasty did not approximate the normal ankle in most conditions tested. Displacement was significantly greater for total ankle arthroplasty in both posterior and lateral translation, and internal rotation, with 5 N axial loading, and anterior-posterior, medial-lateral translation, and internal-external rotation for 700 N axial loading. For the 700 N axial load condition, in the neutral ankle position, total anterior-posterior translation averaged 0.4 mm (SD 0.2 mm), but 6.0 mm (SD 1.5 mm) after total ankle arthroplasty (P<0.01). This study demonstrated more laxity in the replaced ankle than normal ankle for both unloaded and 700 N axially loaded conditions. INTERPRETATION: These data indicate the increased responsibility of the ligaments for ankle laxity after total ankle arthroplasty and suggest the importance of meticulous ligament reconstruction with total ankle arthroplasty operations.

Prothèses totales de genoux. Analyse clinique et numérique des micromouvements de l'implant tibial [Total knee prosthesis. Clinical and numerical study of micromovements of the tibial implant].

INTRODUCTION: The importance of the micromovements in the mechanism of aseptic loosening is clinically difficult to evaluate. To complete the analysis of a series of total knee arthroplasties (TKA), we used a tridimensional numerical model to study the micromovements of the tibial implant. MATERIAL AND METHODS: Fifty one patients (with 57 cemented Porous Coated Anatomic TKAs) were reviewed (mean follow-up 4.5 year). Radiolucency at the tibial bone-cement interface was sought on the AP radiographs and divided in 7 areas. The distribution of the radiolucency was then correlated with the axis of the lower limb as measured on the orthoradiograms. The tridimensional numerical model is based on the finite element method. It allowed the measurement of the cemented prosthetic tibial implant's displacements and the micromovements generated at bone-ciment interface. A total load (2000 Newton) was applied at first vertically and asymetrically on the tibial plateau, thereby simulating an axial deviation of the lower limbs. The vector's posterior inclination then permitted the addition of a tangential component to the axial load. This type of effort is generated by complex biomechanical phenomena such as knee flexion. RESULTS: 81 per cent of the 57 knees had a radiolucent line of at least 1 mm, at one or more of the tibial cement-epiphysis jonctional areas. The distribution of these lucent lines showed that they came out more frequently at the periphery of the implant. The lucent lines appeared most often under the unloaded margin of the tibial plateau, when axial deviation of lower limbs was present. Numerical simulations showed that asymetrical loading on the tibial plateau induced a subsidence of the loaded margin (0-100 microns) and lifting off at the opposite border (0-70 microns). The postero-anterior tangential component induced an anterior displacement of the tibial implant (160-220 microns), and horizontal micromovements with non homogenous distribution at the bone-ciment interface (28-54 microns). DISCUSSION: Comparison of clinical and numerical results showed a relation between the development of radiolucent lines and the unloading of the tibial implant's margin. The deleterious effect of lower limbs' axial deviation is thereby proven. The irregular distribution of lucent lines under the tibial plateau was similar of the micromovements' repartition at the bone-cement interface when tangential forces were present. A causative relation between the two phenomenaes could not however be established. Numerical simulation is a truly useful method of study; it permits to calculate micromovements which are relative, non homogenous and of very low amplitude. However, comparative clinical studies remain as essential to ensure the credibility of results.

Chest pain in daily practice: occurrence, causes and management

QUESTIONS UNDER STUDY: We assessed the occurrence and aetiology of chest pain in primary care practice. These features differ between primary and emergency care settings, where most previous studies have been performed. METHODS: 59 GPs in western Switzerland recorded all consecutive cases presenting with chest pain. Clinical characteristics, laboratory tests and other investigations as well as the diagnoses remaining after 12 months of follow-up were systematically registered. RESULTS: Among 24,620 patients examined during a total duration of 300 weeks of observation, 672 (2.7%) presented with chest pain (52% female, mean age 55 +/- 19(SD)). Most cases, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the reason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pain (including chest wall syndrome) (49%), cardiovascular (16%), psychogenic (11%), respiratory (10%), digestive (8%), miscellaneous (2%) and without diagnosis (3%). The three most prevalent diseases were: chest wall syndrome (43%), coronary artery disease (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were uncommon (1.8%). Potentially serious conditions including cardiac, respiratory and neoplasic diseases accounted for 20% of cases. A large number of laboratory tests (42%), referral to a specialist (16%) or hospitalisation (5%) were performed. Twentyfive patients died during follow-up, of which twelve were for a reason directly associated with thoracic pain [cancer (7) and cardiac causes (5)]. CONCLUSIONS: Thoracic pain was present in 2.7% of primary care consultations. Chest wall syndrome pain was the main aetiology. Cardio - vascular emergencies were uncommon. However chest pain deserves full consideration because of the occurrence of potentially serious conditions.

Changes in volume, surface estimate, three-dimensional shape and total number of neurons of the human primary visual cortex from midgestation until old age.

Macroscopic features such as volume, surface estimate, thickness and caudorostral length of the human primary visual cortex (Brodman's area 17) of 46 human brains between midgestation and 93 years were studied by means of camera lucida drawings from serial frontal sections. Individual values were best fitted by a logistic function from midgestation to adulthood and by a regression line between adulthood and old age. Allometric functions were calculated to study developmental relationships between all the features. The three-dimensional shape of area 17 was also reconstructed from the serial sections in 15 cases and correlated with the sequence of morphological events. The sulcal pattern of area 17 begins to develop around 21 weeks of gestation but remains rather simple until birth, while it becomes more convoluted, particularly in the caudal part, during the postnatal period. Until birth, a large increase in cortical thickness (about 83% of its mean adult value) and caudorostral length (69%) produces a moderate increase in cortical volume (31%) and surface estimate (40%) of area 17. After birth, the cortical volume and surface undergo their maximum growth rate, in spite of a rather small increase in cortical thickness and caudorostral length. This is due to the development of the pattern of gyrification within and around the calcarine fissure. All macroscopic features have reached the mean adult value by the end of the first postnatal year. With aging, the only features to undergo significant regression are the cortical surface estimate and the caudorostral length. The total number of neurons in area 17 shows great interindividual variability at all ages. No decrease in the postnatal period or in aging could be demonstrated.

Expression of MYC, IgM, As Well As Non-Germinal Centre B-Cell Like Immunophenotype and Positive Immunofish Index Predict a Worse Progression Free Survival and Overall Survival in a Series of 670 De Novo Diffuse Large B-Cell Lymphomas Included in Clinical Trials: A GELA Study of the 2003 Program

Introduction: Diffuse large B-cell lymphomas (DLBCL) represent a heterogeneous disease with variable clinical outcome. Identifying phenotypic biomarkers of tumor cells on paraffin sections that predict different clinical outcome remain an important goal that may also help to better understand the biology of this lymphoma. Differentiating non-germinal centre B-cell-like (non-GCB) from Germinal Centre B-cell-like (GCB) DLBCL according to Hans algorithm has been considered as an important immunohistochemical biomarker with prognostic value among patients treated with R-CHOP although not reproducibly found by all groups. Gene expression studies have also shown that IgM expression might be used as a surrogate for the GCB and ABC subtypes with a strong preferential expression of IgM in ABC DLBCL subtype. ImmunoFISH index based on the differential expression of MUM-1, FOXP1 by immunohistochemistry and on the BCL6 rearrangement by FISH has been previously reported (C Copie-Bergman, J Clin Oncol. 2009;27:5573-9) as prognostic in an homogeneous series of DLBCL treated with R-CHOP. In addition, oncogenic MYC protein overexpression by immunohistochemistry may represent an easy tool to identify the consequences of MYC deregulation in DLBCL. Our aim was to analyse by immunohistochemistry the prognostic relevance of MYC, IgM, GCB/nonGCB subtype and ImmunoFISH index in a large series of de novo DLBCL treated with Rituximab (R)-chemotherapy (anthracyclin based) included in the 2003 program of the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Methods: The 2003 program included patients with de novo CD20+ DLBCL enrolled in 6 different LNH-03 GELA trials (LNH-03-1B, -B, -3B, 39B, -6B, 7B) stratifying patients according to age and age-adjusted IPI. Tumor samples were analyzed by immunohistochemistry using CD10, BCL6, MUM1, FOXP1 (according to Barrans threshold), MYC, IgM antibodies on tissue microarrays and by FISH using BCL6 split signal DNA probes. Considering evaluable Hans score, 670 patients were included in the study with 237 (35.4%) receiving intensive R-ACVBP regimen and 433 (64.6%) R-CHOP/R-mini-CHOP. Results: 304 (45.4%) DLBCL were classified as GCB and 366 (54.6%) as non-GCB according to Hans algorithm. 337/567 cases (59.4%) were positive for the ImmunoFISH index (i.e. two out of the three markers positive: MUM1 protein positive, FOXP1 protein Variable or Strong, BCL6 rearrangement). Immunofish index was preferentially positive in the non-GCB subtype (81.3%) compared to the GCB subtype (31.2%), (p<0.001). IgM was recorded as positive in tumor cells in 351/637 (52.4%) DLBCL cases with a preferential expression in non-GCB 195 (53.3%) vs GCB subtype 100(32.9%), p<0.001). MYC was positive in 170/577 (29.5%) cases with a 40% cut-off and in 44/577 (14.2%) cases with a cut-off of 70%. There was no preferential expression of MYC among GCB or non-GCB subtype (p>0.4) for both cut-offs. Progression-free Survival (PFS) was significantly worse among patients with high IPI score (p<0.0001), IgM positive tumor (p<0.0001), MYC positive tumor with a 40% threshold (p<0.001), ImmunoFISH positive index (p<0.002), non-GCB DLBCL subtype (p<0.0001). Overall Survival (OS) was also significantly worse among patients with high IPI score (p<0.0001), IgM positive tumor (p=0.02), MYC positive tumor with a 40% threshold (p<0.01), ImmunoFISH positive index (p=0.02), non-GCB DLBCL subtype (p<0.0001). All significant parameters were included in a multivariate analysis using Cox Model and in addition to IPI, only the GCB/non-GCB subtype according to Hans algorithm predicted significantly a worse PFS among non-GCB subgroup (HR 1.9 [1.3-2.8] p=0.002) as well as a worse OS (HR 2.0 [1.3-3.2], p=0.003). This strong prognostic value of non-GCB subtyping was confirmed considering only patients treated with R- CHOP for PFS (HR 2.1 [1.4-3.3], p=0.001) and for OS (HR 2.3 [1.3-3.8], p=0.002). Conclusion: Our study on a large series of patients included in trials confirmed the relevance of immunohistochemistry as a useful tool to identify significant prognostic biomarkers for clinical use. We show here that IgM and MYC might be useful prognostic biomarkers. In addition, we confirmed in this series the prognostic value of the ImmunoFISH index. Above all, we fully validated the strong and independent prognostic value of the Hans algorithm, daily used by the pathologists to subtype DLBCL.

Strengthening of an Existing Continuous-Span, Steel-Beam, Concrete-Deck Bridge by Post-Tensioning, HR-308, 1990

The need to upgrade a large number of understrength and obsolete bridges in the U.S. has been well documented in the literature. Through several Iowa DOT projects, the concept of strengthening simple-span bridges by post-tensioning has been developed. The purpose of the project described in this report was to investigate the use of post-tensioning for strengthening continuous composite bridges. In a previous, successfully completed investigation, the feasibility of strengthening continuous, composite bridges by post-tensioning was demonstrated on a laboratory 1/3-scale-model bridge (3 spans: 41 ft 11 in. x 8 ft 8 in.). This project can thus be considered the implementation phase. The bridge selected for strengthening was in Pocahontas County near Fonda, Iowa, on County Road N28. With finite element analysis, a post-tensioning system was developed that required post-tensioning of the positive moment regions of both the interior and exterior beams. During the summer of 1988, the strengthening system was installed along with instrumentation to determine the bridge's response and behavior. Before and after post-tensioning, the bridge was subjected to truck loading (1 or 2 trucks at various predetermined critical locations) to determine the effectiveness of the strengthening system. The bridge, with the strengthening system in place, was inspected approximately every three months to determine any changes in its appearance or behavior. In 1989, approximately one year after the initial strengthening, the bridge was retested to identify any changes in its behavior. Post-tensioning forces were removed to reveal any losses over the one-year period. Post-tensioning was reapplied to the bridge, and the bridge was tested using the same loading program used in 1988. Except for at a few locations, stresses were reduced in the bridge the desired amount. At a few locations flexural stresses in the steel beams are still above 18 ksi, the allowable inventory stress for A7 steel. Although maximum stresses are above the inventory stress by about 2 ksi, they are about 5 ksi below the allowable operating stress; therefore, the bridge no longer needs to be load-posted.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

3-year follow-up results of bone mineral content and density after a school-based physical activity randomized intervention trial.

BACKGROUND: As an important modifiable lifestyle factor in osteoporosis prevention, physical activity has been shown to positively influence bone mass accrual during growth. We have previously shown that a nine month general school based physical activity intervention increased bone mineral content (BMC) and density (aBMD) in primary school children. From a public health perspective, a major key issue is whether these effects persist during adolescence. We therefore measured BMC and aBMD three years after cessation of the intervention to investigate whether the beneficial short-term effects persisted. METHODS: All children from 28 randomly selected first and fifth grade classes (intervention group (INT): 16 classes, n=297; control group (CON): 12 classes, n=205) who had participated in KISS (Kinder-und Jugendsportstudie) were contacted three years after cessation of the intervention program. The intervention included daily physical education with daily impact loading activities over nine months. Measurements included anthropometry, vigorous physical activity (VPA) by accelerometers, and BMC/aBMD for total body, femoral neck, total hip, and lumbar spine by dual-energy X-ray absorptiometry (DXA). Sex- and age-adjusted Z-scores of BMC or aBMD at follow-up were regressed on intervention (1 vs. 0), the respective Z-score at baseline, gender, follow-up height and weight, pubertal stage at follow-up, previous and current VPA, adjusting for clustering within schools. RESULTS: 377 of 502 (75%) children participated in baseline DXA measurements and of those, 214 (57%) participated to follow-up. At follow-up INT showed significantly higher Z-scores of BMC at total body (adjusted group difference: 0.157 units (0.031-0.283); p=0.015), femoral neck (0.205 (0.007-0.402); p=0.042) and at total hip (0.195 (0.036 to 0.353); p=0.016) and higher Z-scores of aBMD for total body (0.167 (0.016 to 0.317); p=0.030) compared to CON, representing 6-8% higher values for children in the INT. No differences could be found for the remaining bone parameters. For the subpopulation with baseline VPA (n=163), effect sizes became stronger after baseline VPA adjustment. After adjustment for baseline and current VPA (n=101), intervention effects were no longer significant, while effect sizes remained the same as without adjustment for VPA. CONCLUSION: Beneficial effects on BMC of a nine month general physical activity intervention appeared to persist over three years. Part of the maintained effects may be explained by current physical activity.

Lateral Load Resistance of Diaphragms in Prestressed Concrete Girder Bridges, HR-319, 1991

Each year several prestressed concrete girder bridges in Iowa and other states are struck and damaged by vehicles with loads too high to pass under the bridge. Whether or not intermediate diaphragms play a significant role in reducing the effect of these unusual loading conditions has often been a topic of discussion. A study of the effects of the type and location of intermediate diaphragms in prestressed concrete girder bridges when the bridge girder flanges were subjected to various levels of vertical and horizontal loading was undertaken. The purpose of the research was to determine whether steel diaphragms of any conventional configuration can provide adequate protection to minimize the damage to prestressed concrete girders caused by lateral loads, similar to the protection provided by the reinforced concrete intermediate diaphragms presently being used by the Iowa Department of Transportation. The research program conducted and described in this report included the following: A comprehensive literature search and survey questionnaire were undertaken to define the state-of-the-art in the use of intermediate diaphragms in prestressed concrete girder bridges. A full scale, simple span, restressed concrete girder bridge model, containing three beams was constructed and tested with several types of intermediate diaphragms located at the one-third points of the span or at the mid-span. Analytical studies involving a three-dimensional finite element analysis model were used to provide additional information on the behavior of the experimental bridge. The performance of the bridge with no intermediate diaphragms was quite different than that with intermediate diaphragms in place. All intermediate diaphragms tested had some effect in distributing the loads to the slab and other girders, although some diaphragm types performed better than others. The research conducted has indicated that the replacement of the reinforced concrete intermediate diaphragms currently being used in Iowa with structural steel diaphragms may be possible.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.