Interspinous distraction in lumbar spinal stenosis: a neurophysiological perspective.

STUDY DESIGN: Prospective neurophysiological study. OBJECTIVE: To identify and quantify the neurophysiological effects of interspinous distraction during spine surgery for lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: Interspinous devices have been introduced as an alternative treatment of LSS in selected patients aiming at obtaining indirect decompression. Nevertheless, there is no data on the immediate neurophysiological effect of distraction. METHODS: Thirty patients with LSS undergoing decompression (14 at single level, 16 at multiple levels) were enrolled, resulting in a total of 48 levels to be analyzed. Before decompression, calibrated incremental distraction simulating interspinous device implantation of 8, 10, 12, 14, and 16 mm was performed. Intraoperative motor evoked potentials were acquired before any distraction, during distraction at each incremental value and after bilateral decompression. We evaluated relative changes of motor evoked potentials normalized to hand muscles and related them to the number of affected levels, LSS radiological severity based on the A to D grading, lordosis, and disc height. RESULTS: For single-level disease, 8-mm distraction and open decompression yielded similar improvement in motor evoked potentials not only in levels with morphological grades A or B, but also in levels with morphological grades C or D (i.e., severe or extreme stenosis) (P = 0.32). In contrast, distraction superior to 8 mm was less effective (P ≤ 0.05). In multiple-level stenosis, decompression was significantly more effective than any degree of distraction (P < 0.001). No correlation of those results to disc height or lordosis was observed. Using χ trend test to analyze the effect of distraction, a linear trend favoring moderate over severe stenotic morphology was observed (P = 0.0349). CONCLUSION: Interspinous distraction of 8 mm is sufficient to replicate electrophysiological improvements obtained during full decompression even in severe single-level stenosis but not in multilevel disease. Interspinous distraction has therefore an immediately measurable neurophysiological effect. Level of Evidence: 4.

Etude de la variation interlaboratoire du test de dépistage prénatal des défauts de fermeture du tube neural [Interlaboratory variation in the prenatal screening test for neural tube closing defects].

Early detection of neural-tude defects is possible by determining Alpha-fetoprotein (AFP) in maternal serum. 16'685 pregnant women were observed. Three methods for the determination of the "normal" range are compared. The first one, already used in similar studies, makes use of a constant multiple of the median. The other two ones make use of robust estimates of location and scale. Their comparison shows the interest of the robust methods to reduce the interlaboratory variability.

Etude de validation du "Michigan alcoholism screening test" (MAST) en langue française

Le but de cette étude est de répondre aux 3 questions suivantes: - 1) Le test de MAST est-il applicable, dans sa traduction française, à la population d'un service de médecine interne d'un hôpital universitaire en Suisse romande ? - 2) Le test de MAST apporte-t-il des résultats concordants avec le diagnostic clinique d'une part, et avec les résultats tirés de la littérature d'autre part ? - 3) De quelles façons peut-on définir et choisir deux valeurs critiques du test afin d'optimaliser l'utilisation du test de MAST dans l'étude comparative projetée ? ANNEXE: Traduction littérale en langue française du : "Michigan Alcoholism Screening Test" (MAST); etc.

A benchmark test for a quantitative assessment of simple neuron models

Several methods and algorithms have recently been proposed that allow for the systematic evaluation of simple neuron models from intracellular or extracellular recordings. Models built in this way generate good quantitative predictions of the future activity of neurons under temporally structured current injection. It is, however, difficult to compare the advantages of various models and algorithms since each model is designed for a different set of data. Here, we report about one of the first attempts to establish a benchmark test that permits a systematic comparison of methods and performances in predicting the activity of rat cortical pyramidal neurons. We present early submissions to the benchmark test and discuss implications for the design of future tests and simple neurons models

Iowa Pore Index Test, MLR-80-2, 1980

The objective of the investigation was the development of a test that would readily identify the potential of an aggregate to cause D-cracking because of its susceptivity to critical saturation. A Press-Ur-Meter was modified by replacing the air chamber with a one-inch diameter plastic tube calibrated in milli-. It was concluded that the pore index was sufficiently reliable to determine the D-cracking potential of limestone aggregates in all but a few cases where marginal results were obtained. Consistently poor or good results were always in agreement with established service records or concrete durability testing. In those instances where marginal results are obtained, the results of concrete durability testing should be considered when making the final determination of the D-cracking susceptibility of the aggregate in question. The following applications for the pore index test have been recommended for consideration: concrete durability testing be discontinued in the evaluation process of new aggregate sources with pore index results between 0-20 (Class 2 durability) and over 35 (Class 1) durability; composite aggregates with intermediate pore index results of 20-35 be tested on each stone type to facilitate the possible removal of low durability stone from the production process; and additional investigation should be made to evaluate the possibility of using the test to monitor and upgrade the acceptance of aggregate from sources associated with D-cracking.

Evaluation of the Argentine Nondestructive Test for Determining Concrete Compressive Strength, R-269 and MLR-75-2, 1975

The compressive strength of concrete is an important factor in the design of concrete structures and pavements. To assure the quality of the concrete placed at the project, concrete compressive cylinders are made at the jobsite. These cylinders undergo a destructive test to determine their compressive strength. However, the determination of concrete compressive strength of the concrete actually in the structure or pavement is frequently desirable. For this reason, a nondestructive test of the concrete is required. A nondestructive test of concrete compressive strength should be economical, easily performed by field personnel, and capable of producing accurate, reproducible results. The nondestructive test should be capable of detecting the extent of poor concrete in a pavement or structure due to improper handling, placement, or variations in mixing or materials.

Using Scanning Lasers for Real-Time Pavement Thickness Measurement, TR-538, 2006

Due to limited budgets and reduced inspection staff, state departments of transportation (DOTs) are in need of innovative approaches for providing more efficient quality assurance on concrete paving projects. The goal of this research was to investigate and test new methods that can determine pavement thickness in real time. Three methods were evaluated: laser scanning, ultrasonic sensors, and eddy current sensors. Laser scanning, which scans the surface of the base prior to paving and then scans the surface after paving, can determine the thickness at any point. Also, scanning lasers provide thorough data coverage that can be used to calculate thickness variance accurately and identify any areas where the thickness is below tolerance. Ultrasonic and eddy current sensors also have the potential to measure thickness nondestructively at discrete points and may result in an easier method of obtaining thickness. There appear to be two viable approaches for measuring concrete pavement thickness during the paving operation: laser scanning and eddy current sensors. Laser scanning has proved to be a reliable technique in terms of its ability to provide virtual core thickness with low variability. Research is still required to develop a prototype system that integrates point cloud data from two scanners. Eddy current sensors have also proved to be a suitable alternative, and are probably closer to field implementation than the laser scanning approach. As a next step for this research project, it is suggested that a pavement thickness measuring device using eddy current sensors be created, which would involve both a handheld and paver-mounted version of the device.

Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.

Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.

Dynamic Deflections to Determine Roadway Support Ratings, HR-245, 1983

The Benkelman Beam structural test of flexible pavements was replaced in 1976 by dynamic deflection testing with a model 400 Road Rater. The Road Rater is used to determine structural ratings of flexible pavements. New pavement construction in Iowa has decreased with a corresponding increase of restoration and rehabilitation. A method to determine structural ratings of layered systems and rigid pavements is needed to properly design overlay thickness. The objective of this research was to evaluate the feasibility of using the Road Rater to determine support values of layered systems and rigid pavements. This evaluation was accomplished by correlating the Road Rater with the Federal Highway Administration (FHWA) Thumper, a dynamic deflection testing device. Data were obtained with the Road Rater and Thumper at 411 individual test locations on 39 different structural sections ranging from 10" of PCC pavement and 25" of asphalt pavement to a newly graveled unpaved roadway. A high correlation between a 9000 pound Thumper deflection and the 1185 pound Road Rater deflection was obtained. A Road Rater modification has been completed to provide 2000 pound load inputs. The basin, defined by four sensors spaced at 1 foot intervals, resulting from the 2000 pound loading is being used to develop a graph for determining relative subgrade strengths. Road Rater deflections on rigid pavements are sufficient to support the potential for this technique.

Transscleral Coulomb-controlled iontophoresis of methylprednisolone into the rabbit eye: influence of duration of treatment, current intensity and drug concentration on ocular tissue and fluid levels.

The major problems associated with the use of corticosteroids for the treatment of ocular diseases are their poor intraocular penetration to the posterior segment when administered locally and their secondary side effects when given systemically. To circumvent these problems more efficient methods and techniques of local delivery are being developed. The purposes of this study were: (1) to investigate the pharmacokinetics of intraocular penetration of hemisuccinate methyl prednisolone (HMP) after its delivery using the transscleral Coulomb controlled iontophoresis (CCI) system applied to the eye or after intravenous (i.v.) injection in the rabbit, (2) to test the safety of the CCI system for the treated eyes and (3) to compare the pharmacokinetic profiles of HMP intraocular distribution after CCI delivery to i.v. injection. For each parameter evaluated, six rabbit eyes were used. For the CCI system, two concentrations of HMP (62.5 and 150mg ml(-1)), various intensities of current and duration of treatment were analyzed. In rabbits serving as controls the HMP was infused in the CCI device but without applied electric current. For the i.v. delivery, HMP at 10mg kg(-1)as a 62.5mg ml(-1)solution was used. The rabbits were observed clinically for evidence of ocular toxicity. At various time points after the administration of drug, rabbits were killed and intraocular fluids and tissues were sampled for methylprednisolone (MP) concentrations by high pressure liquid chromatography (HPLC). Histology examinations were performed on six eyes of each group. Among groups that received CCI, the concentrations of MP increased in all ocular tissues and fluids in relation to the intensities of current used (0.4, 1.0 and 2.0mA/0.5cm(2)) and its duration (4 and 10min). Sustained and highest levels of MP were achieved in the choroid and the retina of rabbit eyes treated with the highest current and 10min duration of CCI. No clinical toxicity or histological lesions were observed following CCI. Negligible amounts of MP were found in ocular tissues in the CCI control group without application of current. Compared to i.v. administration, CCI achieved higher and more sustained tissue concentrations with negligible systemic absorption. These data demonstrate that high levels of MP can be safely achieved in intraocular tissues and fluids of the rabbit eye, using CCI. With this system, intraocular tissues levels of MP are higher than those achieved after i.v. injection. Furthermore, if needed, the drug levels achieved with CCI can be modulated as a function of current intensity and duration of treatment. CCI could therefore be used as an alternative method for the delivery of high levels of MP to the intraocular tissues of both the anterior and posterior segments.

Innovative Solutions for Slope Stability Reinforcement and Characterization: Vol. I, TR-489, 2005

Soil slope instability concerning highway infrastructure is an ongoing problem in Iowa, as slope failures endanger public safety and continue to result in costly repair work. Characterization of slope failures is complicated, because the factors affecting slope stability can be difficult to discern and measure, particularly soil shear strength parameters. While in the past extensive research has been conducted on slope stability investigations and analysis, this research consists of field investigations addressing both the characterization and reinforcement of such slope failures. The current research focuses on applying an infrequently-used testing technique comprised of the Borehole Shear Test (BST). This in-situ test rapidly provides effective (i.e., drained) shear strength parameter values of soil. Using the BST device, fifteen Iowa slopes (fourteen failures and one proposed slope) were investigated and documented. Particular attention was paid to highly weathered shale and glacial till soil deposits, which have both been associated with slope failures in the southern Iowa drift region. Conventional laboratory tests including direct shear tests, triaxial compression tests, and ring shear tests were also performed on undisturbed and reconstituted soil samples to supplement BST results. The shear strength measurements were incorporated into complete evaluations of slope stability using both limit equilibrium and probabilistic analyses. The research methods and findings of these investigations are summarized in Volume 1 of this report. Research details of the independent characterization and reinforcement investigations are provided in Volumes 2 and 3, respectively. Combined, the field investigations offer guidance on identifying the factors that affect slope stability at a particular location and also on designing slope reinforcement using pile elements for cases where remedial measures are necessary. The research findings are expected to benefit civil and geotechnical engineers of government transportation agencies, consultants, and contractors dealing with slope stability, slope remediation, and geotechnical testing in Iowa.

Two Signatures For A New Blood-Based Test For Colorectal Cancer Screening

Background: Detection rates for adenoma and early colorectal cancer (CRC) are unsatisfactory due to low compliance towards invasive screening procedures such as colonoscopy. There is a large unmet screening need calling for an accurate, non-invasive and cost-effective test to screen for early neoplastic and pre-neoplastic lesions. Our goal is to identify effective biomarker combinations to develop a screening test aimed at detecting precancerous lesions and early CRC stages, based on a multigene assay performed on peripheral blood mononuclear cells (PBMC).Methods: A pilot study was conducted on 92 subjects. Colonoscopy revealed 21 CRC, 30 adenomas larger than 1 cm and 41 healthy controls. A panel of 103 biomarkers was selected by two approaches: a candidate gene approach based on literature review and whole transcriptome analysis of a subset of this cohort by Illumina TAG profiling. Blood samples were taken from each patient and PBMC purified. Total RNA was extracted and the 103 biomarkers were tested by multiplex RT-qPCR on the cohort. Different univariate and multivariate statistical methods were applied on the PCR data and 60 biomarkers, with significant p-value (< 0.01) for most of the methods, were selected.Results: The 60 biomarkers are involved in several different biological functions, such as cell adhesion, cell motility, cell signaling, cell proliferation, development and cancer. Two distinct molecular signatures derived from the biomarker combinations were established based on penalized logistic regression to separate patients without lesion from those with CRC or adenoma. These signatures were validated using bootstrapping method, leading to a separation of patients without lesion from those with CRC (Se 67%, Sp 93%, AUC 0.87) and from those with adenoma larger than 1cm (Se 63%, Sp 83%, AUC 0.77). In addition, the organ and disease specificity of these signatures was confirmed by means of patients with other cancer types and inflammatory bowel diseases.Conclusions: The two defined biomarker combinations effectively detect the presence of CRC and adenomas larger than 1 cm with high sensitivity and specificity. A prospective, multicentric, pivotal study is underway in order to validate these results in a larger cohort.

Development of a Conductometric Test for Frost Resistance of Concrete, HR-272, 1988

Research is described that was aimed at developing a test method which can be reasonably and rapidly performed in the laboratory and in the field to predict, with a high degree of certainty, the behavior of concrete subjected to the action of alternate freezing and thawing. The conductometric evaluation of concrete durability was explored with 3 different test methods: conductometric evaluation of the resistance of concrete to rapid freezing and thawing; conductomtric evaluation of the resistance of concrete to natural freezing and thawing, and conductometric evaluation of the pore size distribution of concrete and its correlation to concrete durability. The study showed that conductance could be used as a viable method for determining the durability of portland cement concrete. This would also allow the continuous monitoring of concrete durability without the removal twice per week from the freeze/thaw chamber. Recommendations for the continued development of these test methods are also included.

Test result-based sampling: an efficient design for estimating the accuracy of patient safety indicators.

OBJECTIVE: Accuracy studies of Patient Safety Indicators (PSIs) are critical but limited by the large samples required due to low occurrence of most events. We tested a sampling design based on test results (verification-biased sampling [VBS]) that minimizes the number of subjects to be verified. METHODS: We considered 3 real PSIs, whose rates were calculated using 3 years of discharge data from a university hospital and a hypothetical screen of very rare events. Sample size estimates, based on the expected sensitivity and precision, were compared across 4 study designs: random and VBS, with and without constraints on the size of the population to be screened. RESULTS: Over sensitivities ranging from 0.3 to 0.7 and PSI prevalence levels ranging from 0.02 to 0.2, the optimal VBS strategy makes it possible to reduce sample size by up to 60% in comparison with simple random sampling. For PSI prevalence levels below 1%, the minimal sample size required was still over 5000. CONCLUSIONS: Verification-biased sampling permits substantial savings in the required sample size for PSI validation studies. However, sample sizes still need to be very large for many of the rarer PSIs.