960 resultados para Secondary CHD prevention


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This research project was directed at laboratory and field evaluation of sodium montmorillonite clay (Bentonite) as a dust palliative for limestone surfaced secondary roads. It was postulated that the electrically charged surfaces (negative) of the clay particles could interact with the charged surfaces (positive) of the limestone and act as a bonding agent to agglomerate fine (-#200) particulates, and also to bond the fine particulates to larger (+#200) limestone particles. One mile test roads were constructed in Tama, Appanoose, and Hancock counties in Iowa using Bentonite treatment levels (by weight of aggregate) ranging from 3.0 to 12.0%. Construction was accomplished by adding dry Bentonite to the surfacing material and then dry road mixing. The soda ash/water solution (dispersing agent) was spray applied and the treated surfacing material wet mixed by motor graders to a consistency of 2 to 3 inch slump concrete. Two motor graders working in tandem provided rapid mixing. Following wet mixing the material was surface spread and compacted by local traffic. Quantitative and qualitative periodic evaluations and testing of the test roads was conducted with respect to dust generation, crust development, roughness, and braking characteristics. As the Bentonite treatment level increased dust generation decreased. From a cost/benefit standpoint, an optimum level of treatment is about 8% (by weight of aggregate). For roads with light traffic, one application at this treatment level resulted in a 60-70% average dust reduction in the first season, 40-50% in the second season, and 20-30% in the third season. Crust development was rated at two times better than untreated control sections. No discernible trend was evident with respect to roughness. There was no evident difference in any of the test sections with respect to braking distance and braking handling characteristics, under wet surface conditions compared to the control sections. Chloride treatments are more effective in dust reduction in the short term (3-4 months). Bentonite treatment is capable of dust reduction over the long term (2-3 seasons). Normal maintenance blading operations can be used on Bentonite treated areas. Soda ash dispersed Bentonite treatment is estimated to be more than twice as cost effective per percent dust reduction than conventional chloride treatments, with respect to time. However, the disadvantage is that there is not the initial dramatic reduction in dust generation as with the chloride treatment. Although dust is reduced significantly after treatment there is still dust being generated. Video evidence indicates that the dust cloud in the Bentonite treated sections does not rise as high, or spread as wide as the cloud in the untreated section. It also settles faster than the cloud in the untreated section. This is considered important for driving safety of following traffic, and for nuisance dust invasion of residences and residential areas. The Bentonite appears to be functioning as a bonding agent.

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Research project HR-155 was initiated to study soil erosion problems along the secondary road system in Iowa and to find a substitute for straw for the control of soil erosion during the period of seed establishment. Accordingly, six field research sites were established to test the ability of commercial soil conditioners to control soil erosion. The six field research sites were selected on the basis of terrain and type of soil material exposed on the cut-slope areas.

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The Iowa Department of Transportation has been conducting skid resistance tests on the paved secondary system on a routine basis since 1973. This report summarizes the data obtained through 1976 on 10,101 miles in 95 of the 99 counties in Iowa. A summary of the skid resistance on the secondary system is presented by pavement type and age. The data indicates that the overall skid resistance on this road system is excellent. Higher traffic roads (over 1000 vehicles per day) have a lower skid resistance than the average of the secondary roads for the same age and pavement type. The use of non-polishing aggregates in asphaltic concrete paving surface courses and transverse grooving of portland cement concrete paving on high traffic roads is recommended. The routine resurvey of skid resistance on the secondary road system on a 5-year interval is probably not economically justified and could be extended to a 10-year interval.

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As of December 31, 1970 there were 57,270 miles of Local Secondary roads and 32,958 miles of Farm to Market roads in the Iowa secondary road system. The Local Secondary system carried a traffic load of 2,714,180 daily vehicle miles, accounting for 32% of all traffic in the secondary system. For all Local Secondary roads having some form of surfacing, 98% were surfaced with gravel or crushed stone. During the 1970 construction year 335 miles of surfaced roads were constructed in the Local Secondary system with 78% being surfaced with gravel or crushed stone. The total maintenance expenditure for all secondary roads in Iowa during 1970 amounted to $40,086,091. Of this, 42%, or $17,020,332, was spent for aggregate replacement on existing gravel or crushed stone roads with an additional 31% ($12,604,456) being spent on maintenance other than resurfacing. This amounts to 73% of the total maintenance budget and are the largest two maintenance expenditure items out of a list of 10 ranging from bridges to drainage assessments. The next largest item was 7%, for maintenance of existing flexible bases. Three concurrent phases of study were included in this project: (1) laboratory screenings studies of various additives thought to have potential for long-lasting dust palliation, soil additive strength, durability, and additive retention potential; (2) test road construction using those additives that indicated promise for performance-serviceability usage; and (3) observations and tests of constructed sections for evaluation of the additive's contribution to performance and serviceability as well as the relationship to initial costs.

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A combined study of dust control and low-cost surface improvements of soil and aggregate materials for immediate (and intermediate) use as a treated surface course is being conducted in three concurrent phases: (1) laboratory screening of various additives thought to have potential for long-lasting dust palliation, soil-additive strength, durability, and additive retention potential; (2) test road construction, using those additives from the screening studies that indicate promise for performance and serviceability; and (3) observation and tests of constructed sections for evaluation of the additive's contribution to performance and serviceability as well as relationship to initial costs. A brief review is presented of the problem, some methods of measuring it, previously adopted approaches to it, project field tests and a portion of the results thus far, and portions of the laboratory work accomplished in the screening studies.

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Patients admitted to the neurocritical care unit (NCCU) often have serious conditions that can be associated with high morbidity and mortality. Pharmacologic agents or neuroprotectants have disappointed in the clinical environment. Current NCCU management therefore is directed toward identification, prevention, and treatment of secondary cerebral insults that evolve over time and are known to aggravate outcome. This strategy is based on a variety of monitoring techniques including use of intraparenchymal monitors. This article reviews parenchymal brain oxygen monitors, including the available technologies, practical aspects of use, the physiologic rationale behind their use, and patient management based on brain oxygen.

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This article outlines the basis of the technique and shows some examples of applications in order to exhibit the expectations of this technique invaried scientific fields.

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Statins are effective in the treatment of hypercholesterolemia for primary and secondary prevention of cardiovascular disease. While most side effects of statins are mild and transient, muscular symptoms are relatively common (5 to 10% of patients), but rarely serious (myositis, rhabdomyolysis). In cases of myopathy, the severity of symptoms and the determination of CK (creatine kinase) determine whether discontinuation of statin is necessary. Alternative strategies are also suggested. This article reviews suggestions on the management of these complaints that are a challenge in clinical practice.

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R commands to calculate the secondary production estimates using the size-frequency method after Hynes and Coleman (1968), Benke (1979) and Huryn (1996).

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OBJECTIVES: To delineate the various factors contributing to failure or delay in decannulation after partial cricotracheal resection (PCTR) in children. STUDY DESIGN: Case series. SETTING: Academic tertiary medical center. SUBJECTS AND METHODS: A retrospective case review of 100 children who underwent PCTR between 1978 and 2008 for severe subglottic stenosis using an ongoing database. RESULTS: Ninety of 100 (90%) patients were decannulated. Six patients needed secondary tracheostomy. The results of the preoperative evaluation showed grade II stenosis in four patients, grade III in 64 patients, and grade IV in 32 patients. The overall decannulation rate was 100 percent in grade II, 95 percent in grade III, and 78 percent in grade IV stenosis. Fourteen (14%) patients required revision open surgery. The most common cause of revision surgery was posterior glottic stenosis. Partial anastomotic dehiscence was seen in four patients. Delayed decannulation (>1 year) occurred in nine patients. Overall mortality rate in the whole series was 6 percent. No deaths were directly related to the surgery. No iatrogenic recurrent laryngeal nerve injury was present in the entire series. CONCLUSION: Comorbidities and associated syndromes should be addressed before PCTR is planned to improve the final postoperative outcome in terms of decannulation. Perioperative morbidity due to anastomotic dehiscence, to a certain extent, can be avoided by intraoperative judgment in the selection of double-stage surgery when more than five tracheal rings need to be resected. Subglottic stenosis with glottic involvement continues to pose a difficult challenge to pediatric otolaryngologists, often necessitating revision procedures.

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Yhteenveto: Käytännöllinen oikeanpuoleinen viiltogastropeksia mahalaukun laajentumisen ja kiertymisen hoitona tai ennaltaehkäisynä

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Background The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. Methods This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. Discussion By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting.

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Pegfilgrastim is equivalent to daily filgrastim after standard dose chemotherapy in decreasing the duration of neutropenia. Daily filgrastim started within 1-4 days after autologous stem cell transplant (ASCT) leads to significant decrease in time to neutrophil engraftment. We undertook a study of pegfilgrastim after high-dose chemotherapy (HDC) and ASCT. In all, 38 patients with multiple myeloma or lymphoma, eligible to undergo HDC and ASCT, were enrolled. Patients received a single dose of 6 mg pegfilgrastim subcutaneously 24 h after ASCT. There were no adverse events secondary to pegfilgrastim. All patients engrafted neutrophils and platelets with a median of 10 and 18 days, respectively. The incidence of febrile neutropenia was 49% (18/37). Neutrophil engraftment results were compared to a historical cohort of patients who received no growth factors or prophylactic filgrastim after ASCT. Time to neutrophil engraftment using pegfilgrastim was comparable to daily filgrastim and was shorter than in a historical group receiving no filgrastim (10 vs 13.7 days, P<0.001). Pegfilgrastim given as a single fixed dose of 6 mg appears to be safe after HDC and ASCT. It accelerates neutrophil engraftment comparable to daily filgrastim after ASCT. Pegfilgrastim may be convenient to use in outpatient transplant units.

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Switzerland has adopted a prevention strategy including the promotion of non-sharing injection material and use of condoms. The access to sterile equipment has been made easier, but regional differences still exist. Studies conducted between 1989 and 1992 among drug users in different Swiss regions are reviewed in order to examine if progress in prevention occurred. Syringe sharing diminished everywhere, but rather high sharing rates persist where sterile material is less accessible. Condom use increased, but the situation is still unsatisfactory considering the high HIV prevalence among i.v. drug users. Where several surveys have been conducted consecutively, a stabilization of HIV prevalence was observed. This suggests a slowing down of the progression of the epidemic among drug users. These results, obtained in few years, are encouraging in the light of the pessimism which prevailed at the beginning of the epidemic about the ability of drug users to adopt preventive behaviour.