Yield of intermittent versus continuous EEG in comatose survivors of cardiac arrest treated with hypothermia.

INTRODUCTION: Electroencephalography (EEG) has a central role in the outcome prognostication in subjects with anoxic/hypoxic encephalopathy following a cardiac arrest (CA). Continuous EEG monitoring (cEEG) has been consistently developed and studied; however, its yield as compared to repeated standard EEG (sEEG) is unknown. METHODS: We studied a prospective cohort of comatose adults treated with therapeutic hypothermia (TH) after a CA. cEEG data regarding background activity and epileptiform components were compared to two 20 minute sEEG extracted from the cEEG recording (one during TH, and one in early normothermia). RESULTS: In this cohort, 34 recordings were studied. During TH, the agreement between cEEG and sEEG was 97.1% (95% CI: 84.6 - 99.9%) for background discontinuity and reactivity evaluation, while it was 94.1% (95% CI 80.3 - 99.2%) regarding epileptiform activity. In early normothermia, we did not find any discrepancies. Thus, concordance was very good during TH (kappa 0.83), and optimal during normothermia (kappa=1). The median delay between CA and the first EEG reactivity testing was 18 hours (range: 4.75 - 25) for patients with perfect agreement and 10 hours (range: 5.75 - 10.5) for the three patients in whom there were discordant findings (P=0.02, Wilcoxon). CONCLUSION: Standard intermittent EEG has comparable performance than continuous EEG both for variables important for outcome prognostication (EEG reactivity) and identification of epileptiform transients in this relatively small sample of comatose survivors of CA. This finding has an important practical implication, especially for centers where EEG resources are limited.

Guidelines for Development – Transportation Improvement Programs (TIPs) and the Iowa Statewide Transportation Improvement Program (STIP, February 2011

This document serves as a reference guide to local planning agencies for the development of their regional Transportation Improvement Program (TIP) and the Statewide Transportation Improvement Program (STIP).

Continuous phase shift of sinusoidal signals using injection locked oscillators

This work presents an alternative to generate continuous phase shift of sinusoidal signals based on the use of super harmonic injection locked oscillators (ILO). The proposed circuit is a second harmonic ILO with varactor diodes as tuning elements. In the locking state, by changing the varactor bias, a phase shift instead of a frequency shift is observed at the oscillator output. By combining two of these circuits, relative phases up to 90 could be achieved. Two prototypes of the circuit have been implemented and tested, a hybrid version working in the range of 200-300 MHz and a multichip module (MCM) version covering the 900¿1000 MHz band.

Improvement of the quality factor of RF integrated inductors by layout optimization

A systematic method to improve the quality (Q) factor of RF integrated inductors is presented in this paper. The proposed method is based on the layout optimization to minimize the series resistance of the inductor coil, taking into account both ohmic losses, due to conduction currents, and magnetically induced losses, due to eddy currents. The technique is particularly useful when applied to inductors in which the fabrication process includes integration substrate removal. However, it is also applicable to inductors on low-loss substrates. The method optimizes the width of the metal strip for each turn of the inductor coil, leading to a variable strip-width layout. The optimization procedure has been successfully applied to the design of square spiral inductors in a silicon-based multichip-module technology, complemented with silicon micromachining postprocessing. The obtained experimental results corroborate the validity of the proposed method. A Q factor of about 17 have been obtained for a 35-nH inductor at 1.5 GHz, with Q values higher than 40 predicted for a 20-nH inductor working at 3.5 GHz. The latter is up to a 60% better than the best results for a single strip-width inductor working at the same frequency.

2012-2016 Iowa Transportation Improvement Program

The Iowa Transportation Improvement Program (Program) is published to inform Iowans of planned investments in our state’s transportation system. The Iowa Transportation Commission (Commission) and Iowa Department of Transportation (Iowa DOT) are committed to programming those investments in a fiscally responsible manner. This document reflects Iowa’s multimodal transportation system by the inclusion of investments in aviation, transit, railroads, trails, and highways. A major component of this program is the highway section that documents programmed investments on the primary highway system for the next five years. A large part of funding available for highway programming comes from the federal government. Accurately estimating future federal funding levels is dependent on having a current enacted multi-year federal transportation authorization. The most recent authorization, Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), expired September 30, 2009, and to date it has been extended seven times because a new authorization has not yet been enacted. The current extension will expire September 30, 2011. This leads to significant uncertainty in federal funding; however, it is becoming evident that, in Federal Fiscal Year 2012 and beyond, federal funding revenue will likely be reduced by 25 percent from current levels in order to match revenue that flows into the Highway Trust Fund. This Program reflects this anticipated reduction in federal funding. While Iowa law does not require the adoption of a Program when federal transportation funding is being reauthorized, the Commission believes it is important to adopt a Program in order to continue on-going planning and project development efforts so that Iowa will be well positioned when a new authorization is adopted. However, it is important to recognize that, absent a federal authorization bill, there is significant uncertainty in the forecast of federal revenues. The Commission and the Iowa DOT will continue to monitor federal revenues and will adjust future investments as needed to maintain a fiscally responsible Program. For 2012-2016, approximately $2.3 billion is forecast to be available for highway right of way and construction. In developing the highway section of the Program, the Commission’s primary investment objective remains stewardship (i.e. safety, maintenance and preservation) of Iowa’s existing highway system. Over $1.3 billion is programmed in FY2012 through FY2016 for preservation of Iowa’s existing highway system and for enhanced highway safety features. The highway section also includes significant interstate investments on I-29 in Sioux City, I-29/80/480 in Council Bluffs, and I-74 in Bettendorf/Davenport. The FY2016 programming for construction on I-74 in Bettendorf/Davenport is the first of several years of significant investments that will be monitored for available funding. Approximately $200 million of the investments on these three major urban interstate projects address preservation needs. In total, approximately $1.5 billion is programmed for highway preservation activities for 2012- 2016. Another highway programming objective is maintaining the scheduled completion of capacity and economic development projects. Projects that were previously scheduled to be completed within the previous Program continue on their current schedule. However, due to the reduction of projected federal revenues, the Commission has delayed by one year the initiation of construction of all multi-year non-Interstate capacity and economic development projects that cannot be completed within this Program. These projects are U.S. 20 in Woodbury County, U.S. 30 in Benton County, U.S. 61 in Louisa County, and Iowa 100 in Linn County. The Iowa DOT and Commission appreciate the public’s involvement in the state’s transportation planning process. Comments received personally, by letter or through participation in the Commission’s regular meetings or public input meetings held around the state each year, are invaluable in providing guidance for the future of Iowa’s transportation system. It should be noted that this document is a planning guide. It does not represent a binding commitment or obligation of the Commission or Iowa DOT, and is subject to change.

Audit report on Mid-Iowa School Improvement Consortium, Carlisle, Iowa for the year ended June 30, 2010

Audit report on Mid-Iowa School Improvement Consortium, Carlisle, Iowa for the year ended June 30, 2010

Physical quality of a yellow latossol under integrated crop-livestock system

Soil physical quality is essential to global sustainability of agroecosystems, once it is related to processes that are essential to agricultural crop development. This study aimed to evaluate physical attributes of a Yellow Latossol under different management systems in the savanna area in the state of Piaui. This study was developed in Uruçuí southwest of the state of Piauí. Three systems of soil management were studied: an area under conventional tillage (CT) with disk plowi and heavy harrow and soybean crop; an area under no-tillage with soybean-maize rotation and millet as cover crop (NT + M); two areas under Integrated Crop-Livestock System, with five-month pasture grazing and soybean cultivation and then continuous pasture grazing (ICL + S and ICL + P, respectively). Also, an area under Native Forest (NF) was studied. The soil depths studied were 0.00-0.05, 0.05-0.10 and 0.10-0.20 m. Soil bulk density, as well as porosity and stability of soil aggregates were analyzed as physical attributes. Anthropic action has changed the soil physical attributes, in depth, in most systems studied, in comparison to NF. In the 0.00 to 0.05 m depth, ICL + P showed higher soil bulk density value. As to macroporosity, there was no difference between the management systems studied and NF. The management systems studied changed the soil structure, having, as a result, a small proportion of soil in great aggregate classes (MWD). Converting native forest into agricultural production systems changes the soil physical quality. The Integrated Crop-Livestock System did not promote the improvement in soil physical quality.

Improvement of a testing apparatus for dynamometry: procedures for penetrometry and influence of strain rate to quantify the tensile strength of soil aggregates

Soil penetration resistance (PR) and the tensile strength of aggregates (TS) are commonly used to characterize the physical and structural conditions of agricultural soils. This study aimed to assess the functionality of a dynamometry apparatus by linear speed and position control automation of its mobile base to measure PR and TS. The proposed equipment was used for PR measurement in undisturbed samples of a clayey "Nitossolo Vermelho eutroférrico" (Kandiudalfic Eutrudox) under rubber trees sampled in two positions (within and between rows). These samples were also used to measure the volumetric soil water content and bulk density, and determine the soil resistance to penetration curve (SRPC). The TS was measured in a sandy loam "Latossolo Vermelho distrófico" (LVd) - Typic Haplustox - and in a very clayey "Nitossolo Vermelho distroférrico" (NVdf) - Typic Paleudalf - under different uses: LVd under "annual crops" and "native forest", NVdf under "annual crops" and "eucalyptus plantation" (> 30 years old). To measure TS, different strain rates were applied using two dynamometry testing devices: a reference machine (0.03 mm s-1), which has been widely used in other studies, and the proposed equipment (1.55 mm s-1). The determination coefficient values of the SRPC were high (R² > 0.9), regardless of the sampling position. Mean TS values in LVd and NVdf obtained with the proposed equipment did not differ (p > 0.05) from those of the reference testing apparatus, regardless of land use and soil type. Results indicate that PR and TS can be measured faster and accurately by the proposed procedure.

Renormalization-group improvement of the spectrum of hydrogenlike atoms with massless fermions

We obtain the next-to-next-to-leading-logarithmic renormalization-group improvement of the spectrum of hydrogenlike atoms with massless fermions by using potential NRQED. These results can also be applied to the computation of the muonic hydrogen spectrum where we are able to reproduce some known double logarithms at O(m¿s6). We compare with other formalisms dealing with logarithmic resummation available in the literature.

Comparative assessment of intimal hyperplasia development after 14 days in two different experimental settings: tissue culture versus ex vivo continuous perfusion of human saphenous vein.

BACKGROUND: Intimal hyperplasia (IH) is a vascular remodeling process which often leads to failure of arterial bypass or hemodialysis access. Experimental and clinical work have provided insight in IH development; however, further studies under precise controlled conditions are required to improve therapeutic strategies to inhibit IH development. Ex vivo perfusion of human vessel segments under standardized hemodynamic conditions may provide an adequate experimental approach for this purpose. Therefore, chronically perfused venous segments were studied and compared to traditional static culture procedures with regard to functional and histomorphologic characteristics as well as gene expression. MATERIALS AND METHODS: Static vein culture allowing high tissue viability was performed as previously described. Ex vivo vein support system (EVVSS) was performed using a vein support system consisting of an incubator with a perfusion chamber and a pump. EVVSS allows vessel perfusion under continuous flow while maintaining controlled hemodynamic conditions. Each human saphenous vein was divided in two parts, one cultured in a Pyrex dish and the other part perfused in EVVSS for 14days. Testing of vasomotion, histomorphometry, expression of CD 31, Factor VIII, MIB 1, alpha-actin, and PAI-l were determined before and after 14days of either experimental conditions. RESULTS: Human venous segments cultured under traditional or perfused conditions exhibited similar IH after 14 days as shown by histomorphometry. Smooth-muscle cell (SMC) was preserved after chronic perfusion. Although integrity of both endothelial and smooth-muscle cells appears to be maintained in both culture conditions as confirmed by CD31, factor VIII, and alpha-actin expression, a few smooth-muscle cells in the media stained positive for factor VIII. Cell-proliferation marker MIB-1 was also detected in the two settings and PAI-1 mRNA expression and activity increased significantly after 14 days of culture and perfusion. CONCLUSION: This study demonstrates the feasibility to chronically perfuse human vessels under sterile conditions with preservation of cellular integrity and vascular contractility. To gain insights into the mechanisms leading to IH, it will now be possible to study vascular remodeling not only under static conditions but also in hemodynamic environment mimicking as closely as possible the flow conditions encountered in reconstructive vascular surgery.

Mean first-passage time of continuous non-Markovian processes driven by colored noise

An equation for mean first-passage times of non-Markovian processes driven by colored noise is derived through an appropriate backward integro-differential equation. The equation is solved in a Bourret-like approximation. In a weak-noise bistable situation, non-Markovian effects are taken into account by an effective diffusion coefficient. In this situation, our results compare satisfactorily with other approaches and experimental data.

Use of lights and siren: is there room for improvement?

OBJECTIVE: The objective of this study was to analyse the use of lights and siren (L&S) during transport to the hospital by the prehospital severity status of the patient and the time saved by the time of day of the mission. METHODS: We searched the Public Health Services data of a Swiss state from 1 January 2010 to 31 December 2010. All primary patient transports within the state were included (24 718). The data collected were on the use of L&S, patient demographics, the time and duration of transport, the type of mission (trauma vs. nontrauma) and the severity of the condition according to the National Advisory Committee for Aeronautics (NACA) score assigned by the paramedics and/or emergency physician. We excluded 212 transports because of missing data. RESULTS: A total of 24 506 ambulance transports met the inclusion criteria. L&S were used 4066 times, or in 16.6% of all missions. Of these, 40% were graded NACA less than 4. Overall, the mean total transport time to return to the hospital was 11.09 min (confidence interval 10.84-11.34) with L&S and 12.84 min (confidence interval 12.72-12.96) without. The difference was 1.75 min (105 s; P<0.001). For night-time runs alone, the mean time saved using L&S was 0.17 min (10.2 s; P=0.27). CONCLUSION: At present, the use of L&S seems questionable given the severity status or NACA score of transported patients. Our results should prompt the implementation of more specific regulations for L&S use during transport to the hospital, taking into consideration certain physiological criteria of the victim as well as time of day of transport.

Interventions aiming at balance confidence improvement in older adults: an updated review.

BACKGROUND: Loss of balance confidence is a frequent condition that affects 20-75% of community-dwelling older persons. Although a recent fall is a common trigger, loss of balance confidence also appears independent of previous experience with falls. Maintaining or improving balance confidence is important to avoid unnecessary, self-imposed restrictions of activity and subsequent disability. Holding another person's hand or using an assistive device while walking are simple interventions that are used naturally to address poor balance confidence in daily life. However, more complex interventions have also been developed and tested to achieve more sustained improvement in balance confidence. OBJECTIVES: This review describes interventions that have been tested to improve balance confidence in older community-dwelling persons. METHODS: Based on 2 recent systematic reviews, an additional search for literature was performed to update current information on interventions aiming at balance confidence improvement. Interventions were classified as those directly aimed at increasing balance confidence or not, and further stratified into those using monofactorial or multifactorial approaches. RESULTS: A total of 46 randomized controlled trials were identified. Five of the 8 interventions that directly targeted balance confidence showed benefits. Among those, multicomponent behavioral group interventions provided the most robust evidence of benefits in improving balance confidence and in decreasing activity avoidance. Among interventions not directly aiming at balance confidence improvement (11/21 studies with benefits), exercise (including tai chi) appears as the most promising monofactorial intervention. Nine of the 17 multifactorial fall prevention programs showed an effect on balance confidence, exercise being a main component in 7 of these 9 studies. Interventions that targeted elderly persons reporting poor balance confidence and/or those at risk for falls seemed more likely to be beneficial. CONCLUSIONS: Positive and sometimes sustained improvement in balance confidence can be achieved by various interventions among community-dwelling elderly persons. The effect of these interventions on activity restriction associated with poor balance confidence have been less well studied, but some studies also suggest potential benefits.