The Relationship of Ferroan Dolomite Aggregate to Rapid Concrete Deterioration, HR-266, 1987

Some of Iowa's 13,200 miles of portland cement concrete (pcc) pavement have remained structurally sound for over 50 years while others have suffered premature deterioration. Research has shown that the type of coarse aggregate used in the pcc is the major cause of this premature deterioration. Some coarse aggregates for concrete exhibit a nonuniform performance history. They contribute to premature deterioration on heavily salted primary roadways while providing long maintenance-free life on unsalted secondary pavements. This inconsistency supports the premise that there are at least two mechanisms that contribute to the deterioration. Previous research has shown that one of these mechanisms is a bad pore system. The other is apparently a chemical reaction. The objective of this research is to develop simple rapid test methods to predict the durability of carbonate aggregate in pcc pavement. X-ray diffraction analyses of aggregate samples have been conducted on various beds from numerous quarries producing diffraction plots for more than 200 samples of dolomitic or dolomite aggregates. The crystalline structures of these dolomitic aggregates show maximum-intensity dolomite/ankerite peaks ranging from a d-spacing of 2.884 angstroms for good aggregates to a d-spacing of 2.914 angstroms for nondurable aggregates. If coarse aggregates with known bad pore systems are removed from this summary, the d-spacing values of the remaining aggregates correlate very well with expected service life. This may indicate that the iron substitution for magnesium in the dolomite crystal is associated with the instability of the ferroan dolomite aggregates in pcc pavement.

Plasmaferese : veilig bij een goede indicatiestelling en kennis van de complicaties [Plasmapheresis, a safe treatment when applied to the correct indication and with awareness of the complications]

Plasmapheresis is an extracorporeal technique used to remove pathogenic macromolecules from the circulation, particularly autoantibodies. This is illustrated in 2 female patients. The first patient, aged 61 years, was treated successfully with non-selective plasmapheresis for acute humoral rejection shortly after receiving a renal allograft. In the second patient, aged 82 years, plasmapheresis for refractory myasthenia gravis had to be stopped because of bradycardia and hypotension during the procedure. She was treated successfully with immunoglobulins. Plasmapheresis is used to treat neurological, renal, haematological and systemic disorders. In nonselective plasmapheresis, the plasma is replaced with saline and albumin or donor plasma. In selective plasmapheresis a highly selective filter is used to remove a specific, pathogenic macromolecule. Adverse effects of the treatment include disturbances of the acid-base equilibrium or the coagulation, and allergic reactions. Most of these complications, however, can nowadays be avoided.

New diagnoses of dementia among older patients admitted to postacute care.

Objectives: To determine the prevalence of dementia and the proportion of undiagnosed dementia in elderly patients admitted to postacute care, and to identify patients' characteristics associated with undiagnosed dementia. Design: Cross-sectional study. Setting: Academic postacute rehabilitation facility in Lausanne, Switzerland. Participants: Patients (N = 1764) aged 70 years and older. Measurements: Data on socio-demographic, medical, functional, and affective status were collected upon admission. Data on cognitive performance (Mini-Mental State Exam [MMSE]), and cognition-related discharge diagnoses were abstracted through a structured review of discharge summaries. Results: Overall, 24.1% (425/1764) patients had a diagnosis of dementia, most frequently secondary to Alzheimer's disease (260/425, 61.2%). Among dementia cases, 70.8% (301/425) were newly diagnosed during postacute stay. This proportion was lower among patients referred from internal medicine than from orthopedic/surgery services (65.8% versus 74.8%, P = .042). Compared to patients with already diagnosed dementia, those newly diagnosed were older, lived alone more frequently, and had better functional status and MMSE score at admission (all P < .05). In multivariate analysis, previously undetected dementia remained associated with older age (OR = 2.4 for age 85 years and older, 95% CI 1.5-4.0, P = .001) and normal MMSE at admission (OR = 5.9, 95% CI 2.7-12.7, P < .001). Conclusion: Dementia was present in almost a fourth of elderly patients referred to postacute care, but was diagnosed in less than a third before admission. Oldest old patients appear especially at risk for underrecognition. These results emphasize the high diagnostic yield of systematic cognitive assessment in the postacute care setting to improve these patients' management and quality of life.

Comparing interval breast cancer rates in Norway and North Carolina: results and challenges.

OBJECTIVE: To compare interval breast cancer rates (ICR) between a biennial organized screening programme in Norway and annual opportunistic screening in North Carolina (NC) for different conceptualizations of interval cancer. SETTING: Two regions with different screening practices and performance. METHODS: 620,145 subsequent screens (1996-2002) performed in women aged 50-69 and 1280 interval cancers were analysed. Various definitions and quantification methods for interval cancers were compared. RESULTS: ICR for one year follow-up were lower in Norway compared with NC both when the rate was based on all screens (0.54 versus 1.29 per 1000 screens), negative final assessments (0.54 versus 1.29 per 1000 screens), and negative screening assessments (0.53 versus 1.28 per 1000 screens). The rate of ductal carcinoma in situ was significantly lower in Norway than in NC for cases diagnosed in both the first and second year after screening. The distributions of histopathological tumour size and lymph node involvement in invasive cases did not differ between the two regions for interval cancers diagnosed during the first year after screening. In contrast, in the second year after screening, tumour characteristics remained stable in Norway but became prognostically more favorable in NC. CONCLUSION: Even when applying a common set of definitions of interval cancer, the ICR was lower in Norway than in NC. Different definitions of interval cancer did not influence the ICR within Norway or NC. Organization of screening and screening performance might be major contributors to the differences in ICR between Norway and NC.

ALK inhibitors in the treatment of advanced NSCLC.

Pharmacologic agents that target protein products of oncogenes in tumors are playing an increasing clinical role in the treatment of cancer. Currently, the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) represent the standard of care for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) harboring activating EGFR mutations. Subsequently other genetic abnormalities with "driver" characteristics - implying transforming and tumor maintenance capabilities have been extensively reported in several small distinct subsets of NSCLC. Among these rare genetic changes, anaplastic lymphoma kinase (ALK) gene rearrangements, most often consisting in a chromosome 2 inversion leading to a fusion with the echinoderm microtubule-associated protein like 4 (EML4) gene, results in the abnormal expression and activation of this tyrosine kinase in the cytoplasm of cancer cells. This rearrangement occurs in 2-5% of NSCLC, predominantly in young (50 years or younger), never- or former-smokers with adenocarcinoma. This aberration most commonly occurs a independently of EGFR and KRAS gene mutations. A fluorescent in situ hybridization assay was approved by the US Food and Drug Administration (FDA) as the standard method for the detection of ALK gene rearrangement in clinical practice and is considered the gold standard. Crizotinib, a first-in-class dual ALK and c-MET inhibitor, has been shown to be particularly effective against ALK positive NSCLC, showing dramatic and prolonged responses with low toxicity, predominantly restricted to the gastro-intestinal and visual systems, and generally self-limiting or easily managed. However, resistance to crizotinib inevitably emerges. The molecular mechanisms of resistance are currently under investigation, as are therapeutic approaches including crizotinib-based combination therapy and novel agents such as Hsp90 inhibitors. This review aims to present the current knowledge on this fusion gene, the clinic-pathological profile of ALK rearranged NSCLC, and to review the existing literature on ALK inhibitors, focusing on their role in the treatment of NSCLC.

08005-002 Silver Lake Watershed Final Report

Silver Lake is located in an 18,053-acre watershed. The watershed is intensively farmed with almost all of the wetlands being previously drained or degraded over the last 50 years. Silver Lake is listed on the State of Iowa’s impaired water bodies list due to sediment and high nutrient level. Silver Lake is also known be in the bottom 25 percentile of Iowa’s lakes due Secchi disk readings and Chlorophyll a level. Farming in the watershed is the principle concern and cause for many of the problems occurring in Silver Lake currently with 78% of the watershed being intensively farmed. There are two major drainage ditches that have been used to drain the major wetlands and sloughs that, at one time, filtered the water and slowed it down before it reached Silver Lake. With these two major drainage ditches, water is able to reach the lake much faster and unfiltered than it once did historically. The loss of 255 restorable wetland basins to row crop production has caused serious problems in Silver Lake. These wetland basins once slowed and filtered water as it moved through the watershed. With their loss over the last 50 years that traditional drainage no longer occurs. We propose to create a Wetland Reserve Program incentive project to make WRP a more attractive option to landowners within the watershed. The incentive will be based on the amount of sediment delivery reduction to the lake, therefore paying a greater payment for a greater benefit to the lake. The expected result of this project is the restoration of over 250 acres of wetland basins with an associated 650 acres of upland buffers. The benefit for these wetlands and buffers would be reduced sediment, reduced nutrients, and slowed waters to the lake.