Long term global evaluation of a national AIDS prevention strategy: the case of Switzerland.

OBJECTIVES: The Swiss Aids prevention strategy has been subject to a continuous process of evaluation for the past 12 years. This paper describes the conceptual approach, methodology, results obtained and contribution to policy-making of that evaluation.¦DESIGN: The evaluation is on-going, global with respect to all components of the strategy, and utilization-focused. Each successive phase of the evaluation has included 10-20 studies centred either on aspects of process, of outcome or of environmental context. Findings are synthesized at the end of each phase. METHODS: Both quantitative and qualitative methods are used. Studies generally have one of three functions within the overall evaluation: assessment of trends through surveys or other types of repeated studies; evaluation of specific areas through a series of studies from different viewpoints; in-depth investigation or rapid assessment through one-off studies. Various methods of triangulation are used to validate findings. RESULTS: The evaluation has allowed for: the observation of behavioural change in different populations; the availability of scientific data in controversial fields such as drug-use policy; an understanding of the diversity of public appropriation of prevention messages. Recommendations are regularly formulated and have been used by policy-makers and field workers for strategy development. CONCLUSIONS: The global approach adopted corresponds well to the evaluation requirements of an integrated long-term prevention strategy. Cost is low relative to the extent of information provided. Such an evaluation cannot however address the question of causal relationship between the strategy and observed changes. The evaluation has contributed to the development of a culture of evaluation in Swiss AIDS prevention more generally.

Minimal data requirements for a continuous monitoring of the quality of care using the DRG classification.

The DRG classification provides a useful tool for the evaluation of hospital care. Indicators such as readmissions and mortality rates adjusted for the hospital Casemix could be adopted in Switzerland at the price of minor additions to the hospital discharge record. The additional information required to build patients histories and to identify the deaths occurring after hospital discharge is detailed.

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.

Evaluation of Bridge Replacement Alternatives for the County Bridge System, HR-365 August 1994

Recent reports have indicated that 23.5 percent of the nation's highway bridges are structurally deficient and 17.7 percent are functionally obsolete. A significant number of these bridges are on the Iowa county road system. The objective of the investigation described in this report was to identify, review and evaluate replacement bridges currently being used by various counties in Iowa and surrounding states. Iowa county engineers, county engineers in neighboring states as well as private manufacturers of bridge components, and regional precad prestressed concrete manufacturers were contacted to determine the most common replacement bridge types being used. Depending upon the findings of the review, possible improvements and/or new replacement bridge systems were to be proposed. A questionnaire was developed and sent to county engineers in Iowa and several counties in surrounding states. The results of the questionnaire showed that the most common replacement bridges in Iowa are the continuous concrete slab and prestressed concrete bridges. The primary reason these types are used is because of the availability of standard designs and because of their ease of maintenance. Counties seldom construct these types of bridges using their own labor forces, but instead contract the work. However, county forces are used to construct steel stringer, precast reinforced concrete and timber bridges. In general, 69 percent of the counties indicate an ability and willingness to use their own forces to design and construct relatively short span bridges (i.e., 40 A or less) provided the construction procedures are relatively simple. Several unique replacement bridge types used in Iowa that are constructed by county forces are documented and presented in this report. Sufficient details are provided to allow county engineers to determine if some of these bridges could be used to resolve some of their own replacement bridge problems. Where possible, cost information has also been provided. Each of these bridge types were evaluated for various criteria (e.g., cost effectiveness, conformance to AASI-ITO standards, range of sizes, etc.) by a panel of four Iowa county engineers; a summary of this critique is included. After evaluating the questionnaire responses from the counties and evaluating the various bridge replacement concepts currently in use, one new bridge replacement concept and one modification of a current Iowa county bridge replacement concept were developed. Both of these concepts would utilize county labor forces.

Concomitant administration of intravenous drugs in the ICU: evaluation of physico-chemical compatibilities

Background and objective: Patients in the ICU often get many intravenous (iv) drugs at the same time. Even with three-lumen central venous catheters, the administration of more than one drug in the same iv line (IVL) is frequently necessary. The objective of this study was to observe how nurses managed to administer these many medications and to evaluate the proportion of two-drugs associations (TDA) that are compatible or not, based on known compatibility data. Design: Observational prospective study over 4 consecutive months. All patients receiving simultaneously more than one drugs in the same IVL (Y-site injection or mixed in the same container) were included. For each patient, all iv drugs were recorded, as well as concentration, infusion solution, location on the IVL system, time, rate and duration of administration. For each association of two or more drugs, compatibility of each drug was checked with each other. Compatibilities between these pairs of drugs were assessed using published data (mainly Trissel LA. Handbook on Injectable Drugs and Trissel's Tables of Physical Compatibility) and visual tests performed in our quality control laboratory. Setting: 34 beds university hospital adult ICU. Main outcome measures: Percentage of compatibilities and incompatibilities between drugs administered in the same IVL. Results: We observed 1,913 associations of drugs administered together in the same IVL, 783 implying only two drugs. The average number of drugs per IVL was 3.1 ± 0.8 (range: 2-9). 83.2% of the drugs were given by continuous infusion, 14.3% by intermittent infusion and 2.5% in bolus. The associations observed allowed to form 8,421 pairs of drugs (71.7% drug-drug and 28.3% drug-solute). According to literature data, 80.2% of the association were considered as compatible and 4.4% incompatible. 15.4% were not interpretable because of different conditions between local practices and those described in the literature (drug concentration, solute, etc.) or because of a lack of data. After laboratory tests performed on the most used drugs (furosemide, KH2PO4, morphine HCl, etc.), the proportion of compatible TDA raised to 85.7%, the incompatible stayed at 4.6% and only 9.7% remain unknown or not interpretable. Conclusions: Nurses managed the administration of iv medications quite well, as only less than 5% of observed TDA were considered as incompatible. But the 10% of TDA with unavailable compatibility data should have been avoided too, since the consequences of their concomitant administration cannot be predictable. For practical reasons, drugs were analysed only by pairs, which constitutes the main limit of this work. The average number of drugs in the same association being three, laboratory tests are currently performed to evaluate some of the most observed three-drugs associations.

Evaluation of statistical and geostatistical models of digital soil properties mapping in tropical mountain regions

Soil properties have an enormous impact on economic and environmental aspects of agricultural production. Quantitative relationships between soil properties and the factors that influence their variability are the basis of digital soil mapping. The predictive models of soil properties evaluated in this work are statistical (multiple linear regression-MLR) and geostatistical (ordinary kriging and co-kriging). The study was conducted in the municipality of Bom Jardim, RJ, using a soil database with 208 sampling points. Predictive models were evaluated for sand, silt and clay fractions, pH in water and organic carbon at six depths according to the specifications of the consortium of digital soil mapping at the global level (GlobalSoilMap). Continuous covariates and categorical predictors were used and their contributions to the model assessed. Only the environmental covariates elevation, aspect, stream power index (SPI), soil wetness index (SWI), normalized difference vegetation index (NDVI), and b3/b2 band ratio were significantly correlated with soil properties. The predictive models had a mean coefficient of determination of 0.21. Best results were obtained with the geostatistical predictive models, where the highest coefficient of determination 0.43 was associated with sand properties between 60 to 100 cm deep. The use of a sparse data set of soil properties for digital mapping can explain only part of the spatial variation of these properties. The results may be related to the sampling density and the quantity and quality of the environmental covariates and predictive models used.

Debris flows as a factor of hillslope evolution controlled by a continuous or a pulse process?

Flood effectiveness observations imply that two families of processes describe the formation of debris flow volume. One is related to the rainfall?erosion relationship, and can be seen as a gradual process, and one is related to additional geological/geotechnical events, those named hereafter extraordinary events. In order to discuss the hypothesis of coexistence of two modes of volume formation, some methodologies are applied. Firstly, classical approaches consisting in relating volume to catchments characteristics are considered. These approaches raise questions about the quality of the data rather than providing answers concerning the controlling processes. Secondly, we consider statistical approaches (cumulative number of events distribution and cluster analysis) and these suggest the possibility of having two distinct families of processes. However the quantitative evaluation of the threshold differs from the one that could be obtained from the first approach, but they all agree in the sense of the coexistence of two families of events. Thirdly, a conceptual model is built exploring how and why debris flow volume in alpine catchments changes with time. Depending on the initial condition (sediment production), the model shows that large debris flows (i.e. with important volume) are observed in the beginning period, before a steady-state is reached. During this second period debris flow volume such as is observed in the beginning period is not observed again. Integrating the results of the three approaches, two case studies are presented showing: (1) the possibility to observe in a catchment large volumes that will never happen again due to a drastic decrease in the sediment availability, supporting its difference from gradual erosion processes; (2) that following a rejuvenation of the sediment storage (by a rock avalanche) the magnitude?frequency relationship of a torrent can be differentiated into two phases, the beginning one with large and frequent debris flow and a later one with debris flow less intense and frequent, supporting the results of the conceptual model. Although the results obtained cannot identify a clear threshold between the two families of processes, they show that some debris flows can be seen as pulse of sediment differing from that expected from gradual erosion.

An Evaluation of the Consolidation Monitoring Device, HR-1013, 1978

The Iowa Department of Transportation research project HR-1013 is the evaluation of a prototype continuous monitoring nuclear density unit. The Unit, the Consolidation Monitoring Device (CMD), mounts on the rear of a slip-form paver and measures the density of the concrete while still in the plastic state. The evaluation performed determined the usefulness, accuracy, precision and reproducibility of the unit. The CMD was calibrated and tested in the laboratory for one week before field evaluation. The field evaluation consisted of monitoring at least 5 miles of paving and then correlating the CMD data with two conventional density methods. The two supplemental methods were density measurement with a Troxler nuclear gauge and densities obtained from core samples.

Initial and Extended Use of Femoral Versus Nonfemoral Double-Lumen Vascular Catheters and Catheter-Related Infection During Continuous Renal Replacement Therapy.

BACKGROUND: The risk of catheter-related infection or bacteremia, with initial and extended use of femoral versus nonfemoral sites for double-lumen vascular catheters (DLVCs) during continuous renal replacement therapy (CRRT), is unclear. STUDY DESIGN: Retrospective observational cohort study. SETTING & PARTICIPANTS: Critically ill patients on CRRT in a combined intensive care unit of a tertiary institution. FACTOR: Femoral versus nonfemoral venous DLVC placement. OUTCOMES: Catheter-related colonization (CRCOL) and bloodstream infection (CRBSI). MEASUREMENTS: CRCOL/CRBSI rates expressed per 1,000 catheter-days. RESULTS: We studied 458 patients (median age, 65 years; 60% males) and 647 DLVCs. Of 405 single-site only DLVC users, 82% versus 18% received exclusively 419 femoral versus 82 jugular or subclavian DLVCs, respectively. The corresponding DLVC indwelling duration was 6±4 versus 7±5 days (P=0.03). Corresponding CRCOL and CRBSI rates (per 1,000 catheter-days) were 9.7 versus 8.8 events (P=0.8) and 1.2 versus 3.5 events (P=0.3), respectively. Overall, 96 patients with extended CRRT received femoral-site insertion first with subsequent site change, including 53 femoral guidewire exchanges, 53 new femoral venipunctures, and 47 new jugular/subclavian sites. CRCOL and CRBSI rates were similar for all such approaches (P=0.7 and P=0.9, respectively). On multivariate analysis, CRCOL risk was higher in patients older than 65 years and weighing >90kg (ORs of 2.1 and 2.2, respectively; P<0.05). This association between higher weight and greater CRCOL risk was significant for femoral DLVCs, but not for nonfemoral sites. Other covariates, including initial or specific DLVC site, guidewire exchange versus new venipuncture, and primary versus secondary DLVC placement, did not significantly affect CRCOL rates. LIMITATIONS: Nonrandomized retrospective design and single-center evaluation. CONCLUSIONS: CRCOL and CRBSI rates in patients on CRRT are low and not influenced significantly by initial or serial femoral catheterizations with guidewire exchange or new venipuncture. CRCOL risk is higher in older and heavier patients, the latter especially so with femoral sites.

Evaluation of Steel Bridges, Volumes I & II, TR-493, 2007

This report is divided into two volumes. This volume (Volume I) summarizes a structural health monitoring (SHM) system that was developed for the Iowa DOT to remotely and continuously monitor fatigue critical bridges (FCB) to aid in the detection of crack formation. The developed FCB SHM system enables bridge owners to remotely monitor FCB for gradual or sudden damage formation. The SHM system utilizes fiber bragg grating (FBG) fiber optic sensors (FOSs) to measure strains at critical locations. The strain-based SHM system is trained with measured performance data to identify typical bridge response when subjected to ambient traffic loads, and that knowledge is used to evaluate newly collected data. At specified intervals, the SHM system autonomously generates evaluation reports that summarize the current behavior of the bridge. The evaluation reports are collected and distributed to the bridge owner for interpretation and decision making. Volume II summarizes the development and demonstration of an autonomous, continuous SHM system that can be used to monitor typical girder bridges. The developed SHM system can be grouped into two main categories: an office component and a field component. The office component is a structural analysis software program that can be used to generate thresholds which are used for identifying isolated events. The field component includes hardware and field monitoring software which performs data processing and evaluation. The hardware system consists of sensors, data acquisition equipment, and a communication system backbone. The field monitoring software has been developed such that, once started, it will operate autonomously with minimal user interaction. In general, the SHM system features two key uses. First, the system can be integrated into an active bridge management system that tracks usage and structural changes. Second, the system helps owners to identify damage and deterioration.

Evaluation of Gap-Graded Asphalt Concrete Mixtures, Vol. 1. Physical Properties (Part I: Mechanical Properties), HR-157, Volume 1, 1972 (1973)

This report presents the results of a comparative laboratory study between well- and gap-graded aggregates used in asphalt concrete paving mixtures. A total of 424 batches of asphalt concrete mixtures and 3,960 Marshall and Hveem specimens were examined. There is strong evidence from this investigation that, with proper-combinations of aggregates and asphalts, both continuous- and gap-graded aggregates can produce mixtures of high density and of qualities meeting current design criteria. There is also reason to believe that the unqualified acceptance of some supposedly desirable, constant, mathematical relationship between adjacent particle sizes of the form such as Fuller's curve p = 100(d/D)^n is not justified. It is recommended that the aggregate grading limits be relaxed or eliminated and that the acceptance or rejection of an aggregate for use in asphalt pavement be based on individual mixture evaluation. Furthermore, because of the potential attractiveness of gap-graded asphalt concrete in cost, quality, and skid and wear resistance, selected gap-graded mixtures are recommended for further tests both in the laboratory and in the field, especially in regard to ease of compaction and skid and wear resistance.

Evaluation of Gap-Graded Asphalt Concrete Mixtures Vol. 3. Appendix, HR-157, Volume 3 (Part 3), 1972 (1973)

This report presents the results of a comparative laboratory study between well- and gap-graded aggregates used in asphalt concrete paving mixtures. A total of 424 batches of asphalt concrete mixtures and 3,960 Marshall and Hveem specimens were examined. There is strong evidence from this investigation that, with proper combinations of aggregates and asphalts, both continuous- and gap-graded aggregates can produce mixtures of high density and of qualities meeting current design criteria. There is also reason to believe that the unqualified acceptance of some supposedly desirable, constant, mathematical relationship between adjacent particle sizes of the form such as Fuller's curve p = 100 (d/D)n is not justified. It is recommended that. the aggregate grading limits be relaxed or eliminated and that the acceptance or rejection of an aggregate for use in asphalt pavement be based on individual mixture evaluation. Furthermore, because of the potential attractiveness of gap-graded asphalt concrete in cost, quality, and skid and wear resistance, selected gap-graded mixtures are recommended for further tests both in the laboratory and in the field, especially in regard to ease of compaction and skid and wear resistance.

Implementation of a Pilot Continuous Monitoring System: Iowa Falls Arch Bridge, HR-1088, 2015

The goal of this work was to move structural health monitoring (SHM) one step closer to being ready for mainstream use by the Iowa Department of Transportation (DOT) Office of Bridges and Structures. To meet this goal, the objective of this project was to implement a pilot multi-sensor continuous monitoring system on the Iowa Falls Arch Bridge such that autonomous data analysis, storage, and retrieval can be demonstrated. The challenge with this work was to develop the open channels for communication, coordination, and cooperation of various Iowa DOT offices that could make use of the data. In a way, the end product was to be something akin to a control system that would allow for real-time evaluation of the operational condition of a monitored bridge. Development and finalization of general hardware and software components for a bridge SHM system were investigated and completed. This development and finalization was framed around the demonstration installation on the Iowa Falls Arch Bridge. The hardware system focused on using off-the-shelf sensors that could be read in either “fast” or “slow” modes depending on the desired monitoring metric. As hoped, the installed system operated with very few problems. In terms of communications—in part due to the anticipated installation on the I-74 bridge over the Mississippi River—a hardline digital subscriber line (DSL) internet connection and grid power were used. During operation, this system would transmit data to a central server location where the data would be processed and then archived for future retrieval and use. The pilot monitoring system was developed for general performance evaluation purposes (construction, structural, environmental, etc.) such that it could be easily adapted to the Iowa DOT’s bridges and other monitoring needs. The system was developed allowing easy access to near real-time data in a format usable to Iowa DOT engineers.

Continuous monitoring and quantification of multiple parameters of daily physical activity in ambulatory Duchenne muscular dystrophy patients.

Multiple motor function and strength assessment tools exist for the evaluation of neuromuscular diseases, but most do not directly assess functional ability in the patients' daily physical activity in their home environment. In this study our aim was to assess: 1) the feasibility and accuracy of physical activity monitoring during two days in a home environment of five DMD patients using a non-commercialized monitor containing a 3D accelerometer and a gyroscope, 2) if a difference in the physical activity parameters could be measured before and one month after starting prednisolone. We reliably quantified the time spend sitting, standing, lying, walking, the number of steps taken, the cadence, the number of walking episodes and their duration as well as how these were distributed over the day. Parameters possibly reflecting endurance, such as the duration of the walking episodes or the succession of two or three walking episodes lasting more than 30 s were the most improved after prednisolone treatment. This degree of detailed determination of physical activity in a home environment has not been previously reported in neuromuscular disorders to our knowledge and some of the reported parameters are potential new outcome measures in clinical trials.

Evaluation of Post-Tension Strengthened Steel Girder Bridge Using FRP Bars, 2003

Many state, county, and local agencies are faced with deteriorating bridge infrastructure composed of a large percentage of relatively short to medium span bridges. In many cases, these older structures are rolled or welded longitudinal steel stringers acting compositely with a reinforced concrete deck. Most of these bridges, although still in service, need some level of strengthening due to increases in legal live loads or loss of capacity due to deterioration. Although these bridges are overstressed in most instances, they do not warrant replacement; thus, structurally efficient but cost-effective means of strengthening needs to be employed. In the past, the use of bolted steel cover plates or angles was a common retrofit option for strengthening such bridges. However, the time and labor involved to attach such a strengthening system can sometimes be prohibitive. This project was funded through the Federal Highway Administration’s Innovative Bridge Research and Construction program. The goal is to retrofit an existing structurally deficient, three-span continuous steel stringer bridge using an innovative technique that involves the application of post-tensioning forces; the post-tensioning forces were applied using fiber reinforced polymer post-tensioning bars. When compared to other strengthening methods, the use of carbon fiber reinforced polymer composite materials is very appealing in that they are highly resistant to corrosion, have a low weight, and have a high tensile strength. Before the post-tensioning system was installed, a diagnostic load test was conducted on the subject bridge to establish a baseline behavior of the unstrengthened bridge. During the process of installing the post-tensioning hardware and stressing the system, both the bridge and the post-tensioning system were monitored. The installation of the hardware was followed by a follow-up diagnostic load test to assess the effectiveness of the post-tensioning strengthening system. Additional load tests were performed over a period of two years to identify any changes in the strengthening system with time. Laboratory testing of several typical carbon fiber reinforced polymer bar specimens was also conducted to more thoroughly understand their behavior. This report documents the design, installation, and field testing of the strengthening system and bridge.