Évaluation d'un score simplifié de bas débit cardiaque chez l'enfant.

1.1 Objectifs Le syndrome de bas débit cardiaque est une appréciation clinique (Hoffman et al.) dont les signes sont peu sensibles, peu spécifiques, souvent tardifs et dont la mesure chez l'enfant est rendue impossible en clinique pour des raisons techniques et de fiabilités des systèmes de mesures. Aucun score n'est applicable à l'heure actuelle chez l'enfant. C'est pourquoi, ces 10 dernières années, de nombreuses équipes se sont penchée activement sur ce problème afin de définir des marqueurs performants prédisant la survenue du LCOS après chirurgie cardiaque chez l'enfant. Cette étude s'est attachée à réunir ses marqueurs cardiaques, de les combiner et de les inclure dans un score de bas débit cardiaque. 1.2 Méthode Enfants et nouveau-nés ayant subit une chirurgie cardiaque au CHUV, après malformation cardiaque congénitale, entre janvier 2010 et octobre 2011 (N=48). Age : 8 jours à 13 ans (médiane : 16.3 mois). Deux scores développés. Soumission à l'aveugle de la liste des patients à un comité d'expert pour identifier les patients en LCOS à 48h post-chirurgie, puis comparaison avec le résultat du score. Les paramètres du premier score (SCORE 1), sont agendées de manière ordinales, alors que dans le deuxième score (SCORE 2) elles le sont de manière dichotomiques. Valeurs cut-off supérieures et inférieures des scores choisies selon une recherche extensive dans la littérature. Les valeurs cut-off intermédiaires (SCORE 1) ont été choisies au hasard. 1.3 Résultats La régression logistique multivariée pour la prédiction d'un LCOS à 48h, démontre que seul le score d'amine durant les 24 premières heures et un prédicteur indépendant de LCOS (OR 16.6 [2.6- 105.5] p<0.0001). Ce paramètre est bien corrélé avec le résultat des experts avec un coefficient de corrélation r=0.57 (p<0.0001). Les spécificités des deux scores (AUC=0.78 (p<0.0001) respectivement AUC=0.81 (p<0.0001)) sont de 71% respectivement 93.5%, les sensibilités de 70.6% respectivement 41.2 %, VPP de 57.1% respectivement 77.8%, VPN de 81.5 % respectivement 74.4%. Les tests du khi2 valent 7.7 (p=0.006) respectivement 8.69 (p=003), rejettent l'hypothèse nulle d'indépendance entre le résultat des experts et celui prédit par le score. 1.4 Conclusions Les scores développés dans le cadre de cette étude ne montrent pas une corrélation significative avec l'apparition d'un bas débit cardiaque. Même si le choix des paramètres permettant de quantifier l'apparition d'un bas débit cardiaque à 48h fût réalisé selon une recherche extensive dans la littérature, le design rétrospectif de l'étude, n'a pas permit de vérifier efficacement la relation entre l'apparition d'un bas débit cardiaque et le score de bas débit cardiaque.

Council Bluffs Interstate System Improvements Project Pottawatomie County, Iowa and Douglas County, Nebraska Project Number: IM-029-3(62)54-13-78, November 2004

The Iowa Department of Transportation (Iowa DOT), Nebraska Department of Roads (NDOR), and the Federal Highway Administration (FHWA) are proposing to improve the interstate system around Council Bluffs with improvements extending across the Missouri River on I-80 to east of the I-480 interchange in Omaha, Nebraska, see Figure 1-1. The study considers long-term, broad-based transportation improvements along I-80, I-29, and I-480, including approximately 18 mainline miles of interstate and 14 interchanges (3 system1, 11 service), that would add capacity and correct functional issues along the mainline and interchanges and upgrade the I-80 Missouri River Crossing. These improvements, once implemented, would bring the segments of I-80 and I-29 up to current engineering standards and modernize the roadway to accommodate future traffic needs. In 2001, Iowa DOT and FHWA initiated the Council Bluffs Interstate System (CBIS) Improvements Project. The agencies concluded that the environmental study process would be conducted in two stages; that is, a tiered approach would be applied. The project is being conducted pursuant to the National Environmental Policy Act (NEPA) regulations issued by the Council on Environmental Quality (CEQ), 40 Code of Federal Regulations (CFR) Part 1502.20, and FHWA 23 CFR Part 771.111, that permit tiering for large, complex NEPA studies. Tier 1 is an examination of the overall interstate system improvement needs, including a clear explanation of the area’s transportation needs, a study of alternatives to satisfy them, and broad consideration of potential environmental and social impacts. The Tier 1 evaluation is at a sufficient level of engineering and environmental detail to assist decision makers in selecting a preferred transportation strategy. Tier 1 includes preparation of a draft and final Environmental Impact Statement (EIS) that would disclose the potential environmental and social effects (evaluated at a planning level that considers a variety of conceptual designs) of the proposed improvements. The final EIS will conclude with a Record of Decision (ROD) that states the preferred plan for improvements to be implemented. Essentially, the Tier 1 document will establish the planning framework for the needed improvements. Because the scope of the overall system improvements is large, the interstate improvements would be implemented as a series of individual projects that fit into the overall planning framework. The Tier 1 Area of Potential Impact, which is discussed in detail in Section 4 is an alternative that considers a combination of the most reasonable concepts that have been developed, buffered by approximately 100 or more feet to ensure that any Tier 2 design modifications would remain inside the outer boundary.

Record of Decision Council Bluffs Interstate System (I-29, I-80 and I-480) Improvements Project TIER 1 Environmental Impact Statement Council Bluffs, Iowa to Omaha, Nebraska FHWA-IA- EIS-04-01F Project Number: IM-029-3(62)54—13-78 Submitted Pursuant to 42 USC 4332(2)(c) and 49 USC 303, October 2008

The Federal Highway Administration (FHWA) approves the selection of the Reconstruction of All or Part of the Interstate (Construction Alternative) as the Preferred Alternative to provide improvements to the interstate system in the Omaha/Council Bluffs metropolitan area, extending across the Missouri River on Interstate 80 to east of the Interstate 480 interchange in Omaha, Nebraska. The study considered long-term, broad-based transportation improvements along Interstate I-29 (I-29), I-80, and I-480, including approximately 18 mainline miles of interstate and 14 interchanges (3 system, 11 service), that would add capacity and correct functional issues along the mainline and interchanges and upgrade the I-80 Missouri River Crossing. FHWA also approves the decisions to provide full access between West Broadway and I-29, design the I-80/I-29 overlap section as a dual-divided freeway, and locating the new I-80 Missouri River Bridge north of the existing bridge. Improvements to the interstate system, once implemented, would bring the segments of I-80 and I-29 (see Figure 1) up to current engineering standards and accommodate future traffic needs. This Record of Decision (ROD) concludes Tier 1 of the Council Bluffs Interstate System (CBIS) Improvements Project. Tier 1 included an examination of the area’s transportation needs, a study of alternatives to satisfy them, and broad consideration of potential environmental and social impacts. The Tier 1 evaluation consisted of a sufficient level of engineering and environmental detail to assist decision makers in selecting a preferred transportation strategy. During Tier 1 a Draft EIS (FHWA-IA- EIS-04-01D) was developed which was approved by FHWA, Iowa DOT, and Nebraska Department of Roads (NDOR) in November 2004 with comments accepted through March 15, 2005. The Draft EIS summarized the alternatives that were considered to address the transportation needs around Council Bluffs; identified reconstruction of all or part of the interstate, the “Construction Alternative,” as the Preferred Alternative; identified three system-level decisions that needed to be made at the Tier 1 level; and invited comment on the issues. The Final EIS (FHWA-IA- EIS-04-01F) further documented the Construction Alternative as the Preferred Alternative and identified the recommended decisions for the three system level decisions that needed to be made in Tier 1. This ROD defines the Selected Alternative determined in the Tier 1 studies.

A Laboratory Evaluation of Asphaltic Concrete Containing Asphadur, MLR-78-2, 1978

This report describes a laboratory evaluation of three asphaltic concrete, plant produced mixtures containing Asphadur. The mixtures represent a type A asphaltic concrete and two type B asphaltic concretes. The type A and one of the type B mixtures were used in pavements and will be evaluated later for durability and serviceability. The second type B mixture was made only for laboratory testing. In each instance, control batches of the same mixtures but without Asphadur were made for comparison. Type A is a high type asphaltic concrete, requires a minimum of 65 percent crushed particles and is generally used for higher traffic volume roads. Type B is used for intermediate or lower traffic volumes and requires a minimum of 30 percent crushed particles.

Nanomedicines for active targeting: physico-chemical characterization of paclitaxel-loaded anti-HER2 immunonanoparticles and in vitro functional studies on target cells.

Paclitaxel (Tx)-loaded anti-HER2 immunonanoparticles (NPs-Tx-HER) were prepared by the covalent coupling of humanized monoclonal anti-HER2 antibodies (trastuzumab, Herceptin) to Tx-loaded poly (dl-lactic acid) nanoparticles (NPs-Tx) for the active targeting of tumor cells that overexpress HER2 receptors. The physico-chemical properties of NPs-Tx-HER were compared to unloaded immunonanoparticles (NPs-HER) to assess the influence of the drug on anti-HER2 coupling to the NP surface. The immunoreactivity of sulfo-MBS activated anti-HER2 mAbs and the in vitro efficacy of NPs-Tx-HER were tested on SKOV-3 ovarian cancer cells that overexpress HER2 antigens. Tx-loaded nanoparticles (NPs-Tx) obtained by a salting-out method had a size of 171+/-22 nm (P.I.=0.1) and an encapsulation efficiency of about of 78+/-10%, which corresponded to a drug loading of 7.8+/-0.8% (w/w). NPs-Tx were then thiolated and conjugated to activated anti-HER2 mAbs to obtain immunonanoparticles of 237+/-43 nm (P.I.=0.2). The influence of the activation step on the immunoreactivity of the mAbs was tested on SKOV-3 cells using 125I-radiolabeled mAbs, and the activity of the anti-HER2 mAbs was minimally affected after sulfo-MBS functionalization. Approximately 270 molecules of anti-HER2 mAbs were bound per nanoparticle. NPs-Tx-HER exhibited a zeta potential of 0.2+/-0.1 mV. The physico-chemical properties of the Tx-loaded immunonanoparticles were very similar to unloaded immunonanoparticles, suggesting that the encapsulation of the drug did not influence the coupling of the mAbs to the NPs. No drug loss was observed during the preparation process. DSC analysis showed that encapsulated Tx is in an amorphous or disordered-crystalline phase. These results suggest that Tx is entrapped in the polymeric matrix and not adsorbed to the surface of the NPs. In vitro studies on SKOV-3 ovarian cancer cells demonstrated the greater cytotoxic effect of NPs-Tx-HER compared to other Tx formulations. The results showed that at 1 ng Tx/ml, the viability of cells incubated with drug encapsulated in NP-Tx-HER was lower (77.32+/-5.48%) than the viability of cells incubated in NPs-Tx (97.4+/-12%), immunonanoparticles coated with Mabthera, as irrelevant mAb (NPs-Tx-RIT) (93.8+/-12%) or free drug (92.3+/-9.3%).

Jasper County, Township 78 North Range 20 West

Des Moines River Plat Maps.

Jasper County, Township 78 North Range 21 West

Des Moines River Plat Maps.

Polk County, Township 78 North Range 22 West

Des Moines River Plat Maps.

Polk County, Township 78 North Range 23 West

Des Moines River Plat Maps.

Polk County, Township 78 North Range 24 West

Des Moines River Plat Maps.

Polk County, Township 78 North Range 25 West

Des Moines River Plat Maps.

Sprinkle Treatment of Asphalt Pavements, MLR-78-01, 1978

The paper reviews methods, materials, equipment and results to date of sprinkle treatment within the state. The Iowa Department of Transportation formerly the Iowa State Highway Commission, made its first attempts at sprinkle treatment of fresh asphalt concrete in 1974. Increased emphasis in mix design of asphalt mixes and aggregate selection of durable non-polishing materials has generated costly restrictions on the use of local materials. During the summer of 1975, a dual spinner, tail-gate spreader was mounted on a standard departmental dump truck to attempt additional sprinkle treatment on a section of Iowa 7 west of Ft. Dodge. The dump truck equipment was marginally satisfactory, but results of increased surface skid texture and durability were well demonstrated. On 1976 a new, current order dump truck was modified with an auxiliary transmission and a set of slick surfaced tires, and dual spinner spreader was mounted to again attempt surface sprinkle treatment, which was conducted in 1977.

A Study of the Frictional Properties of New Asphaltic Concrete Pavements in Iowa, MLR-78-03, 1978

Seven asphaltic concrete resurfacing projects were tested for their frictional properties to determine the age-friction relationship of new paving. Projects studied included Type A asphaltic concrete which is generally used for higher traffic volume roads and Type B asphaltic concrete, a lower type material. Also included in the study were asphaltic concretes containing Type 3 and Type 4 coarse aggregate texture classifications. The classifications are based upon material type and grain size composition. Surfaces both with and without sprinkle treatment aggregates were also included. The data gathered suggests that properly designed and placed dense graded asphaltic concrete mixes are adequate to serve the traveling public at all ages tested.

Prevalence of cognitive disorders in HIV plus patients with long-term suppression of viremia

Background: HAART has contributed to decrease the HIV-related mortality and morbidity. However, the prevalence of HIV-associated neurocognitive disorders (HAND) seems to have increased. The aim of this study was to determine the prevalence of cognitive complaint and of HAND in a cohort of aviremic HIV_patients in the South-western part of Switzerland. Design/Methods: Two hundred HIV_ patients who had (1) undetectable HIV RNA concentrations in the plasma for_3 months, (2) no history of major opportunistic infection of the CNS in the past three years, (3) no current use of IV drugs and (4) no signs of major depression according to the DSM-IV criteria, answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of a subset of HIV_ patients with or without cognitive complaints were assessed using the HIV Dementia scale (HDS) and a battery of neuropsychological tests evaluating the sub-cortical functions. Cognitive impairment was defined according to the revised diagnostic criteria for HAND. Non-parametric tests were used for statistics and a Bonferroni corrected standard p level of pB0.002 was applied for multiple comparisons. Results: The prevalence of cognitive complaints was 27% (54 patients) among the 200 questioned patients. At the time of writing this abstract, cognitive functions of 50 complaining and 28 noncomplaining aviremic patients had been assessed with the HDS and the full neuropsychological battery. The prevalence of HAND producing at least mild interference in daily functioning (mild neurocognitive disorders [MND] or HIV-associated dementia [HAD]) was 44% (34/78 patients) in the group who underwent neuropsychological testing. Objective evidences of HAND were more frequent in complaining than in non-complaining patients (pB0.001). Using a ROC curve, a cut-off of 13 on the HDS was found to have a sensitivity of 74% and a specificity of 71% (p_0.001) for the diagnosis of HAND. A trend for lower CNS Penetrating-Effectiveness scores for HAART in patients with MND or HAD as compared to the others was present (1.59 0.6 vs. 1.990.6; p_0.006 [Bonferroni correction]). Conclusions/Relevance: So far, our results suggest that (1) the prevalence of HAND is high in HIV_ patients with a long-term suppression of viremia, and (2) cognitive complaints expressed by aviremic HIV_ patients should be carefully investigated as they correlate with objective evidences of cognitive decline in a neuropsychological testing. HAART with a high CNS penetrating-effectiveness may contribute to prevent HAND. Funding: Swiss HIV Cohort Study.