834 research outputs found
The administrative-production hall in Litovel - assembly skeleton
Předmětem bakalářské práce je etapa montáže skeletu administrativně-výrobní haly v Litovli. Řešený objekt se dělí na administrativní a halovou část, pro které byla vypracována technická zpráva, položkový rozpočet včetně výkazu výměr, technologický předpis, řešení organizace výstavby, včetně výkresů zařízení staveniště, časový plán zpracovaný v programu Contec, návrh strojní sestavy, kontrolní a zkušební plán a bezpečnost práce pro montáž skeletu.The subject of this bachelor thesis is the assembly stage of the administrative-production hall in Litovel. Addressed property is divided into administrative and hall part, for which has been drawn up technical report, item budget including bill of quantities, technological standard, solution for construction organization including construction site equipment drawing, timetable processed by Contec program, machine assembly suggestion, control and test plan and work safety for the skeleton assembly.
Mixed-use Building in Uherské Hradiště
Diplomová práce se zabývá návrhem projektové dokumentace polyfunkčního domu v Uherském Hradišti na parcele č. 712/7 v katastrálním území Uherské Hradiště. Objekt má dvě nadzemní podlaží a částečně podsklepený suterén. V přízemí se nachází komerční plochy a kavárna. V druhém nadzemním podlaží jsou navrženy kancelářské prostory. Objekt je navržen jako skeletový s výplňovým zdivem, s plochou střechou a je zateplený kontaktním zateplovacím systémem ETICS.The diploma thesis deals with the project documentation of the multifunctional house in Uherské Hradiště on plot no. 712/7 in the cadastral area of Uherské Hradiště. The building has two floors and a basement. On the ground floor there is a commercial area and a café. Office space is designed on the second floor. The building is designed as a skeleton with filling masonry, with a flat roof and is insulated with ETICS contact insulation system.
Risk Factors for Long-Term Coronary Artery Calcium Progression in the Multi-Ethnic Study of Atherosclerosis.
BackgroundCoronary artery calcium (CAC) detected by noncontrast cardiac computed tomography scanning is a measure of coronary atherosclerosis burden. Increasing CAC levels have been strongly associated with increased coronary events. Prior studies of cardiovascular disease risk factors and CAC progression have been limited by short follow-up or restricted to patients with advanced disease.Methods and resultsWe examined cardiovascular disease risk factors and CAC progression in a prospective multiethnic cohort study. CAC was measured 1 to 4 times (mean 2.5 scans) over 10 years in 6810 adults without preexisting cardiovascular disease. Mean CAC progression was 23.9 Agatston units/year. An innovative application of mixed-effects models investigated associations between cardiovascular disease risk factors and CAC progression. This approach adjusted for time-varying factors, was flexible with respect to follow-up time and number of observations per participant, and allowed simultaneous control of factors associated with both baseline CAC and CAC progression. Models included age, sex, study site, scanner type, and race/ethnicity. Associations were observed between CAC progression and age (14.2 Agatston units/year per 10 years [95% CI 13.0 to 15.5]), male sex (17.8 Agatston units/year [95% CI 15.3 to 20.3]), hypertension (13.8 Agatston units/year [95% CI 11.2 to 16.5]), diabetes (31.3 Agatston units/year [95% CI 27.4 to 35.3]), and other factors.ConclusionsCAC progression analyzed over 10 years of follow-up, with a novel analytical approach, demonstrated strong relationships with risk factors for incident cardiovascular events. Longitudinal CAC progression analyzed in this framework can be used to evaluate novel cardiovascular risk factors
Clinical utility of rosuvastatin and other statins for cardiovascular risk reduction among the elderly
Age is one of the strongest predictors of cardiovascular disease (CVD) risk. Treatment with statins can significantly reduce CVD events and mortality in both primary and secondary prevention. Yet despite the high CVD risk among the elderly, there is underutilization of statins in this population (ie, the treatment-risk paradox). Few studies have investigated the use of statins in the elderly, particularly for primary prevention and, as a result, guidelines for treating the elderly are limited. This is likely due to: uncertainties of risk assessment in older individuals where the predictive value of individual risk factors is decreased; the need to balance the benefits of primary prevention with the risks of polypharmacy, health care costs, and adverse medication effects in a population with decreased life expectancy; the complexity of treating patients with many other comorbidities; and increasingly difficult social and economic concerns. As life expectancy increases and the total elderly population grows, these issues become increasingly important. JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) is the largest primary prevention statin trial to date and enrolled a substantial number of elderly adults. Among the 5695 JUPITER participants ≥70 years of age, the absolute CVD risk reduction associated with rosuvastatin was actually greater than for younger participants. The implications of this JUPITER subanalysis and the broader role of statins among older adults is the subject of this review
Potential implications of coronary artery calcium testing for guiding aspirin use among asymptomatic individuals with diabetes.
ObjectiveIt is unclear whether coronary artery calcium (CAC) is effective for risk stratifying patients with diabetes in whom treatment decisions are uncertain.Research design and methodsOf 44,052 asymptomatic individuals referred for CAC testing, we studied 2,384 individuals with diabetes. Subjects were followed for a mean of 5.6 ± 2.6 years for the end point of all-cause mortality.ResultsThere were 162 deaths (6.8%) in the population. CAC was a strong predictor of mortality across age-groups (age <50, 50-59, ≥60), sex, and risk factor burden (0 vs. ≥1 additional risk factor). In individuals without a clear indication for aspirin per current guidelines, CAC stratified risk, identifying patients above and below the 10% risk threshold of presumed aspirin benefit.ConclusionsCAC can help risk stratify individuals with diabetes and may aid in selection of patients who may benefit from therapies such as low-dose aspirin for primary prevention
Risk-taking and self-harm behaviors as markers of adolescent borderline personality disorder.
Adolescence is a critical period for early identification and intervention of borderline personality disorder (BPD). Risk-taking and self-harm behaviors (RSB) have been identified as promising early markers of BPD and correlates of depression in school-based samples. The present study aimed, first, to examine the association between RSB and BPD in a clinical sample of adolescents and, second, to examine whether RSB are also linked to depression. N = 405 participants (82.7% female) were recruited from an outpatient clinic for adolescents with RSB. RSB assessed included truancy, excessive media use, alcohol, tobacco, and illicit drug use, sexual risk-taking, and self-harm behavior. Regression analyses and generalized linear models were performed to examine the associations between individual RSB or patterns of RSB (identified using latent class analysis, LCA) and a diagnosis and severity of BPD or depression. All RSB (except excessive media use) were positively associated with BPD diagnosis and severity. In contrast, only non-suicidal self-injury (NSSI) and suicide attempts were positively associated with depression diagnosis and severity, while illicit drug use was negatively associated with depression severity. The LCA yielded two classes differing in the occurrence of RSB. The high RSB class was more likely to have a BPD diagnosis and greater BPD severity than the low RSB class. Classes did not differ regarding depression diagnosis or severity. As NSSI and suicide attempts were associated with both BPD and depression, the presence of additional RSB, besides self-harm behavior, may represent a specific risk marker for BPD in adolescents
Knee Loading Due to Varus and External Rotation in Gait Supports Medial Compartment Wear in Total Knee Arthroplasty
Malalignment of the lower extremity may be a cause for gonarthrosis and failure of total knee prosthetic components. Neutral lower limb alignment is considered straight alignment of the axes formed from the center of the femoral head to the center of the knee and from the center of the knee to the center of the ankle joint (the mechanical axes of the thigh and shank). Malalignment of the mechanical axis (measured by δv, the angle between the femoral and the tibial mechanical axes) occurs when varus moves the line of action farther medially from the knee joint center. Malalignment due to varus results in increases in medial compartment loading and has been attributed to medial compartment articular cartilage degeneration. External rotation of the hip and knee compared to the direction of gait is another form of malalignment. In external rotation, the knee displaces from the midline at stance phase. Knee loading and the consequences of external rotation on cartilage degeneration are not well understood. The purpose of our study was to develop a mathematical model that would calculate forces and moments in knees for gait and study how they vary with varus and external rotation malalignment. An additional objective was to develop a finite element model of total knee replacement to study stress patterns on the polyethylene insert during malaligned gait. We hypothesized that medial compartment loads would be increased by both varus and external rotation alignment of the knee compared to the direction of gait. We also hypothesize that stress patterns on total knee replacement (TKR) inserts under conditions related to malaligned gait will correlate with wear patterns observed in retrieval studies. It was found that for varus and external rotation, there is a shift towards adduction moment, which resulted in an increase in medial compartment loads, supporting our hypothesis. It was also found that the malalignment in gait results in alterations in tibial tray load magnitudes and load distribution that support elevated wear in the medial compartment as observed clinically
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All-cause and cause-specific mortality in individuals with zero and minimal coronary artery calcium: A long-term, competing risk analysis in the Coronary Artery Calcium Consortium.
Background and aimsThe long-term associations between zero, minimal coronary artery calcium (CAC) and cause-specific mortality are currently unknown, particularly after accounting for competing risks with other causes of death.MethodsWe evaluated 66,363 individuals from the CAC Consortium (mean age 54 years, 33% women), a multi-center, retrospective cohort study of asymptomatic individuals undergoing CAC scoring for clinical risk assessment. Baseline evaluations occurred between 1991 and 2010.ResultsOver a mean of 12 years of follow-up, individuals with CAC = 0 (45% prevalence, mean age 45 years) had stable low rates of coronary heart disease (CHD) death, cardiovascular disease (CVD) death (ranging 0.32 to 0.43 per 1000 person-years), and all-cause death (1.38-1.62 per 1000 person-years). Cancer was the predominant cause of death in this group, yet rates were also very low (0.47-0.79 per 1000 person-years). Compared to CAC = 0, individuals with CAC 1-10 had an increased multivariable-adjusted risk of CVD death only under age 40. Individuals with CAC>10 had multivariable-adjusted increased risks of CHD death, CVD death and all-cause death at all ages, and a higher proportion of CVD deaths.ConclusionsCAC = 0 is a frequent finding among individuals undergoing CAC scanning for risk assessment and is associated with low rates of all-cause death at 12 years of follow-up. Our results support the emerging consensus that CAC = 0 represents a unique population with favorable all-cause prognosis who may be considered for more flexible treatment goals in primary prevention. Detection of any CAC in young adults could be used to trigger aggressive preventive interventions
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