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Transportation Asset Management (TAM) is a data-driven decision-making process to maintain and extend the serviceability of transportation assets throughout their lifecycle. TAM is an extensive data process that requires accurate and high-quality information for better decision-making. A significant challenge faced by state Departments of Transportation (DOTs) is the need to allocate their limited funds to optimize their assets' performance. The criticality of this challenge increases when state DOTs need to manage a wide variety of assets distributed along with a vast network. To address this challenge, a new paradigm of digitizing the management of the built environment is emerging and is perceived to highly depend on the integration of several technologies namely on Digital Twins. Digital Twins, by definition, are the connection between the physical and the digital aspects of an asset, thus, aligning with the overarching objective of asset management of leveraging the use of the asset information (i.e., digital aspect of the asset) to improve the asset's performance throughout its lifecycle (i.e., physical aspect of the asset). At the core of implementing Digital Twins is having the right data collected for use throughout the lifecycle of the asset. Thus, realizing the potentials of Digital Twins in supporting state DOTs to manage their transportation assets and the anticipated benefits, this paper investigated the current practices of state DOTs in digitizing the Data Collection for Roadside Asset Systems by developing and distributing a web-based survey. Five major Data Collection variables and seven Roadside Asset Systems were considered. Furthermore, this paper presents a case study from a leading DOT in digitizing the management of the built environment to further understand the requirements of implementing Digital Twins to support transportation asset data management. [ABSTRACT FROM AUTHOR]

The construction industry has undergone a radical transformation in its design and documentation process as it evolved from the days of the drafting board to today’s Building Information Modeling process. Despite the progress, a paradox of designing 3D in 2D space remains, calling for new visualization technologies that leverage the use of information in construction. Augmented Reality (AR) is an emerging technology that can serve as an information aggregator and a data-publishing platform, allowing users to view and interact with information while collaborating with others in real-time from remote locations. While AR holds the key to advance the construction industry, no research project has yet comprehensively investigated the holistic integration of AR in construction. Thus, this paper presents a comprehensive map that provides a holistic framework to understand the integration of AR into the construction phase. To achieve the research objective, the paper identifies and describes 23 use-cases of AR in the construction phase, nine AR capabilities, and 14 AR potential benefits. Then, four AR applications in construction are explored, where the underlying use-cases are discussed and mapped as a function of their corresponding AR capabilities and potential benefits. These AR applications provide an example to illustrate the concept behind the comprehensive map. Finally, the map is developed by outlining the relationships between the identified AR use-cases, capabilities, and potential benefits. The findings of this paper are crucial for the AR implementation roadmap as it provides industry practitioners an understanding of the capabilities and benefits of integrating AR into construction tasks.

Les pseudarthroses de l'extrémité distale du fémur sont relativement rares du fait de la qualité de la vascularisation de cette région. La prise en charge d'une telle complication pose un certain nombre de difficultés. Le traitement chirurgical fait appel à plusieurs techniques conservatrices, le traitement par prothèse peut s'avérer utile quand la perte de substance est importante chez le sujet âgé. L'objectif de ce travail est de discuter l'intérêt de la mégaprothèse du genou dans le traitement de la pseudarthrose de l'extrémité distale du fémur, à travers l'étude de l'observation d'une patiente et revue de la littérature. Il s'agit d'une patiente âgée de 62 ans qui présente une pseudarthrose de l'extrémité distale du fémur gauche. Sur le plan clinique la patiente présente des douleurs du genou gauche, avec gène fonctionnelle importante. Le score de l'IKS préopératoire était de 60. Elle a bénéficié d'un remplacement prothétique par une mégaprothèse du genou. En postopératoire la flexion du genou était à 90, le score de l'IKS était de 130. A travers l'étude de cette observation, et la revue de la littérature, nous pensons que l'utilisation de mégaprothèse du genou, constitue une solution efficace et durable pour le traitement des pseudarthroses du fémur distal et particulièrement chez le sujet âgé. Cette technique permet de répondre aux impératifs d'un tel aléa de la consolidation : lutter contre la douleur et garantir une mobilité satisfaisante permettant de répondre aux besoins de la vie quotidienne du patient et ainsi améliorer sa qualité de vie.

Background: We present this case to highlight the importance of considering seromucinous hamartoma in the differential diagnosis of nasal cavity lesions, particularly due to its rarity and potential for being mistaken for more aggressive pathologies. Seromucinous hamartoma, although benign, can exhibit clinical and histological features that overlap with those of malignant tumors, posing a diagnostic challenge. This case is especially noteworthy due to the unusual presentation of sebaceous differentiation within seromucinous hamartoma, a feature not previously documented in the literature. Recognizing such rare entities is crucial for ensuring appropriate patient management and avoiding unnecessary interventions., Case Presentation: We report a unique case of a 41-year-old Caucasian man with seromucinous hamartoma, presenting with chronic left nasal obstruction and recurrent mild epistaxis. Nasal endoscopy revealed a well-defined, multilobulated lesion in the left nasal cavity. Computed tomography scans confirmed an anteromedial polypoid lesion, 31 mm × 15 mm. The lesion was endoscopically resected without complications, with no recurrence at 6-month follow-up. Pathological examination showed a filiform polypoid lesion with clusters of seromucinous glands, ducts, and tubules, and no invasive growth patterns. Immunohistochemical studies revealed distinct epithelial membrane antigen (EMA) and p63 staining patterns. Notably, mature sebaceous gland formation interspersed with seromucinous glands was observed, a novel finding in seromucinous hamartoma. Recognizing seromucinous hamartoma is crucial to avoid unnecessary treatments, and it should be included in differential diagnoses of nasal cavity lesions., Conclusion: Seromucinous hamartoma is a rare and benign nasal cavity lesion that presents significant diagnostic challenges due to its potential to mimic more aggressive pathologies. This case highlights the importance of including seromucinous hamartoma in the differential diagnosis of sinonasal lesions, particularly when unusual histological features, such as sebaceous differentiation, are present., Competing Interests: Declarations. Ethics approval and consent to participate: This study has obtained IRB approval from the hospital ethical committee. Informed consent was obtained from the patient. Consent for publications: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that they have no conflict of interest., (© 2024. The Author(s).)

Bullous pemphigoid (BP) is the most prevalent autoimmune subepidermal blistering disease of the skin and mucous membranes. This disease typically affects the elderly and manifests with pruritus and localized or, most commonly, generalized bullous lesions. Numerous studies have established the association between BP and oral antidiabetic agents, particularly dipeptidyl peptidase 4 (DPP4) inhibitors, diuretics, and certain antibiotics, notably levofloxacin and cephalexin. In this report, we present a case of an 85-year-old female who presented with diffuse vesicles and bullae on her trunk and extremities five days after completing a four-week course of cefixime for pyelonephritis. Clinical examination and histopathological analysis confirmed the diagnosis of BP. The patient responded well to topical and systemic corticosteroids. This article presents the first documented case of BP induced by cefixime and underscores the importance of considering medication-induced BP in elderly patients presenting with blistering eruptions., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sandakly et al.)

Background: Growing data indicates that thiamine deficiency occurs during acute illness in the absence of alcohol use disorder. Our primary objective was to measure clinical factors associated with thiamine deficiency in patients with sepsis, diabetic ketoacidosis, and oncologic emergencies., Methods: This was an analysis of pooled data from cross-sectional studies that enrolled adult emergency department (ED) patients at a single academic center with suspected sepsis, diabetic ketoacidosis, and oncologic emergencies. We excluded patients who had known alcohol use disorder or who had received ED thiamine treatment prior to enrollment. Investigators collected whole blood thiamine levels in addition to demographics, clinical characteristics, and available biomarkers. We defined thiamine deficiency as a whole blood thiamine level below the normal reference range and modeled the adjusted association between this outcome and age., Results: There were 269 patients, of whom the average age was 57 years; 46% were female, and 80% were Black. Fifty-five (20.5%) patients had thiamine deficiency. In univariate analysis, age >60 years (odds ratio [OR] 2.5, 95% confidence interval [CI], 1.3-4.5), female gender (OR 1.9, 95% CI 1.0-3.4), leukopenia (OR 4.9, 95% CI 2.3-10.3), moderate anemia (OR 2.8, 95% CI 1.5-5.3), and hypoalbuminemia (OR 2.2, 95% CI 1.2-4.1) were associated with thiamine deficiency. In adjusted analysis, thiamine deficiency was significantly higher in females (OR 2.1, 95% CI 1.1-4.1), patients >60 years (OR 2.0, 95% CI 1.0-3.8), and patients with leukopenia (OR 5.1, 95% CI 2.3-11.3)., Conclusion: In this analysis, thiamine deficiency was common and was associated with advanced age, female gender, and leukopenia., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. Funding for the work was through a unrestricted physician scientist award given to Joseph Miller by Henry Ford Health (grant number A20300). There are no other conflicts of interest or sources of funding to declare.

Objective: Protocols to evaluate for myocardial infarction (MI) using high-sensitivity cardiac troponin (hs-cTn) have the potential to drive costs upward due to the added sensitivity. We performed an economic evaluation of an accelerated protocol (AP) to evaluate for MI using hs-cTn to identify changes in costs of treatment and length of stay compared with conventional testing., Methods: We performed a planned secondary economic analysis of a large, cluster randomized trial across nine emergency departments (EDs) from July 2020 to April 2021. Patients were included if they were 18 years or older with clinical suspicion for MI. In the AP, patients could be discharged without further testing at 0 h if they had a hs-cTnI < 4 ng/L and at 1 h if the initial value were 4 ng/L and the 1-h value ≤7 ng/L. Patients in the standard of care (SC) protocol used conventional cTn testing at 0 and 3 h. The primary outcome was the total cost of treatment, and the secondary outcome was ED length of stay., Results: Among 32,450 included patients, an AP had no significant differences in cost (+$89, CI: -$714, $893 hospital cost, +$362, CI: -$414, $1138 health system cost) or ED length of stay (+46, CI: -28, 120 min) compared with the SC protocol. In lower acuity, free-standing EDs, patients under the AP experienced shorter length of stay (-37 min, CI: -62, 12 min) and reduced health system cost (-$112, CI: -$250, $25)., Conclusion: Overall, the implementation of AP using hs-cTn does not result in higher costs., Competing Interests: Joe Miller: Research support and consulting for Beckman Coulter; consulting for Siemens and AstraZeneca. Ben Cook: Research support for Abbott; research support and consulting for Beckman Coulter; research support for Roche. David Lanfear: Abbott Laboratories, Amgen, Astra Zeneca, Cytokinetics, DCRI (CONNECT‐HF), Illumina, Janssen, Lilly, Martin Pharmaceuticals, Ortho Diagnostics, Otsuka, Somalogic, Vicardia. Simon Mahler: funding/support from Roche Diagnostics, Abbott Laboratories, Ortho Clinical Diagnostics, Siemens, Grifols, Pathfast, Quidel, and HRSA (1H2ARH399760100). He is an advisor for Roche Diagnostics, Abbott Laboratories, Genetesis, Quidel, Inflammatix, Radiometer, and Amgen and the Chief Medical Officer for Impathiq Inc. Phil Levy: past chair of the American College of Cardiology (ACC) Accreditation Oversight Committee and a current member of the ACC NCDR Oversight Committee and the NCDR Chest Pain/MI Registry Publications Committee; he was also Vice Chair for the ACC/AHA Chest Pain Guidelines. Dr. Levy has served as a consultant for Quidel, Siemens, Roche Diagnostics, Ortho Diagnostics, Beckman Coulter, Pathfast, and the Baim Institute. James McCord: research support for Roche and Abbott; research support and consulting for Siemens and Beckman Coulter. Nicholas Mills has received honoraria or consultancy from Abbott Diagnostics, Roche Diagnostics, Siemens Healthineers, and LumiraDx, and the University of Edinburgh has received research grants from Abbott Diagnostics and Siemens Healthineers is supported by Chair, Programme and Research Excellence Awards (CH/F/21/90010, RG/20/10/34966, RE/18/5/34216) from the British Heart Foundation. Other coauthors have no disclosures to make., (© 2024 The Authors. Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

The increasing demand for safe, reliable, and higher-quality infrastructure systems has led to more complex transportation construction and maintenance projects. This, coupled with the declining staff levels at many transportation agencies, requires a more comprehensive evaluation of technology implementation to compensate for these challenges. With a focus on effective technology implementation, this research goes beyond simply evaluating technologies to investigate technology implementation with personnel and policies at departments of transportation (DOTs). The study methodology involved a comprehensive literature review, a survey of all 50 state DOTs, and an in-person workshop of 18 DOT experts to validate the survey results and preliminary research findings. The findings support the need for those implementing technologies to understand people, processes, and technology maturity for their improved chances of implementation success. Using the approach presented, the DOTs can assess themselves and identify pathways to higher maturity levels in the areas of their people, processes, and technologies. This study also highlighted six factors that are important considerations for technology implementation and thus determined the relative importance of people, processes, and technology for these factors. The objective of this study was to assess the importance of people, processes, and technology that DOTs should prioritize to enhance the likelihood of successfully implementing technologies. The framework presented herein can be extended to any new or existing technology implementation initiatives at a DOT, including automatic identification and data capture (AIDC), emerging sensing and wireless technologies, safety technologies, and others.

Background: Antibody-mediated rejection (AMR) was described in kidney transplant patients after viral infections, such as the cytomegalovirus. Very few cases were recently reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, probably in the context of lowering of immunosuppressive therapy. To date, no direct immunological link was proved to explain a connection between the coronavirus disease 19 (COVID-19) infection and antibody-mediated rejection (AMR) if it exists., Case Presentation: Here we try to find this association by presenting the case of a low immunological risk patient who presented, six years post-transplant, with c4d negative antibody mediated rejection due to an anti-HLA-C17 de novo donor specific antibody (DSA) after contracting the coronavirus disease 19. The HLA-Cw17 activated the antibody-dependent cell-mediated cytotoxicity via the KIR2DS1 positive NK cells., Discussion and Conclusions: This case report may prove a direct role for COVID-19 infection in AMRs in the kidney transplant recipients, leading us to closely monitor kidney transplant recipients, especially if they have "at-risk" donor antigens., (© 2022. The Author(s).)

Periosteal osteosarcoma (PO), an intermediate-grade chondroblastic osteosarcoma (OST) arising from the surface of the bones, is a rare histological subtype among primary bone sarcomas, most commonly diagnosed in young patients. It is characterized by distinct specific radiological and pathological features. The current management strategy is based on several case reports and series, without any solid international recommendations. Most sarcoma experts agree on the crucial role of an optimal complete surgical approach. However, with the paucity of available reports, the role of systemic treatment and its timing remains debatable. With this paper, we will review the available data on the actual impact of chemotherapy in PO patients with emphasis on the radiological, pathological, and therapeutic characteristics of this rare entity., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier GmbH.)

To retrospectively characterize the molecular features of Non-Small Cell Lung Carcinomas (NSCLC) with peritoneal carcinomatosis (PC), clinicopathological data of 12 patients diagnosed with NSCLC and PC between 2007 and 2016 were collected. Immunohistochemistry and Next Generation Sequencing (NGS) were performed on cases with available material. PC was the initial presentation of NSCLC in 17% of the cases. Overall, patients with PC displayed a poor median survival of 12 weeks. Histology was adenocarcinoma in 11 cases. 37.5% of cases showed PD-L1 immunostaining positivity (50% cut-off). ALK and ROS1 immunostainings were negative. Using NGS, we identified 17 molecular alterations in 9 genes (TP53, KRAS, STK11, BRAF, EGFR, DDR2, ERBB4, SMAD4, CTNNB1) in 88.9% of adenocarcinomas. To the best of our knowledge, 5 of these variants are not referenced in the literature. In conclusion, PC might be the initial presentation of NSCLC. Molecular profiling of our cases did not find any effective targetable alteration, except from high PD-L1 expression.

Well-differentiated/dedifferentiated (WD/DD) liposarcomas, the most common form of liposarcomas, constitute up to 20 % of all soft tissue sarcomas. Several oncogenes are thought to be involved in liposarcoma pathogenesis, mainly MDM2, CDK4 and HMGA2. While MDM2 inhibitors are now tested in clinical trials, a second actionable and promising target appears to be cyclin-dependent kinase 4 (CDK4), which is amplified in up to 90 % of well differentiated or dedifferentiated (WD/DD) liposarcoma. With the paucity of available therapeutic options, the inhibition of CDK4 represent a potential therapeutic option. In this paper, we review the role of CDK4/6 inhibitors in targeting the commonly identified CDK4 amplification in WD/DD liposarcoma, with an emphasis on the published and currently ongoing trials., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Only a few hundred cases of intimal sarcomas of pulmonary artery (ISPA) were reported on the literature. Diagnosis of this rare entity is a challenging dilemma with the need for a high expertise in the radiological and pathological identification of ISPA. Treatment strategies rely initially on an early aggressive surgery aiming for complete surgical resection with clear margins while no clear recommendations guiding the choice for additional drug therapy or radiotherapy exist. In this article, we perform an extensive review of the literature on ISPA with details on the clinical presentation, diagnosis and management strategies. An additional goal of this paper is to make practicing oncologists aware of this rare entity with clear idea on the initial management., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier B.V.)

Background: Testicular tumors constitute a rare type of cancer affecting adolescents and young adults with recent reports confirming an increase in incidence worldwide. The purpose of this study was to estimate the epidemiological characteristics and histological subtypes of testicular tumors in the Lebanese population according to the WHO classification of testicular and paratesticular tumors., Materials and Methods: In this single institutional retrospective study, all patients diagnosed with a testicular tumor in Hotel-Dieu de France Hospital University in Beirut between 1992 and 2014 were enrolled. The age, subtype based on the 2004 WHO classification and body side of tumor were analyzed., Results: A total of two hundred and forty-four (244) patients diagnosed with a testicular tumor in our institution were included in the study. Two hundred and one patients (82.4% of all testicular tumors) had germ cell tumors (TGCT). Among TGCT, 50% were seminomatous tumors, 48% non-seminomatous tumors (NST) and 2% were spermatocytic seminomas. The NST were further divided into mixed germ cell tumors (63.9%), embryonic carcinomas (18.6%), teratomas (15.4%) and yolk sac tumors (2.1%). The mean age for testicular tumors was 32 years. The mean age for germ cell tumors was 31 years and further subtypes such as seminomatous tumors had a mean age of 34 years, 28 years in non-seminomatous tumors and 56 years in spermatocytic seminoma. Patients with right testicular tumor were the predominant group with 55% of patients. Three patients (1.2%) presented with bilateral tumors., Conclusions: The distribution of different subgroups and the mean age for testicular tumors proved comparable to most countries of the world except for some Asian countries. Germ cell tumors are the most common subtype of testicular tumors with seminomatous tumors being slightly more prevalent than non-seminomatous tumors in Lebanese patients.