Search

This paper describes a procedure developed and validated to assess the accuracy of an infrared-based motion measurement system used to perform a kinematic analysis of the torso with respect to the pelvis during simulated lifting tasks. Two rigid reflective marker triads were designed and fabricated for attachment to the thorax over the 6th thoracic vertebra and the pelvis. System accuracy was assessed for planar rotation as well as rotations about multiple orthogonal axes. A test fixture was used to validate known triad orientations. The spatial coordinates of these triads were collected at 120 Hz using a ProReflex motion measurement system. Single value decomposition was used to estimate a rotation matrix describing the rigid body motion of the thorax triad relative to the sacral triad at each point in time. Euler angles corresponding to flexion, lateral bending, and twisting were computed from the rotation matrix. All measurement error residuals for flexion, lateral bending, and twisting were below 1.75°. The estimated mean measurement errors were less than 1° in all three planes. These results suggest that the motion measurement system is reliable and accurate to within approximately 1.5° for the angles examined.

Objectives: The purpose of this study was to assess the attitude of paramedics to on-scene termination of cardiopulmonary resuscitation (T-CPR) efforts in children prior to developing a pediatric T-CPR policy. Methods: A 26-item anonymous survey was conducted of all of the active paramedics in a large urban EMS system where T-CPR had been practiced routinely for adults. Questions addressed paramedic demographics, training level, experience with adult and pediatric advanced cardiac life support (ACLS), experience with T-CPR in adults, T-CPR case scenarios, and T-CPR in children. Results: All 201 paramedics in the system (mean age = 34.2 years; mean years as paramedic = 8.5) completed all relevant items of the survey (100% compliance). Two-thirds had provided ACLS for cardiac arrest to >50 adults (93% >10 adults) and more than one-third had performed ACLS on >20 children (72% >5 children). In addition, 90% had participated in T-CPR for adults. The majority of paramedics reported at least occasional (pre-defined) difficulty with adult T-CPR including family confrontation, 43%; personal discomfort, 13%; disagreement with physician decision to continue efforts, 11%; and fear of liability, 10%. Paramedic self ratings of comfort with terminating CPR on a scale from 1 to 10 (1: very comfortable; 10: uncomfortable) for adults and children were 1 and 9, respectively (P < 0.001). In addition, the clear majority (72%) responded that children deserve more aggressive resuscitative efforts than adults. Conclusions: Paramedics feel relatively uncomfortable with the concept of terminating resuscitation efforts in children in the pre-hospital setting.

Spherical objects, identified as microfossils and named Isuasphaera isua (Pflug), were reported in 1978 from a chert in the 3.7–3.8 Ga Isua Greenstone Belt (IGB). Soon afterwards the biological nature of these objects was questioned on a number of grounds by several authors. Following renewed, recent claims for biogenicity, the locality has been revisited and the host-rock (metamorphosed chert) to the putative microfossils re-examined. Extreme stretching deformation of the metachert cannot possibly have preserved syn-depositional spherical objects. We conclude that the objects (whether biological or not) are entirely post-tectonic and probably result from pre-Quaternary weathering.

The purpose of this study was to analyze the impact of more selective use of admission angiography combined with protocolized nonoperative management for blunt splenic injury.This was a retrospective chart review of all patients with splenic injuries and Injury Severity Score20 managed by protocol and comparison with a prior matched group managed with admission angiography.Forty-three patients were managed under the protocol, with 22 patients treated with admission angiography and the remainder undergoing observation only. Nonoperative salvage was 100% in this group, with a length of stay of 3.3 days. The matched, nonprotocol group had a nonoperative salvage rate of 95%, with a length of stay of 6.8 days.Protocol-driven management of splenic injury using admission angiography selectively for higher grade splenic injuries led to a decreased length of stay, higher therapeutic yield, and decreased use of hospital resources without any increase in the failure rate of nonoperative management in a selected group of patients with isolated splenic injuries.

This study investigates learning about civics and citizenship throughout individuals' lives (lifelong) and across various pedagogical settings (lifewide). A basic hypothesis is that civics teachers, among all social actors, are particularly well positioned for engaging in this type of introspective exercise because they are both familiar with civics and politics and also with teaching and learning processes. The lifelong civic learning of civics teachers was examined in the different settings in which they acquire their knowledge, values, skills and ideological frameworks, and to understand the relative weight of each one in their overall learning process. This study also coincides with the implementation of a new provincial civics course for grade 10 students in Ontario, Canada during the 2000–1 school year. This case study consists of interviews with 15 social studies teachers who have taught the new civics course in Ontario. One of the clearest findings of the study is the powerful influence of the exp...

Recent literature supports the use of CT for all patients with right lower quadrant pain to improve diagnostic accuracy and reduce hospital cost. Our current practice at a large teaching hospital is to use CT only for patients whose diagnosis remains in question after a thorough history, physical examination, and focused laboratory assessment. In consideration of a more liberal use of CT for right lower quadrant pain, we reviewed our experience with selective CT and the effect this has had on our practice, paying particular attention to perforation rate and negative appendectomy rate.A retrospective chart review was performed for all patients who underwent appendectomy in 1995 and 1998. These two patient populations were evaluated for patient demographics, use of CT scan, perforation rate, and incidence of negative appendectomy.Three hundred ninety-four patients underwent appendectomy in 1995 versus 372 in 1998. Gender (64% male in 1995 vs. 60% in 1998), age (mean 24.9 vs. 25.5) and perforation rate (31% in 1995 vs. 29% in 1998) did not change. The use of CT increased in 1998 (12% vs. 34%, p0.001) and overall nontherapeutic appendectomy decreased (14% vs. 7%, p0.005). This decrease was seen in patients who were operated without CT (13% vs. 7%, p0.03) and after CT (19% vs. 6%, p0.02).Selective use of CT scan in patients presenting with right lower quadrant pain is helpful in reducing the incidence of nontherapeutic appendectomy.

Acknowledgment: We would like to thank Nanette K. Wenger, MD, and Dan Sorescu, MD, for critically reviewing this manuscript. 1. Fichtenbaum CJ, Dunagan WC, Powderly WG. Bacteremia in hospitalized patients infected with the human immunodefiency virus: a case-control study of risk factors and outcome. J Acquired Immune Defic Syndr 1995;8:51–57. 2. Tumbarello M, Tacconeli E, Donati KG, Citton R, Leone F, Spanu T, Cauda R. HIV-associated bacteremia: how it has changed in the highly active antiretroviral therapy (HAART) era. J Acquired Immune Defic Syndr 2000; 23:145–151. 3. Erbel R, Rohmann S, Drexler M, Mohr-Kahaly S, Gerharz CD, Iversen S, Oelert H, Meyer J. Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach. A prospective study. Eur Heart J 1988;9:43–53. 4. Taams MA, Gussenhoven EJ, Bos E, de Jaegere P, Roelandt JR, Sutherland GR, Bom B. Enhanced morphological diagnosis in infective endocarditis by transoesophageal echocardiography. Br Heart J 1990;63:109–113. 5. Birmingham G, Rahko PS. Ballantyne F III. Improved detection of infective endocarditis with transesophageal echocardiography. Am Heart J 1992;123:774– 781. 6. Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB. Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol 1991;18:391–397. 7. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994;96:200–209. 8. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–638.

For its significant economical savings and greater design flexibility, high-performance concrete (HPC) is becoming more widely used in highway bridge structures. High-performance bridges with HPC and large-diameter prestressed strands are becoming attractive to designers. Bridge A6130 is the first fully HPC superstructure bridge in Missouri. The bridge has HPC cast-in-place deck and high-strength concrete girders reinforced with 15.2-mm (0.6-in.) diameter strands. The bridge was instrumented with embedded strain gauges and thermocouples to monitor the early-age and later-age behavior of the structures from construction through service. To investigate the overall behavior of the bridge under live load, a static live-load test was developed and carried out. During the live-load test, 64 embedded vibrating wire strain gauges and 14 embedded electrical-resistance strain gauges were used to acquire the changing strain rate in the bridge caused by the varying live-load conditions. Girder deflections and rotations were also recorded with external sensors and a data acquisition system. Based on the test results, the load distribution to the girders was studied. The AASHTO specifications live-load distribution factor recommended for design was compared with the measured value and found to be overly conservative. The AASHTO load and resistance factor design live-load distribution factors recommended for design were found to be comparable to measured values. Two finite element models were developed with ANSYS and compared with measured values to investigate the continuity level of the Missouri Department of Transportation interior bent detail.

75 Background: The treatment options for cancer are ever-evolving & now include vaccines targeting tumor-specific immunogenic peptides to induce tumor cytolysis. Folate binding protein (FBP) is a tumor-associated antigen (TAA) highly expressed in most endometrial & ovarian cancers (Ca), shielded from the normal immune system. The most promising FBP peptides are E39 & an attenuated form, E39' (aka J65). In our most recent phase I/IIa trial we evaluated an E39+GM-CSF inoculation series at 3 doses (VG) vs controls (CG) as well as booster vaccination with E39 or E39' after the initial inoculation series. Here we present the immunologic data from this phase I/IIa trial. Methods: Patients (pts) with ovarian or endometrial Ca who were disease-free after standard of care therapy but at risk for recurrence were enrolled. HLA-A2+ pts were vaccinated in a 3+3 dose escalation of 100mcg, 500mcg, & 1000mcg. The remaining pts received 1000mcg inoculations. Vaccine was given every 3-4 weeks for a total of 6 inoculums. Pts were then offered to participate in booster vaccination with 9 pts randomized to receive E39 & 9 pts E39'. FBP expression level was measured on the resected disease. Overall immunologic response & by subgroups was measured by delayed type hypersensitivity (DTH) & ELISPOT in the VG. Results: A total of 29 pts were vaccinated. Mean DTH prior to the initial dose of E39 was 5.74mm & after final dose was 10.33mm (p = 0.018). Mean overall ELISPOT change over time through 18 months was +69.1 when compared to baseline (p = 0.675). At 18 months, mean ELISPOT increased by 97.1 in 1000mcg vs -57.0 in < 1000mcg dosed pts (p = 0.047) & by +255.33 in pts with > average initial DTH vs -0.75 in < average initial DTH (p = 0.004) when compared to baseline. Immunological analyses were not significantly different between FBP hi/lo expression or E39 vs E39’ booster (p > 0.05). Conclusions: E39 demonstrated significant overall immunogenicity on in vivo testing as measured by DTH. Ex vivo analysis (ELISPOT) suggests that E39 is more immunogenically efficacious in pts with > average initial DTH & those who are optimally dosed (1000mcg). FBP expression level & E39 vs E39’ use in booster inoculations did not significantly impact in vivo or ex vivo immunogenicity. Clinical trial information: NCT01580696.

TPS201 Background: Melanoma is a potentially lethal skin malignancy; patients with stage III/IV resected disease have a recurrence rate of 50-90%. Adjuvant checkpoint inhibitor immunotherapy decreases the risk of recurrence but also causes significant immune-related toxicity. Vaccines are a promising strategy for patients with high risk melanoma. The optimal time to intervene may be in the adjuvant setting after attaining a disease-free state through standard of care therapies. Our strategy uses autologous tumor lysate (TL) in a yeast cell wall particle (YCWP) to load dendritic cells (DC) ex vivo. The tumor lysate particle loaded dendritic cell (TLPLDC) vaccine is then given to prevent melanoma recurrences. An alternate vaccine delivery method that we are evaluating utilizes the tumor lysate particle-only (TLPO) technique, in which tumor lysate is loaded into capped YCWP and injected intradermally, allowing an in vivo uptake by the patient’s dendritic cells. Methods: We are performing a prospective, randomized, blinded, placebo-controlled phase IIb trial in patients with resected stage III/IV melanoma who have been rendered disease-free but remain at high risk of recurrence. The study will utilize the TLPLDC strategy vs placebo (2:1) in 120 patients, followed by a bridging study of TLPO vs TLPLDC (2:1) in 60 patients. Both TLPLDC and TLPO inoculations will be monthly x3, followed by boosters at 6, 12, and 18 months. Primary endpoints will be disease free survival (DFS) at 24 months in the TLPLDC arm, and overall safety in the TLPO arm. We have completed enrollment in the phase IIb portion of the study. Clinical trial information: NCT02301611.

The 8th International Conference on Pediatric Mechanical Circulatory Support Systems & Pediatric Cardiopulmonary Perfusion will be held at the Galatasaray University, Istanbul, Turkey, June 13–16, 2012. Atif Akcevin, MD, Chief of Cardiovascular Surgery at the American Hospital in Istanbul, will be the Local Conference Chair. The scientific cochairs of this unique event will be Tijen AlkanBozkaya, MD, Turkey; Ihsan Bakir, MD, Turkey; Yves Durandy, MD, France; Huriyet Ersayin-Kantas, FCCP, UK; Colleen E. Gruenwald, PhD, Canada; Giovanni Battista Luciani, MD, Italy; John L. Myers, MD, USA; David Palanzo, CCP, USA; Linda B. Pauliks, MD, MPH, USA; Chitra Ravishankar, MD, USA; Eugen Sandica, MD, Germany; Shunji Sano, MD, PhD, Japan; Kyung Sun, MD, PhD, MBA, Korea; Riza Turkoz, MD, Turkey; and Bonnie Weaver, RN, CCRN, USA. This year, we were fortunate enough to organize our event at the historic Galatasaray University and its magnificent facilities located in Istanbul which is the only city in the world built on two continents, Asia and Europe. The university was first established in 1481 and was called the Galata Palace (“Galata Saray”) as an “Enderun-u Humayunu” (Galata Palace Imperial School). All of the magnificent past of this university can be found at the following link: http://gsu.edu.tr/en/universite/tarihce. We hope that all of the participants will enjoy the event in this historic setting and incredible view of the Bosphorus. As soon as the registration was opened, it was a pleasure to see participants immediately registering for the 8th event from locations as far as New Zealand. This year’s meeting will commence with registration on Wednesday, June 13, 2012. Plenary sessions, mini-symposiums, and regular slide and poster presentations will start on Thursday morning, June 14, and continue through 5 pm on Saturday, June 16th. This year’s participants will also have the distinct pleasure of welcoming Professor Emeritus,William S. Pierce, MD, from Penn State Hershey College of Medicine, as the key note lecturer. His lecture is entitled “A 40-Year Odyssey in Mechanical Circulatory Support.” The topic of the first plenary session will be “Managing the Single Ventricle Patient From Fetus to Definite Treatment,” followed by a key note lecture.The second plenary panel will focus on “Pediatric Mechanical Circulatory Support Devices and Outcomes” including a special lecture entitled “Pediatric MCS and Pediatric Heart Transplantation in Japan” by Shunji Sano, MD. The first day’s scientific program will end with a mini-symposium entitled “Bioengineering Approaches in Pediatric Cardiovascular Medicine.” After the end of the scientific program at 5:30 pm, participants are invited to a special gala dinner aboard a ship from 7 pm to 10 pm. This dinner cruise will offer spectacular sightseeing of the Bosphorus as the boat travels between Europe and Asia. The second and third days of the event will also cover the most important neonatal/pediatric cuttingedge topics and all new results on extracorporeal life support systems including a multidisciplinary team approach to solve the complex problems in neonatal and pediatric cardiac surgery, cardiopulmonary perfusion, myocardial protection, neonatal and pediatric anesthesia, neuromonitoring, and pediatric MCS and cardiopulmonary bypass (CPB) around the globe. In addition, there will be dozens of slide and poster presentations from young investigators. The last day of the event will bring several wet labs including neuromonitoring, near-infrared spectroscopy, extracorporeal life support (ECLS) circuits, ventricular assist devices, ultrafiltration, pulsatile perfusion, neonatal/pediatric CPB circuit—step-bystep circuit setup, and neonatal/pediatric oxygenators with integrated arterial filters. These wet labs doi:10.1111/j.1525-1594.2012.01450.x bs_bs_banner

Early recognition and treatment of trauma patients requiring massive transfusion (MT) has been shown to reduce mortality. While many risk factors predicting MT have been demonstrated, there is no universally accepted method or algorithm to identify these patients. We hypothesised that even among experienced trauma surgeons, the clinical gestalt of identifying patients who will require MT is unreliable.Transfusion and mortality outcomes after trauma were observed at 10 U.S. Level-1 trauma centres in patients who survived ≥ 30 min after admission and received ≥ 1 unit of RBC within 6h of arrival. Subjects who received ≥ 10 units within 24h of admission were classified as MT patients. Trauma surgeons were asked the clinical gestalt question "Is the patient likely to be massively transfused?" 10 min after the patients arrival. The performance of clinical gestalt to predict MT was assessed using chi-square tests and ROC analysis to compare gestalt to previously described scoring systems.Of the 1245 patients enrolled, 966 met inclusion criteria and 221 (23%) patients received MT. 415 (43%) were predicted to have a MT and 551(57%) were predicted to not have MT. Patients predicted to have MT were younger, more often sustained penetrating trauma, had higher ISS scores, higher heart rates, and lower systolic blood pressures (all p0.05). Gestalt sensitivity was 65.6% and specificity was 63.8%. PPV and NPV were 34.9% and 86.2% respectively.Data from this large multicenter trial demonstrates that predicting the need for MT continues to be a challenge. Because of the increased mortality associated with delayed therapy, a more reliable algorithm is needed to identify and treat these severely injured patients earlier.

Apolipoprotein E (apoE) may play a critical role in modulating the response to neurological injury after cardiopulmonary bypass (CPB) in children. Plasma samples were collected from 38 pediatric patients. Half of the patients received nonpulsatile flow and the other half underwent pulsatile flow during CPB. Plasma samples were collected at three time points: at baseline prior to incision (T1), 1 h after CPB (T2), and 24 h after CPB (T3). The study included 38 pediatric patients undergoing heart surgery (mean age 2.5 ± 2.1 years). Baseline apoE levels were low (30 μg/mL) in 21 patients (55%). ApoE levels were significantly decreased at 1 h after CPB compared with baseline (22 ± 14 vs. 34 ± 18 μg/mL, P = 0.001). At 24 h after CPB, apoE levels were significantly increased compared with baseline (47 ± 25 vs. 34 ± 18 μg/mL, P = 0.002). Pulsatile mode was associated with lower apoE levels at 24 h after CPB compared with nonpulsatile mode (38 ± 14 vs. 57 ± 29 μg/mL, P = 0.018). ApoE levels correlated negatively with pump time (r = -0.525, P = 0.021) and cross-clamp time (r = -0.464, P = 0.045) at 24 h following CPB for the nonpulsatile group but not for the pulsatile group. In this cohort of young children with congenital heart disease, baseline apoE levels were low in the majority of patients prior to surgery. ApoE levels decreased further at 1 h after CPB, and then significantly increased by 24 h. The mode of perfusion and the duration of pump time and clamp time influence the apoE levels after CPB. An improved understanding of these mechanisms may translate into the development of new techniques to improve the clinical outcomes after pediatric CPB.

Three bridges were recently constructed in Missouri using a new type of hybrid composite beam (HCB) incorporated within traditional RC deck systems. These HCBs are comprised of three main subcomponents: a composite shell, compression reinforcement, and tension reinforcement. The compression reinforcement is a self-consolidating concrete (SCC) arch that is tied at the ends by high-strength galvanized steel strands. The compression and tension reinforcements are encapsulated in a glass fiber–reinforced polymer (GFRP) box, and the voids are filled with polyisocyrunate (polyiso) foam. This unique configuration aims to optimize the structural performance of the HCB constituents, hence optimizing the overall performance of the beam. However, because of the novelty of the HCB, its structural behavior is not yet completely understood. Consequently, the finite-element (FE) modeling of this new type of beam is crucial for providing deeper insight into its structural behavior and validating the current desig...

The development of cement-based composites has been fruitful in the recent years. It is important to examine the new materials and technologies so they can fulfill repairing and strengthening applications in the structural engineering fields. An experimental study on the behavior of reinforced concrete beams strengthened in shear using an externally applied fiber reinforced cementitious matrix (FRCM) is presented. The PBO-FRCM system consists of two components: the reinforcing mesh is Polyparaphenylene benzobisoxazole – PBO fiber composite and the bonding agent is cementitious matrix. The test variables included two different configurations of U-wrapped systems and the PBO reinforcement’s ratio. The aims of this study were to investigate the effectiveness and the shear performance of the PBO-FRCM system for strengthening reinforced concrete beams in shear. All the beams were instrumented and tested under four-points loading. The test results included the observed shear contribution of the PBO-FRCM system and the failure mode of the strengthened beams.

Optimizing concrete mixtures with regard to replace a part of cement content with supplementary cementitious materials can prompt the design of ecological-self consolidating concrete. By replacing more than 60% of cement with residual product from other industries such as Fly Ash, Micro Silica, and lime, the energy consumption and CO2 emission of concrete are reduced. This study was performed to monitor the creep and shrinkage of high volume supplementary cementitious material of self consolidating concrete (HVSCM-SCC) and ensure desired performance of concrete. Total sixteen and Twenty Four specimens from different concrete mixtures with different replacement level (up to 75% of cement replacement) were monitored for creep and shrinkage respectively. Moist and accelerated curing regimes were utilized in this study to see the effect of accelerated curing on creep and shrinkage of HVSCM-SCC. Mechanical properties of different age 1,3,7,28,56 and 90 days were conducted. Experiments have shown that 75% level replacement of cement experienced low creep and shrinkage rate than other mixtures. The creep and shrinkage values of HVSCM-SCC were compared to prediction models proposal by AASHTO LRFD (2007), ACI-209R (2009), and AS 3600 (2009) to ensure the validity of these models for HVSCM-SCC.

One of the oldest well-preserved sequences of tectonic events on Earth is recorded in intrusive rocks that lie north of the Isua greenstone belt, southern West Greenland. Detailed mapping and U-Pb dating of zircon and titanite build upon previous work to better define the timing and nature of the 3700-3600 Ma tectonic history. Voluminous 3698 ′ 2 Ma tonalite was converted into gneiss during a deformation event (D 1 ) that predated intrusion of 3659 ′ 2 Ma diorite dikes. The dikes and the earliest gneissosity (S 1 ) are most abundant in a zone of low regional deformation (D 2 ) located 8 km north of the Isua greenstone belt. F 2 folding produced the dominant gneissosity (S 2 ) during injection of meter-wide granite and pegmatite sheets along S 2 at ca. 3650 Ma. D 3 shearing transposed S 2 into a narrow mylonite zone at the contact between the intrusive rocks and the Isua greenstone belt. Motion on this contact must have occurred in the Early Archean; mylonites are cut by dolerite dikes that are correlated with nearby Middle Archean dikes. Titanite from the low D 2 strain zone yielded concordant U-Pb dates of 3606 ′ 3 Ma, indicating that these rocks were little affected by Late Archean metamorphism. In contrast, significant Late Archean heating of rocks adjacent to the Isua greenstone belt is shown by titanite that lost considerable Pb and/or was largely recrystallized at 2915 ′ 32 Ma. Late Archean strain was also restricted to rocks adjacent to the belt. This sequence of overprinting deformation and metamorphism is similar to that in younger orogenic belts.

(2002). Civic Responsibility and Higher Education. The Journal of Higher Education: Vol. 73, No. 3, pp. 423-427.

Acute graft-versus-host disease (GVHD) classically occurs in the setting of bone marrow or peripheral blood progenitor (hematopoietic stem cell) transplantation following high doses of irradiation or chemotherapy (1). Billingham originally described three prerequisites for the development of GVHD: the grafted organ must contain immunologically competent cells, the tissue antigens of the host and donor must differ, and the recipient must be unable to destroy donor cells (2). The basic mechanism of GVHD is that activated donor T cells undergo clonal expansion with release of a variety of proinflammatory cytokines, resulting in secondary activation of cytotoxic T lymphocytes, natural killer cells, B cells, and macrophages to cause target cell death (3). The prototypic acute GVHD patient develops a red, macular skin rash, abdominal cramping with profuse watery diarrhea, and jaundice, with high serum alkaline phosphatase approximately 15–20 days after receiving a bone marrow transplant (1). Although most often caused by bone marrow or stem cell transplantation, GVHD may also occur following transfusion of unirradiated blood products or transplantation of solid organs containing lymphoid tissue (1). In the patient we present, disruption of T-cell function associated with malignant thymoma resulted in GVHD-like colitis; the patient’s severe diarrhea improved only after treatment with the somatostatin analog octreotide, despite metastatic spread of the primary tumor.

Molecular structures at the surface and buried interface of an amorphous ultralow-k pSiCOH dielectric film were quantitatively characterized before and after reactive ion etching (RIE) and subsequent dielectric repair using sum frequency generation (SFG) vibrational spectroscopy and Auger electron spectroscopy. SFG results indicated that RIE treatment of the pSiCOH film resulted in a depletion of ∼66% of the surface methyl groups and changed the orientation of surface methyl groups from ∼47° to ∼40°. After a dielectric recovery process that followed the RIE treatment, the surface molecular structure was dominated by methyl groups with an orientation of ∼55° and the methyl surface coverage at the repaired surface was 271% relative to the pristine surface. Auger depth profiling indicated that the RIE treatment altered the top ∼25 nm of the film and that the dielectric recovery treatment repaired the top ∼9 nm of the film. Both SFG and Auger profiling results indicated that the buried SiCNH/pSiCOH interface ...

Objective: Parenting anticipatory guidance is one way to promote optimal child health and development and minimize disparities between children from lower socio-economic status families and their higher income peers. However, low rates of attendance at and completion of parenting programs has been demonstrated. Understanding barriers to participation has important implications. The Obstacles to Engagement Scale (OES) has been used in some populations, but it has not been evaluated for use with low-income African American samples. The aim of the current study is to evaluate the factor structure of the OES with a sample of low-income, African American parents.Method: Parents or legal guardians with children aged 3-8 years completed a survey in the waiting room of a primary care pediatric academic practice in an urban location in the southern United States of America (N = 114). Almost 87% had < 12th grade education and 93% of the children received Medicaid services. The OES was one measure from a larger study and only participants with complete data on the OES were included in the exploratory factor analysis (EFA).Results: The EFA did not support the previous 4-factor solution (intervention demands, personal or family stressors or obstacles, relevance of or trust in intervention, and time and scheduling demands. Instead, a 3-factor statistical solution emerged, but not all items held together conceptually.Conclusions: The current study supports the necessity for evaluating study instruments for use with specific populations. Larger samples are needed to disentangle the effects of educational and poverty status from race and ethnicity and to develop and validate instruments that are appropriate for the study population.

Background— Vitamin D supplementation may be an inexpensive intervention to reduce heart failure (HF) incidence. However, there are insufficient data to support this hypothesis. This study evaluates whether vitamin D plus calcium (CaD) supplementation is associated with lower rates of HF in postmenopausal women and whether the effects differ between those at high versus low risk for HF. Methods and Results— Analyses were restricted to 35 983 (of original 36 282) women aged 50 to 79 years old in the Women’s Health Initiative randomized trial of CaD supplementation who were randomized 1:1 in a double-blinded fashion to receive 1000 mg/d of calcium plus 400 IU/d of vitamin D 3 or placebo. Overall, 744 adjudicated incident HF cases (intervention, 363; control, 381) occurred during a median follow-up of 7.1 (interquartile range, 1.6) years. CaD supplementation, compared with placebo, was not associated with reduced HF risk in the overall population, hazard ratio, 0.95; P =0.46. However, CaD supplementation had differential effects ( P interaction=0.005) in subgroups stratified by baseline risk status of HF defined by the presence (high risk=17 449) or absence (low risk=18 534) of pre-existing HF precursors including coronary heart diseases, diabetes mellitus, or hypertension: 37% (hazard ratio, 0.63 [95% confidence interval, 0.46–0.87]) lower risk of HF in the low-risk versus hazard ratio, 1.06; P =0.51, in the high-risk subgroups. Conclusions— CaD supplementation did not significantly reduce HF incidence in the overall cohort, however, it was beneficial among postmenopausal women without major HF precursors while of little value in high-risk subgroups. Additional studies are warranted to confirm these findings and investigate the underlying mechanism. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00000611.

Background Bovine pericardial valves are often used for pulmonary valve replacement (PVR) in patients with previously repaired congenital heart disease. Attention has recently focused on the safety of the Mitroflow (Sorin Group USA, Arvada, CO) bovine pericardial valve after a national alert describing several cases of sudden valve failure in young patients. In response, we reviewed our experience using the Mitroflow bioprosthesis for PVR. Methods Medical records were reviewed for all patients who underwent PVR using a Mitroflow valve at our center (2008–2013). Results The cohort included 84 patients with a median age of 18.3 years (range, 0.8–62.1 years) and weight of 48.4 kg (range, 5.7–167.8 kg). Indications for surgical intervention included native outflow tract insufficiency (59 patients), valved conduit failure (20 patients), and isolated prosthetic valve failure (5 patients). Median length of stay was 3 days (range, 2–13 days). There were no hospital deaths. Median follow-up was 2.4 years (range, 0.2–5.6 years). Pulmonary valve insufficiency and peak gradient increased with time. At latest follow-up, freedom from insufficiency greater than or equal to a moderate degree was 83%, and freedom from a peak gradient greater than or equal to 50 mm Hg was 92%. Reintervention was required in 4 patients. One patient experienced endocarditis and underwent surgical PVR (0.6 years after initial intervention). Three patients underwent transcatheter treatment for valve stenosis including PVR (at 4.2 and 4.4 years in 2 patients) and balloon valvuloplasty (at 5.2 years in the third patient). Kaplan-Meier freedom from reintervention at 5 years was 81%. Conclusions Early outcomes using the Mitroflow bovine pericardial valve for PVR in children and adults with repaired congenital heart disease appear acceptable and similar to reported outcomes for other tissue valve options. Valve failure from premature structural deterioration was not observed.

Economic analysis of an ARPA-e Electrofuels (http://arpa-e.energy.gov/?q=arpa-e-programs/electrofuels) process is presented, utilizing metabolically engineered Rhodobacter capsulatus or Ralstonia eutropha to produce the C30+ hydrocarbon fuel, botryococcene, from hydrogen, carbon dioxide, and oxygen. The analysis is based on an Aspen plus® bioreactor model taking into account experimentally determined Rba. capsulatus and Rls. eutropha growth and maintenance requirements, reactor residence time, correlations for gas-liquid mass-transfer coefficient, gas composition, and specific cellular fuel productivity. Based on reactor simulation results encompassing technically relevant parameter ranges, the capital and operating costs of the process were estimated for 5000 bbl-fuel/day plant and used to predict fuel cost. Under the assumptions used in this analysis and crude oil prices, the Levelized Cost of Electricity (LCOE) required for economic feasibility must be less than 2¢/kWh. While not feasible under current market prices and costs, this work identifies key variables impacting process cost and discusses potential alternative paths toward economic feasibility.

In the early 1990s, several groups of scientists—including epidemiologists and pneumologists—began to publish a series of prospective studies reporting an increased incidence of cardiovascular diseases in people exposed to low levels of airborne particles.1 ,2 Before these publications, toxicological studies had primarily focused on pulmonary effects of particulates in laboratory animals—and the results from those studies indicated that air pollution levels in many places were too low to cause harm to humans. This created something of a paradox, seemingly: epidemiologists finding adverse effects for which the biological mechanisms were not apparent. Over the next several years, the epidemiological and clinical evidence on cardiovascular effects associated with particulates increased,2 leading to the design of toxicological and other laboratory studies aiming at understanding mechanisms for the effects. Epidemiological data challenged assumptions and furthered knowledge about the mechanisms of toxicity. And ultimately, the toxicologists began asking and answering different questions. Laboratory and population studies were enriching each other, as they should. As a result, we now have a good understanding of cardiovascular risks from particulates, and have corresponding policies and regulation to protect citizens from air pollution.3–5 As ubiquitous as particulate air pollution (or more), but until recently with a much lower profile, food contact materials (FCMs) have long posed a silent challenge to researchers concerned with human health, nutrition and the environment. FCMs are articles used in packaging, food storage, processing or preparation equipment that come directly into contact with human foods. Most often FCMs are made of plastic or have a synthetic material in direct contact with the foodstuff—for example, as can coating, laminate in beverage cartons or the closures of glass jars. Importantly, most FCMs are not inert. Chemicals contained in the FCM, such as monomers, additives, processing aids or reaction by-products, can diffuse into foods. …

The use of standardized patients (SPs) shows promise in tobacco cessation treatment (TCT) training by providing a simulated clinical environment for dental students to practice counseling skills with individuals trained to portray patients. The purpose of this study was to determine if there was a difference in attitudes, perceptions, and knowledge between dental students who received a lecture and practice sessions with SPs and those who received a lecture only. Dental students in an introductory clinical course at one dental school were invited to participate in the study by completing a pre and post questionnaire. The pre questionnaire was administered to all students prior to a tobacco cessation lecture. Students were group-randomized to either the intervention or control group. The intervention group completed the post questionnaire after the lecture and practice sessions with SPs, and the control group completed it after the lecture only. Of ninety-eight students who attended the lecture and were invited to participate in the study, a total of ninety-four from the two groups (96 percent) provided two linkable questionnaires for analysis. In the results, training with lecture and SPs increased the students' understanding of barriers, subjective norms, perceived skills, self-efficacy, and intentions to provide TCT more than those in the lecture only; however, it did not significantly increase their attitudes and knowledge. These findings suggest that using SPs is a valuable educational method to promote the provision of TCT by dental students and graduates.

The advantages of high-performance concrete (HPC) have been well documented in recent years. These include enhanced design flexibility and improved durability performance resulting in reduced maintenance costs and an increased service life. In spite of these obvious benefits, implementation of HPC has been very slow. This can be attributed to several factors including the uncertainty related to current design codes and a lack of familiarity of designers and contractors with proper design and construction practices and requirements for HPC structures. This paper introduces and discusses some fundamental issues that affect the implementatation of HPC and impact the practitioner. These include those related to quality control/quality assurance, specifications, material performance, and structural behavior. Within the scope of this discussion, the fundamental differences and similarities between HPC and conventional concrete are discussed. The aim is to provide the practicing engineer with a conceptual understanding of the practical issues that affect the design and use of HPC for highway structures with the desire to further stimulate the implementation of HPC.

This article examines the main trends in adult education policy in Latin America during the 1990s. During this period, in spite of the commitments made by national governments in Jomtien in 1990 and ratified in Dakar in 2000, adult education in Latin America has been marginalized and neglected, both in terms of public policy and public funding. This paper raises different hypotheses in order to explain this dynamic and the variety of strategies that have been proposed to garner support for the field. Adult education in Latin America is now at a crossroads, and the collective search for its mission, purpose and identity is as urgent as ever. In discussing the revitalization of adult education in Latin America, the debates undertaken in the region by governmental and non-governmental organizations in the preparation for and in the follow-up to the 1997 Hamburg International Conference on Adult Education (CONFINTEA V) are described. In the final section, after summarizing the main issues and achievements, th...

New structural and stratigraphic mapping in the Isua greenstone belt, West Greenland has revealed that the exposed lithologic succession is quite different to that depicted in earlier studies. The key to a better understanding of the stratigraphy has been the recognition of intense strain and metasomatic effects combined with ductile fault structures that segment the belt into a number of tectonic slices. In some of these slices, deformation and metasomatism are somewhat lower than in surrounding slices (though still significant), which permit the recognition of primary depositional features that may be used to compare with lithologies from elsewhere in the belt. The belt is dominated by amphibolite that in a number of places show well-defined pillows. Pillow breccias and basaltic debris flows also occur within this package. Strongly recrystallized ultramafic bodies that occur in the belt are interpreted as intrusions or komatiitic flows. The most common sedimentary rock type is chert/banded iron-formation. These lithologies have been strongly affected by brittle and ductile deformation in combination with coarse recrystallization. Siliciclastic detrital rocks such as conglomerate and sandstone are much less common in the belt, and where present, have intrabasinally derived sources. Highly deformed quartzo-feldspathic schist crops out in a number of places in the belt and most likely has multiple origins. Previously these schists have been considered to be felsic volcaniclastic rocks, though recent mapping, and geochemical, and isotopic studies support the hypothesis that at least some of these schists are highy deformed and carbonated tonalitic gneiss sheets or replaced pillow-lava successions. Carbonate rocks in the belt are now considered to be mostly, or entirely, replacement in origin, where metasomatizing fluids have particularly utilized amphibolite–chert contacts; additionally, some carbonate may represent the products of early sea-floor alteration. We envision a temporarily emergent, below wave base, sea-floor origin for the succession based on the assemblage of lithologies.

The Isua greenstone belt ( Fig. 1 ) contains the oldest known, relatively well preserved, metavolcanic and metasedimentary rocks on Earth. The rocks are all deformed and many were substantially altered by metasomatism, but both the deformation and metasomatism were heterogeneous. Transitional stages can be seen from relatively well preserved primary volcanic and sedimentary structures to schists in which all primary features have been obliterated. Likewise different kinds, and different episodes, of metasomatic alteration can be seen that produced a diversity of different compositions and metamorphic mineral assemblages from similar protoliths. New geological mapping has traced out gradations between the best preserved protoliths and their diverse deformed and metasomatised equivalents. By this means, the primary nature of the schists that make up most of the Isua greenstone belt was reinterpreted, and a new map that better portrays the primary nature of the rocks has been produced. The previously mapped stratigraphy was found to be of little value in understanding the geology. Stratigraphic units were defined by different and diverse criteria, such as current composition, structure, metamorphic texture, and inferred protoliths. Much of this stratigraphy represents a misinterpretation of the primary nature of the rocks. The new work indicates that most of the Isua greenstone belt consists of fault-bounded rock packages, mainly derived from basaltic and high-Mg basaltic pillow lava and pillow lava breccia, chert–BIF, and a minor component of clastic sedimentary rocks derived from chert and basaltic volcanic rocks. A previously mapped, extensive, unit of felsic volcanic rocks was found to be derived from metasomatised basaltic pillow lava and pillow breccia intruded by numerous sheets of tonalite.

Concrete technology has continued to advance throughout the years to meet the demands of designers and innovative structural systems. Traditionally, the most common means to specify durable concrete has been via specifying a maximum water-to-cementitious material ratio or a minimum cement content. With the advent of high-performance concrete (HPC), which often has higher contents of cementitious materials and a variety of admixtures, questions about permeability performance and alternative methods to specify durable concrete have arisen. The study conducted herein comments on the applicability of prescriptive specifications for HPC and investigates the influence of curing regimes and concrete temperature development during hydration on the permeability performance of HPC prestressed and precast beams and cast-in-place decks. These components were constructed for use in two recently constructed HPC bridges in Texas. Results indicate the benefits of an ASTM Class C fly ash from a permeability standpoint and emphasize that variables such as material constituents, curing condition, and concrete temperature play a dramatic role in the permeability performance of HPC.

Many elements of the nation’s surface transportation infrastructure are deteriorating as a consequence of aging and increasing stresses. The American Recovery and Reinvestment Act of 2009 the stimulus package provided an initial infusion of funds for transportation infrastructure renewal and restoration, but these resources are not sufficient for rebuilding and sustaining the condition and performance of that infrastructure. Under these circumstances, it is particularly important to develop and deploy the best methods and technologies to support effective management of transportation infrastructure. To respond to this challenge, the U.S. DOT Research and Innovative Technology Administration sponsored a conference organized by the Transportation Research Board that brought infrastructure owners and decision makers together with researchers to consider problems, needs, and achievements and to define the directions for essential research to manage and preserve the nation’s surface transportation infrastructure. Participants at the November 2009 conference outlined the challenges and opportunities facing the highway, public transit, and rail systems and

The Godthabsfjord region of West Greenland contains the most extensive, best exposed and most intensely studied early Archean rocks on Earth. A geological record has been described of numerous magmatic events between ∼3.9 and 3.6 Ga, and evidence of life at >3.85 Ga and ∼3.8–3.7 Ga has been proposed from two widely-separated localities. Some of these claims have recently been questioned, and the nature of the best preserved remnants of the oldest known terrestrial volcanic and sedimentary rocks in the Isua greenstone belt are being reinvestigated and substantially reinterpreted. The first part of this article reviews the evolution of geological research and interpretations, outlining the techniques by which the geological history has been determined and the ensuing controversies. The second part re-examines crucial field evidence upon which the antiquity of the oldest terrestrial life is claimed from the island of Akilia.

Zircons older than 4.0 Ga have previously been identified as detrital grains within ca. 3.0 Ga clastic metasedimentary rocks of the Narryer Terrane. In this study, a detailed microstructural investigation of ≥4.0 Ga zircons recently discovered as xenocrysts within two late Archaean granitic gneisses from the Narryer and Murchison terranes of the Yilgarn Craton is reported. The microstructures of these ca. 200 μm long crystals record complex histories of disturbance between ca. 4183 and 3945 Ma that may reflect high-grade thermal events. Younger events recorded within these grains can be related to regional magmatic and metamorphic episodes known from the regional geology of the northwestern part of the Yilgarn Craton. By combining detailed examination of zircon microstructures using back-scattered electron and cathodoluminescence imaging with trace element and ion microprobe isotopic microanalytical methods, this study has demonstrated that complex histories can be determined from individual zircons.

A perceived high rate of complicated (gangrenous or perforated) appendicitis, despite advances in laboratory and radiographic diagnostic modalities, prompted a review of our experience with appendicitis followed by a prospective analysis that examined the time course from presentation to definitive treatment in 218 consecutive patients. In 5755 appendectomies, our overall rate of complicated appendicitis was 32 per cent; higher in males, in the young, and in the elderly; and relatively stable over each year reviewed. Prospectively, we determined that of the various time intervals, the time from the onset of symptoms to first seeking medical attention is the only significant predictor of complicated appendicitis (39.8 vs 16.5 hours for acute appendicitis). On the other hand, the time from surgical evaluation to operative intervention was significantly shorter for complicated appendicitis (3.8 vs 4.7 hours for acute appendicitis). The high rate of complicated appendicitis with its subsequent sequelae of increased morbidity and resource expenditure is primarily the direct result of patient delay in seeking medical attention and not the result of diagnostic dilemma or surgical delay. Public education, specifically targeting those groups at risk, may provide a substantial and significant solution to the complicated appendix.

We used data from the U.S. Bureau of Labor Statistics' Census of Fatal Occupational Injuries to describe fatal agricultural work injuries among youth less than 20 years of age from 1992-1996. There were 188 deaths, 23− of which were tractor-related. Eighty-three deaths were reported among individuals engaged in family businesses. The fatality rate for 15- to 19-year-olds was 12.2 deaths per 100,000 full-time equivalents. Youth fatality rates were comparable to those of adult workers up until the age group of 45-54 years. Non-regulatory approaches to preventing injuries, especially in family businesses, are important given the current form of U.S. child labor laws.

BACKGROUND Selective nonoperative management (NOM) of blunt splenic injuries is becoming a more prevalent practice. Inclusion criteria for NOM, which have been a source of controversy, continue to evolve. Age > or = 55 years has been proposed as a predictor for failure of and even a contraindication to NOM of blunt splenic trauma. Additionally, the high rate of NOM in children (up to 79%) has been attributed to their management by pediatric surgeons. We evaluated our experience with NOM of blunt splenic injury with special attention to these age groups. METHODS By using our trauma registry, all patients with blunt splenic injuries (documented by computed tomography, operative findings, or both) cared for over a 36-month period, at a single American College of Surgeons verified Level I trauma center were reviewed. Detailed chart reviews were performed to examine admission demographics, laboratory data, radiologic findings, outcome measures, and patient management strategy. All patients were managed by nonpediatric trauma surgeons. We then compared our adult data with that in the recent literature and our pediatric data with that of the National Pediatric Trauma Registry over the same time period. RESULTS We identified 251 consecutive patients with blunt splenic injuries. Eighteen patients who expired in the immediate postinjury period were excluded from statistical evaluation. No deaths occurred as a result of splenic injury. Of the remaining 233 patients, 73 patients (31%) required early celiotomy, 160 patients (69%) were selected for NOM, with 151 patients (94%) being successfully managed without operation. Blunt splenic injury occurred in 23 patients age 55 years or older. Eighteen patients (78%) were selected for NOM and 17 patients (94%) were successfully treated without operation. Blunt splenic injury occurred in 35 patients less than 16 years of age. Thirty-two patients (91%) were selected for NOM. Thirty-one patients (89% of all pediatric patients) were successfully treated without operation. CONCLUSION Age > or = 55 years is not a contraindication to nonoperative management of blunt splenic injuries. Children with blunt splenic injuries can be successfully managed nonoperatively by nonpediatric trauma surgeons.

The extant nomenclature for pericardial disease is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories, using synonyms where appropriate. No classification system has been reported. The groups were based on disease processes, and include: effusive pericarditis (pericardial effusion), constrictive pericarditis, cardiac tamponade, postoperative pericardial effusion, postoperative cardiac tamponade, postpericardiotomy syndrome, congenital defect, neoplastic process, benign mass, pericardial cyst, pneumopericardium, and chylopericardium. A comprehensive database set is presented that is based on a hierarchical scheme. Data are entered at various levels of complexity and detail, which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented that will allow for data sharing and would lend itself to basic interpretation of trends.

The extant nomenclature for aortico-left ventricular tunnel is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. Efforts were made to include all relevant nomenclature categories using synonyms where appropriate. The Hovaguimian classification appears most useful to surgeons: type 1, a simple tunnel with a slit-like opening at the aortic end, no aortic valve distortion; type II, a large extracardiac aortic wall aneurysm of the tunnel with an oval opening at the aortic end, with or without ventricular distortion; type III, intracardiac aneurysm of the septal portion of the tunnel, with or without right ventricular outflow tract obstruction; and type IV, a combination of type II and III. A comprehensive database set is presented, which is based on a hierarchical scheme. Data are entered at various levels of complexity and detail, which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented which will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented.

The Isukasia region of southern West Greenland contains the Earth’s oldest known supracrustal rocks (the c. 3.8‐3.7 Ga Isua greenstone belt: Appel et al. 1998) and well-preserved mafic dyke swarms (Inaluk and Tarssartoq dykes: Nutman et al. 1983). This report describes field investigations of the dykes carried out in 1999 as part of the Isua Multidisciplinary Research Project, and summarises current knowledge of the dykes. The project was initiated in 1997 with the aim of coordinating a detailed reinvestigation of this geologically important region. Fifteen members of the group were involved in field work in 1999 and this article represents only one aspect of the work. The occurrence, state of deformation and geochemical composition of the dykes provide important information on the evolution of the continental crust into which the dykes were intruded. Cross-cutting relationships between dykes and host rocks, and between different generations of dykes, yield valuable relative time constraints, and dykes provide significant time markers between structural and metamorphic events. The compositions of the least altered and least metamorphosed dykes help to define the properties of their mantle source region, as well as the nature of the crust through which the magmas travelled.

Concrete technology has continued to advance throughout the years to meet the demands of designers and innovative structural systems. With the advent of high-performance concrete (HPC), which contains large amounts of cementitious materials, the investigation of the impact of concrete temperature development during hydration on concrete performance is of keen interest. Match-curing technology was used to investigate the influence of concrete temperature development during hydration on the mechanical and material property performance of prestressed and precast HPC beams. These members were fabricated for use in two recently constructed HPC bridges in Texas. The investigation was conducted in conjunction with the design, instrumentation, and construction of the Louetta Road Overpass in Houston, Texas, and the North Concho River US-87 and South Orient Railroad Overpass in San Angelo, Texas. FHWA and the Texas Department of Transportation cosponsored these projects as part of the Strategic Highway Research Program to stimulate the use of HPC and to demonstrate the suitability of HPC in highway structures. The results of the study indicated that for HPCs that contain large amounts of cementitious materials, the concrete temperature during hydration can have a dramatic impact on both the mechanical and the material (durability) performance of the concrete. Temperature recommendations are provided to avoid less than optimal concrete performance on the basis of the member shapes and mix designs investigated in the study.

We describe the first two successful cases of transcarotid balloon aortic valvuloplasty for critical aortic valve stenosis in the neonate utilizing continuous transesophageal echocardiographic guidance performed at the bedside. This method obviates the need for transporting a sick and hemodynamically unstable neonate to the catheterization laboratory and additionally reduces costs without compromising clinical care.