Diabétologie [Diabetology]

In 2008, two highly discussed trials regarding the impact of glycemic control in type 2 diabetes, ACCORD and AVANCE, have been published. They showed a modest benefit of optimal glycemic control on morbidity and conflicting results on mortality, with an excess in the intensive treatment group of ACCORD. However several questionable aspects can be pointed out, the most prominent being the very limited duration of the intervention. This constrasts strongly with the long-term postintervention outcomes of UKPDS, which show a persistant benefit of glycemic control during 10 years of post-trial follow-up. These findings emphasize the need for an individualized approach of type 2 diabetic patients, aiming at the best possible control of all risk factors while minimizing the risk of hypoglycemia.

Knowledge management: uncovering risky gaps underlying the criticisms and moving to another perspective

The comments related to the sustainability of knowledge management (KM) have shown signs that it possibly can be a discourse which determines a quick style, but otherwise have also allowed the building of a better understanding about the limits and weaknesses of the knowlege management. In addition to the criticisms, the conceptual bases of knowledge management have been undermined by a contradictory combination of paradigms; there are also contradictions between the theoretical perspective jubjacent to the knwoledge management and its operationality. As a way of minimizing the possibility that the knowledge management may be turned into an umbrella concept and fail, it is suggested that its approaches embody a more interpretative perspective, taking up the role of an instrument which enables and facilitates the processes and practices in building up knowledge and information, enhancing their focus on the support to the establishment of human competences in order to deal intelligently with the present overcharge of information resources and need for building up information in the organizations.

Underseal Evaluation Project: Poweshiek County I-80 Near Milepost 189.5, Eastbound Roadway, MLR-85-10, 1985

The purpose of this project was to determine the optimal hole pattern needed for undersealing work, and also to determine if it is feasible to underseal a roadway with existing longitudinal subdrains without plugging the subdrain system. At the test site the hole pattern had little effect on the grout distribution. It was found that the hole pattern, to be effective, must locate existing voids and that holes must extend at least 2 in. (5 cm) below the underside of the pavement. It appeared that pavements can be undersealed without significant damage to the existing subdrains, but special care is needed to assure that excess grout is not injected into the drainage system. Recommendations are made concerning the hole pattern, grout efflux time, and procedures for minimizing the risk of plugging the subdrains with grout.

Fast Geodesic Active Fields for Image Registration Based on Splitting and Augmented Lagrangian Approaches.

In this paper, we present an efficient numerical scheme for the recently introduced geodesic active fields (GAF) framework for geometric image registration. This framework considers the registration task as a weighted minimal surface problem. Hence, the data-term and the regularization-term are combined through multiplication in a single, parametrization invariant and geometric cost functional. The multiplicative coupling provides an intrinsic, spatially varying and data-dependent tuning of the regularization strength, and the parametrization invariance allows working with images of nonflat geometry, generally defined on any smoothly parametrizable manifold. The resulting energy-minimizing flow, however, has poor numerical properties. Here, we provide an efficient numerical scheme that uses a splitting approach; data and regularity terms are optimized over two distinct deformation fields that are constrained to be equal via an augmented Lagrangian approach. Our approach is more flexible than standard Gaussian regularization, since one can interpolate freely between isotropic Gaussian and anisotropic TV-like smoothing. In this paper, we compare the geodesic active fields method with the popular Demons method and three more recent state-of-the-art algorithms: NL-optical flow, MRF image registration, and landmark-enhanced large displacement optical flow. Thus, we can show the advantages of the proposed FastGAF method. It compares favorably against Demons, both in terms of registration speed and quality. Over the range of example applications, it also consistently produces results not far from more dedicated state-of-the-art methods, illustrating the flexibility of the proposed framework.

Full-waveform inversion of cross-hole ground-penetrating radar data to characterize a gravel aquifer close to the Thur River, Switzerland

Cross-hole radar tomography is a useful tool for mapping shallow subsurface electrical properties viz. dielectric permittivity and electrical conductivity. Common practice is to invert cross-hole radar data with ray-based tomographic algorithms using first arrival traveltimes and first cycle amplitudes. However, the resolution of conventional standard ray-based inversion schemes for cross-hole ground-penetrating radar (GPR) is limited because only a fraction of the information contained in the radar data is used. The resolution can be improved significantly by using a full-waveform inversion that considers the entire waveform, or significant parts thereof. A recently developed 2D time-domain vectorial full-waveform crosshole radar inversion code has been modified in the present study by allowing optimized acquisition setups that reduce the acquisition time and computational costs significantly. This is achieved by minimizing the number of transmitter points and maximizing the number of receiver positions. The improved algorithm was employed to invert cross-hole GPR data acquired within a gravel aquifer (4-10 m depth) in the Thur valley, Switzerland. The simulated traces of the final model obtained by the full-waveform inversion fit the observed traces very well in the lower part of the section and reasonably well in the upper part of the section. Compared to the ray-based inversion, the results from the full-waveform inversion show significantly higher resolution images. At either side, 2.5 m distance away from the cross-hole plane, borehole logs were acquired. There is a good correspondence between the conductivity tomograms and the natural gamma logs at the boundary of the gravel layer and the underlying lacustrine clay deposits. Using existing petrophysical models, the inversion results and neutron-neutron logs are converted to porosity. Without any additional calibration, the values obtained for the converted neutron-neutron logs and permittivity results are very close and similar vertical variations can be observed. The full-waveform inversion provides in both cases additional information about the subsurface. Due to the presence of the water table and associated refracted/reflected waves, the upper traces are not well fitted and the upper 2 m in the permittivity and conductivity tomograms are not reliably reconstructed because the unsaturated zone is not incorporated into the inversion domain.

Freeze-Thaw Durability of Concretes with Infilling of Ettringite in Voids, Phase 2, MLR-94-9, 1997

Examination of field portland cement concrete cores, from Iowa pavements with premature deterioration, reveals extensive infilling of calcium sulfate aluminum (CSA) compound in their air voids. A previous study (Phase I) has shown some evidence of the correlation between freeze-thaw durability of concretes and ettringite infilling. To further verify the previous observation, a more extensive experimental program was conducted in this Phase 2 study. A total of 101 concrete mixes were examined. Seven cements, six fly ashes, two water reducers and three coarse aggregates were used in the concrete mixes. Specimens were under moist curing for up to 223 days before being subjected to the freeze-thaw cycling. An environmental treatment consisting of three consecutive wet [70 deg F (21 deg C) in distilled water]/dry [120 deg F (49 deg C) in oven] cycles was applied to some specimens. Immediately prior to the freeze-thaw cycling, most specimens were examined by a low-vacuum scanning electron microscope (SEM) for their microstructure. The results obtained further demonstrate the correlation between concrete freeze-thaw response and CSA compound infilling in the air voids. The extent of the infilling depends on the period of moist curing as well as the wet/dry treatment. The extent of the infilling also relates to materials used. Concrete mixes with extensive infilling are more vulnerable to the freeze-thaw attack. Based on the obtained results, material criteria on cements and fly ashes for mainline paving were proposed for minimizing potential infilling of CSA compound in concrete.

Joint inversion of crosshole GPR and seismic traveltime data

Joint inversion of crosshole ground-penetrating radar and seismic data can improve model resolution and fidelity of the resultant individual models. Model coupling obtained by minimizing or penalizing some measure of structural dissimilarity between models appears to be the most versatile approach because only weak assumptions about petrophysical relationships are required. Nevertheless, experimental results and petrophysical arguments suggest that when porosity variations are weak in saturated unconsolidated environments, then radar wave speed is approximately linearly related to seismic wave speed. Under such circumstances, model coupling also can be achieved by incorporating cross-covariances in the model regularization. In two case studies, structural similarity is imposed by penalizing models for which the model cross-gradients are nonzero. A first case study demonstrates improvements in model resolution by comparing the resulting models with borehole information, whereas a second case study uses point-spread functions. Although radar seismic wavespeed crossplots are very similar for the two case studies, the models plot in different portions of the graph, suggesting variances in porosity. Both examples display a close, quasilinear relationship between radar seismic wave speed in unconsolidated environments that is described rather well by the corresponding lower Hashin-Shtrikman (HS) bounds. Combining crossplots of the joint inversion models with HS bounds can constrain porosity and pore structure better than individual inversion results can.

Allergy to betalactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests.

To cite this article: Ponvert C, Perrin Y, Bados-Albiero A, Le Bourgeois M, Karila C, Delacourt C, Scheinmann P, De Blic J. Allergy to betalactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests. Pediatr Allergy Immunol 2011; 22: 411-418. ABSTRACT: Studies based on skin and challenge tests have shown that 12-60% of children with suspected betalactam hypersensitivity were allergic to betalactams. Responses in skin and challenge tests were studied in 1865 children with suspected betalactam allergy (i) to confirm or rule out the suspected diagnosis; (ii) to evaluate diagnostic value of immediate and non-immediate responses in skin and challenge tests; (iii) to determine frequency of betalactam allergy in those children, and (iv) to determine potential risk factors for betalactam allergy. The work-up was completed in 1431 children, of whom 227 (15.9%) were diagnosed allergic to betalactams. Betalactam hypersensitivity was diagnosed in 50 of the 162 (30.9%) children reporting immediate reactions and in 177 of the 1087 (16.7%) children reporting non-immediate reactions (p < 0.001). The likelihood of betalactam hypersensitivity was also significantly higher in children reporting anaphylaxis, serum sickness-like reactions, and (potentially) severe skin reactions such as acute generalized exanthematic pustulosis, Stevens-Johnson syndrome, and drug reaction with systemic symptoms than in other children (p < 0.001). Skin tests diagnosed 86% of immediate and 31.6% of non-immediate sensitizations. Cross-reactivity and/or cosensitization among betalactams was diagnosed in 76% and 14.7% of the children with immediate and non-immediate hypersensitivity, respectively. The number of children diagnosed allergic to betalactams decreased with time between the reaction and the work-up, probably because the majority of children with severe and worrying reactions were referred for allergological work-up more promptly than the other children. Sex, age, and atopy were not risk factors for betalactam hypersensitivity. In conclusion, we confirm in numerous children that (i) only a few children with suspected betalactam hypersensitivity are allergic to betalactams; (ii) the likelihood of betalactam allergy increases with earliness and/or severity of the reactions; (iii) although non-immediate-reading skin tests (intradermal and patch tests) may diagnose non-immediate sensitizations in children with non-immediate reactions to betalactams (maculopapular rashes and potentially severe skin reactions especially), the diagnostic value of non-immediate-reading skin tests is far lower than the diagnostic value of immediate-reading skin tests, most non-immediate sensitizations to betalactams being diagnosed by means of challenge tests; (iv) cross-reactivity and/or cosensitizations among betalactams are much more frequent in children reporting immediate and/or anaphylactic reactions than in the other children; (v) age, sex and personal atopy are not significant risk factors for betalactam hypersensitivity; and (vi) the number of children with diagnosed allergy to betalactams (of the immediate-type hypersensitivity especially) decreases with time between the reaction and allergological work-up. Finally, based on our experience, we also propose a practical diagnostic approach in children with suspected betalactam hypersensitivity.

Low environmental impact bleaching sequences for attaining high brightness level with eucalyptus SPP pulp

The alternatives used for minimizing the usage of chlorine dioxide in bleaching sequences included a hot acid hydrolysis (Ahot) stage, the use of hot chlorine dioxide (Dhot) and ozone stages at medium consistency and high consistency (Zmc and Zhc), in addition to stages with atmospheric hydrogen peroxide (P) and pressurized hydrogen peroxide (PO). The results were interpreted based on the cost of the chemical products, bleaching process yields and on minimizing the environmental impact of the bleaching process. In spite of some process restrictions, high ISO brightness levels were kept around 90 % brightness. Additionally, the inclusion of stages like acid hydrolysis, pressurized peroxide and ozone in the bleaching sequences provided an increase in operating flexibility, aimed at reducing environmental impact (ECF Light). The Dhot(EOP)D(PO) sequence presented lower operating cost for ISO brightness above 92 %. However, this kind of sequence was not allowed for closing the wastewater circuit, even partially. For ISO brightness level around 91%, the AhotZhcDP sequence presented a lower operating cost than the others

Pharmacotherapeutic management of locally advanced prostate cancer: current status.

Locally advanced prostate cancer (LAPC) is a heterogeneous entity usually embracing T3-4 and/or pelvic lymph-node-positive disease in the absence of established metastases. Outcomes for LAPC with single therapies have traditionally been poor, leading to the investigation of adjuvant therapies. Prostate cancer is a hormonally sensitive tumour, which usually responds to pharmacological manipulation of the androgen receptor or its testosterone-related ligands. As such, androgen deprivation therapy (ADT) has become an important adjuvant strategy for the treatment of LAPC, particularly for patients managed primarily with radiotherapy. Such results have generally not been replicated in surgical patients. With increased use of ADT has come improved awareness of the numerous toxicities associated with long-term use of these agents, as well as the development of strategies for minimizing ADT exposure and actively managing adverse effects. Several trials are exploring agents to enhance radiation cell sensitivity as well as the application of adjuvant docetaxel, an agent with proven efficacy in the metastatic, castrate-resistant setting. The recent work showing activity of cabazitaxel, sipuleucel-T and abiraterone for castrate-resistant disease in the post-docetaxel setting will see these agents investigated in conjunction with definitive surgery and radiotherapy.

Post-Nonlinear Mixtures and Beyond

Although sources in general nonlinear mixturm arc not separable iising only statistical independence, a special and realistic case of nonlinear mixtnres, the post nonlinear (PNL) mixture is separable choosing a suited separating system. Then, a natural approach is based on the estimation of tho separating Bystem parameters by minimizing an indcpendence criterion, like estimated mwce mutual information. This class of methods requires higher (than 2) order statistics, and cannot separate Gaarsian sources. However, use of [weak) prior, like source temporal correlation or nonstationarity, leads to other source separation Jgw rithms, which are able to separate Gaussian sourra, and can even, for a few of them, works with second-order statistics. Recently, modeling time correlated s011rces by Markov models, we propose vcry efficient algorithms hmed on minimization of the conditional mutual information. Currently, using the prior of temporally correlated sources, we investigate the fesihility of inverting PNL mixtures with non-bijectiw non-liacarities, like quadratic functions. In this paper, we review the main ICA and BSS results for riunlinear mixtures, present PNL models and algorithms, and finish with advanced resutts using temporally correlated snu~sm

Video Inspection of Highway Edgedrain Systems, HR-317, 1998

Minimizing infiltration of water in pavement structures has long been a priority of pavement designers. Incorporation of subsurface edgedrains is frequently an integral part of an pavement drainage system. In order for such a system to be effective however, it must be properly installed and maintained. With advances in video technology, inspection of edgedrain systems can now be conducted quite efficiently. This report documents the results of 287 video inspections of highway edgedrain systems in 29 states. These inspections were conducted to both demonstrate the capabilities of the technology as well as demonstrating some of the common problems associated with the performance of edgedrain systems. Findings indicated not only that the equipment was quite effective in identifying edgedrain performance concerns, but also how widespread the concerns of edgedrain performance are. Almost one third of the systems inspected had nonfunctional outlets, another third were either found to have non-functional mainlines or the mainlines could not be inspected due to physical obstructions. Only one third of the systems inspected were found to be performing as intended. Recommendations are provided for edgedrain design improvements to facilitate performance of the system and their inspections as well as recommendations to improve quality control during construction. Suggestions are also provided for maintenance procedures to address concerns identified in the inspection process. A Draft Guide Specification For Video Edgedrain Inspection and Acceptance is also provided as an Appendix.

Lexan Gate Arm, HR-536, 1987

Innovative Rail Ltd. of Cedar Rapids, Iowa produced a new rail/highway crossing gate arm that shows promise in two areas: a. Minimizing arm breakage, and b. Added target value to motorists. The new gate was demonstrated to the Chicago and North Western Transportation Company, and that railroad has requested its use at two crossings on an "experimental basis" to determine if its installation provides relief in those areas. On April 18, 1986, the Department observed a test of the material under field conditions with the Transportation Company. The gate received four mid-center strikes at 5 MPH by a company truck while in the lowered position, and showed no damage. In a fifth mid-center strike at 15 MPH, the gate was visibly damaged at the connection to its raising mechanism, but continued to function though at a 5-10 degree drop. Several pictures of the gate and its saddle mechanism are shown in Appendix A of this report. Innovative Rail established distributorships in the United States and Canada, and has since gone out of business.

Selective ablation of photovoltaic materials with UV laser sources for monolithic interconnection of devices based on a-Si:H

Lasers are essential tools for cell isolation and monolithic interconnection in thin-film-silicon photovoltaic technologies. Laser ablation of transparent conductive oxides (TCOs), amorphous silicon structures and back contact removal are standard processes in industry for monolithic device interconnection. However, material ablation with minimum debris and small heat affected zone is one of the main difficulty is to achieve, to reduce costs and to improve device efficiency. In this paper we present recent results in laser ablation of photovoltaic materials using excimer and UV wavelengths of diode-pumped solid-state (DPSS) laser sources. We discuss results concerning UV ablation of different TCO and thin-film silicon (a-Si:H and nc-Si:H), focussing our study on ablation threshold measurements and process-quality assessment using advanced optical microscopy techniques. In that way we show the advantages of using UV wavelengths for minimizing the characteristic material thermal affection of laser irradiation in the ns regime at higher wavelengths. Additionally we include preliminary results of selective ablation of film on film structures irradiating from the film side (direct writing configuration) including the problem of selective ablation of ZnO films on a-Si:H layers. In that way we demonstrate the potential use of UV wavelengths of fully commercial laser sources as an alternative to standard backscribing process in device fabrication.

Do fire and seed additions alter strong seed timing and priority effects on prairie establishment?, 2011

Many prairie restoration projects are hampered by a lack of knowledge on how to restore the high diversity found in prairies, while at the same time preventing the establishment of a large weedy component. Methods are needed to increase diversity and abundance of native species while minimizing exotic species invasions in both 1) newly planted restorations and 2) established restorations. We established an experiment in Story and Monona counties in 2005 to determine the effects of different native cover crop species and timing of seeding on the establishment of new prairie restorations. We found that adding a 30-species prairie mix in early spring led to diverse native communities, but adding the mix in the late summer or the following year after cover crops established led to low diversity communities dominated by exotics. The identity of cover crops affected communities less than timing of seed additions. A second seed addition added to ash after a spring fire in the seventh year (Monona County site) increased recruitment from the prairie mix slightly, but the increase was not enough to cause convergence in the treatments. Surprisingly, the second seed addition increased diversity only in communities that were already the most diverse (i.e., in plots seeded with the prairie mix in early spring before cover crops established). These results imply that 1) cover crops are not effective for establishing prairie and 2) over seeding into established plots may not be an easy and efficient way to increase native recruitment and lower weedy species abundances. Therefore, focusing on establishing high levels of recruitment and diversity and excluding weedy species during the critical time early in establishment should be a priority for new projects.