Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: Case report

We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010, in which surprisingly the presence of an annuloaortic ectasia (root 73 × 74 mm) in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation, the left ventricle was massively dilated presenting a reduced ejection fraction of 45%. A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement (David procedure) in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum.

Alcohol consumption in late adolescence and early adulthood - where is the problem?

Risky single-occasion drinking (RSOD) is more common in late adolescence and early adulthood (approximately between the ages of 16 and 30) than in any other period in life. This is also the age when young people in Switzerland and many other European countries are legally allowed to buy and drink alcohol, but they usually do not yet have adult responsibilities. This paper reviews evidence from the international literature and provides examples of studies conducted in Switzerland demonstrating that (a) RSOD is by far most prevalent on Saturday evenings followed by Friday evenings, usually because young people go out and do not have any work or study responsibilities the next day; (b) RSOD results from drinking in private before going out ("predrinking") and accelerating the pace of drinking (i.e. increasing the number of drinks consumed per hour); (c) RSOD is often not accidental but purposeful,. to seek excitement, to have fun and to feel the effects of alcohol; (d) RSOD occurs predominantly outside the home, mostly in bars, pubs, discos or at special events and festivals; (e) RSOD often results in intended and unintended injuries and other acute consequences, which are leading risk factors for mortality and morbidity in this age group. Effective prevention strategies should include attempts to reduce opportunities to engage in heavy drinking as well as strategies to reduce its harmful consequences.

Cell polarity in plants: a PARspective on PINs.

Plants have acquired the ability for organized multicellular development independent from animals. Because of this, they represent an independent example in nature for the development of coordinated, complex cell polarity from the simple polarity found in unicellular eukaryotes. Plants display a striking array of polarized cell types, with different axes of polarity being defined in one cell. The most investigated and best understood aspect of plant polarity is the apical-basal polarity of the PIN family of auxin efflux facilitators, which are of crucial importance for the organization of the entire plant body. Striking differences exist between the PAR-polarity modules known in animals and the ways PINs polarize plant cells. Nonetheless, a common regulatory logic probably applies to all polarizing eukaryotic cells, which includes self-reinforcing, positive feedback loops, intricate interactions between membrane-attached proteins, lipid signatures, and the targeting of transmembrane proteins to the correct domains of the plasma membrane.

Physiological traits affecting the distribution and wintering strategy of the bat Tadarida teniotis

The ability to enter torpor at low ambient temperature, which enables insectivorous bats to survive seasonal food shortage, is often seen as a prerequisite for colonizing cold environments. Free-tailed bats (Molossidae) show a distribution with a maximum latitudinal extension that appears to be intermediate between truly tropical and temperate-zone bat families. We therefore tested the hypothesis that Tadarida teniotis, the molossid species reaching the highest latitude worldwide (46 degrees N), lacks the extreme physiological adaptations to cold that enable other sympatric bats to enter further into the temperate zone. We studied the metabolism of individuals subjected to various ambient temperatures in the laboratory by respirometry, and we monitored the body temperature of free-ranging individuals in winter and early spring in the Swiss Alps using temperature-sensitive radio-tags. For comparison, metabolic data were obtained from Nyctalus noctula, a typically hibernating vespertilionid bat of similar body size and convergent foraging tactics. The metabolic data support the hypothesis that T. teniotis cannot experience such low ambient temperatures as sympatric temperate-zone vespertilionid bats without incurring much higher energetic costs for thermogenesis. The minimum rate of metabolism in torpor was obtained at 7.5 degrees-10 degrees C in T. teniotis, as compared to 2.5 degrees-5 degrees C in N. noctula. Field data showed that T. teniotis behaves as a classic thermo-conforming hibernator in the Alps, with torpor bouts lasting up to 8 d. This contradicts the widely accepted opinion that Molossidae are nonhibernating bars. However, average body temperature (10 degrees-13 degrees C) and mean arousal frequency (3.4 d in one bat in January) appear to be markedly higher than in other temperate-zone bat species. At the northern border of its range T. teniotis selects relatively warm roosts (crevices in tall, south-exposed limestone cliffs) in winter where temperatures oscillate around 10 degrees C. By this means, T. teniotis apparently avoids the risk of prolonged exposure to energetically critical ambient temperatures in torpor (<6.5 degrees-7.5 degrees C) during cold spells. Possibly shared by other Molossidae, the physiological pattern observed in T. teniotis may clearly be linked to the intermediate latitudinal extension of this bat family.

Concrete Pavement Construction Basics, June 2006

General principles • Everyone at the construction site, particularly foremen and supervisors, is responsible for recognizing and troubleshooting potential problems as they arise. • Batches of concrete should be consistent and uniformly mixed. • A major cause of pavement failure is unstable subgrade. The subgrade should consist of uniform material, and the subgrade system must drain well. • Dowel bars are important for load transfer at transverse joints on pavements with high truck volumes. Dowels must be carefully aligned, horizontally and vertically, to prevent pavement damage at the joints. • Stringlines control the slipform paver’s horizontal and vertical movement and ensure a smooth pavement profile. Once stringlines are set, they should be checked often and not disturbed. • Overfinishing the new pavement and/or adding water to the surface can lead to pavement surface problems. If the concrete isn’t sufficiently workable, crews should contact the project manager. Changes to the mixture or to paver equipment may reduce the problem. • Proper curing is critical to preventing pavement damage from rapid moisture loss at the pavement surface. • A well spaced and constructed system of joints is critical to prevent random cracking. • Joints are simply controlled cracks. They must be sawed during the brief time after the pavement has gained enough strength to prevent raveling but before it begins to crack randomly (the “sawing window”). • Seasonal and daily weather variations affect setting time and other variables in new concrete. Construction operations should be adjusted appropriately.

Characterization of Ornamental Rock Residue and Potassium Liberation Via Organic Acid Application

ABSTRACT Organic acids present in organic matter and, or, exudates by microorganisms and plants can increase the liberation of potassium present in minerals. The objective of this study was to characterize the residue from ornamental rocks and evaluate the release of K from these residues after the application of organic acids. The experiment was conducted under laboratory conditions and followed a 2 × 3 × 5 factorial design with three replicates. The studied factors were: two organic acids (citric acid and malic acid), three ornamental rock residues (R1, R2 and R3) and five organic acid rates (0, 5, 10, 20 and 40 mmol L-1). After agitation, K concentrations were determined in the equilibrium solution. Successive extractions were performed (1, 5, 10, 15, 30 and 60 days after the start of the experiment). The organic acids used (citric and malic) promoted the release of up to 4.86 and 4.34 % of the total K contained in the residue, respectively, reinforcing the role of organic acids in the weathering of minerals and in providing K to the soil. The K quantities were, on average, 6.1 % higher when extracted with citric acid compared to malic acid.

What the Law Requires Accessible Multi-family Housing in Iowa, Janaury 2001

For people with disabilities, however, housing options have been limited. Today, state and federal laws are changing this. Who will benefit? All of us. For “accessibility” is an issue that, at one time or another, affects us all. This is true whether _ temporarily or permanently _ we use wheelchairs, need grab bars, cannot climb stairs, require easy-to-reach shelves, or rely on easy-to-navigate living spaces. The primary purpose of accessible housing law is to prevent discrimination against people with disabilities, but the end result is a living environment that is more usable for everyone. For example, both the very young and the very old will find an accessible dwelling more comfortable. People with temporary limitations due to injury or illness will find it easier to live in. Such a home will be more welcoming to guests with disabilities.

Hostigamiento en la vivienda: Es ilegal, Janaury 2001

For people with disabilities, however, housing options have been limited. Today, state and federal laws are changing this. Who will benefit? All of us. For “accessibility” is an issue that, at one time or another, affects us all. This is true whether _ temporarily or permanently _ we use wheelchairs, need grab bars, cannot climb stairs, require easy-to-reach shelves, or rely on easy-to-navigate living spaces. The primary purpose of accessible housing law is to prevent discrimination against people with disabilities, but the end result is a living environment that is more usable for everyone. For example, both the very young and the very old will find an accessible dwelling more comfortable. People with temporary limitations due to injury or illness will find it easier to live in. Such a home will be more welcoming to guests with disabilities.

No variation of physical performance and perceived exertion after adrenal gland stimulation by synthetic ACTH (Synacthen) in cyclists.

There is anecdotal evidence that athletes use the banned substance Synacthen because of its perceived benefit with its associated rise in cortisol. To test the performance-enhancing effects of Synacthen, eight trained cyclists completed two, 2-day exercise sessions separated by 7-10 days. On the first day of each 2-day exercise session, subjects received either Synacthen (0.25 mg, TX) or placebo (PLA) injection. Performance was assessed by a 20-km time trial (TT) after a 90-min fatigue period on day 1 and without the fatiguing protocol on day 2. Plasma androgens and ACTH concentrations were measured during the exercise bouts as well as the rate of perceived exertion (RPE). Spot urines were analyzed for androgens and glucocorticoids quantification. Basal plasma hormones did not differ significantly between PLA and TX groups before and 24 h after the IM injection (P > 0.05). After TX injection, ACTH peaked at 30 min and hormone profiles were significantly different compared to the PLA trial (P < 0.001). RPE increased significantly in both groups as the exercise sessions progressed (P < 0.001) but was not influenced by treatment. The time to completion of the TT was not affected on both days by Synacthen treatment. In the present study, a single IM injection of synthetic ACTH did not improve either acute or subsequent cycling performance and did not influence perceived exertion. The investigated urinary hormones did not vary after treatment, reinforcing the difficulty for ACTH abuse detection.

Evaluation of Low Cost Traffic Calming for Rural Communities – Phase II, April 2013

The main goal of the research described in this report was to evaluate countermeasures that agencies can use to reduce speeds as drivers enter rural communities located on high-speed roadways. The objectives of this study were as follows: * Identify and summarize countermeasures used to manage speeds in transition zones * Demonstrate the effectiveness of countermeasures that are practical for high- to low-speed transition zones * Acquire additional information about countermeasures that may show promise but lack sufficient evidence of effectiveness * Develop an application toolbox to assist small communities in selecting appropriate transition zones and effective countermeasures for entrances to small rural communities The team solicited small communities that were interested in participating in the Phase II study and several communities were also recommended. The treatments evaluated were selected by carefully considering traffic-calming treatments that have been used effectively in other countries for small rural communities, as well as the information gained from the first phase of the project. The treatments evaluated are as follows: * Transverse speed bars * Colored entrance treatment * Temporary island * Radar-activated speed limit sign * Speed feedback sign The toolbox publication and four focused tech briefs also cover the results of this work.

Se former à l'entretien motivationnel pour aider ses patients à changer: Les étudiants en médecine le confirment [Learning motivational interviewing to help patients change their health-related behaviors: medical students confirm it].

At the Lausanne University, 5th year medical students were trained in Motivational interviewing (MI). Eight hours of training improved their competence in the use of this approach. This experience supports the implementation of MI training in medical schools. Motivational interviewing allows the health professional to actively involve the patient in this behavior change process (drinking, smoking, diet, exercise, medication adherence, etc.), by encouraging reflection and reinforcing personal motivation and resources.

Feasibility Study for Detection and Quantification of Corrosion in Bridge Barrier Rails, RB11-012, 2013

"Technical challenges exist with infrastructure that can be addressed by nondestructive evaluation (NDE) methods, such as detecting corrosion damage to reinforcing steel that anchor concrete bridge railings to bridge road decks. Moisture and chloride ions reach the anchors along the cold joint between the rails and deck, causing corrosion that weakens the anchors and ultimately the barriers. The Center for Nondestructive Evaluation at Iowa State University has experience in development of measurement techniques and new sensors using a variety of interrogating energies. This research evaluated feasibility of three technologies — x-ray radiation, ground-penetrating radar (GPR), and magnetic flux leakage (MFL) — for detection and quantification of corrosion of embedded reinforcing steel. Controlled samples containing pristine reinforcing steel with and without epoxy and reinforcing steel with 25 percent and 50 percent section reduction were embedded in concrete at 2.5 in. deep for laboratory evaluation. Two of the techniques, GPR and MFL, were used in a limited field test on the Iowa Highway 210 Bridge over Interstate 35 in Story County. The methods provide useful and complementary information. GPR provides a rapid approach to identify reinforcing steel that has anomalous responses. MFL provides similar detection responses but could be optimized to provide more quantitative correlation to actual condition. Full implementation could use either GPR or MFL methods to identify areas of concern, followed by radiography to give a visual image of the actual condition, providing the final guidance for maintenance actions." The full 103 page report and the 2 page Tech Transfer Summary are included in this link.

Speed Management Toolbox for Rural Communities, TR-630, 2012

The primary objective of this toolbox is to summarize various known traffic-calming treatments and their effectiveness. This toolbox focuses on roadway-based treatments for speed management, particularly for rural communities with transition zones. Education, enforcement, and policy strategies should also be considered, but are not the focus of this toolbox. The research team identified treatments based on their own research, a review of the literature, and discussion with other professionals. This toolbox describes each treatment and summarizes placement, advantages, disadvantages, effectiveness, appropriateness, and cost for each treatment. The categories of treatments covered in this toolbox are as follows: horizontal physical displacement, vertical physical displacement, narrowing, surroundings, pavement markings, traffic control signs, and other strategies. Separate 3- to 4-page Tech Briefs for various aspects of this toolbox are attached to this record: Center Islands with Raised Curbing for Rural Traffic Calming, Colored Entrance Treatments for Rural Traffic Calming, Dynamic Speed Feedback Signs for Rural Traffic Calming, Transverse Speed Bars for Rural Traffic Calming. This toolbox and the tech briefs are related to the report Evaluation of Low Cost Traffic Calming for Rural Communities – Phase II, which is also included in this record or can be found at http://publications.iowa.gov/id/eprint/14769

Evaluation of Low Cost Traffic Calming for Rural Communities – Phase II [Updated], TR-630, October, 2013

The main goal of the research described in this report was to evaluate countermeasures that agencies can use to reduce speeds as drivers enter rural communities located on high-speed roadways. The objectives of this study were as follows: * Identify and summarize countermeasures used to manage speeds in transition zones * Demonstrate the effectiveness of countermeasures that are practical for high- to low-speed transition zones * Acquire additional information about countermeasures that may show promise but lack sufficient evidence of effectiveness * Develop an application toolbox to assist small communities in selecting appropriate transition zones and effective countermeasures for entrances to small rural communities The team solicited small communities that were interested in participating in the Phase II study and several communities were also recommended. The treatments evaluated were selected by carefully considering traffic-calming treatments that have been used effectively in other countries for small rural communities, as well as the information gained from the first phase of the project. The treatments evaluated are as follows: * Transverse speed bars * Colored entrance treatment * Temporary island * Radar-activated speed limit sign * Speed feedback sign The toolbox publication and four focused tech briefs also cover the results of this work.

Vibratory Effects in Reinforced Portland Cement Concrete Pavement, MLR-97-2, 1997

A double mat of reinforcement steel consisting of No. 5 bars was placed in the longitudinal and transverse directions in a 26' wide, 10" thick pavement. The bars were placed on 12" centers with 2" of cover from the top and bottom surfaces. The special reinforcement is to provide additional strength in the pavement over an area of old coal mine tunnels. Auxiliary and standard paver vibrators were used to consolidate the concrete. There was concern that over-vibration could be occurring in some areas and also that a lack of consolidation may be occurring under the steel bars in some areas. A core evaluation study of the pavement was developed. The results showed that the consolidation and the air contents were satisfactory. Additional paving with reinforcement in the same area should use the same or similar method and amount of vibration as was used in the area evaluated in this study.