Electronic Construction Collaboration System – Phase III, December 2011

This phase of the electronic collaboration project involved two major efforts: 1) implementation of AEC Sync (formerly known as Attolist), a web-based project management system (WPMS), on the Broadway Viaduct Bridge Project and the Iowa Falls Arch Bridge Project and 2) development of a web-based project management system for bridge and highway construction projects with less than $10 million in contract value. During the previous phase of this project (fiscal year 2010), the research team helped with the implementation process for AEC Sync and collected feedback from the Broadway Viaduct project team members before the start of the project. During the 2011 fiscal year, the research team collected the post-project surveys from the Broadway Viaduct project members and compared them to the pre-project survey results. The results of the AEC Sync implementation on the Broadway project were positive. The project members were satisfied with the performance of the AEC Sync software and how it facilitated document management and its transparency. In addition, the research team distributed, collected, and analyzed the pre-project surveys for the Iowa Falls Arch Bridge Project. The implementation of AEC Sync for the Iowa Falls Arch Bridge Project appears to also be positive, based on the pre-project surveys. The fourth phase of this electronic collaboration project involves the identification and implementation of a WPMS solution for smaller bridge and highway projects. The workflow for the shop drawing approval process for sign truss projects was documented and used to identify possible WPMS solutions. After testing and evaluating several WPMS solutions, Microsoft SharePoint Foundation’s site pages were selected to be pilot-tested on sign truss projects. Due to the limitation on the SharePoint license that the Iowa Department of Transportation (DOT) has, a file transfer protocol (FTP) site will be developed alongside this site to allow contractors to upload shop drawings to the Iowa DOT. The SharePoint site pages are expected to be ready for implementation during the 2012 calendar year.

Carotid-subclavian arteries Index (CSI), a new echocardiographic index to recognize coarctation of the aorta in neonates and infants

Introduction: Coarctation of the aorta is a common congenital heart malformation. Mode of diagnosis changed from clinically to almost exclusively by echocardiogram and MRI. We claim to find a new echocardiographic index, based on simple and reliable morphologic measurements, to facilitate the diagnosis of aortic coarctation in the newborn.We reproduce the same procedure for older child to validate this new index. Material and Methods: We reviewed echocardiographic studies of 47 neonates with diagnosis of coarctation who underwent cardiac surgery between January 1997 and February 2003 and compared them with a matched control group. We measured 12 different sites of the aorta, aortic arch and the great vessels on the echocardiographic bands. In a second time we reviewed 23 infants for the same measurements and compare them with a matched control group. Results: 47 neonates with coarctation were analysed, age 11.8 _ 10 days,weight 3.0 _ 0.6 kg, body surface 0.20 _ 0.02m2. The control group was of 16 newborns aged 15.8 _ 10 days,weight 3.2 _ 0.9 kg and body surface 0.20 _ 0.04m2. A significant difference was noted in many morphologic measurement between the both groups, the most significant being the distance between the left carotid artery and the left subclavian artery (coarctation vs control: 7.3 _ 3mm vs 2.4 _ 0.8mm, p _ 0.0001). We then defined a new index, the carotid-subclavian arteries index (CSI) as the diameter of the distal tranverse aortic arch divided to the distance left carotid artery to left subclavian artery being also significaly different (coarctation vs control: 0.76 _ 0.86 vs 2.95 _ 1.24, p _ 0.0001). With the cutoff value of this index of 1.5 the sensitivity for aortic coarctation was 98% and the specificity of 92%. In an older group of infant with coarctation (16 patients) we apply the same principle and find for a cut-off value of 1.5 a sensitivity of 95% and a specificity of 100%. Conclusions: The CSI allows to evaluate newborns and infants for aortic coarctation with simple morphologic measurement that are not depending of the left ventricular function, presence of a patent ductus arteriosus or not. Further aggressive evaluation of these patient with a CSI _ 1.5 is indicated.

Underdiagnosed and undertreated: obesity in the portuguese population.

Comment on: Post RE, Mainous AG 3rd, Gregorie SH, Knoll ME, Diaz VA, Saxena SK. The influence of physician acknowledgment of patients' weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med. 2011 Feb 28;171(4):316-21. PMID: 21357807.

eComment: Everyday clinical practice consequences?

Comment on : "Type A aortic dissection involving the carotid arteries: carotid stenting during open aortic arch surgery by Salvatore Lentini, Fabrizio Tancredi, Filippo Benedetto, and Roberto Gaeta in Interactive CardioVascular and Thoracic Surgery 2009 8: 157-159

Validation of two echocardiographic indexes to improve the diagnosis of complex coarctations.

OBJECTIVES: Coarctation of the aorta is one of the most common congenital heart defects. Its diagnosis may be difficult in the presence of a patent ductus arteriosus, of other complex defects or of a poor echocardiographic window. We sought to demonstrate that the carotid-subclavian artery index (CSA index) and the isthmus-descending aorta ratio (I/D ratio), two recently described echocardiographic indexes, are effective in detection of isolated and complex aortic coarctations in children younger and older than 3 months of age. The CSA index is the ratio of the distal aortic arch diameter to the distance between the left carotid artery and the left subclavian artery. It is highly suggestive of a coarctation when it is <1.5. The I/D ratio defined as the diameter of the isthmus to the diameter of the descending aorta, suggests an aortic coarctation when it is less than 0.64. METHODS: This is a retrospective cohort study in a tertiary care children's hospital. Review of all echocardiograms in children aged 0-18 years with a diagnosis of coarctation seen at the author's institution between 1996 and 2006. An age- and sex-matched control group without coarctation was constituted. Offline echocardiographic measurements of the aortic arch were performed in order to calculate the CSA index and I/D ratio. RESULTS: Sixty-eight patients were included in the coarctation group, 24 in the control group. Patients with coarctation had a significantly lower CSA index (0.84+/-0.39 vs 2.65+/-0.82, p<0.0001) and I/D ratio (0.58+/-0.18 vs 0.98+/-0.19, p<0.0001) than patients in the control group. Associated cardiac defects and age of the child did not significantly alter the CSA index or the I/D ratio. CONCLUSIONS: A CSA index less than 1.5 is highly suggestive of coarctation independent of age and of the presence of other cardiac defects. I/D ratio alone is less specific than CSA alone at any age and for any associated cardiac lesion. The association of both indexes improves sensitivity and permits diagnosis of coarctation in all patients based solely on a bedside echocardiographic measurement.

Avulsion fracture of peroneus longus tendon at the first metatarsal insertion: a case report : P16

Introduction: Isolated avulsion fracture at the plantar lateral base of the first metatarsal (M1) is very rare. Case report: A 35 year old overweight woman sustained an eversion strain of her right foot. Despite pain along M1 she was able to continue walking for three days before presenting to her family doctor. Swelling on the plantar aspect of the foot was noticed, there was also pain at eversion of the foot and extension of the ankle. Plain X-ray showed no abnormalities. A MRI showed minimal bone bruise at the basis of M1 and a partial rupture of the peroneus longus tendon at its insertion. The patient was allowed to walk with partial weight bearing with a soft ankle brace. After 6 months she presented at our hospital because of persistent pain. There was still a painful insertion of the peroneus longus but active plantarflexion of M1 was possible. Plain X-rays were poorly contributive except for a discrete flattening of the longitunal arch. CT-scan showed a non displaced fracture at the M1-basis. A protocol with partial weight-bearing in a short-leg cast and partial weight-bearing orthosis each for 6 weeks was unsuccessfully attempted. Therefore, an excision of the non healed bone fragment at the basis of M1 and a first tarsometatarsal joint arthrodesis were performed. Postoperatively the patient wore a partial weight-bearing short leg cast for 6 weeks followed by a weight-bearing short leg cast for 6 weeks with favourable outcome. Discussion: Initial internal fixation has been reported to lead to good results [1, 2]. In our case the conservative treatment failed and leaded to non union. At that time we considered as too risky (overweight) to excise the fragment and reattach the peroneus longus tendon. Therefore, we excised the fragment and fused the first tarsometatarsal joint. This procedure allowed, at least partially, to compensate for the function of the peroneus longus tendon. 1 Murakami T, et al. Avulsion fracture of the peroneus longus at the first metatarsal insertion: a case report. Br J Sports Med. 2004. 2 Kwak HY, and Bae SW. Isolated avulsion fracture at the plantar lateral base of the first metatarsal: a case report. Foot Ankle Int 2000.

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

Evaluation et validation des équations de prédiction du risque de diabète dans la population lausannoise : étude CoLaus

Le diabète de type 2 est une maladie fréquente et en augmentation dans le monde entier. Malheureusement, elle est souvent diagnostiquée à un stade ou des complications sont déjà apparues. Depuis quelques années, des scores ont été développés pour identifier les sujets à risque de développer cette maladie. L'utilisation d'un tel score par le praticien pourrait amener ces patients à des mesures préventives, telles que le changement d'hygiène de vie, ou la prescription d'un traitement médicamenteux. Le but de notre étude est de comparer et de valider différents scores de risques de diabète de type 2 et de déterminer leur capacité à prédire la survenue de cette maladie dans la population de la cohorte CoLaus. Les premiers résultats, en étude transversale, ont tout d'abord montré de grandes différences quant à la population à risque d'un score à l'autre. En effet, le nombre de personnes à traiter varie considérablement selon la méthode utilisée. Ces différents scores ont donc nécessité une validation prospective. Ces résultats ont fait l'objet d'une publication (Schmid et col, Diabetes Care. 2011 Aug;34(8):1863-8). Au moyen des données du suivi à 5 ans, il est sorti qu'un score de risque utilisant des variables biologiques et cliniques, ainsi qu'un score utilisant des variables uniquement cliniques, obtenaient de très bon résultats quant à la prédiction du diabète de type 2. En effet, un des scores testés donne une valeur prédictive positive d'environ 20% à 5 ans, ce qui signifie qu'un patient « détecté » sur 5 pourrait bénéficier d'une intervention précoce. Toutefois, ces résultats concernent la population lausannoise et ne sont donc pas forcément applicables à l'ensemble de la population suisse. De plus, de plus amples études sont nécessaires évaluer l'efficacité d'un tel score dans la prévention du diabète en Suisse. Ces résultats ont fait l'objet d'une seconde publication (Schmid et col, Arch Intern Med. 2012 Jan 23;172(2):188-9). Dans un troisième volet de l'étude, l'impact de marqueurs génétiques a été évalué dans un sous- groupe de la population CoLaus. Les résultats n'ont toutefois montré qu'une très faible amélioration de la prédiction du risque en utilisant ces marqueurs. Ceci devrait nous encourager à intensifier les efforts de prévention sur le style de vie pour toute la population, plutôt qu'une approche ciblée sur les personnes génétiquement prédisposées. Ces résultats ont fait l'objet d'une troisième publication (Schmid et col, J Clin Endocrinol Metab. 2012 Apr 24. [Epub ahead of print]). La même démarche méthodologique a été utilisée pour évaluer l'importance pronostique de plusieurs marqueurs inflammatoires (interleukines 1 et 6, Τ Ν F-, protéine C-réactive) hépatiques (GT) ou adipocytaires (leptine et adiponectine) dans la survenue du diabète. Ces résultats sont actuellement soumis au Journal of Clinical Endocrinology and Metabolism).

Electronic Construction Collaboration System – Final Phase, SPR RB02-008, 2014

This phase of the research project involved two major efforts: (1) Complete the implementation of AEC-Sync (formerly known as Attolist) on the Iowa Falls Arch Bridge project and (2) develop a web-based project management system (WPMS) for projects under $10 million. For the first major effort, AEC-Sync was provided for the Iowa Department of Transportation (DOT) in a software as a service agreement, allowing the Iowa DOT to rapidly implement the solution with modest effort. During the 2010 fiscal year, the research team was able to help with the implementation process for the solution. The research team also collected feedback from the Broadway Viaduct project team members before the start of the project and implementation of the solution. For the 2011 fiscal year, the research team collected the post-project surveys from the Broadway Viaduct project members and compared them to the pre-project survey results. The result of the AEC-Sync implementation in the Broadway Viaduct project was a positive one. The project members were satisfied with the performance of AEC-Sync and how it facilitated document management and transparency. In addition, the research team distributed, collected, and analyzed the pre-project surveys for the Iowa Falls Arch Bridge project. During the 2012 fiscal year, the research team analyzed the post-project surveys for the Iowa Falls Arch Bridge project AEC-Sync implementation and found a positive outcome when compared to the pre-project surveys. The second major effort for this project involved the identification and implementation of a WPMS solution for smaller bridge and highway projects. During the 2011 fiscal year, Microsoft SharePoint was selected to be implemented on these smaller highway projects. In this year, workflows for the shop/working drawings for the smaller highway projects specified in Section 1105 of the Iowa DOT Specifications were developed. These workflows will serve as the guide for the development of the SharePoint pages. In order to implement the Microsoft SharePoint pages, the effort of an integrated team proved to be vital because it brought together the expertise required from researchers, programmers, and webpage developers to develop the SharePoint pages.

En torno al “entablamento arcuado” y al “frontón sirio” en la arquitectura construida y la iconografía arquitectónica romana

This work is conceived to provide a general approach to the study of the different structures of Roman architecture - and of its representations – that combine the arched system with the architrave and that are traditionally grouped under terms like “arcuated trabeation” and “Syrian pediment” or other similar (“Syrian arch”, “arcuated lintel”, “arcuated architrave”, “arcuated gable”, “arcuated pediment”). This paper will address all-round issues of form and terminology, of origin and spread (with particular attention to the problem presented by the site of Sî῾ Syria), of use in constructions and iconography and of possible symbolic value. The study focuses on key concepts and basic bibliography as well as on some technical, functional and symbolic aspects able to broaden what has been outlined so far.

Entre rabbis et brahmanes : exercices de comparaison

(Résumé de l'ouvrage) L'histoire des religions autant dans ses procédés que dans ses concepts est fondée sur la comparaison. Tels le mythe, le sacrifice, l'initiation ou la purification, ces concepts comparatifs ont fini par être neutralisés dans une ontologie à prétention universelle. Des religions on en est revenu à la religion, pour le plus grand profit des théologiens chrétiens, protestants et catholiques, qui y ont trouvé une nouvelle légitimité académique. Raison supplémentaire pour revenir sur les démarches comparatives et pour en critiquer les effets totalisants : la comparaison s'impose comme méthode à condition d'être contrastive et différentielle. Elle induit un regard relativisant et décentré ; ce regard oblique d'une part rend justice aux spécificités des manifestations et pratiques religieuses décrites dans leur diversité ; d'autre part il est la condition même, en sciences humaines en général, d'une position critique, antidote indispensable aux replis disciplinaires et institutionnels de nos contemporains. Les contributions réunies ici à la suite d'une journée d'échange passée à comparer les démarches comparatives en histoire des religions entraînent lectrices et lecteurs des rites du polythéisme grec aux pratiques contemporaines du yoga, en passant par différentes prétentions universalisantes du monothéisme chrétien, par les pratiques de l'hospitalité en régime rabbinique et en hindouisme brahmanique, mais aussi par la question du salut individuel en philosophie néoplatonicien, ne ou en théologie augustinienne, par les gestes de la prière dans les religions amérindiennes et dans la mystique chrétienne ou par les prophétismes chrétien et musulman ; ceci par le biais de méthodes comparatives se fondant sur une démarche historique, structurale, discursive ou cognitive.

Ancient dispersal of the human fungal pathogen Cryptococcus gattii from the Amazon rainforest

Over the past two decades, several fungal outbreaks have occurred, including the high-profile 'Vancouver Island' and 'Pacific Northwest' outbreaks, caused by Cryptococcus gattii, which has affected hundreds of otherwise healthy humans and animals. Over the same time period, C. gattii was the cause of several additional case clusters at localities outside of the tropical and subtropical climate zones where the species normally occurs. In every case, the causative agent belongs to a previously rare genotype of C. gattii called AFLP6/VGII, but the origin of the outbreak clades remains enigmatic. Here we used phylogenetic and recombination analyses, based on AFLP and multiple MLST datasets, and coalescence gene genealogy to demonstrate that these outbreaks have arisen from a highly-recombining C. gattii population in the native rainforest of Northern Brazil. Thus the modern virulent C. gattii AFLP6/VGII outbreak lineages derived from mating events in South America and then dispersed to temperate regions where they cause serious infections in humans and animals.

Genetic diversity between improved banana diploids using canonical variables and the Ward-MLM method

The objective of this work was to estimate the genetic diversity of improved banana diploids using data from quantitative analysis and from simple sequence repeats (SSR) marker, simultaneously. The experiment was carried out with 33 diploids, in an augmented block design with 30 regular treatments and three common ones. Eighteen agronomic characteristics and 20 SSR primers were used. The agronomic characteristics and the SSR were analyzed simultaneously by the Ward-MLM, cluster, and IML procedures. The Ward clustering method considered the combined matrix obtained by the Gower algorithm. The Ward-MLM procedure identified three ideal groups (G1, G2, and G3) based on pseudo-F and pseudo-t² statistics. The dendrogram showed relative similarity between the G1 genotypes, justified by genealogy. In G2, 'Calcutta 4' appears in 62% of the genealogies. Similar behavior was observed in G3, in which the 028003-01 diploid is the male parent of the 086079-10 and 042079-06 genotypes. The method with canonical variables had greater discriminatory power than Ward-MLM. Although reduced, the genetic variability available is sufficient to be used in the development of new hybrids.

Initial experience with hybrid surgery in congenital heart disease in a single center : P171

Introduction: A hybrid intervention is a joint procedure involving the interventional cardiologist and the cardiac surgeon. At our institution we have opted for this type of approach in congenital heart disease since 2005. We report here our initial experience. Cases: 1. A 3 year old boy with double aortic arch and multiple muscular ventricular septal defects (VSD),was readdressed for pulmonary band (PAB) removal and residual VSD closure after previous palliation. After surgical removal of the PAB, the surgeon provided a minimal transventricular access for placement of a 6mm Amplatzer® muscular VSD occluder by the cardiologist under transoesophageal guidance. The patient was extubated the same day and discharged after 5 days. 2. An 8 year old girl with Williams syndrome was followed for two large VSDs and severe peripheral pulmonary arteries (PA) stenosis. The membranous VSD was closed surgically, the muscular VSD during the same operation by direct placement of a 12 mm Amplatzer® muscular VSD occluder. During rewarming, balloon angioplasty of peripheral PA stenosis was achieved under fluoroscopy. Patient was extubated the following day and discharged after 8 days. 3. A 9 year old boy post tetralogy of Fallot repair had severe distal stenosis of the right ventricular to PA conduit.With patient on partial cardiopulmonary bypass, an incision was made on the conduit and a CP 8 Zig 16 stent placed on the stenosis. The child passed on full bypass and the definitive placement of the stent achieved. The child was extubated at the end of the intervention and discharged after 6 days. 4. A newborn presented at 2 days life with complex aortic arch anatomy: left aortic arch and right descending thoracic aorta perfused directly from a right arterial duct and left PA atresia. The arterial duct was stented with a Genesis XD stent dilated at 7mm. Two days later the cardiac surgeon made banded the right PA. The child was extubated after the operation and discharged a week later. Conclusion: Hybrid approach opens new ways of correction or palliation in congenital heart disease with encouraging results and less morbidity.