Acute hypersensitivity pneumonitis in a paint quality controller : a case report

Introduction: Isocyanates are sensitizing chemicals used in various industries such as polyurethane foam production or paint-related purposes. Acting as haptens recognized by T-lymphocytes, they can cause allergic asthma and rarely hypersensitivity pneumonitis (HP). We aim to present a case report of acute HP due to hexamethylene diisocyanate (HDI) in a paint quality controller, a profession not generally considered at a high risk for work-related Isocyanates exposure. Case report: A 30-yr-old otherwise healthy female, light smoker working as a paint quality controller developed shortness of breath, malaise, sweating and chills at workplace six hours after handling a HDI-based hardener. Upon admission to emergency department, symptoms had progressed to severe respiratory failure. HR computer tomography (HRCT) showed bilateral ground-glass attenuation without pleural effusion. Rapid clinical and radiological improvement occurred under facial oxygen supply and systemic steroid therapy. Occupational medicine investigations revealed regular handling of HDI using latex gloves without respiratory protection. Assessment at workplace showed insufficient air renewal (1.5 times per hour), inadequate local aspiration and HDI exposure at levels of 1-4.25 ppb/m3 (Swiss Occupation Exposure Limit 5 ppb/m3). Biological monitoring after identical work procedure executed by a co-worker showed HDI exposure (5.1 micrograms hexamethylene diamine/g creatinine). Resumption of work was disadvised because of the life-threatening event. Discussion: The diagnosis of occupational HP is highly supported by classical findings on imagery and typical symptoms occurring within approved latency interval, associated with rapid clinical improvement. Although neither broncho-alveolar lavage nor specific IgG diagnosis (en route) were performed during the acute episode, various blood tests managed to rule out evidence of an infection or autoimmune disease. Other causes of HP seem unlikely as the patient did not have any recurrence of symptoms since absence from work. Workplace evaluation provided significant information on HDI exposure and allowed substantial recommendations to diminish Isocyanate exposure for the 20 still healthy laboratory co-workers. Although the entryways (air or skin) and precise mechanism of toxicity remain unclear, the present case clearly shows that Isocyanates may trigger acute HP in susceptible workers in a profession not generally considered at a high risk.

Predictive models of syncope causes in an outpatient clinic

The investigation of unexplained syncope remains a challenging clinical problem. In the present study we sought to evaluate the diagnostic value of a standardized work-up focusing on non invasive tests in patients with unexplained syncope referred to a syncope clinic, and whether certain combinations of clinical parameters are characteristic of rhythmic and reflex causes of syncope. METHODS AND RESULTS: 317 consecutive patients underwent a standardized work-up including a 12-lead ECG, physical examination, detailed history with screening for syncope-related symptoms using a structured questionnaire followed by carotid sinus massage (CSM), and head-up tilt test. Invasive testings including an electrophysiological study and implantation of a loop recorder were only performed in those with structural heart disease or traumatic syncope. Our work-up identified an etiology in 81% of the patients. Importantly, three quarters of the causes were established non invasively combining head-up tilt test, CSM and hyperventilation testing. Invasive tests yielded an additional 7% of diagnoses. Logistic analysis identified age and number of significant prodromes as the only predictive factors of rhythmic syncope. The same two factors, in addition to the duration of the ECG P-wave, were also predictive of vasovagal and psychogenic syncope. These factors, optimally combined in predictive models, showed a high negative and a modest positive predictive value. CONCLUSION: A standardized work-up focusing on non invasive tests allows to establish more than three quarters of syncope causes. Predictive models based on simple clinical parameters may help to distinguish between rhythmic and other causes of syncope

Global regulation of the knowledge-based economy: The rise of standards in educational services

This article examines the extent and limits of non-state forms of authority in international relations. It analyses how the information and communication technology (ICT) infrastructure for the tradability of services in a global knowledge-based economy relies on informal regulatory practices for adjustment of ICT-related skills. Companies and associations provide training and certification programmes as part of a growing market for educational services setting their own standards. The existing literature on non-conventional forms of authority in the global political economy has emphasised that the consent of actors subject to informal rules and explicit or implicit state recognition remains crucial for the effectiveness of those new forms of power. However, analyses based on a limited sample of actors tend toward a narrow understanding of the issues and fail to fully explore the differentiated space in which non-state authority is emerging. This paper examines the form of authority underpinning the global knowledge-based economy within the broader perspective of the issues likely to be standardised by technical ICT specification, the wide range of actors involved, and the highly differentiated space where standards become authoritative. The empirical findings highlight the role of different private actors in establishing international educational norms in this field. They also pinpoint the limits of profit-oriented standard-settings, notably with regard to generic norms.

Using 3D surface datasets to understand landslide evolution: From analogue models to real case study

Early detection of landslide surface deformation with 3D remote sensing techniques, as TLS, has become a great challenge during last decade. To improve our understanding of landslide deformation, a series of analogue simulation have been carried out on non-rigid bodies coupled with 3D digitizer. All these experiments have been carried out under controlled conditions, as water level and slope angle inclination. We were able to follow 3D surface deformation suffered by complex landslide bodies from precursory deformation still larger failures. These experiments were the basis for the development of a new algorithm for the quantification of surface deformation using automatic tracking method on discrete points of the slope surface. To validate the algorithm, comparisons were made between manually obtained results and algorithm surface displacement results. Outputs will help in understanding 3D deformation during pre-failure stages and failure mechanisms, which are fundamental aspects for future implementation of 3D remote sensing techniques in early warning systems.

Developmental and reproductive patterns of Triatoma brasiliensis infected with Trypanosoma cruzi under laboratory conditions

The aim of this work was to study the interaction between Trypanosoma cruzi-1 and Triatoma brasiliensis. A group of 1st instar nymphs was initially fed on T. cruzi-infected mice and a control group was fed on uninfected mice. From the second feeding onwards, both groups were otherwise fed on non-infected mice. The resulting adults were grouped in pairs: infected male/uninfected female, uninfected male/infected female, infected male and female and uninfected male/uninfected female. The infection affected only the 1st instar nymphs, which took significantly more time to reach the 2nd instar than uninfected nymphs. The differences in the molting time between the infected and uninfected nymphs from the 2nd to the 5th instars were not statistically significant. Both groups presented similar rates of nymphal mortality and reproductive performance was not significantly affected by infection in any of the treatments.

Methods and representativeness of European surveys in children and adolescents: the KIDSCREEN study

Background: The objective of the present study was to compare three different sampling and questionnaire administration methods used in the international KIDSCREEN study in terms of participation, response rates, and external validity. Methods: Children and adolescents aged 8–18 years were surveyed in 13 European countries using either telephone sampling and mail administration, random sampling of school listings followed by classroom or mail administration, or multistage random sampling of communities and households with self-administration of the survey materials at home. Cooperation, completion, and response rates were compared across countries and survey methods. Data on non-respondents was collected in 8 countries. The population fraction (PF, respondents in each sex-age, or educational level category, divided by the population in the same category from Eurostat census data) and population fraction ratio (PFR, ratio of PF) and their corresponding 95% confidence intervals were used to analyze differences by country between the KIDSCREEN samples and a reference Eurostat population. Results: Response rates by country ranged from 18.9% to 91.2%. Response rates were highest in the school-based surveys (69.0%–91.2%). Sample proportions by age and gender were similar to the reference Eurostat population in most countries, although boys and adolescents were slightly underrepresented (PFR <1). Parents in lower educational categories were less likely to participate (PFR <1 in 5 countries). Parents in higher educational categories were overrepresented when the school and household sampling strategies were used (PFR = 1.78–2.97). Conclusion: School-based sampling achieved the highest overall response rates but also produced slightly more biased samples than the other methods. The results suggest that the samples were sufficiently representative to provide reference population values for the KIDSCREEN instrument.

Multilateral Trade and Agricultural Policy Reforms in Sugar Markets, September 2005

We analyze the impact of trade liberalization, removal of production subsidies, and elimination of consumption distortions in world sugar markets using a partial-equilibrium international sugar model calibrated on 2002 market data and current policies. The removal of trade distortions alone induces a 27% price increase while the removal of all trade and production distortions induces a 48% increase by 2011/12 relative to the baseline. Aggregate trade expands moderately, but location of production and trade patterns change substantially. Protectionist OECD countries (the EU, Japan, the US) experience an import expansion or export reduction and significant contraction in production in unfettered markets. Competitive producers in both OECD countries (Australia) and non-OECD countries (Brazil, Cuba), and even some protected producers (Indonesia, Turkey), expand production when all distortions are removed. Consumption distortions have marginal impacts on world markets and location of production. We discuss the significance of these results in the context of mounting pressures to increase market access in highly protected OECD countries and the impact on non-OECD countries.

Generalized low-density codes with BCH constituents for full-diversity near-outage performance

A new graph-based construction of generalized low density codes (GLD-Tanner) with binary BCH constituents is described. The proposed family of GLD codes is optimal on block erasure channels and quasi-optimal on block fading channels. Optimality is considered in the outage probability sense. Aclassical GLD code for ergodic channels (e.g., the AWGN channel,the i.i.d. Rayleigh fading channel, and the i.i.d. binary erasure channel) is built by connecting bitnodes and subcode nodes via a unique random edge permutation. In the proposed construction of full-diversity GLD codes (referred to as root GLD), bitnodes are divided into 4 classes, subcodes are divided into 2 classes, and finally both sides of the Tanner graph are linked via 4 random edge permutations. The study focuses on non-ergodic channels with two states and can be easily extended to channels with 3 states or more.

Asymmetries in the opportunity structure. Intergenerational mobility trends in Europe

It remains unclear whether social mobility is increasing in the advancednations. The answer may depend on mobility patterns within very recentbirth cohorts. We use the inter-generational module in the 2005 EUSILCwhich allows us to include more recent cohorts. Comparingacross two Nordic and three Continental European countries, weestimate inter-generational mobility trends for sons both indirectly, viasocial origin effects on educational attainment, and directly in terms ofadult income attainment. In line with other studies we find substantiallymore mobility in Scandinavia, but also that traditionally less mobilesocieties, like Spain, are moving towards greater equality. We focusparticularly on non-linear relations. Most interestingly, we revealevident asymmetries in the process of equalizing life chances, inDenmark. The disadvantages associated with low social class originshave largely disappeared, but the advantages related to privilegedorigins persist.

Measurements of three-dimensional glenoid erosion when planning the prosthetic replacement of osteoarthritic shoulders.

The three-dimensional (3D) correction of glenoid erosion is critical to the long-term success of total shoulder replacement (TSR). In order to characterise the 3D morphology of eroded glenoid surfaces, we looked for a set of morphological parameters useful for TSR planning. We defined a scapular coordinates system based on non-eroded bony landmarks. The maximum glenoid version was measured and specified in 3D by its orientation angle. Medialisation was considered relative to the spino-glenoid notch. We analysed regular CT scans of 19 normal (N) and 86 osteoarthritic (OA) scapulae. When the maximum version of OA shoulders was higher than 10°, the orientation was not only posterior, but extended in postero-superior (35%), postero-inferior (6%) and anterior sectors (4%). The medialisation of the glenoid was higher in OA than normal shoulders. The orientation angle of maximum version appeared as a critical parameter to specify the glenoid shape in 3D. It will be very useful in planning the best position for the glenoid in TSR.

Investigation of Maquoketa's Pit Bull Ban Ordinance and Enforcement, 2006

Case File 0603634 On September 13, 2006, Kelly Wilslef submitted a complaint to the Ombudsman about the Maquoketa City Council (Council). Ms. Wilslef stated a Maquoketa police officer served her an abatement notice for violating the city ordinance preventing owners from keeping pit bull terrier dogs in the city. The Council subsequently determined her dog was a pit bull mix, and ordered her to remove the dog from the city. Ms. Wilslef claimed the Council unreasonably relied on non-expert testimony supporting the city’s position her dog was a pit bull mix. She further claimed that if her dog was in fact a pit bull mix, the city ordinance did not apply to mixed-breed pit bulls; therefore, the Council acted contrary to law when it concluded she violated the city ordinance and ordered her to remove her dog from the city.

Financial protection of patients through compensation of providers: the impact of health equity funds in Cambodia

Public providers have no financial incentive to respect their legal obligation to exempt the poor from user fees. Health Equity Funds (HEFs) aim to make exemptions effective by giving NGOs responsibility for assessing eligibility and compensating providers for lost revenue. We use the geographic spread of HEFs in Cambodia to identify their impact on out-of-pocket (OOP) payments. Among households with some OOP payment, HEFs reduce the amount by 29%, on average. The effect is larger for households that are poorer, mainly use public health care and live closer to a district hospital. HEFs are more effective in reducing OOP payments when they are operated by a NGO, rather than the government, and when they operate in conjunction with the contracting of public health services. HEFs reduce households' health-related debt by around 25%, on average. There is no significant impact on non-medical consumption and health care utilisation

Perfusion and diffusion MRI of glioblastoma progression in a four-year prospective temozolomide clinical trial.

PURPOSE: This study was performed to determine the impact of perfusion and diffusion magnetic resonance imaging (MRI) sequences on patients during treatment of newly diagnosed glioblastoma. Special emphasis has been given to these imaging technologies as tools to potentially anticipate disease progression, as progression-free survival is frequently used as a surrogate endpoint. METHODS AND MATERIALS: Forty-one patients from a phase II temolozomide clinical trial were included. During follow-up, images were integrated 21 to 28 days after radiochemotherapy and every 2 months thereafter. Assessment of scans included measurement of size of lesion on T1 contrast-enhanced, T2, diffusion, and perfusion images, as well as mass effect. Classical criteria on tumor size variation and clinical parameters were used to set disease progression date. RESULTS: A total of 311 MRI examinations were reviewed. At disease progression (32 patients), a multivariate Cox regression determined 2 significant survival parameters: T1 largest diameter (p < 0.02) and T2 size variation (p < 0.05), whereas perfusion and diffusion were not significant. CONCLUSION: Perfusion and diffusion techniques cannot be used to anticipate tumor progression. Decision making at disease progression is critical, and classical T1 and T2 imaging remain the gold standard. Specifically, a T1 contrast enhancement over 3 cm in largest diameter together with an increased T2 hypersignal is a marker of inferior prognosis.

Improving rainwater-use in Cabo Verde drylands by reducing runoff

Dryland agriculture in Cabo Verde copes with steep slopes, inadequate practices, irregular intense rain, recurrent droughts, high runoff rates, severe soil erosion and declining fertility, leading to the inefficient use of rainwater. Maize and beans occupy N80% of the arable land in low-input, low-yielding subsistence farming. Three collaborative field trialswere conducted in different agroecological zones to evaluate the effects ofwater-conservation techniques (mulching of crop residue, a soil surfactant and pigeon-pea hedges) combinedwith organic amendments (compost and animal or green manure) on runoff and soil loss. During the 2011 and 2012 rainy seasons, three treatments and one control (traditional practice) were applied to 44- and 24-m2 field plots. A local maize variety and two types of beanswere planted. Runoff and suspended sedimentswere collected and quantified after each daily erosive rainfall. Runoff occurred for rainfalls≥50mm(slope b10%, loamy Kastanozem),≥60mm(slope≤23%, silt–clay–loam Regosol) and≥40mm(slope≤37%, sandy loam Cambisol). Runoffwas significantly reduced only with themulch treatment on the slope N10% and in the treatment of surfactant with organic amendment on the slope b10%. Soil loss reached 16.6, 5.1, 6.6 and 0.4 Mg ha−1 on the Regosol (≤23% slope) for the control, surfactant, pigeon-pea and mulch/pigeon-pea (with organic amendment) treatments, respectively; 3.2, 0.9, 1.3 and 0.1 Mg ha−1 on the Cambisol (≤37% slope) and b0. 2Mg ha−1 for all treatments and control on the Kastanozem(b10% slope). Erosion was highly positively correlated with runoff. Mulch with pigeon-pea combinedwith an organic amendment significantly reduced runoff and erosion fromagricultural fields on steep slopes, contributing to improved use of rainwater at the plot level. Sustainable land management techniques, such as mulching with pigeon-pea hedges and an organic amendment, should be advocated and promoted for the semiarid hillsides of Cabo Verde prone to erosion to increase rainwater-use and to prevent further soil degradation.

Caracterização Geológica e Geotécnica das Unidades Litológicas da Cidade da Praia (Santiago - Cabo Verde)

Este trabalho produz uma avaliação das características geológicas e geotécnicas de um território da ilha de Santiago, Cabo Verde, incidindo sobre a cidade da Praia e a área envolvente. Os objectivos principais do trabalho são a representação cartográfica das unidades litológicas, com uma proposta de coluna litológica sintética, a correlação com as unidades geológicas definidas por outros autores, bem como a realização de um conjunto de ensaios in situ e análises laboratoriais visando a caracterização dos parâmetros físicos e mecânicos das diferentes unidades litológicas definidas para a área em estudo. É efectuada uma compilação sobre as principais investigações geológicas realizadas em Cabo Verde, desde o séc. XIX até a actualidade, assim como a descrição das características geológicas da ilha de Santiago e dos principais processos de formação e evolução das formas de relevo e dos recursos naturais (hídricos e solos). A pesquisa incluiu uma revisão dos conceitos descritivos de caracterização dos vulcanitos e vulcanoclastitos presentes e compreendeu a redefinição das unidades litológicas da região, a respectiva representação cartográfica na escala 1: 10.000 (com maior detalhe do que a informação pré-existente) e o levantamento de campo dos principais alinhamentos estruturais. São igualmente apresentados os resultados do tratamento das bandas espectrais de imagens de satélite que suportam a definição das unidades litológicas, bem como dos principais alinhamentos tectónicos que afectam as unidades da área de estudo. Para a caracterização das diferentes unidades litológicas com base nas propriedades in situ, recorreu-se a perfis-tipo, estabelecendo uma descrição das características mineralógicas, petrográficas, texturais e estruturais das materiais presentes. Os materiais foram igualmente ensaiados in situ e amostrados para uma caracterização laboratorial. Os resultados dos ensaios geotécnicos, geomecânicos, mineralógicos e de radioactividade natural permitiram refinar a cartografia proposta e estabelecer parâmetros de comportamento para as 30 unidades litológicas consideradas, a partir de intervalos de valores não homogéneos, contudo representativos da variabilidade observada. Com base nestes resultados são apresentados valores indicativos de aptidão dos materiais, nomeadamente para fundações de edifícios, aterros, construção e potencial hidrogeológico.