Congenital high airway obstruction syndrome and airway reconstruction: an evolving paradigm.

OBJECTIVES: To refine the classic definition of, and provide a working definition for, congenital high airway obstruction syndrome (CHAOS) and to discuss the various aspects of long-term airway reconstruction, including the range of laryngeal anomalies and the various techniques for reconstruction. DESIGN: Retrospective chart review. PATIENTS: Four children (age range, 2-8 years) with CHAOS who presented to a single tertiary care children's hospital for pediatric airway reconstruction between 1995 and 2000. CONCLUSIONS: To date, CHAOS remains poorly described in the otolaryngologic literature. We propose the following working definition for pediatric cases of CHAOS: any neonate who needs a surgical airway within 1 hour of birth owing to high upper airway (ie, glottic, subglottic, or upper tracheal) obstruction and who cannot be tracheally intubated other than through a persistent tracheoesophageal fistula. Therefore, CHAOS has 3 possible presentations: (1) complete laryngeal atresia without an esophageal fistula, (2) complete laryngeal atresia with a tracheoesophageal fistula, and (3) near-complete high upper airway obstruction. Management of the airway, particularly in regard to long-term reconstruction, in children with CHAOS is complex and challenging.

Influência da espessura de biofilmes feitos à base de proteínas miofibrilares sobre suas propriedades funcionais

O emprego potencial de filmes comestíveis e biodegradáveis em embalagens é condicionado pelas suas propriedades funcionais, que são influenciadas por muitos fatores, inclusive pela espessura. O objetivo deste trabalho foi estudar a influência da espessura dos biofilmes feitos à base de proteínas miofibrilares (de carne bovina e de tilápia-do-nilo) sobre suas propriedades funcionais. Os biofilmes foram preparados a partir de uma solução filmogênica com 1 g de proteínas/100 g de solução. A concentração de plastificante foi de 45 g de glicerina/100 g de proteínas, e o pH foi mantido em 2,7. Após secagem, os filmes foram acondicionados em dessecadores a 58% de umidade relativa e 22°C, por quatro dias. As propriedades mecânicas foram determinadas por teste de perfuração; a permeabilidade ao vapor de água, por um método gravimétrico, e a cor e a opacidade, com colorímetro HunterLab, a 22°C. A força na perfuração, a permeabilidade ao vapor de água, a diferença de cor e a opacidade dos dois biofilmes aumentaram linearmente com a espessura dos corpos-de-prova. A deformação na perfuração foi pouco dependente da espessura e apresentou grande dispersão, em ambos os filmes. A taxa de permeabilidade ao vapor de água diminuiu linearmente com a espessura.

Seleção de genótipos parentais de acerola com base na divergência genética multivariada

Este trabalho teve por objetivo identificar e selecionar genótipos parentais de acerola (Malpighia emarginata L.) adequadas a programas de melhoramento genético. Nove caracteres quantitativos de maior importância agronômica foram usados para determinação da distância genética e formação de grupos similares de acessos. O agrupamento pelo método de Tocher, a partir das distâncias generalizadas de Mahalanobis, possibilitou a divisão de 14 genótipos em três grupos. Com base na divergência genética e no caráter agronômico-chave (teor de vitamina C), destacaram-se como mais promissores os cruzamentos dos genótipos: AM Mole pertencente ao grupo III, com os genótipos PR AM, N° 18, PR 17, PR 16, Eclipse, AM 22 e Dominga, todos pertencentes ao grupo I.

Efficient total variation algorithm for fetal brain MRI reconstruction.

Fetal MRI reconstruction aims at finding a high-resolution image given a small set of low-resolution images. It is usually modeled as an inverse problem where the regularization term plays a central role in the reconstruction quality. Literature has considered several regularization terms s.a. Dirichlet/Laplacian energy, Total Variation (TV)- based energies and more recently non-local means. Although TV energies are quite attractive because of their ability in edge preservation, standard explicit steepest gradient techniques have been applied to optimize fetal-based TV energies. The main contribution of this work lies in the introduction of a well-posed TV algorithm from the point of view of convex optimization. Specifically, our proposed TV optimization algorithm or fetal reconstruction is optimal w.r.t. the asymptotic and iterative convergence speeds O(1/n2) and O(1/√ε), while existing techniques are in O(1/n2) and O(1/√ε). We apply our algorithm to (1) clinical newborn data, considered as ground truth, and (2) clinical fetal acquisitions. Our algorithm compares favorably with the literature in terms of speed and accuracy.

Experimental Macadam Stone Base Des Moines County, HR-175, Construction Report, 1977

In today's era of advanced methods, it is interesting that a centuries-old Roman road-building concept can be the most attractive alternative available. The need for a less expensive road base construction method is very apparent, especially to the county engineer faced with maintaining quality lower traffic volume farm-to-market roads. The revival of the Macadam stone base is one possible solution. Des Moines County believed a Macadam road had excellent possibilities for their particular needs. They proposed a research project designed to eliminate some of the unknown factors of Macadam stone base construction. It is the intent of this research project to develop standardized design procedures and serve as an aid for others in constructing a Macadam base roadway. The Iowa Department of Transportation has published special provisions for the construction of Macadam stone bases that were adopted as the guideline specifications for the research project.

Macadam Base Shoulders, HR-181, 1977

Highway safety and pavement performance can be directly influenced by the type of shoulders that are constructed. Shoulder design alternatives have always been rather limited. Moreover, the use of some of the alternatives has always been restricted by funding limitations. This research project seeks to explore the use of modified macadam base construction for shoulders. This type of shoulder design could offer the designer another option when paved or stabilized shoulders are being considered. Macadam base construction has in the past been shown to be quite strong and freedraining. Two macadam base shoulder designs were developed and constructed for this research project. A new roadway embankment and P.C.C. pavement were constructed on a section of US 6 east of Adel in Dallas County. The macadam base shoulders were constructed adjacent to the pavement as part of the project. The north shoulder was finished with a choke stone course and bituminous surface treatment and the south shoulder was finished with a two (2) inch layer of Type B Class II asphalt concrete. The initial results are considered satisfactory. Follow-up performance evaluation and load bearing tests are planned.

Una nova eina per a l’estudi del paper i les filigranes. Anàlisi i desenvolupament d’una base de dades per a l’estudi del paper i de les filigranes: font per a l’elaboració de la història del paper a Espanya

L’aspiració de trobar una eina que pugui ajudar a identifi car els papers atenent les sevescaracterístiques sorgeix a fi nal segle XVIII amb les primeres descripcions de les filigranespapereres i va prenent cos al segle XIX com a ciència auxiliar de la codicologia.Des de les últimes dècades del segle XX, les filigranes han anat adquirint un interès creixententre els restauradors de document gràfi c —com una eina més per a la presa de decisions i pera la valoració del procés de restauració— i entre els documentalistes, historiadors, museòlegsi bibliòfils —per a la datació i autenticació de les obres— i, fins i tot, en investigacionspolicials i jurídiques per aclarir algun fet delictiu. No obstant això, durant aquests 150 anys, l’estudi del paper a través de les filigranes papereres a Espanya no ha experimentat cap avenç significatiu pel que fa als mètodes i procediments seguits per a l’obtenció i gestió deles dades. En l’àmbit europeu, encara que a partir dels anys 90 sorgeixen noves propostesd’estudi, aquestes limiten la investigació a l’anàlisi de la filigrana sense assolir una visió global del plec sortit de la forma.

Biologically enhanced ACL reconstruction.

Biological integration of the tendon graft is a crucial prerequisite for successful ACL reconstruction. Histological studies showed that the human ACL remnants contain a cellular capacity for healing potential. The goal of this technical note is to describe an ACL reconstruction technique, using ACL remnants as a biological sleeve for the graft. In case of complete ACL rupture with a large remnant, the tibial tunnel was performed inside and through the ACL tibial stump by careful sequential drilling. Femoral tunnel placement was performed by an outside-in technique. The hamstring graft was kept attached to the tibia and routed through the ACL remnant to the femur. The aim of this technique is the preservation of the biological and mechanical properties of the ACL remnant. In order to preserve large remnants resulting in greater graft coverage, the best period to perform this reconstruction is during the first weeks after the injury.

Alternatives for Rural Roads, HR-242, 1989

Much of the nation's rural road system is deteriorating. Many of the roads were built in the 1880s and 1890s with the most recent upgrading done in the 1940s and 1950s. Consequently, many roads and bridges do not have the capacity for the increased loads, speed, and frequent use of today's vehicles. Because of the growing demands and a dense county road system (inherited from the land settlement policies two centuries ago), revenue available to counties is inadequate to upgrade andmaintain the present system. Either revenue must be increased - an unpopular option - or costs must be reduced. To examine cost-saving options, Iowa State University conducted a study of roads and bridges in three 100 square mile areas in Iowa: • A suburban area • A rural area with a large number of paved roads, few bridges, and a high agricultural tax base and •A more rural area in a hilly terrain with many bridges and gravel roads, and a low agricultural tax base. A cost-benefit analysis was made on the present road system in these areas on such options as abandoning roads with limited use, converting some to private drives, and reducing maintenance on these types of roads. In only a few instances does abandonment of low traffic volume roads produce cost savings for counties and abutting land owners that exceed the additional travel costs to the public. In this study, the types of roads that produced net savings when abandoned were: • A small percentage (less than 5 percent) of the nonpaved county roads in the suburban area. However, net savings were very small. Cost savings from reducing the county road system in urbanized areas are very limited. • Slightly more than 5 percent of the nonpaved county roads in the most rural area that had a small number of paved county roads. • More than 12 percent of the nonpaved roads in the rural area that had a relatively large number of paved county and state roads. Converting low-volume roads to low-maintenance or Service B roads produces the largest savings of all solutions considered. However, future bridge deterioration and county liability on Service B roads are potential problems. Converting low-volume roads to private drives also produces large net savings. Abandonment of deadend roads results in greater net savings than continuous roads. However, this strategy shifts part of the public maintenance burden to land owners. Land owners also then become responsible for accident liability. Reconstruction to bring selected bridges with weight restrictions up to legal load limits reduces large truck and tractor-wagon mileage and costs. However, the reconstruction costs exceeded the reduction in travel costs. Major sources of vehicle miles on county roads are automobiles used for household purposes and pickup truck travel for farm purposes. Farm-related travel represents a relatively small percent of total travel miles, but a relatively high percentage of total travel costs.

Iterative statistical reconstruction method: A new way to reduce dose in pediatric cardiac CT

Purpose: Although several approaches have been already used to reduce radiation dose, CT doses are still among the high doses in radio-diagnostic. Recently, General Electric introduced a new imaging reconstruction technique, adaptive statistical iterative reconstruction (ASIR), allows to taking into account the statistical fluctuation of noise. The benefits of ASIR method were assessed through classic metrics and the evaluations of cardiac structures by radiologists. Methods and materials: A 64-row CT (MDCT) was employed. Catphan600 phantom acquisitions and 10 routine-dose CT examinations performed at 80 kVp were reconstructed with FBP and with 50% of ASIR. Six radiologists then assessed the visibility of main cardiac structures using the visual grading analysis (VGA) method. Results: On phantoms, for a constant value of SD (25 HU), CTDIvol is divided by 2 (8 mGy to 4 mGy) when 50% of ASIR is used. At constant CTDIvol, MTF medium frequencies were also significantly improved. First results indicated that clinical images reconstructed with ASIR had a better overall image quality compared with conventional reconstruction. This means that at constant image quality the radiation dose can be strongly reduced. Conclusion: The first results of this study shown that the ASIR method improves the image quality on phantoms by decreasing noise and improving resolution with respect to the classical one. Moreover, the benefit obtained is higher at lower doses. In clinical environment, a dose reduction can still be expected on 80 kVp low dose pediatric protocols using 50% of iterative reconstruction. Best ASIR percentage as a function of cardiac structures and detailed protocols will be presented for cardiac examinations.

Accuracy and predictability in use of AO three-dimensionally preformed titanium mesh plates for posttraumatic orbital reconstruction: a pilot study.

The aim of this study was to prospectively evaluate the accuracy and predictability of new three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction.We analyzed the preoperative and postoperative clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. Fracture locations were as follows: floor (N = 7; 70%), medial wall (N = 1; 1%), and floor/medial wall (N = 2; 2%). The floor fractures were exposed by a standard transconjunctival approach, whereas a combined transcaruncular transconjunctival approach was used in patients with medial wall fractures. A three-dimensional preformed AO titanium mesh plate (0.4 mm in thickness) was selected according to the size of the defect previously measured on the preoperative computed tomographic (CT) scan examination and fixed at the inferior orbital rim with 1 or 2 screws. The accuracy of plate positioning of the reconstructed orbit was assessed on the postoperative CT scan. Coronal CT scan slices were used to measure bony orbital volume using OsiriX Medical Image software. Reconstructed versus uninjured orbital volume were statistically correlated.Nine patients (90%) had a successful treatment outcome without complications. One patient (10%) developed a mechanical limitation of upward gaze with a resulting handicapping diplopia requiring hardware removal. Postoperative orbital CT scan showed an anatomic three-dimensional placement of the orbital mesh plates in all of the patients. Volume data of the reconstructed orbit fitted that of the contralateral uninjured orbit with accuracy to within 2.5 cm(3). There was no significant difference in volume between the reconstructed and uninjured orbits.This preliminary study has demonstrated that three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction results in (1) a high rate of success with an acceptable rate of major clinical complications (10%) and (2) an anatomic restoration of the bony orbital contour and volume that closely approximates that of the contralateral uninjured orbit.

Thin Asphalt Concrete Pavement on Crushed Rock Base - Cass County, Construction Report, HR-2075, 1997

The road paving cost continues to increase and the backlog of projects waiting for funding is growing. Finding a more cost-effective way to use the available money to pave roads will result in more miles of road being paved with the same amount of money. This project is in Cass County on G35 between US 71 and Norway-Center. It consists of a thin layer of asphalt over a base designed to achieve stability while having some permeability. This project was paved in 1996. An asphalt cement concrete pavement was chosen for the project based on cost, convenience, and historic portland cement concrete problems in Cass County. The new pavement gives quicker access time to farms and residences.

La articulación de ámbitos sociales a partir de la base temporal

Uno de los objetivos de la investigación ha consistido, en un primer nivel de análisis, en conseguir una tipología general de la forma de vinculación entre los ámbitos de TP (trabajo productivo), TR (trabajo reproductivo) y TL (disponibilidad de tiempo libre) a partir de datos e indicaciones cuantitativas. Después de diversos ensayos, los resultados y el procedimiento más simple y eficaz se han conseguido a partir de dimensiones indicativas del empleo del tiempo para cada uno de los ámbitos. Por tanto, una vez construidas las tipologías de cada uno de los ámbitos, se toma el tiempo, en este artículo, como referente o sustrato para la constitución de modos de vida cotidiana. Los tipos de modos de vida cotidiana serán a su vez la base de la intervención por entrevistas en la segunda y tercera parte de la investigación. El artículo muestra cómo el tiempo, en tanto que instrumento y soporte para la construcción de los modos de vida, pasa a ser un descritor y clasificador de grupos sin necesidad de recurrir directamente a las variables categoriales: sexo, categorías sociales, edad, etc. Este artículo es parte de una investigación cuyos resultados aparecen en este mismo número de PAPERS. El artículo tiene autonomía y entidad por sí mismo pero la lectura del resto de los artículos de este número facilitará su contextualización.

Evaluation Study of Pit Run Gravel Asphalt Treated Base Mixtures with Various Percentages of Crushed Limestone, R-217, 1968

In November of 1966, an investigation of the rigid Class I asphalt treated base specification, requiring 70 per cent crushed limestone, was initiated. It was felt that it might be possible to modify the need for crushed particles, in the construction of basis on heavy duty roads, at a savings, by using more local materials, without sacrificing strength and/or durability. This is a short study on typical sources of pit run gravel, with various percentages of limestone. It is conducted with an eye open to the possibility that our specifications may be modified. The possibility that further investigation may be desirable is not ignored.

Evaluation of Cohesion and Swell Characteristics of Asphalt Treated Base Mixtures, R-223, 1968

This study was undertaken to evaluate the suitability of various stones which play an important role in the properties of compacted mixtures in asphalt treated bases. The determination of the effect of water temperature on the cohesion of the mixes is investigated. A number of stones were prepared for the test. Attention is paid to the particular source of stone with the corresponding test results. A preliminary study of the effect of lime when added to mixed aggregate was also conducted. The purpose of this study is to provide needed information on the cohesive characteristics of asphalt treated bases using a wide range of stones. This study is also to evaluate the suitability of the various stone sources.