The ADVANCE trial: clarifying the role of perindopril/indapamide fixed-dose combination in the reduction of cardiovascular and renal events in patients with diabetes mellitus.

Patients with type 2 diabetes mellitus exhibit a marked increase in cardiovascular and renal risk. A number of interventional trials have shown that these patients benefit greatly from aggressive BP lowering, especially when the drug regimen comprises an inhibitor of the renin-angiotensin system. The results of the placebo-controlled ADVANCE (Action in Diabetes and Vascular disease: PreterAx and DiamicroN MR Controlled Evaluation) trial, conducted in patients with type 2 diabetes, are exemplary in this respect. The systematic use of a fixed-dose combination containing the ACE inhibitor perindopril and the diuretic indapamide afforded substantial protection against cardiovascular mortality and myocardial infarction, while providing important renoprotection, reducing the development of micro- and macroalbuminuria, and allowing regression of nephropathy. The beneficial effects were obtained regardless of baseline BP and whether or not the patients were receiving antihypertensive therapy.

Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis.

BACKGROUND: For patients with acute iliofemoral deep vein thrombosis, it remains unclear whether the addition of intravascular high-frequency, low-power ultrasound energy facilitates the resolution of thrombosis during catheter-directed thrombolysis. METHODS AND RESULTS: In a controlled clinical trial, 48 patients (mean age 50 ± 21 years, 52% women) with acute iliofemoral deep vein thrombosis were randomized to receive ultrasound-assisted catheter-directed thrombolysis (N = 24) or conventional catheter-directed thrombolysis (N = 24). Thrombolysis regimen (20 mg r-tPA over 15 hours) was identical in all patients. The primary efficacy end point was the percentage of thrombus load reduction from baseline to 15 hours according to the length-adjusted thrombus score, obtained from standardized venograms and evaluated by a core laboratory blinded to group assignment. The percentage of thrombus load reduction was 55% ± 27% in the ultrasound-assisted catheter-directed thrombolysis group and 54% ± 27% in the conventional catheter-directed thrombolysis group (P = 0.91). Adjunctive angioplasty and stenting was performed in 19 (80%) patients and in 20 (83%) patients, respectively (P > 0.99). Treatment-related complications occurred in 3 (12%) and 2 (8%) patients, respectively (P > 0.99). At 3-month follow-up, primary venous patency was 100% in the ultrasound-assisted catheter-directed thrombolysis group and 96% in the conventional catheter-directed thrombolysis group (P = 0.33), and there was no difference in the severity of the post-thrombotic syndrome (mean Villalta score: 3.0 ± 3.9 [range 0-15] versus 1.9 ± 1.9 [range 0-7]; P=0.21), respectively. CONCLUSIONS: In this randomized controlled clinical trial of patients with acute iliofemoral deep vein thrombosis treated with a fixed-dose catheter thrombolysis regimen, the addition of intravascular ultrasound did not facilitate thrombus resolution. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01482273.

Audit report on the City of Center Point, Iowa for the year ended June 30, 2014

Audit report on the City of Center Point, Iowa for the year ended June 30, 2014

Mise au point concernantl'utilisation du dosagede l'antigène carcino-embryonnaire (CEA)en clinique

The carcinoembryonic antigen (CEA) is a tumor marker defined by specific heterologous antisera. Elevated levels of circulating CEA have been detected by radioimmunoassay in 20-90 per cent of cases of colorectal carcinomas depending on the degree of tumor spread. The fact that elevation of CEA level can also be observed in other types of carcinomas and in several non malignant conditions greatly limit the value of the CEA test for the early diagnosis of colorectal carcinoma. Thus, the CEA assay should not be used as a screening test for cancer. Repeatecl CEA mesurements, however, appear to be of importance for the evaluation of tumor resection and the detection of tumor recurrence. The only localized tumors known to produce elevation of CEA above the levels observed in non malignant diseases are carcinomas of the large bowel and the pancreas. In carcinomas derived from other organs a marked increase of CEA level is always associated with the presence of distant metastasis. Therefore at the present time the clinical applications of the CEA radioimmunoassay should be limited to the differentiai diagnosis of patients with suspicion of primary colorectal or pancreatic carcinoma, to the detection of distant metastasis in other types of carcinomas and to the post operative follow up of patients who had elevated levels of CEA before surgery. Well-controlled studies are still needed to determine if therapeutic decisions based on CEA results can lead to improved survival.

Oral flurbiprofen metabolic ratio assessment using a single-point dried blood spot.

We investigated whether a single blood measurement using the minimally invasive technique of a finger prick to draw a blood sample of 5 µl (to yield a dried blood spot (DBS)) is suitable for the assessment of flurbiprofen (FLB) metabolic ratio (MR). Ten healthy volunteers who had been genotyped for CYP2C9 were recruited as subjects. They received FLB alone in session 1 and FLB with fluconazole in session 2. In session 3, the subjects were pretreated for 4 days with rifampicin and received FLB with the last dose of rifampicin on day 5. Plasma and DBS samples were obtained between 0 and 8 h after FLB administration, and urine was collected during the 8 h after administration. The pharmacokinetic profiles of the drugs were comparable in DBS and plasma. FLB's apparent clearance values decreased by 35% in plasma and DBS during session 2 and increased by 75% in plasma and by 30% in DBS during session 3. Good correlations were observed between MRs calculated from urine, plasma, and DBS samples.

Comparison of Roadway Roughness Derived from LIDAR and SFM 3D Point Clouds, HR-3001, 2015

This report describes a short-term study undertaken to investigate the potential for using dense three-dimensional (3D) point clouds generated from light detection and ranging (LIDAR) and photogrammetry to assess roadway roughness. Spatially continuous roughness maps have potential for the identification of localized roughness features, which would be a significant improvement over traditional profiling methods. This report specifically illustrates the use of terrestrial laser scanning (TLS) and photogrammetry using a process known as structure from motion (SFM) to acquire point clouds and illustrates the use of these point clouds in evaluating road roughness. Five roadway sections were chosen for scanning and testing: three gravel road sections, one portland cement concrete (PCC) section, and one asphalt concrete (AC) section. To compare clouds obtained from terrestrial laser scanning and photogrammetry, the coordinates of the clouds for the same section on the same date were matched using open source computer code. The research indicates that the technologies described are very promising for evaluating road roughness. The major advantage of both technologies is the large amount of data collected, which allows the evaluation of the full surface. Additional research is needed to further develop the use of dense 3D point clouds for roadway assessment.

Road Safety Audits for County Road X-23 from IA 2 to the South Corporate Limits of West Point and for County Road W-62 from US 218 to IA 27 in Lee County, Iowa, 2010

On October 20–21, 2009, two road safety audits were conducted in Lee County, Iowa: one for a 6 mile section of County Road X-23 from IA 2 to the south corporate limits of West Point and one for a 9.7 mile section of County Road W-62 from US 218 to IA 27. Both roads have high severe crash histories for the years of 2001 through 2008. Using these crash data, the Iowa Department of Transportation (Iowa DOT) has identified County Road X-23 as being in the top 5 percent of similar roads for run-off-road crashes. The Iowa DOT lists County Road W-62 as a high-risk rural road that has above-average crash numbers and is eligible for funding under the Federal High-Risk Rural Road Program. Considering these issues, the Lee County Engineer and Iowa DOT requested that road safety audits be conducted to address the safety concerns and to suggest possible mitigation strategies.

Modeling the Emergence of Social Structure from a Phylogenetic Point of View

Based on provious (Hemelrijk 1998; Puga-González, Hildenbrant & Hemelrijk 2009), we have developed an agent-based model and software, called A-KinGDom, which allows us to simulate the emergence of the social structure in a group of non-human primates. The model includes dominance and affiliative interactions and incorporate s two main innovations (preliminary dominance interactions and a kinship factor), which allow us to define four different attack and affiliative strategies. In accordance with these strategies, we compared the data obtained under four simulation conditions with the results obtained in a provious study (Dolado & Beltran 2012) involving empirical observations of a captive group of mangabeys (Cercocebus torquatus)

Représentations sociales et représentations intimes de la maladie. Quelques réflexions d'un clinicien [Social and private representations of cancer. A clinician's point of view]

This paper discusses social representations in scientific communications and private ones that are linked to the individual imagination. Social representations, in a limited sense, are useful for the development of preventive messages, but of little benefit to clinical work. We highlight some non-explicit aspects of scientific discourse that impact on treatment: projected beliefs and values. We tackle the relationship between the concepts of representation, imagination, identity and temporality in the individual approach of the cancer patient.

GPS to LRM: Integration of Spatial Point Features with Linear Referencing Methods, 2001

Global positioning systems (GPS) offer a cost-effective and efficient method to input and update transportation data. The spatial location of objects provided by GPS is easily integrated into geographic information systems (GIS). The storage, manipulation, and analysis of spatial data are also relatively simple in a GIS. However, many data storage and reporting methods at transportation agencies rely on linear referencing methods (LRMs); consequently, GPS data must be able to link with linear referencing. Unfortunately, the two systems are fundamentally incompatible in the way data are collected, integrated, and manipulated. In order for the spatial data collected using GPS to be integrated into a linear referencing system or shared among LRMs, a number of issues need to be addressed. This report documents and evaluates several of those issues and offers recommendations. In order to evaluate the issues associated with integrating GPS data with a LRM, a pilot study was created. To perform the pilot study, point features, a linear datum, and a spatial representation of a LRM were created for six test roadway segments that were located within the boundaries of the pilot study conducted by the Iowa Department of Transportation linear referencing system project team. Various issues in integrating point features with a LRM or between LRMs are discussed and recommendations provided. The accuracy of the GPS is discussed, including issues such as point features mapping to the wrong segment. Another topic is the loss of spatial information that occurs when a three-dimensional or two-dimensional spatial point feature is converted to a one-dimensional representation on a LRM. Recommendations such as storing point features as spatial objects if necessary or preserving information such as coordinates and elevation are suggested. The lack of spatial accuracy characteristic of most cartography, on which LRM are often based, is another topic discussed. The associated issues include linear and horizontal offset error. The final topic discussed is some of the issues in transferring point feature data between LRMs.

Monsieur le Minotaure et son point de vue

Les visions hallucinées de Friedrich Dürrenmatt, l'un des plus importants écrivains suisses de l'après-guerre, au travers des dessins et des manuscrits consacrés aux mythes de la Pythie, du Minotaure et de Midas. L'itinéraire créatif de Friedrich Dürrenmatt, outre sa production littéraire bien connue, est constellé d'une intense activité de peintre, de dessinateur et de graveur sur cuivre, activité qui délimite un important terrain de confrontation des pensées et des thèmes caractérisant sa recherche. Ce volume, qui accompagne l'exposition organisée par le célèbre architecte tessinois Mario Botta, présente une sélection de dessins et de notes de voyage appartenant à la collection privée de Charlotte Kerr-Dürrenmatt. Ceux-ci ont trait aux mythes de la Pythie, du Minotaure et de Midas, auxquels Dürrenmatt a consacré tant de réflexions. Les thèmes de la mythologie grecque ont toujours été présents dans la recherche de l'auteur sur la condition humaine, au point qu'il en est parfois arrivé à se représenter, de manière autobiographique, comme le protagoniste des événements décrits. Ces oeuvres revêtent une importance fondamentale car elles mettent en valeur l'importance et la signification que l'écrivain attribue à cette activité, considérée comme " mineure " par la critique mais qu'il faut en revanche interpréter comme un complément important des métaphores écrites auxquelles renvoie toute sa pensée.