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Antecedentes: la persistencia del uraco es una patología poco frecuente. Su diagnóstico y tratamiento oportuno puede impactar en el pronóstico. Reporte de caso: recién nacido a término de 8 días, antecedente de quiste de cordón umbilical, que consulta por cuadro onfalitis, se inició manejo antimicrobiano, se realizó ecografía abdominal evidenciándose imagen compatible con persistencia del uraco. Fue llevada a cirugía con adecuada evolución clínica y completó cubrimiento antibiótico para Klebsiella pneumoniae y Staphylococcus aureus de manera favorable. Conclusión: La persistencia del uraco es una patología poco frecuente que requiere un manejo multidisciplinar para iniciar un tratamiento de manera oportuna. Los quistes de cordón umbilical y la onfalitis están asociados a la persistencia del uraco.

Antecedentes: La fibrosis quística es una enfermedad de herencia autosómica recesiva, consistente en mutaciones en el gen regulador de la conductibilidad transmembrana, provocando una alteración en la viscosidad de las secreciones. Reporte de caso: Presentamos el caso de una paciente preescolar que ingresa por un cuadro de dolor abdominal crónico en quien se le diagnosticó pancreatitis necrosante como debut de fibrosis quística, quien requirió cuatro meses de hospitalización. Conclusión: La fibrosis quística es una enfermedad con alta tasa de morbimortalidad en la población pediátrica, por lo que se deben conocer sus posibles formas de debut y su clínica, para un manejo oportuno y seguimiento interdisciplinario.

Farmers adopting and implementing innovations, such as new technologies and new products, often require “collaborative inter-segment innovation” by other actors in other segments of the value chain, such as wholesalers implementing new product innovations such as supply of commercial fish feed and chemicals and buying and marketing non-traditional fish species. We tested whether the clustering, and thus economies of agglomeration with implied lower transaction costs, encourage and facilitate farmers to innovate. That potential determinant of farmer choices has not been studied in agriculture or aquaculture or indeed the food sector. We use a unique data set from our own primary survey of the aquaculture value chain in Bangladesh, including micro data for 1500 fish farm households and 20 districts (77 villages) for meso level data. We calculate an index to include both horizontal agglomeration and vertical interconnections among actors in the value chain. We find being in an area with a high clustering index is associated with a higher probability of farmers using more modern inputs and growing non-traditional commodity fish species, controlling for farmers’ other characteristics as well as proximity to cities.

Risk management has taken considerable importance in the supply chain. Much research has been focused on this area to improve quality and competitiveness within organisations. This paper is focused on the identification, analysis, and evaluation of risks associated to materials/purchasing departments through the failure mode and effect analysis (FMEA) and analytic hierarchy process (AHP). This integrated analysis led to prioritise the potential risks that generate downtime and financially impact of the supply chain. Having a unique supply source was identified as the main risk, and restriction on the contract's length was determined to be a suitable solving approach. The identified risks should also be quantified considering the negative effects on cost, time, and quality‐functionality to provide immediate or long‐term solutions.

Older adults who age in place face many health problems and need to be taken care of. Fall is a serious problem among elderly people. In this paper, we present the design and implementation of collaborative fall detection using a wearable device and a companion robot. First, we developed a wearable device by integrating a camera, an accelerometer and a microphone. Second, a companion robot communicates with the wearable device to conduct collaborative fall detection. The robot is also able to contact caregivers in case of emergency. The collaborative fall detection method consists of motion data based preliminary detection on the wearable device and video-based final detection on the companion robot. Both convolutional neural network (CNN) and long short-term memory (LSTM) are used for video-based fall detection. The experimental results show that the overall accuracy of video-based algorithm is 84%. We also investigated the relation between the accuracy and the number of image frames. Our method improves the accuracy of fall detection while maximizing the battery life of the wearable device. In addition, our method significantly increases the sensing range of the companion robot.

This paper focuses its study in the generation of a Supply Chain Resilience strategy for a metal-transformation company located in the City of Puebla, Mexico. The study tends to strengthen the capacity of the company, in terms of resilience in case of any logistic or operational disruption caused by the negative impacts of a disaster. It was suggested to start with a Risk Management Analysis (RMA) following by a Business Continuity Plan implementation. Using the (Define, Measure, Analyze, Improve, and Control) DMAIC methodology, disturbing agents from a national federal agency were analyzed to detect potential risks on the complete Mapping Production Process of the company, to sort those risks per weighted damage impact later. The strategy set up would help to the Tool Manufacturer to control risks better and improve the resilience culture of the company. The risk cost impact was estimated to be reduced from 1.2 M USD to USD 500 k USD. In the second scenario, an AHP was used, but considering other aspects like infrastructure, roads, and so forth, the safety sites were found in the northwest, center-west, center-east, southwest, southeastern, and central areas of the state of Puebla.

Inadequate fruit and vegetable intake is a risk factor for malnutrition and non-communicable diseases, particularly in low- and middle-income countries. This study aimed to identify the determinants of daily fruit and vegetable consumption among low-income households in urban and peri-urban areas of Hanoi, Vietnam and Ibadan, Nigeria. We used the barrier analysis rapid assessment tool to assess the influence of psychosocial and individual factors and perceived characteristics of the food environment. In Hanoi, determinants were family preferences and habits, home production, and perceived benefits and action efficacy. In Ibadan, consumption was determined by affordability. Gender- and neighbourhood-related differences were found to be influential factors. As results are contextual, we recommend that interventions promoting fruit and vegetable consumption assess local determinants.

Driven by climate change concerns, Europe has taken significant initiatives toward the decarbonization of its energy system. The European Commission (EC) has set targets for 2030 to achieve at least 40% reduction in greenhouse gas emissions with respect to the 1990 baseline level and cover at least 32% of the total energy consumption in the European Union (EU) through renewable energy sources, predominantly wind and solar generation. However, these technologies are inherently characterized by high variability, limited predictability and controllability, and lack of inertia, significantly increasing the balancing requirements of the system with respect to historical levels. The flexibility burden is currently carried by flexible fossil-fueled conventional generators (mainly gas), which are required to produce significantly less energy (as low operating cost and CO2-free renewable and nuclear generation are prioritized in the merit order) and operate part loaded with frequent startup and shut-down cycles, with devastating effects on their cost efficiency. info:eu-repo/semantics/publishedVersion

Metabolic spine disease lies on the dynamic nature of bone constantly changing and adapting in response to load variations in the body. The ability of magnetic resonance imaging (MRI) to detect even the slightest changes in water content makes it an invaluable tool for imaging soft tissue pathology and edema associated with metabolic diseases of the spine. Furthermore, MRI can also serve as a preoperative guide for the treatment of such diseases. In this chapter, we summarize and discuss osteoporosis, Paget’s disease, and renal osteodystrophy. The pathophysiology of each disease is reviewed briefly, along with the American College of Radiology (ACR) Appropriateness Criteria, relevant findings on MRI, and how these findings can be used by the orthopedic surgeon to diagnose and treat patients suffering from these diseases.

Introduction Erdheim-Chester disease is a rare, multisystem hematologic disease. Cardiovascular involvement is seen in patients with Erdheim-Chester disease and can lead to increased morbidity and mortality. In this series, we report various cardiovascular manifestations of patients with Erdheim-Chester disease. Methods This study includes patients with Erdheim-Chester disease who were referred to our institution from 12/3/2009 through 12/13/2017. All patients had biopsy-proven Erdheim-Chester disease. Clinical data, multimodality imaging, and cardiac tests were reviewed. Results Cardiovascular findings in 24 patients with Erdheim-Chester disease were included in the study. We reviewed available transthoracic echocardiograms, whole body PET/CT scans, and CMR studies. Most patients were male and mean age at the time of diagnosis was 58 years. Pericardial involvement (13%), myocardial infiltration (25%), endocardial involvement (4%), valvular disease (17%), aortic/vascular disease (17%), conduction system infiltration (8%), and coronary artery disease (25%) were present. At a median follow-up of 5.5 years, mortality was 17%. Conclusions Erdheim-Chester disease can involve various cardiovascular structures and is frequently diagnosed on an imaging modality. Some patients had asymptomatic involvement, but others presented with ischemic heart disease, heart failure, valvular disease, and conduction system abnormalities. Early recognition of cardiovascular involvement of Erdheim-Chester disease is needed because of high morbidity and mortality.

The study has produced a single, powerful finding: the fish value chain in Bangladesh is growing and transforming very rapidly, in all segments. (1) The quiet revolution in the fish value chain is a domestic market revolution: 94% of aquaculture production is destined for domestic consumption. (2) The farmed fish market grew by a factor of 25 times in three decades to nearly 2 million tons today. At most 10% of farmed fish are home-consumed, the rest are marketed. 42% of marketed farmed fish is consumed in urban areas and that share is growing fast. (3) There has been a tripling of volumes and actors in all the segments of the value chain over the past decade. (4) There has been rapid capital deepening in the form of investments by hundreds of thousands of actors in the fish value chain; apparent in a great jump in feed use, investment in equipment and pond construction, and investments in mills, hatcheries and vehicles. These investments have been made by, and provided opportunities for, a multitude of smallholder farmers and small and medium enterprises throughout the chain. (5) There has been diversification and specialization beyond carps into production of commercial species such as tilapia and pangasius catfish, which have raised yields and helped to move the fisheries sector along the “product cycle.” (6) So far the quiet revolution is driven by increase in demand, improvement in infrastructure, and investments by small-scale actors apart from large feed mills. Very little change is due to imposition of standards and contracts, or NGO or government action (except initial government support at the earliest stages in the 1980s). The most important policy has been infrastructure investment, good business environment, and laissez faire policy in terms of crop choice of farmers. Statement of relevance This study focuses on the transformation of aquaculture in Bangladesh, a dynamic sector that has been driven by investments of hundreds of thousands of mainly small actors in the fish value chain. Investments that have bolstered the diversification beyond the production of carps, into production of new commercial species, raising yields and then reducing the price of consumed fish over time.

Modern manufacturing for global markets tends to homogenize material culture through its centralized production and divisive production process. In contrast, craft practices usually have a strong local identity through their application of holistic making practices, context-based knowledge, culturally specific responses and community-centred production. This form of locally-based, customizable and responsive production is discussed here in terms of its relationship to sustainability and as a promising direction for future manufacturing. Despite the potentially strong relationship between craft and sustainability, there is still only limited research exploring this relationship and how craft can more effectively contribute to contemporary industry and life in general. This paper begins by developing an understanding of the relationship between craft and sustainability. From this, we identify: 1) barriers to craft’s development for sustainability, and 2) potential directions to which design can contribute. We then provide an analysis of the current state of crafts in the Yangtze River Delta (YRD) and identify the challenges and potential for design interventions in this region.

Background Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use. The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters. Methods Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) Results The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1. Prevalence of RV dysfunction Conclusions The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.

The majority of literature on aquaculture in Bangladesh focuses on “microsocioeconomics†and “value chains†(VCs) and tends to have a static perspective. However, this approach is at odds with several important emerging trends (Ali 1997; Ali, Haque, and Belton 2013). First, aquaculture is growing fast in Asia. From 1984 to 2014, Bangladesh’s farmed fish jumped from 124,000 metric tons to 1.96 million metric tons, increasing by 1,580 percent. As a result, aquaculture now accounts for 55 percent of Bangladesh’s fish supply, up from just 16 percent three decades ago (Bangladesh, DoF 1994, 1997, 2006, 2015). Second, there has been a rapid shift from home consumption (from one’s own pond) to purchasing farmed fish from the market—consumers of farmed fish got 92 percent of it via purchase from the market in 2010 versus 79 percent in 2000 (data extracted from BBS 2012). This implies that “commercial aquaculture†(which we define simply as fish farming output that is sold, with no specification of the farm size) has moved to be far more important than subsistence fish farming.

Background: Chronic pelvic pain (CPP) of myofascial origin is a condition that is difficult to control and with great repercussion on the quality of life for women who suffer from it. This study objective was to compare the effectiveness of two treatments for the management of this pathology; vaginal analgesic electrostimulation (VES) versus sacral electroacupuncture (EAS).Methods: Quasi-experimental comparative study of two treatments in patients with myofascial CPP. The sample was made up of women who presented this condition during the period 2016 to 2019. The main objective was to assess the effectiveness of the treatments in comparison in terms of the decrease in the VAS score, the secondary ones were: To know the effectiveness of the VES for pain chronic pelvic myofascial (MFPP), the effectiveness of EA for the same condition, complications of therapies, main urological dysfunctions and other chronic pelvic pain associated with myofascial CPP.Results: Thirteen thousand patient files were reviewed, of which 47 were diagnosed with myofascial CCP, with 38 patients eligible for our study. The VES was more effective than the EAS in decreasing the VAS in the twelfth session from 1.36 versus 2.62 p .001. Both therapies were effective for the management of myofascial DCP as they decreased the VAS score to more than 60% of the initial VAS. Vulvodynia (34%), mixed urinary incontinence (32%), and voiding symptoms (26%) were other pelvic floor dysfunctions that presented concomitantly to the MFPP.Conclusions: In patients with myofascial CPP, vaginal VES is better than AD for the treatment of this condition.

Background Obesity is a major public health disorder associated with multiple co-morbidities. Knee magnetic resonance imaging (MRI) permits visualization of the subcutaneous fat anatomy, which can be correlated to body mass index (BMI) and obesity-related co-morbidities. Purpose This study intends to validate a method of correlating measurements of subcutaneous fat around the distal femur on axial MR images to BMI and obesity-related co-morbidities. Material and Methods The most proximal axial slice of each knee MRI was divided into four quadrants. Measurements of the thickest portion of the subcutaneous fat in each quadrant were independently obtained, yielding a value which was assigned the name of the SubCut fat index. The relationship between the SubCut fat index of each quadrant and the patient’s BMI was then evaluated. Receiver operating characteristic curves utilizing both the subcutaneous fat in the medial and lateral quadrants as well as BMI were performed with respect to obesity-related co-morbidities. Results SubCut fat index measurements in all four quadrants and BMI show the strongest correlation (all four, ANOVA P Conclusion The SubCut fat index, a marker of distal femur subcutaneous fat on axial MRI, correlates with severity of obesity (BI) and associated obesity-related co-morbidities.

Obstructive sleep apnea (OSA) prevalence has been increasing in the past years adding significant morbidity. Perioperative management is controversial and few studies have addressed this matter. The American Society of Anesthesiology (ASA) and the American Academy of Sleep Medicine (AASM) have developed clinical practice guidelines for the perioperative management of patients with OSA. Existing evidence suggest an increase in early postoperative complications in patients with OSA. Nevertheless, data about perioperative management of OSA is limited. To our knowledge, only two studies that address this matter, none in Puerto Rico. A questionnaire was given to participants at the annual meeting of anesthesiology in Puerto Rico. The document was then anonymously deposited into sealed box. The response rate was 80 %. The awareness about written postoperative policy in patients with diagnosed (23 %) and suspected (11 %) OSA was low. If a written policy were available, 46 % of patients would have gone to ICU. The most important factor for final disposition was the degree of OSA, which was decided by surgery and anesthesia (69 %). In the last year, at least one complication related to OSA was observed in 20 % of respondents. The most common preoperative screening tool was the ASA guidelines. Seventy-two percent of respondents suggested a lack of institutional policies as the main reason for disparity. There is a significant heterogeneity in the current clinical practice. The main barriers identified to achieve current recommendations were lack of institutional policies, awareness of current guideline, formal training in management of OSA, and access to a sleep specialist.

Background Partnerships between corporate entities and non-governmental organizations (NGOs) involved in delivering community focused health and well-being programs are becoming increasingly valuable especially in the context of promoting healthy lifestyles around the globe. The Mondelēz International Foundation (MIF) has funded healthy lifestyles community based programs targeting children and youth through partnership with seven global NGOs. To assess collective impact of these programs, it is crucial to identify best practices and common impact indicators that can be measured across programs. MIF therefore organized the Healthy Life-styles Evaluation Workshop to explore these pertinent questions. Objective Share best practices and identify common impact indicators to measure the success of current and future MIF funded healthy lifestyles programs. Methods Analysis of the Program Impact Pathways (PIPs) and measured output of each of the seven programs. Results Individual and combined analysis of PIPs of the seven NGO programs led to identification of three critical impact indicators: nutrition knowledge, physical activity, and healthier eating, and also enabled NGOs to identify pathways to improve program delivery among the target population. Conclusions This workshop enabled MIF and partner NGOs to came together to align on metrics and future engagement approaches for promoting and evaluating community based healthy lifestyles programs.

Background: Chronic pelvic pain of myofascial origin is an underdiagnosed condition and with partial responses to the different treatment modalities. The objective of this study was to report the results of the multimodal management of Myofascial Chronic Pelvic Pain.Methods: Retrospective cohort of 33 patients with myofascial chronic pelvic pain, during the period 01 January 2016 to August 31, 2018, who were treated based on trigger point infiltration and analgesic vaginal electrostimulation. The analogous visual pain scale (VAS) was used at the beginning, sixth, twelfth and six months after the last electrostimulation session, in order to measure the effect of the treatment.Results: During the study period, 32 patients with chronic myofascial pelvic pain were found who received the multimodal scheme that is offered in our clinic. The average score of the EVA before starting the treatment was 8.5 points, at the sixth session of the treatment the average EVA was 3.6 points, at the twelfth session of 1.3 points and the average score of the EVA at six months after the last session of the multimodal treatment was 2.9 points. A significant difference was demonstrated in the average EVA score in the first with respect to the sixth, twelfth and six months (p =

Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that—at least in a survey setting—surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies. Clinical relevance The role of objective verification of pathophysiology is debated, but it is an influential factor in recommendations for hand surgery.

This chapter presents results of analyses of survey-based data on the rate of adoption of modern stress-tolerant rice varieties by the beneficiary farmers of the Cereal Systems Initiative for South Asia (CSISA) and compares that with non-CSISA rice farmers who cultivated the CSISA-promoted rice varieties. The study reveals that the adoption of such varieties has been very low. Just 27 % of the farmers in the CSISA beneficiary survey and 9 % of non-CSISA rice farmers grew at least one of the CSISA-promoted rice varieties. Though our survey did not specifically ask the farmers for reasons for non-adoption, education plays a key role in new rice technology adoption and diffusion. Moreover, the role of complementary technologies should not be overlooked when analyzing the adoption of new/modern technologies.

International audience; —This paper describes an FPGA Correlation-Edge Distance approach for real time disparity map generation in stereo-vision. The proposed method calculates the disparity map for the input and disparity map for Edge Distance images of a stereopair. In both cases the approximation algorithm of disparity map SAD (Sum of Absolute Differences) is used. The final disparity map is determined from the previously generated maps, considering a homogeneity parameter defined for each point in the scene. Due to low complexity when implementing stereo-vision algorithms in FPGA devices, the proposed method was implemented in a Cyclone II EP2C35F672C6 FPGA assembled in an Altera DE2 breadboard. The developed module can process stereo-pairs of 1280×1024 pixel resolution at a rate of 75 frames/s and produces 8-bit dense disparity maps within a range of disparities up to 63 pixels. The presented architecture provides a significant improvement in regions with uniformed texture over correlation based stereo-vision algorithms in the reported literature and an accelerated processing rate.

This work presents an experimental investigation that correlates the stiffness changes of reinforced concrete beams with the amount of steel cross section loss and concrete covercracking m...

This work compares biomass gasification and conventional direct combustion in steam boilers for producing power in the context of Brazilian sugar cane mills. The objective of this technical report is to show that gasification could be a more attractive way to convert biomass in energy, compared to using steam boilers, which in some cases can show a low efficiency. The idea is to use the gasifiers in sugarcane mills that have low pressure boilers (21 to 42 kgf/cm2) that are currently dedicated only to generate steam or electrical power for the mill own energy consumption. The results shows that gasification could be a cost-effective alternative for power production in Brazilian sugar cane plants with some additional advantages like the bagasse usage between the season and off-season periods to maintain a constant power generation throughout the entire year, higher energy availability and efficiency. However, nowadays in Brazil the economic advantage of gasification depends highly on political support and reliable long-term stable political framework conditions with an enough timeframe for the development, construction and operation of biomass gasification plants.

International audience; Water industry is facing increased pressure to produce higher quality treated water at a lower cost. The coagulation-flocculation unit is a major step in the production of potable water, allowing the removal of colloidal particles and contamination sources. Currently, the coagulant dosing is manual and it is determined by the way of jar test (off-line dosing tests). This test cannot be applied to supervision and diagnostic real-time. In order to obtain a simple model to describe the water treatment plant, a behavior model sets out, from the analysis of raw water characteristics to the entrance of the plant: (1) prediction on-line the amount of optimal coagulant dosage (software sensor) and (2) the determination of the functional states in real time. The innovative aspect of this paper resides in the design of intelligent control techniques of information water treatment plant (fuzzy logic for the classifier and neuronal networks for the softwaresensor)

Purpose To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. Results Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. Conclusions Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved

Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between "very important" and "very unimportant." Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were "works in my hands," "familiarity with the treatment," and "what my mentor taught me." The most important factors when evidence shows no difference between 2 surgeries were "fewer complications," "quicker recovery," "burns fewer bridges," "works in my hands" and "familiarity with the procedure." Europeans rated "works in my hands" and "cheapest/most resourceful" of significantly greater importance and "what others are doing," "highest reimbursement," and "shorter procedure" of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated "what my mentor taught me," "what others are doing" and "highest reimbursement" of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

In this paper, flow visualization of the blade vortices of four-bladed Mach-scaled rotor, as used in the ONERA-DLR ABC project (Active Blade Concept) in hover flight condition, were investigated experimentally by means of Background Oriented Schlieren method (BOS). For BOS setup, a high-speed camera with a resolution of 4 Mpx was used with pulsed LED-illumination in order to illuminate a reflective background. The ABC rotor blades include a trailing edge flap of 15% chord mounted from 80% to 90% blade radius. In this project, the influence of several flap angles of deflections on the density field of the blade tip vortices was studied. In order to compute the density field of the compressible vortex, a tomographic reconstruction algorithm was applied to the BOS data.

California legislation requires acute-care hospital buildings designed prior to the 1973 code to be evaluated, and if necessary, retrofitted to Life Safety (LS) in order to keep providing acute care until 2030. Innovative and cost-effective solutions are required in order to meet the requirements of the regulatory agency, namely the Office of Statewide Health Planning and Development (OSHPD), as well as the owner expectations. This paper presents a case study of a six-story steel moment frame structure built in 1972 that is retrofitted using supplemental viscous damping. The building is located near two major Southern California active faults. In addition, the building is triangular in plan with non-parallel lateral force resisting systems. Because of the retrofit methodology, Non-linear Dynamic Procedure (NDP) per ASCE 41-06 is required. The building will be retrofitted by adding new primary external damped 3bay moment frames and modifying the existing moment frame base connections to prevent brittle failure by allowing controlled frame uplift. The basic retrofit criterion is to upgrade to LS under an earthquake with a 10% probability of exceedence in 50 years (475 year return period), namely BSE-1 earthquake. This paper presents some of the challenges found by the authors from a constructability perspective, as well as in the implementation of the NDP for a nonconventional building geometry near two major fault lines while satisfying the acceptance criteria delineated by OSHPD and ASCE 41-06. INTRODUCTION AND BACKGROUND After the Northridge Earthquake in 1994, the California legislature enacted Senate Bill 1953 (SB 1953) with the intent of assuring the public that acute care hospital buildings would remain operational after a major seismic event. In order to address high seismic risk buildings, all hospitals were required to perform an 1620 Structures Congress 2012 © ASCE 2012

Recent studies have shown that the use of winglets in aircrafts wing tips have been able to reduce fuel consumption by reducing the lift-induced drag caused by wing tip vortex. This paper presents a 3-D numerical study to analyze the drag and lift forces, and the behavior of the vortexes generated in the wing tips from a modified commercial Boeing aircraft 767-300/ER. This type of aircraft does not contain winglets to control the wing tip vortex, therefore, the aerodynamic effects were analyzed adding two models of winglets to the wing tip. The first one is the vortex diffuser winglet and the second one is the tip fence winglet. The analyses were made for steady state and compressible flow, for a constant Mach number. The results show that the vortex diffuser winglet gives the best results, reducing the core velocity of the wing tip vortex up to 19%, the total drag force of the aircraft up to 3.6% and it leads to a lift increase of up to 2.4% with respect to the original aircraft without winglets.Copyright © 2008 by ASME

Coagulation is one of the most important stages in surface water treatment, allowing for the removal of colloidal particles. Its control, in the majority of the plants remains still manual and requires long and expensive analyses of laboratory which provide only periodic information. The present work describes an innovative methodology integrating various techniques for the development of a diagnosis system of this plant. A first part, concerned by this paper, consisted in developing a software sensor based on artificial neural networks for predicting on-line the amount of optimal coagulant dosage from raw water characteristics such as turbidity, pH, temperature, etc. In a second part this information will be integrated like an input to a diagnosis system of the plant. The development of the neural sensor has been performed based in real data covering several years of operation and its performance have been compared toward those given by a multi-linear interpolation.

National Cholesterol Education Program Adult Treatment Panel III guidelines for patients at a high risk of coronary heart disease set a low-density lipoprotein cholesterol (LDL-C) target of100 mg/dL. This target can be difficult to attain with diet and current therapy.In a 16-week multinational trial, 1993 high-risk patients were randomized to rosuvastatin 20 mg, atorvastatin 10 mg, atorvastatin 20 mg, simvastatin 20 mg, or simvastatin 40 mg for 8 weeks. Patients either remained on starting treatment or switched to lower or milligram-equivalent doses of rosuvastatin for 8 more weeks.At 16 weeks, more patients achieved their LDL-C target by switching to rosuvastatin 10 mg than staying on atorvastatin 10 mg (66% vs 42%, P.001) or simvastatin 20 mg (73% vs 32%, P.001). Changing to rosuvastatin 20 mg brought more patients to their LDL-C target than staying on atorvastatin 20 mg (79% vs 64%, P.001) or simvastatin 40 mg (84% vs 56%, P.001). More very high risk patients achieved an LDL-C target of70 mg/dL when changed to rosuvastatin from atorvastatin or simvastatin (within-arm comparisons P.01). More hypertriglyceridemic patients (triglyceridesor = 200 mg/dL) met LDL-C, non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B targets by changing to rosuvastatin. Switching to rosuvastatin produced greater reductions in LDL-C, total cholesterol, non-HDL-C, apolipoprotein B, and lipid ratios. All treatments were well tolerated, with no differences among treatment groups in skeletal muscle, hepatic, or renal toxicity.Rosuvastatin 10 or 20 mg is an effective and safe therapeutic option for high-risk patients to achieve their lipid and apolipoprotein targets.

This paper describes the experimental analysis of a heat pump assisted recuperative air dehumidifier. The system consisted of an air-to-air vapor compression heat pump, coupled to the air ducting. Dehumidification was generated by reduction of the air temperature through the evaporator below the dew point, and thus promoting the condensation of the water vapor. Moist air was then warmed up in the condenser, resulting in a lowtemperature low-humidity air stream. Low energy consumption values are achieved in such systems as the latent heat of the water vapor acts as the heat pump own heat source. Occasionally, the compressor heat is also recoverable. The innovative feature of the present analysis was the introduction of an air-to-air plate recuperator, to further promote dehumidification, yet at the expense of greater compressor energy consumption. An experimental apparatus was constructed to perform comparative tests of the dehumidifier operating with and without the recuperator. A closed air circuit was employed, with the air mass flow rate as the controlling parameter of the experiment. Tests were also carried out with an open circuit.

Purpose To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. Methods One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. Conclusions Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TF—differences that might be addressed by a decision aid. Clinical relevance Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.