Ohio River Bridges, East End Crossing

The East End Crossing of the Ohio River Bridges Project is pursuing sustainability certification using Envision. When certified, it will be one of the largest P3 infrastructure projects in North America to be third-party certified by a horizontal infrastructure sustainability rating system. In this presentation owner’s representatives will discuss how the owner’s early commitment ensured that sustainability practices were followed, the inherent compatibility of P3 projects with Envision, how collaboration among team members enhanced performance, and lessons learned

The Tanganyika Plateau

n/

El trabajo: desde el Marxismo, Liberalismo y el Mundo Andino, un Análisis desde la Antropología Filosófica

El presente trabajo de se planteó como objetivo general determinar cómo interpreta la antropología filosófica el concepto del trabajo desde la cosmovisión andina, la teoría liberal y la teoría marxista. El tipo de investigación fue básicamente descriptiva y explicativa por ser una investigación cualitativa, para su desarrollo se realizaron entrevistas abiertas para poder tener resultados sobre el tema a investigar. Se trabajó con una muestra de 8 sujetos entrevistados cada uno de ellos representante de cada postura invetigada En la investigación se tuvieron diferencias a respecto de cómo se conceptualiza el trabajo en las diferentes posiciones expuestas.This job was raised as a general objective to determine how philosophical anthropology interprets the concept of work from the Andean worldview, liberal theory and Marxist theory. The type of research was basically descriptive and explanatory because it was a qualitative research, for its development open interviews were carried out in order to obtain results on the topic to be investigated. We worked with a sample of 8 interviewed subjects, each one representing each position investigated. In the research there were differences regarding how the work is conceptualized in the different positions exposed

Sub-optimal pain control in patients with rheumatic disease.

The visual analog scale (VAS) of pain is a ubiquitous clinical and research tool with widespread application in the rheumatic diseases. The objectives of this study were to assess if patients report pain differently to doctors or nurses, to determine reproducibility of this test for diagnosis, age, gender, and treatment, and to ascertain the level of pain in patients attending general rheumatology clinics. Using a standardized line of exactly 100 mm and instructions with identical wording, consecutive patients attending general rheumatology clinics were asked to score their perceived level of pain in the preceding week. Two assessments were carried out, one before and one after the clinic visit, and each patient was questioned by both a doctor and a nurse. Differences between the first and second VAS scores (VAS1 and VAS2) were recorded. One hundred and eight patients completed the study (69 female). VAS1 and VAS2 scores were administered by a similar number of doctors and nurses. There was no significant difference between mean VAS1 and VAS2 scores (41.1 vs. 41.4 mm, p = 0.78). VAS1 and VAS2 differed by \u3c4 mm in\u3e59% of patients. Age, gender, or diagnosis did not influence VAS1 or VAS2. Differences in scores were independent of which health professional administered the scale (p = 0.19). Patients taking painkillers had higher mean VAS scores (49 mm) compared with those not on analgesia (27 mm; p \u3c 0.001). Anti-rheumatic treatment did not influence pain scores (p = 0.13). The VAS is a reliable and effective method of pain assessment. Results are independent of which health professional administers the scale. Patients with rheumatic disease report their pain similarly regardless of diagnosis. However, pain control is sub-optimal in patients taking analgesia. Specific assessment of pain is, thus, important in patients attending rheumatology clinics

The Utility of Deformable Image Registration for Small Artery Visualisation in Contrast-Enhanced Whole Body MR Angiography

Purpose; An investigation was carried out into the effect of three image registration techniques on the diagnostic image quality of contrast-enhanced magnetic resonance angiography (CE-MRA) images. Methods Whole-body CE-MRA data from the lower legs of 27 patients recruited onto a study of asymptomatic atherosclerosis were processed using three deformable image registration algorithms. The resultant diagnostic image quality was evaluated qualitatively in a clinical evaluation by four expert observers, and quantitatively by measuring contrast-to-noise ratios and volumes of blood vessels, and assessing the techniques’ ability to correct for varying degrees of motion. Results The first registration algorithm (‘AIR’) introduced significant stenosis-mimicking artefacts into the blood vessels’ appearance, observed both qualitatively (clinical evaluation) and quantitatively (vessel volume measurements). The other two algorithms (‘Slicer’ and ‘SEMI’) based on the normalised mutual information (NMI) concept and designed specifically to deal with variations in signal intensity as found in contrast-enhanced image data, did not suffer from this serious issue but were rather found to significantly improve the diagnostic image quality both qualitatively and quantitatively, and demonstrated a significantly improved ability to deal with the common problem of patient motion. Conclusions This work highlights both the significant benefits to be gained through the use of suitable registration algorithms and the deleterious effects of an inappropriate choice of algorithm for contrast-enhanced MRI data. The maximum benefit was found in the lower legs, where the small arterial vessel diameters and propensity for leg movement during image acquisitions posed considerable problems in making accurate diagnoses from the un-registered images

An initial assessment of the environmental impact of grocery products

This report presents a series of analyses with the common purpose of establishing which grocery products are likely to contribute most to the environmental impacts (carbon footprint or embodied carbon, embodied energy, water, materials use and waste) associated with UK household consumption. Understanding and prioritising these has enabled reduction actions, interventions and further research to be directed more effectively at those products with the greatest potential to influence overall consumption impacts.The report includes a systematic review of 1,900 grocery carbon footprint data points for 191 products; believed to be the largest assessment of its kind at the time of publication

Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan

OBJECTIVE: To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. METHODS: Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility. RESULTS: RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively. CONCLUSIONS: This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic

Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

Methods: 697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008–9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007–2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 39 756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA. Conclusions: Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use