Assessment of construction and demolition waste materials for sublayers of low traffic rural roads

The need for exploiting massive amounts of natural raw materials for constructing pavements of roads as a key element for development of infrastructures in modern age, together with enormous production amounts of wastes related to civil engineering activities as biggest portion of solid waste generated all over the world, have highlighted the importance of utilizing recycled aggregates of these materials in road pavement layers. The key factor in this quest, is to evaluate load-bearing abilities of various kinds of waste aggregates. Aggregates of reclaimed asphalt, pre-stressed or normal concrete, masonry and demolition waste (CDW) exhibit different behavior under loading after compaction. The ideal situation would be to achieve the densest compacted and durable layer in order to get the highest durability, comparing to traditional road materials. In this study, aggregates from four types of recycled materials are being subjected to study for unbound and cemented pavement layers. Initial laboratory evaluations of size and composition are followed by constructing a field on a subgrade with high non-homogenous surface. Vibrating elastic modulus (Evib) for these materials were determined by Continuous Compaction Control (CCC) Oscillating Rollers. It is observed that, despite the weaknesses arisen from weak components such as masonry and elongated tiles, the stabilized distribution of the particle size can accelerate reaching to final compaction of unbound aggregates with roller passing. This process could be repeated with more or less same pattern in cemented layer, which exhibited an enhanced stiffness and uniformity in order to minimize the weak parts of non-uniform subgrade layer, and provide a high rigid pavement

Research model for farm building design: General structure and physiognomic characterization phase

The design of contemporary farm buildings often subordinates architectural quality and aesthetic features to economic aspects, thus leading to poor landscape consistency and compatibility.  The research presented in this paper is based on the theoretical principle that historic rural buildings, being expression of an accumulation of empirical knowledge broadly associated with high architectural quality, have remarkable potentials to contribute with useful elements to the design of contemporary buildings, and on the awareness that the design process is also necessarily and substantially determined by technological, economic and functional variables.  The paper presents the FarmBuiLD model (Farm Building Landscape Design), a research model proposed by the authors as a tool for the analysis of the architectural characteristics of both historical and contemporary rural buildings, as well as the meta-design of new construction and transformation of contemporary rural buildings.  In particular, the work focuses on the general structure of this model and a synthesis of the main results of the critical analysis of the scientific literature aimed at identifying a set of synthetic architectural parameters suitable for its implementation, through the interpretation of the main physiognomical characteristics of rural buildings.  These parameters are not meant as a tool to obtain quantitative data to be translated into design constraints automatically; on the contrary, they are mainly considered as an interpretive-analytical tool, part of a broader knowledge framework aimed at supporting, stimulating and suggesting the design choices.Keywords: Rural building design, historical-typological consistency, landscape compatibility, architectural quality, analytical and meta-design criteria, Italian rural building heritage Citation: Tassinari P, D. Torreggiani, S. Benni, and E. Dall’Ara.  Research model for farm building design: General structure and physiognomic characterization phase.  Agric Eng Int: CIGR Journal, 2010; 12(1): 47-54

Recurrent fever in children

Children presenting with recurrent fever may represent a diagnostic challenge. After excluding the most common etiologies, which include the consecutive occurrence of independent uncomplicated infections, a wide range of possible causes are considered. This article summarizes infectious and noninfectious causes of recurrent fever in pediatric patients. We highlight that, when investigating recurrent fever, it is important to consider age at onset, family history, duration of febrile episodes, length of interval between episodes, associated symptoms and response to treatment. Additionally, information regarding travel history and exposure to animals is helpful, especially with regard to infections. With the exclusion of repeated independent uncomplicated infections, many infective causes of recurrent fever are relatively rare in Western countries; therefore, clinicians should be attuned to suggestive case history data. It is important to rule out the possibility of an infectious process or a malignancy, in particular, if steroid therapy is being considered. After excluding an infectious or neoplastic etiology, immune-mediated and autoinflammatory diseases should be taken into consideration. Together with case history data, a careful physical exam during and between febrile episodes may give useful clues and guide laboratory investigations. However, despite a thorough evaluation, a recurrent fever may remain unexplained. A watchful follow-up is thus mandatory because new signs and symptoms may appear over time

Lung involvement in childhood onset granulomatosis with polyangiitis

Granulomatosis with polyangiitis is an ANCA-associated systemic vasculitis with a low incidence in the pediatric population. Lung involvement is a common manifestation in children affected by granulomatosis with polyangiitis, both at disease's onset and during flares. Its severity is variable, ranging from asymptomatic pulmonary lesions to dramatic life-threatening clinical presentations such as diffuse alveolar haemorrhage. Several radiologic findings have been described, but the most frequent abnormalities detected are nodular lesions and fixed infiltrates. Interstitial involvement, pleural disease and pulmonary embolism are less common. Histology may show necrotizing or granulomatous vasculitis of small arteries and veins of the lung, but since typical features may be patchy, the site for lung biopsy should be carefully chosen with the help of imaging techniques such as computed tomography. Bronchoalveolar lavage is helpful to confirm the diagnosis of alveolar haemorrhage. Pulmonary function tests are frequently altered, showing a reduction in the diffusion capacity for carbon monoxide, which can be associated with obstructive abnormalities related to airway stenosis. Nodular lung lesions tend to regress with immunosuppressive therapy, but lung disease may also require second line treatments such as plasmapheresis. In cases of massive diffuse alveolar haemorrhage, ventilator support is crucial in the management of the patient

A New Biocomposite Material Based on Wheat Waste and Suitable for 3D Printing Applications

Biopolymers, such as poly(lactic) acid (PLA), which is obtained through green synthesis pathways from renewable resources, has attracted considerable interest in recent years because of the increasing need to reduce petroleum-based plastic pollution and bringing their prices comparable with conventional thermoplastic commodities’ price (e.g., polyethylene, polypropylene, and polystyrene). The present work investigates the employment of 10% wt of natural materials, deriving from wheat milling process, as biofiller of PLA to develop a biocomposite filament suitable for 3D-printing technique. The inclusion of a cost-free natural material leads to a strong reduction of the whole material cost. Implementing this new class of composite material to additive manufacturing technique allows to dramatically reduce the environmental impact of 3D printed products

Smart Flow for the evaluation of the hemodialysis arteriovenous fistula

Background: Smart Flow is an innovative tool available on the Carestream Touch Prime Ultrasound machines, which provides automated blood flow measurement and shows the vectors that form the blood flow in the vessel. We compared the use of Smart Flow with traditional Duplex Doppler Ultrasound to evaluate blood flow of arteriovenous fistulas in prevalent hemodialysis patients. Methods: A total of 31 chronic patients on hemodialysis were enrolled. Blood flow was measured on the brachial artery with Smart Flow and duplex Doppler ultrasound. In a subset of 26 patients, a video of the juxta-anastomotic efferent vein was recorded and analyzed to calculate an index of flow turbulence. Results: We enrolled 21 males and 10 females aged 68.52 ± 11.64 years at the time of evaluation with an average arteriovenous fistulas vintage of 50.23 ± 47.42 months and followed them up for 18.03 ± 5.18 months. Smart Flow and Duplex Doppler Ultrasound blood flow measurements positively correlated (p < 0.0001) in the same patient but Smart Flow gave higher blood flow values (995.0 vs 730.3 mL/min, p < 0.0001), and the Duplex Doppler Ultrasound blood flow standard deviation was similar to Smart Flow (125.4 vs 114.4 mL/min, p < 0.0001). The time needed to evaluate arteriovenous fistulas with Smart Flow was significantly shorter than Duplex Doppler Ultrasound (67.58 ± 19.89 vs 146.3 ± 26.35 s, p < 0.0001). No correlation was found between blood flow turbulence and the subsequent access failure. Conclusion: Smart Flow is reliable, reproducible, and faster than traditional duplex ultrasound. However, the additional information given by the Smart Flow technique does not seem to add any further benefits in terms of prediction of the access failure

Radiation-induced aortic occlusion.

Arterial occlusion is a late complication of radiotherapy usually seen in extracranial vessels following treatment for head and neck malignancy. Determining the etiology behind vessel occlusion can be difficult and involves consideration of several factors. We present a case of radiotherapy induced aortic occlusion and discuss the relevant clinical and imaging factors that allow the diagnosis to be made

Microalbuminuria and sRAGE in High-Risk Hypertensive Patients Treated with Nifedipine/Telmisartan Combination Treatment: A Substudy of TALENT

Some antihypertensive drugs have also renoprotective and anti-inflammatory properties that go beyond their effect on blood pressure. It has been suggested that microalbuminuria and glomerular filtration rate (GFR) are associated with circulating levels of the soluble form of the receptor, sRAGE (soluble receptor for advanced glycation ends-products). In the present analysis, we used data from the TALENT study to evaluate soluble receptor for advanced glycation end-products (sRAGE) plasma levels in patients with hypertension and high-cardiovascular risk-treated nifedipine and telmisartan in combination. Treatment with nifedipine-telmisartan significantly decreased mean systolic and diastolic ambulatory blood pressure and resulted in a significant increase in sRAGE plasma concentrations after 24 weeks of therapy. We concluded that in hypertensive patients with early-stage renal disease, sRAGE concentrations are not influenced by either microalbuminuria or GFR. Long-term treatment with a combination of nifedipine-telmisartan may have a beneficial effect increasing sRAGE plasma levels, thus exerting an atheroprotective and anti-inflammatory activity

Prolapsed bilateral ureteroceles leading to intermittent outflow obstruction

A ureterocele refers to a cystic dilatation of the distal ureter. It may be unilateral or bilateral and may be associated with a duplex system in some cases. We present an unusual case where a young patient was found to have large bilateral ureteroceles which prolapsed into the urethra, causing intermittent incontinence and obstruction. We discuss the case and review the literature concerning this rare anomaly

Interstitial lung disease in a newborn affected by mevalonic aciduria

Introduction: Mevalonic aciduria (MA) is the most severe phenotype of mevalonate-kinase deficiency (MKD), with a onset in early infancy and poor prognosis. MA diagnosis may be challenging in the neonatal period given its rarity and its unspecific symptoms that frequently recall those of other neonatal diseases. To our knowledge, interstial lung involvement has never been described as onset feature in a newborn with MKD. Objectives: We report the case of a newborn affected by MKD characterized by interstitial lung disease. Methods: The patient underwent laboratory and radiology evaluation as clinically indicated. Direct Sanger sequencing was used to screen the 10 exons of the MVK gene. Results: A female neonate born at term from consanguineous parents was referred to our hospital at 16 days of life (DOL) for mild hypotonia and persistent raised inflammatory markers despite antibiotic therapy. Infectious work-up was negative for both viral and bacterial infections. Chest x-ray revealed bilateral perihilar peribronchial thickening. Electroencephalography (EEG) reported moderate diffuse anomalies of background activity without major abnormalities. On DOL 20 the first episode of fever was recorded. Due to worsening tachypnea and persistent abnormal chest x-ray, a pulmonary CT scan was performed and showed diffuse ground-glass bilateral infiltrates consistent with alveolar-interstitial lung disease. On DOL 22 a palpable maculo-papular skin rash appeared on feet and hands, vanishing spontaneously 24 hours later. Bone marrow examination and levels of perforins, neuron-specific enolase and urinary catabolites of catecholamines were normal. A total body MRI was normal except for a mild cerebellar hypoplasia and the known interstitial lung disease. The patient kept presenting hypotonia, relapsing episodes of fever and skin rashes, developed anemia requiring blood transfusions and failure to thrive became evident. Type-I IFN signature was negative. A genetic test was requested, as well as quantification of urinary levels of mevalonic acid, which were markedly above the normal range. Direct Sanger sequencing allowed to detect a homozygous c.709A&gt;T missense mutation in the exon 8 of the MVK gene, coding for a protein substitution p.T237S already classified as pathogenic in the INFEVERS database (http://fmf.igh.cnrs.fr/ISSAID/infevers/) and therefore consistent with the diagnosis of MKD. Both parents and her sister were found to be heterozygous carriers of the same mutation. On DOL 38 treatment with anakinra was started, with prompt regression of fever and skin rash, decrease in inflammatory markers, increase in reticulocytes count and weight gain. Hypotonia improved but persisted. The patient was discharged from hospital on DOL 56 in good clinical conditions, with acute phase reactants within the normal range and mild hypotonia. She is now 4 months old, still on anakinra treatment without adverse events. Conclusion: Autoinflammatory diseases in the neonatal period are a diagnostic challenge. Clinical suspicion is crucial in order to perform specific laboratory and genetic testing and start appropriate treatment. Interstitial lung involvement may be present in MKD and, together with increased inflammatory markers, could be the first manifestation of the disease