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Goode J.C.,III | McCartney J.S.,University of California at San Diego
Journal of Geotechnical and Geoenvironmental Engineering | Year: 2015

This study presents the results from physical modeling experiments on centrifuge-scale energy foundations in dry sand and unsaturated silt layers. These experiments were performed to characterize end restraint effects on soil-structure interaction for energy foundations in different soils and include tests on foundations with semifloating and end-bearing toe boundary conditions and free-expansion and restrained-expansion head boundary conditions. Two scale-model energy foundations having different lengths were constructed from reinforced concrete to simulate end-bearing and semifloating conditions in soil layers having the same thickness. The foundations include embedded thermocouples and strain gauges, which were calibrated under applied mechanical loads and nonisothermal conditions before testing. The variables measured during the experiments include axial strain and temperature distributions in the foundation, temperature, and volumetric water content measurements in the soil, vertical displacements of the foundation head and soil surface, and axial stress at the foundation head. These variables were used to calculate the distributions in thermal axial stress and thermal axial displacement, which are useful in evaluating soil-structure interaction mechanisms. The results confirm observations from full-scale energy foundations in the field for end-bearing foundations and provide new insight into the behavior of semifloating foundations. Heating of the semifloating foundations in compacted silt led to a clear increase in ultimate capacity, potentially due to changes in radial normal stress and thermally induced water flow, while heating of the semifloating foundations in dry sand led to a negligible change in ultimate capacity. © 2015 American Society of Civil Engineers.

Morgentaler A.,Mens Health Boston | Conners W.P.,III
Asian Journal of Andrology | Year: 2015

For several decades any diagnosis of prostate cancer (PCa) has been considered an absolute contraindication to the use of testosterone (T) therapy in men. Yet this prohibition against T therapy has undergone recent re-examination with refinement of our understanding of the biology of androgens and PCa, and increased appreciation of the benefits of T therapy. A reassuringly low rate of negative outcomes has been reported with T therapy after radical prostatectomy (RP), radiation treatments, and in men on active surveillance. Although the number of these published reports are few and the total number of treated men is low, these experiences do provide a basis for consideration of T therapy in selected men with PCa. For clinicians considering offering this treatment, we recommend first selecting patients with low grade cancers and undetectable prostate-specific antigen following RP. Further research is required to define the safety of T therapy in men with PCa. However, many patients symptomatic from T deficiency are willing to accept the potential risk of PCa progression or recurrence in return for the opportunity to live a fuller and happier life with T therapy. © 2015 AJA, SIMM & SJTU. All rights reserved.

Anderson W.C.,III | Anderson W.C.,Aurora University | Szefler S.J.,Aurora University | Szefler S.J.,Breathing Institute
Journal of Allergy and Clinical Immunology | Year: 2015

Symptomatic asthma in childhood has lifelong effects on lung function and disease severity, emphasizing the need for improved pediatric asthma control. Control of pediatric risk and impairment domains can be achieved through increased medication adherence or new therapeutic strategies. Developing electronic monitoring device technology with reminders might be a key noninvasive resource to address poor adherence in children and adolescents in a clinical setting. In patients who have persistently poor control despite optimal medication compliance, newly emerging pharmaceuticals, including inhaled therapies and biologics, might be key to their treatment. However, barriers exist to their development in the pediatric population, and insights must be drawn from adult studies, which has its own unique limitations. Biomarkers to direct the use of such potentially expensive therapies to those patients most likely to benefit are imperative. In this review the current literature regarding strategies to improve pediatric asthma control is addressed with the goal of exploring the potential and pitfalls of strategies that might be available in the near future. © 2015 American Academy of Allergy, Asthma & Immunology.

Merker M.,Research Center Borstel | Barry C.E.,III
Nature Genetics | Year: 2015

Mycobacterium tuberculosis strains of the Beijing lineage are globally distributed and are associated with the massive spread of multidrug-resistant (MDR) tuberculosis in Eurasia. Here we reconstructed the biogeographical structure and evolutionary history of this lineage by genetic analysis of 4,987 isolates from 99 countries and whole-genome sequencing of 110 representative isolates. We show that this lineage initially originated in the Far East, from where it radiated worldwide in several waves. We detected successive increases in population size for this pathogen over the last 200 years, practically coinciding with the Industrial Revolution, the First World War and HIV epidemics. Two MDR clones of this lineage started to spread throughout central Asia and Russia concomitantly with the collapse of the public health system in the former Soviet Union. Mutations identified in genes putatively under positive selection and associated with virulence might have favored the expansion of the most successful branches of the lineage. © 2015 Nature Publishing Group, a division of Macmillan Publishers Limited. All Rights Reserved.

Quillin R.C.,III | Shah S.A.,University of Cincinnati
Journal of the American College of Surgeons | Year: 2015

Background Although donation after cardiac death (DCD) liver allografts have been used to expand the donor pool, concerns exist regarding primary nonfunction and biliary complications. Our aim was to compare resource use and outcomes of DCD allografts with donation after brain death (DBD) liver allografts. Study Design Using a linkage between the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases, we identified 11,856 patients who underwent deceased donor liver transplantation (LT) from 2007 to 2011. Patients were divided into 2 cohorts based on type of allograft (DCD vs DBD). Matched pair analysis (n = 613 in each group) was used to compare outcomes of the 2 donor types. Results Donation after cardiac death allografts comprised 5.2% (n = 613) of all LTs in the studied cohort; DCD allograft recipients were healthier and had lower median Model of End-Stage Liver Disease (MELD) score (17 vs 19; p < 0.0001). Post LT, there was no significant difference in length of stay, perioperative mortality, and discharge to home rates. However, DCD allografts were associated with higher direct cost ($110,414 vs $99,543; p < 0.0001) and 30-day readmission rates (46.4% vs 37.1%; p < 0.0001). Matched analysis revealed that DCD allografts were associated with higher direct cost, readmission rates, and inferior graft survival. Conclusions While confirming the previous reports of inferior graft survival associated with DCD allografts, this is the first national report to show increased financial and resource use associated with DCD compared with DBD allografts in a matched recipient cohort. © 2015 American College of Surgeons.

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