Large-scale performance and design for construction activity erosion control best management practices.

The National Pollutant Discharge Elimination System (NPDES) Phase II requires construction activities to have erosion and sediment control best management practices (BMPs) designed and installed for site storm water management. Although BMPs are specified on storm water pollution prevention plans (SWPPPs) as part of the construction general permit (GP), there is little evidence in the research literature as to how BMPs perform or should be designed. The objectives of this study were to: (i) comparatively evaluate the performance of common construction activity erosion control BMPs under a standardized test method, (ii) evaluate the performance of compost erosion control blanket thickness, (iii) evaluate the performance of compost erosion control blankets (CECBs) on a variety of slope angles, and (iv) determine Universal Soil Loss Equation (USLE) cover management factors (C factors) for these BMPs to assist site designers and engineers. Twenty-three erosion control BMPs were evaluated using American Society of Testing and Materials (ASTM) D-6459, standard test method for determination of ECB performance in protecting hill slopes from rainfall induced erosion, on 4:1 (H:V), 3:1, and 2:1 slopes. Soil loss reduction for treatments exposed to 5 cm of rainfall on a 2:1 slope ranged from-7 to 99%. For rainfall exposure of 10 cm, treatment soil loss reduction ranged from 8 to 99%. The 2.5 and 5 cm CECBs significantly reduced erosion on slopes up to 2:1, while CECBs < 2.5 cm are not recommended on slopes >or= 4:1 when rainfall totals reach 5 cm. Based on the soil loss results, USLE C factors ranged from 0.01 to 0.9. These performance and design criteria should aid site planners and designers in decision-making processes.

[Conservative treatment of puerperal breast abscesses with repeated sonographically guided aspirations and oral antibiotic administrations]. / Behandlung puerperaler Mammaabszesse durch wiederholte ultraschallgezielte Punktionen und perorale Antibiotikagabe.

BACKGROUND: Breast abscesses have usually been treated by incision and drainage. During the past 10 years conservative treatment with repeated ultrasound-guided drainage to evacuate the abscess combined with antibiotic treatment has become a valuable alternative. PATIENTS AND METHODS: From 1991 to 2003 the authors treated 17 patients with puerperal abscess with this method. Under local anesthesia with ultrasound guidance a thick needle (preferably a Venflon) is introduced into the cavity. The procedure is repeated every two or three days until the ultrasound image demonstrates a diameter of the cavity of 1.5 cm or less. The oral antibiotic treatment lasts for 6 to 10 days. RESULTS: In 7 cases only one puncture was needed, 5 cases needed 2 punctures while 4 women needed 3 or more punctures (up to 5). In 16 cases an open drainage could be avoided. One patient wanted to discontinue the conservative treatment after the first puncture and requested the surgical drainage. CONCLUSIONS: Conservative therapy with ultrasound-guided drainage of puerperal breast abscesses can therefore be recommended as a standard treatment.

Minds, modules, and meta-analysis.

Wellman and colleagues' meta-analysis of performance on the false-belief task is methodologically useful, but it does not lead to any theoretical progress concerning the nature of the mechanisms that underlie the existence and development of "theory of mind." In particular, the results of this meta-analysis are perfectly compatible with "early competence" accounts that posit a specific, innate, and possibly modular basis for theory of mind. The arguments presented by Wellman and colleagues against such views stem not from their meta-analytic data, but from mistaken assumptions regarding the requirements of such theories (e.g., that there exist manipulations that improve performance only, or to a greater degree, in young children). Contrary to what Wellman and colleagues claim, their meta-analysis, while consistent with conceptual change, does not lend any new support for such theories.

How not to be seen: the contribution of similarity and selective ignoring to sustained inattentional blindness.

When people attend to objects or events in a visual display, they often fail to notice an additional, unexpected, but fully visible object or event in the same display. This phenomenon is now known as inattentional blindness. We present a new approach to the study of sustained inattentional blindness for dynamic events in order to explore the roles of similarity, distinctiveness, and attentional set in the detection of unexpected objects. In Experiment 1, we found that the similarity of an unexpected object to other objects in the display influences attentional capture: The more similar an unexpected object is to the attended items, and the greater its differencefrom the ignored items, the more likely it is that people will notice it. Experiment 2 explored whether this effect of similarity is driven by selective ignoring of irrelevant items or by selective focusing on attended items. The results of Experiment 3 suggest that the distinctiveness of the unexpected object alone cannot entirely account for the similarity effects found in the first two experiments; when attending to black items or white items in a dynamic display, nearly 30% of observers failed to notice a bright red cross move across the display, even though it had a unique color, luminance, shape, and motion trajectory and was visible for 5s. Together, the results suggest that inattentional blindness for ongoing dynamic events depends both on the similarity of the unexpected object to the other objects in the display and on the observer's attentional set.

Objects and attention: the state of the art.

What are the units of attention? In addition to standard models holding that attention can select spatial regions and visual features, recent work suggests that in some cases attention can directly select discrete objects. This paper reviews the state of the art with regard to such 'object-based' attention, and explores how objects of attention relate to locations, reference frames, perceptual groups, surfaces, parts, and features. Also discussed are the dynamic aspects of objecthood, including the question of how attended objects are individuated in time, and the possibility of attending to simple dynamic motions and events. The final sections of this review generalize these issues beyond vision science, to other modalities and fields such as auditory objects of attention and the infant's 'object concept'.

What is a visual object? Evidence from target merging in multiple object tracking.

The notion that visual attention can operate over visual objects in addition to spatial locations has recently received much empirical support, but there has been relatively little empirical consideration of what can count as an 'object' in the first place. We have investigated this question in the context of the multiple object tracking paradigm, in which subjects must track a number of independently and unpredictably moving identical items in a field of identical distractors. What types of feature clusters can be tracked in this manner? In other words, what counts as an 'object' in this task? We investigated this question with a technique we call target merging: we alter tracking displays so that distinct target and distractor locations appear perceptually to be parts of the same object by merging pairs of items (one target with one distractor) in various ways - for example, by connecting item locations with a simple line segment, by drawing the convex hull of the two items, and so forth. The data show that target merging makes the tracking task far more difficult to varying degrees depending on exactly how the items are merged. The effect is perceptually salient, involving in some conditions a total destruction of subjects' capacity to track multiple items. These studies provide strong evidence for the object-based nature of tracking, confirming that in some contexts attention must be allocated to objects rather than arbitrary collections of features. In addition, the results begin to reveal the types of spatially organized scene components that can be independently attended as a function of properties such as connectedness, part structure, and other types of perceptual grouping.

Adenovirus-mediated gene transfer into selected liver segments using a vascular exclusion technique.

Adenovirus-mediated gene therapy is hampered by severe virus-related toxicity, especially to the liver. The aim of the present study was to test the ability of a vascular exclusion technique to achieve transgene expression within selected liver segments, thus minimizing both viral and transgene product toxicity to the liver. An E1-E3-deleted replication-deficient adenovirus expressing a green fluorescent protein (GFP) reporter gene was injected into the portal vein of BDIX rats, with simultaneous clamping of the portal vein tributaries to liver segments II, III, IV, V, and VIII. GFP expression and inflammatory infiltrate were measured in the different segments of the liver and compared with those of the livers of animals receiving the viral vector in the portal vein without clamping. The GFP expression was significantly higher in the selectively perfused segments of the liver as compared with the non-perfused segments (p < 0.0001) and with the livers of animals that received the vector in the portal vein without clamping (p < 0.0001). Accordingly, the inflammatory infiltrate was more intense in the selectively perfused liver segments as compared with all other groups (p < 0.0001). Fluorescence was absent in lungs and kidneys and minimal in spleen. The clinical usefulness of adenovirus-mediated gene transfer to the liver largely depends on the reduction of its liver toxicity. Clamping of selected portal vein branches during injection allows for delivery of genes of interest to targeted liver segments. Transgene expression confined to selected liver segments may be useful in the treatment of focal liver diseases, including metastases.

Esophageal cancer as second primary tumor after breast cancer radiotherapy.

BACKGROUND: An increased risk of esophageal cancer has been reported in survivors of breast cancer treated with radiotherapy. This study further characterizes this association. METHODS: Through hospital databases, 118 patients (109 men, 9 women) treated for esophageal cancer between 1985 and 1993 were identified, of whom 37 had 60 synchronous or metachronous cancers. 5 women had primary esophageal cancer after having breast cancer, and are the subjects of this case-control study. RESULTS: All 5 women had been treated with radical mastectomy and adjuvant radiotherapy; none received chemotherapy. Their ages at the time of breast cancer ranged from 36 to 82 years; at esophageal cancer, 61 to 95 years. Time between radiotherapy and esophageal cancer varied from 13 to 31 years. All esophageal cancers were squamous cell carcinomas. Mean survival after esophageal cancer was 14.2 months. CONCLUSIONS: Radio-induced esophageal cancer can occur as a second primary cancer in women who survive at least 1 decade after mastectomy and adjuvant radiotherapy.

Value of laparoscopic staging for Hodgkin disease.

Because of the potential for complications with laparotomy and splenectomy, and the widespread use of combination chemotherapy as first-line treatment, surgical staging is now performed in only 30% of patients with Hodgkin disease. Laparoscopic staging has rarely been reported. Three patients with the nodular sclerosis cell type of Hodgkin disease underwent laparoscopic staging. Mean operative time was 207 minutes. No conversion to laparotomy was necessary. There were no peri- or postoperative complications and no deaths. Mean blood loss was negligible. The pathologist deemed all liver and lymph nodes biopsies adequate for histologic analysis. Stage IA and IIA were confirmed in two patients: one patient with stage IIA was upstaged to IIIA after surgery. Performed by an experienced team, laparoscopy is the procedure of choice for abdominal staging of patients with Hodgkin disease.

Angiogenesis of liver metastases: role of sinusoidal endothelial cells.

PURPOSE: Tumor-induced angiogenesis requires migration and remodeling of endothelial cells derived from pre-existing blood vessels. Vascular endothelial growth factor is the growth factor most closely implicated in the development of neovessels in colon cancer. However, vascular endothelial growth factor-specific receptors flt-1 and KDR mRNA expression are absent in normal sinusoid vessels surrounding vascular endothelial growth factor-producing secondary hepatic tumors. Thus, the potential role of sinusoidal endothelial cells in the mechanism of neovessel formation within liver metastatic carcinomas remains unclear. The purpose of this study was to determine whether sinusoidal endothelial cells are involved in tumor angiogenesis in a syngeneic model of liver metastases from colorectal cancer. METHODS: Sinusoidal endothelial cells were identified by fluorescence microscopy after uptake of acetylated low density lipoprotein labeled with a fluorescent probe (dioctadecylindocarbocyanine). One hundred microliters of dioctadecylindocarbocyanine acetylated low density lipoprotein were injected intraportally at the start of experiment in BD IX rats. Two days later, intraportal injection of 10(7) DHD K12, a chemically induced colon carcinoma cell line, was performed in syngeneic BD IX rats. Animals were killed one week later and the livers were processed for routine histologic examination and immunohistochemistry using the rat endothelial cell antigen-1 monoclonal antibody. RESULTS: In normal parenchyma fluorescence was associated with sinusoidal cells but not with endothelium of large blood vessels. Thus, specific acetylated low density lipoprotein uptake allowed histological differentiation of sinusoidal endothelial cells from other large-vessel endothelial cells present in the hepatic parenchyma. In tumor-bearing liver a spatial gradient of fluorescence was generated. Labeled cells accumulated at the periphery of the metastases. When tumors grow beyond 200 microm, neovessel formation was observed; there was an invasion of fluorescent-labeled cells from the periphery, which were arranged in a tubular formation within neoplasia. CONCLUSION: In liver metastases tumor vessels are lined with sinusoidal endothelial cells. Identification of a specific cell type involved in the formation of the stromal compartment of tumors has important implications. Sinusoidal endothelial cells express well-characterized surface receptors and differ morphologically and metabolically from large-vessel endothelia. They should be considered as attractive targets for future and existing antiangiogenic strategies directed against the stromal compartment of liver metastases.

Permanent access to the portal vein in rats: an experimental model.

A safe and reproducible method for placement of indwelling catheters into the portal venous system is a prerequisite for improved delivery of anticancer drugs to experimental liver metastases. Due to the lack of tumor models in large animals and the difficulty in establishing permanent access to the portal vein in rodents, this type of model has rarely been described in the laboratory setting. We propose a simple, minimally invasive method for repeated portal vein injections in rats. A vascular access device was used, which remained patent for periods of up to 3 months. Placement and support of the catheter tip in the portal vein was performed with a technique designed to avoid portal thrombosis and infections. Permanent portal vein access in a rodent model of liver metastases will be invaluable for the development of novel therapeutic strategies.

Growth inhibition of liver metastases by the anti-angiogenic drug TNP-470.

OBJECTIVE: This study was undertaken in order to assess the efficacy of a potent angiogenesis inhibitor, TNP-470, on tumor growth in a syngeneic rodent model of liver metastases from colorectal cancer. BACKGROUND: New blood vessel formation is a prerequisite for primary and metastatic tumor growth. TNP-470, a synthetic derivative of fumagillin when subcutaneously transplanted into nude mice, inhibits endothelial cell proliferation and migration, as well as the growth of various human cancers. However, the antitumor effect of this drug has not been studied in models reproducing a natural metastatic environment. Since the liver provides an extensive vascular bed for secondary tumor growth, an anti-angiogenic strategy may therefore be less efficient for treating hepatic metastases than primary tumors. METHODS: 10(7) DHD K12 colon carcinoma cells were injected intrasplenically into syngeneic BD IX rats to produce diffuse liver metastases. TNP-470 (30 mg/kg/day) was administered on alternate days starting 4 days after tumor implantation. The animals were sacrificed after 4 weeks and their livers were processed for histologic examination. In both the treatment and control groups (n=7), tumor volume was determined using a computerized analytical system, and tumor microvessel density was measured by immunostaining with anti-von Willebrand Factor monoclonal antibody. RESULTS: In vitro, TNP-470 demonstrated a direct toxicity towards the DHD K12 cell line with an IC50 of 0.1 microg/ml. Metastases were present in all animals from both groups. Liver weight (15.2 g vs 11.7 g, p=0.01), and tumor volume (1218 mm3 vs 406 mm3, p=0.03) were significantly reduced in the TNP-470 group compared to the control group. Tumor microvessel density was not statistically different between the two groups (67 vs 63 microvessels/x200 field, p=0.41). CONCLUSION: TNP-470 inhibits the growth of liver metastases in a syngeneic rat model of colorectal cancer. The mechanism responsible for this effect remains unclear, but may involve a combination of anti-angiogenic and direct cytotoxic effects.

Tracking multiple items through occlusion: clues to visual objecthood.

In three experiments, subjects attempted to track multiple items as they moved independently and unpredictably about a display. Performance was not impaired when the items were briefly (but completely) occluded at various times during their motion, suggesting that occlusion is taken into account when computing enduring perceptual objecthood. Unimpaired performance required the presence of accretion and deletion cues along fixed contours at the occluding boundaries. Performance was impaired when items were present on the visual field at the same times and to the same degrees as in the occlusion conditions, but disappeared and reappeared in ways which did not implicate the presence of occluding surfaces (e.g., by imploding and exploding into and out of existence instead of accreting and deleting along a fixed contour). Unimpaired performance did not require visible occluders (i.e., Michotte's tunnel effect) or globally consistent occluder positions. We discuss implications of these results for theories of objecthood in visual attention.

Indexing and the object concept: developing `what' and `where' systems.

The study of object cognition over the past 25 years has proceeded in two largely non-interacting camps. One camp has studied object-based visual attention in adults, while the other has studied the object concept in infants. We briefly review both sets of literature and distill from the adult research a theoretical model that we apply to findings from the infant studies. The key notion in our model of object representation is the `sticky' index, a mechanism of selective attention that points at a physical object in a location. An object index does not represent any of the properties of the entity at which it points. However, once an index is pointing to an object, the properties of that object can be examined and featural information can be associated with, or `bound' to, its index. The distinction between indexing and feature binding underwrites the distinction between object individuation and object identification, a distinction that turns out to be crucial in both the adult attention and the infant object-concept literature. By developing the indexing model, we draw together two disparate sets of literature and suggest new ways to study object-based attention in infancy.

What's next for managed care? Panel discussion.

Change continues to be health care's only constant in the United States. As enrollment in managed care organizations skyrockets, the glare of public scrutiny intensifies. Success is no longer as simple as undercutting traditional fee-for-service providers; MCOs have to become more responsive to consumer needs as they compete with one another. Whether substantial set of values or mere buzzword, quality is the lingua franca of the MCO arena. Although MCO executives attribute the concept's ubiquity to many factors, the common denominator is staying competitive in a high-growth industry. Along with the elimination of the gatekeeper, a major trend to watch for is the rise of industry oversight provided by standardized practice guidelines. MCO executives recognized that implementing such measures will streamline operations and make MCOs more user-friendly.