Current status of the Cincinnati GCL test plots

This paper describes the design, layout, construction and current status on the performance of fourteen full scale test plots targeted at assessing the internal shear strength of GCLs in landfill cover applications. Five different commercially available GCLs from four manufacturers were used in the study. Each test plot is two geosynthetic clay line roll widths wide, with lengths of 29m (95 ft) on the 3(H)-to-1(V) (horizontal-to-vertical) slopes and 20m (67 ft) on the 2(H)-to-1(V) (horizontal-to-vertical) slopes. The plots are being monitored with numerous deformation ‘telltales’ as well as subgrade and GCL moisture gages.

Two slides occurred shortly after construction. Both involved the upper surfaces of the GCLs against the overlying textured geomembranes. The slides were clearly the result of bentonite lubricated interfaces and (although of interest) did not relate to the internal shear strength focus and goals of the project.

Upon inducing internal shear stress in the GCLs by cutting all of the overlying geosynthetics, the deformations have been small except for one plot. This plot involved a unreinforced bentonite GCL, sandwiched between two geomembranes. It was sampled and found to have a large region of unexpected and excessively high moisture content. Subsequently, the test plot slid, the interface being the upper geomembrane against the bentonite of the GCL. The test plot was constructed a second time and the current response is more in keeping with the anticipated behaviour. Other than these slides, however, all of the other GCL plots appear to be stable.

If the internal stability of the GCLs continue, it can be assumed that the 2(H)-to-1(V) slopes have a factor-of-safety of 1.0 or greater. This being the case, the 3(H)-to-1(V) slopes have a factor-of-safety of 1.5 or greater. While this hypothesis is still being substantiated, it speaks well for the internal shear strength of the GCLs used in the study when properly installed. The project is ongoing as of, the writing of this paper.     

Massive hemorrhage caused by a perforating Gianturco-Z stent resulting in an aortoesophageal fistula

Squamous cell carcinoma of the tonsil has a relatively poor prognosis. Aggressive surgery, radiation therapy and combinations of irradiation and surgery have been employed but there exists some controversy about the efficacy of these treatment modalities. The purpose of this paper is to compare the efficacy of treatment between the surgery followed by radiation therapy and the preoperative radiation therapy followed by surgical resection. The medical records of 33 patients treated for squamous cell carcinoma of the tonsil at the Department of Otolaryngology-Head and Neck Surgery, Korea University Hospital between 1989-1993 were reviewed retrospectively. None of the patients were stage I, but stage II, III, and IV were four, five, and 24 patients, respectively. There were 30 males and three females. The most common histopathology was moderately differentiated squamous cell carcinoma (20/33). The 13 patients treated initially with surgery had an overall three-year survival rate of 38.5%, and the rate for the 20 patients treated initially with radiation was 40%. The main pattern of treatment failure was a local recurrence and neck metastases, and pathologic differentiation thought to be an important prognostic factor. Complications are fewer in patients treated initially with surgery (23.1%) than patients initially treated with radiation (50.0%). There is no difference in the efficacy between the two therapeutic groups.     

Evaluation of the diagnostic usefulness of CA125 immunoscintigraphy for ovarian carcinoma follow-up after treatment: contribution of this technique in Grenoble University Medical Center

Immunoscintigraphy using indium-111-labeled OC125 monoclonal antibody F(ab')2 fragments is a technic complementary of morphological imaging (i.e. ultrasonography and computed tomography). It allows early detection of recurrences of ovarian carcinomas. We performed immunoscintigraphy 30 times in 26 patients who previously underwent radical treatment for ovarian carcinoma, and were suspected to have a recurrence. Our purposes were appreciation of diagnostic accuracy of the method, and above all its impact on clinical decisions and evolution of the patients. There were, after reevaluation of the results, 18 true positives, 7 true negatives, 3 false negatives and 2 false positive cases (sensitivity 85.7%, specificity 77.8%). Bayesian analysis showed positive and negative predictive values of 86% and 87% when probability of recurrence a priori was 50%, and 80% and 58% when probability of recurrence a priori was 70%. The result of immunoscintigraphy contributed to clinical decisions in 24 cases out of 30, and led to a correct decision for the patient in 21 cases. Conversely, for the 6 cases in which the result has not been considered, to take this result into account would have been beneficial in 4 cases, but harmful in 2. Finally, survival tended to be longer when immunoscintigraphy was negative, which could be associated with a better prognosis. We conclude that OC125-immunoscintigraphy may be useful for ovarian carcinoma follow-up and may contribute to a better therapeutic strategy.     

Vergleich von hydraulischen und chemischen Sedimenteigenschaften aus Spül- und Kernbohrungen im Raum Peine (Norddeutschland)

Comparison of hydraulic and chemical properties of sediments from flush- and core drillings in the area of Peine (Germany). Because of financial constraints, investigations of nitrate metabolism are often based on disturbed borehole samples. It is arguable, however, whether disturbed samples are suitable for these types of investigations. Disadvantages of disturbed samples in comparison to undisturbed core samples are well known and include possible contamination of the sample by mud additives, destruction of the sediment formation and the insecurity concerning the correct depth allocation. In this study, boreholes were drilled at three locations to a maximum depth of 50?m. The extracted samples, as intact sediment cores and drill cuttings, were studied with regard to chemical and hydraulic parameters of the aquifer sediments. The results show: 1. hydraulic parameters are not affected by clay-based mud; 2. disturbed samples contain less fine grain material relative to the core samples, and the hydraulic conductivity can only be estimated from catch samples; 3. catch samples contain fewer reducing agents (sulphides, organic carbon) than core samples in hydraulically passive zones (defined as K < 10^–6?m?·?s^–1); 4. the results of analyses of disturbed and undisturbed core samples are in good agreement for hydraulically active zones (K ≥ 10^–6?m?·?s^–1).     

Perfluorinated acids in Arctic snow: new evidence for atmospheric formation

Perfluorinated acids (PFAs) are ubiquitously found in water and biota, including remote regions such as the High Arctic. Under environmental conditions, PFAs exist mainly as anions and are not expected to be subject to long-range atmospheric transport in the gas phase. Fluorinated telomer alcohols (FTOHs) are volatile and can be atmospherically oxidized to form perfluorocarboxylic acids. Analogously, fluorosulfamido alcohols can be oxidized to form perfluorooctane sulfonate (PFOS). High Arctic ice caps experience contamination solely from atmospheric sources. By examining concentrations of PFAs in ice cap samples, it is possible to determine atmospheric fluxes to the Arctic. Ice samples were collected from high Arctic ice caps in the spring of 2005 and 2006. Samples were concentrated using solid-phase extraction and analyzed by LC-MS-MS. PFAs were observed in all samples, dating from 1996 to 2005. Concentrations were in the low-mid pg L(-1) range and exhibited seasonality, with maximum concentrations in the spring-summer. The presence of perfluorodecanoic acid (PFDA) and perfluoroundecanoic acid (PFUnA) on the ice cap was indicative of atmospheric oxidation as a source. Ratios of PFAs to sodium concentrations were highly variable, signifying PFA concentrations on the ice cap were unrelated to marine chemistry. Fluxes of the PFAs were estimated to the area north of 65 degrees N for the 2005 season, which ranged from 114 to 587 kg year(-1) for perfluorooctanoic acid (PFOA), 73 to 860 kg year(-1) for perfluorononanoic acid (PFNA), 16 to 84 kg year(-1) for PFDA, 26 to 62 kg year(-1) for PFUnA, and 18 to 48 kg year(-1) for PFOS. The PFOA and PFNA fluxes agreed with FTOH modeling estimations. A decrease in PFOS concentrations through time was observed, suggesting a fast response to changes in production. These data suggest that atmospheric oxidation of volatile precursors is a primary source of PFAs to the Arctic.     

Unusual case of tracheal agenesis

We describe the clinical presentation and pathological features of an unusual case of tracheal agenesis. The axial derivatives of the primitive foregut between the larynx and stomach were represented by a single structure featuring sequential segmentation into regions showing exclusively tracheal or esophageal differentiation in a pattern that is not easily classified by existing nosologic systems nor explained by the conventional hypothesis of dysontogenesis.     

Die effiziente Organisation

Definition of the problem The hospital as an organization has undergone substantial changes during recent decades due to reforms in the health care system. There have been necessary and quite helpful modifications; however, some modifications raise the question: what public tasks should hospitals fulfill in the future? The following question, thus, arises: what kind of effectiveness, besides cutting costs, should be achieved by the permanent increase of efficiency in hospitals? Paradoxically spoken, the change of the organization hospital seems to be entailed by economization which at the same time is meant to be a remedy for change. Arguments This article reflects on the process of economization from an ethical perspective using patterns from organizational and institutional theory, e.g., a model to evaluate levels of economization contributed by the French sociologist Pierre Bourdieu, applied in this case to German hospitals. Conclusion Market-driven incentives are no answer to the question which goals (i.e., morally, socially, and legally) the health care system should meet. Therefore, public deliberation and performance-orientated shaping of the institutions is required.