Blowout - Capping - Fracturing - Relief Well, A Full Cycle Workflow

Broaching is defined as the uncontrolled release of hydrocarbons to ocean seafloor after a loss of subsurface well control event. Failed attempts to cap the offshore wells undergoing worst case discharge may lead to hydraulic fracture initiation and subsequent propagation, leading to renewed release of hydrocarbon to the seafloor. During the capping stack shut-in process, pressure build-up will occur along the wellbore, exposing locations of possible fracture initiation to overpressurized fluid, such as directly below the casing shoe, and critical points along the well casing. Shall there be enough build-up pressure to exceed the minimum horizontal stress in an exposed layer, a fracture will initiate and may propagate as energy is provided from the movement of fluids in the wellbore. This can lead to a severe environmental impact on marine ecology if the fracture broaches to the seafloor. A quintessential example of fracture broaching during post-blowout is the Santa Barbara Channel Alpha Well 21 blowout in 1969 which resulted in an oil slick discovered near the discharging well. To help evaluate the possibility of such an event occurring in offshore waters of the Gulf of Mexico, numerical modeling is performed on a hypothetical case study using deepwater parameters examining the propagation of a “longitudinal” (i.e., parallel to the axis along the center of the wellbore) fracture during the containment or capping shut-in period. A workflow is developed for Worst Case Discharge (WCD) calculation, assessment of fracture initiation, propagation, and broaching during the capping shut-in period, and relief well heavy-mud injection strategy. A transient wellbore model accurately captures the fracture properties as they grow in height and length. The results of this study show that the growth of a fracture initiated from the side of the wellbore is sensitive to depth of the casing shoe where the fracture had initiated, young’s modulus of overburden rocks, and the duration of the preceding discharge period. In xiv addition, sufficient mud density, and pump rate are needed to compensate the oil column and successfully kill the main wellbore

Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy

Study DesignThis was a retrospective study.PurposeThe purpose of this study was to study the relationship between prevalence of pyramidal signs and the severity of cervical myelopathy. The study is focused on patients having increased signal intensity in T2-weighted magnetic resonance imaging.Overview of LiteratureCervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in elderly population. It is the consequence of spondylotic changes leading to cervical cord injury with resulting clinical deficits. Diagnosis in such patients is made based on clinical and radiographic features. A patient must have both symptoms and signs consistent with cervical cord injury as well as radiographic evidence of damage to spondylotic cord.MethodsForty-six patients with complaint of cervical spondylotic myelopathy with increased signal intensity in T2-weighted magnetic resonance imaging were included in the study. The neurological finding of the patients was reviewed for the presence of pyramidal signs. The prevalence of each pyramidal sign was calculated and correlated to severity of cervical myelopathy. The motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopedic Association (motor Japanese Orthopaedic Association score, m-JOA) scores were used to assess severity of myelopathy.ResultsThe most prevalent signs were hyperreflexia (89.1%), Hoffmann reflex (80.4%), Babiniski sign (56.5%), and ankle clonus (39.1%). Babiniski sign, ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score.ConclusionsIn patients with cervical myelopathy, hyperreflexia exhibited highest sensitivity whereas ankle clonus demonstrated lowest sensitivity. The prevalence of the pyramidal signs is correlated with increasing severity of myelopathy

Percutaneous Vertebroplasty: A First Line Treatment in Traumatic Non-Osteoporotic Vertebral Compression Fractures

Study DesignThis was a prospective cohort study.PurposeThe purpose of this study was to document and evaluate the clinical and radiological results of percutaneous vertebroplasty (PV) as a first line treatment in traumatic non-osteoporotic vertebral compression fractures (TNVCFs).Overview of LiteraturePV is commonly used for osteoporotic and neoplastic compression fractures, however its use in traumatic non-osteoporotic compression fractures is uncertain.MethodsWe included 23 patients with traumatic non-osteoporotic TNVCFs and normal bone mineral densitometry scores who were treated with PV. Pain was evaluated at 2 hours, 1 week, 1 month, 6 months, 1 year, and 2 years post procedure using the 10-point visual analogue scale (VAS). Ronald-Morris disability Questionnaire (RDQ) scores were also collected. Statistical analysis included a 2-tailed t test comparing postoperative data with preoperative values. Range of mobility was also evaluated.ResultsThe 23 patients had an average age of 36 years, and 69.5% were female. There was a significant improvement in VAS scores of pain at rest and in motionand in RDQ scores (p<0.05).ConclusionsThe results of this study proved that PV can be used successfully as a first line treatment in patients with non-osteoporotic compression fractures. It is also, an effective method to decrease pain, increase mobility, and decrease narcotic administration

Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty

Study DesignProspective cohort study.PurposeTo prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV).Overview of LiteratureAlthough PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain.MethodsSixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done.ResultsA good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups.ConclusionsPV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure

Paraoxonase 1 gene (Gln192–Arg) polymorphism and the risk of coronary artery disease in type 2 diabetes mellitus

AbstractBackgroundParaoxonase 1 (PON1) is reported to have antioxidant and cardioprotective properties. Recently, an association of glutamine (Gln) or type A/arginine (Arg) or type B polymorphism at position 192 of PON1 gene has been suggested with coronary artery disease (CAD) among patients with diabetes mellitus (DM). However, conflicting results have also been reported.ObjectivesTo investigate the relationship between PON1 gene (Gln192–Arg) polymorphism and the presence, extent and severity of CAD in type 2 DM.MethodsThe study comprised 180 patients recruited from those undergoing coronary angiography for suspected CAD, who were divided according to the presence or absence of CAD and DM into four groups: Group I (n=40 patients) nondiabetic subjects without CAD, Group II (n=45 patients) diabetic patients without CAD, Group III (n=47 patients) nondiabetic patients with CAD and Group IV (n=48 patients) diabetic patients with CAD. PON1(Gln192–Arg) genotype was assessed using polymerase chain reaction (PCR) followed by AlwI digestion.ResultsThe frequency of Gln allele (type A) was significantly higher in Group I and Group II compared to Group III and Group IV (62.5%, 60% vs. 38.3%, 31.25%, respectively, p<0.001) while the frequency of Arg allele (type B+type AB) was significantly higher in ischemic groups (III and IV) compared to nonischemic groups (I and II) (61.7%, 68.75% vs. 37.5%, 40%, respectively, p<0.001). Patients with CAD and DM (Group IV) have significantly higher severity score and vessel score than those with CAD only (Group III) (9.7±2.97, 2.44±0.56 vs. 6.99±3.71, 1.67±0.89, respectively, p<0.001) Patients with vessel score 3 had significantly higher severity score and higher Arg allele frequency than patients with vessel score 2, the latter group had also significantly higher severity score and Arg allele frequency than patients with vessel score 1 (8.9±2.79 vs. 5.21±2.13 and 80.49% vs. 67.86%), (5.21±2.13 vs. 3.11±0.89 and 67.86% vs. 53.85%), p<0.001 for all. In multivariate logistic regression analysis of different variables for prediction of CAD, age [OR 2.99, CI (1.11–10.5), p<0.01], smoking [OR 4.13, CI (1.37–11.7), p<0.001], low-density lipoprotein (LDL) cholesterol>100mg/dL [OR 4.31, CI (1.25–12.5), p<0.001], high-density lipoprotein (HDL) cholesterol<40mg/dL [OR 5.11, CI (1.79–16.33), p<0.001] and PON1 192 Arg allele [OR 4.62, CI (1.67–13.57), p<0.001] were significantly independent predictors of CAD.ConclusionArg allele of PON1 192 gene polymorphism is an independent risk factor for CAD and is associated not only with the presence of CAD but also with its extent and severity and its impact is clearly more pronounced in diabetic patients

Interior design and its impact on students' behavioral problems

Design decisions are usually dominated by concern for economic and material aspects, and neglect or omission of social and human aspects (human behavior), Thus, the needs and requirements of the individual users (basic education students) are ignored. This completely contradicts the views of the users of those spaces, as well as specialists in the field of psychology and sociology, about the role of design processes in achieving a suitable physical environment for the human behavior of the users of those spaces (the school building). Ignoring the requirements of the users on the one hand, and the behaviors of the users on the other hand creates an inefficient, and unfulfilled vacuum for the aesthetic, social, cultural, economic, and recreational goals. It is necessary to know the requirements needs, and behaviors of students to achieve successful spaces, as it is the main factor in the success of school buildings, given that the human being affects and is affected by the physical environment. From this standpoint, it is clear that urban designers should pay attention to the process of designing school buildings from a perspective based on behavioral human considerations, and there is a need to integrate studies of the physical environment with human studies (human behavior) in designing spaces to achieve the physical and moral functions of those spaces. educational environments affect the creation of a psychological atmosphere conducive to educating students and encouraging them to be creative, and are considered a strong basis in preparing a conscious generation that helps the renaissance and progress of society. Hence the need to pay attention to this environment (represented by educational spaces), which has become the basis for the development of the architectural educational environment, which is part of the educational and educational development. Many studies were conducted to find out the relationship between the behavioral problems of students and the geometric spaces of the educational building. Therefore, many researchers stressed the need to develop the engineering spaces of the educational building and to pay attention to their implementation and development in line with the needs of the times to produce more attractive schools for students. In light of this, the research problem was determined in the need to know the effect of interior design on students' behavior, achievement and scientific performance

A Novel Approach to Standard Techniques in the Assessment and Quantification of the Interventricular Systolic Relationship

<p>Abstract</p> <p>Background</p> <p>Blood flow between the right and left ventricles is subject to the continuity equation and systolic ventricular interdependence. Quantification of this relationship might aid in understanding inter-ventricular function. The purpose of this study was to evaluate and quantify ventricular interdependence by directly comparing right and left ventricular systolic function though echocardiographic surrogates of right and left ventricular systolic function such as MAPSE, TAPSE, RV TVI and LV TVI.</p> <p>Methods</p> <p>This study prospectively evaluated 51 healthy participants (mean age, 41 ± 17 years) by resting echocardiography. In addition to standard measurements, tricuspid annular plane of systolic excursion, (TAPSE), mitral annular plane of systolic excursion (MAPSE), and the peak annulus systolic velocity of the right ventricular (RVs) and left ventricular (LVs) free walls were measured by M-mode and pulsed wave Doppler tissue echocardiography and further evaluated for variance across age, gender, and body surface area.</p> <p>Results</p> <p>TAPSE (22.1 ± 2.9 mm) was over 54.5% greater than MAPSE (14.3 ± 2.6 mm) and RVs was 64.4% greater than LVs. The LV to RV systolic relationship measured by MAPSE/TAPSE and LVs/RVs ratios were 0.66 ± 0.14 and 0.76 ± 0.21 respectively. These values were not significantly affected by age, gender or body surface area (BSA).</p> <p>Conclusion</p> <p>MAPSE/TAPSE and LVs/RVs ratios appear stable across age, gender, and BSA potentially making them good surrogates of systolic ventricular relationship and interdependence.</p

Pre- and post-operative cardiac evaluation of dogs undergoing lobectomy and pneumonectomy

This study aimed to assess the influence of lobectomy and pneumonectomy on cardiac rhythm and on the dimensions and function of the right-side of the heart. Twelve dogs undergoing lobectomy and eight dogs undergoing pneumonectomy were evaluated preoperatively and one month postoperatively with electrocardiography and Doppler echocardiography at rest. Pulmonary artery systolic pressure (PASP) was estimated by the tricuspid regurgitation jet (TRJ) via the pulse wave Doppler velocity method. Systemic inflammatory response syndrome criteria (SIRS) were also evaluated based on the clinical and hematological findings in response to lobectomy and pneumonectomy. Following lobectomy and pneumonectomy, we predominantly detected atrial fibrillation and varying degrees of atrioventricular block (AVB). Dogs that died within seven days of the lobectomy (n = 2) or pneumonectomy (n = 1) had complete AVB. Preoperative right atrial, right ventricular, and pulmonary artery dimensions increased gradually during the 30 days (p<0.05) following pneumonectomy, but did not undergo significant changes during that same period after lobectomy. Mean PASP was 56.0 ± 4.5 mmHg in dogs having significant TRJ after pneumonectomy. Pneumonectomy, but not lobectomy, could lead to increases (p<0.01) in the SIRS score within the first day post-surgery. In brief, it is important to conduct pre- and postoperative cardiac evaluation of dogs undergoing lung resections because cardiac problems are a common postoperative complication after such surgeries. In particular, complete AVB should be considered a life-threatening complication after pneumonectomy and lobectomy. In addition, pneumonectomy appears to increase the likelihood of pulmonary hypertension development in dogs

The perceived impact of the Covid-19 pandemic on medical student education and training – an international survey

Abstract: Background: The Covid-19 pandemic led to significant changes and disruptions to medical education worldwide. We evaluated medical student perceived views on training, their experiences and changes to teaching methods during the pandemic. Methods: An online survey of medical students was conducted in the Autumn of 2020. An international network of collaborators facilitated participant recruitment. Students were surveyed on their perceived overall impact of Covid-19 on their training and several exposure variables. Univariate analyses and adjusted multivariable analysis were performed to determine strengths in associations. Results: A total of 1604 eligible participants from 45 countries took part in this survey and 56.3% (n = 860) of these were female. The median age was 21 (Inter Quartile Range:21–23). Nearly half (49.6%, n = 796) of medical students were in their clinical years. The majority (n = 1356, 84.5%) were residents of a low or middle income country. A total of 1305 (81.4%) participants reported that the Covid-19 pandemic had an overall negative impact on their training. On adjusted analysis, being 21 or younger, females, those reporting a decline in conventional lectures and ward based teaching were more likely to report an overall negative impact on their training (p ≤ 0.001). However, an increase in clinical responsibilities was associated with lower odds of participants reporting a negative impact on training (p < 0.001). The participant’s resident nation economy and stage of training were associated with some of the participant training experiences surveyed (p < 0.05). Conclusion: An international cohort of medical students reported an overall significant negative impact of the Covid-19 pandemic on their undergraduate training. The efficacy of novel virtual methods of teaching to supplement traditional teaching methods warrants further research