The consolidation of the Central Authority in Afghanistan under Amir 'Abd al-Rahman, 1880-1896.

The subject of this thesis is the establishment and consolidation of the power of Amir 'Abd al-Rahman in Afghanistan between 1880 and 1896.;'Abd al-Rahman reappeared in Afghanistan from exile in Russian Turkistan at a critical time when the British were considering how to establish a government satisfactory to their interest, in Kabul. 'Abd al-Rahman showed skill in obtaining both the support of anti-British groups (who were committed to the former ruling family) and the British themselves. At first, he obtained only the reduced state of Kabul, the British being determined to retain control of the province of Kandahar. Later, following the defeat of their army in Kandahar, the British reversed their former policy and evacuated Kandahar which passed to 'Abd al-Rahman. Subsequently, 'Abd al-Rahman succeeded in expelling Mohammad Ayub (a brother of the former Amir) from Herat and thus establishing his rule over the whole of Afghanistan, (chapters 2 and 3).;'Abd al-Rahman then extended and consolidated his rule over the provinces at the expense of the authority of the tribal elders and dynastic governors. This led to conflict between him and the elders, who aroused the tribes against him. The several disturbances which ensued are described. They were all ultimately suppressed (chapters 4, 5 and 6). Further, the Amir brought under control the territories of the Hazarajat and Kafiristan (chapters 7 and 8). At the same time, the Government of India contained the extension of the Amir's authority into the territories beyond the frontiers which the Government of India was largely instrumental in establishing for Afghanistan during the reign of 'Abd al-Rahman

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Afghanistan: the Soviet invasion and the Afghan response, 1979-1982

Few people are more respected or better positioned to speak on the Soviet invasion of Afghanistan than M. Hassan Kakar. A professor at Kabul University and scholar of Afghanistan affairs at the time of the 1978 coup d'état, Kakar vividly describes the events surrounding the Soviet invasion in 1979 and the encounter between the military superpower and the poorly armed Afghans. The events that followed are carefully detailed, with eyewitness accounts and authoritative documentation that provide an unparalleled view of this historical moment.Because of his prominence Kakar was at first treated with deference by the Marxist government and was not imprisoned, although he openly criticized the regime. When he was put behind bars the outcry from scholars all over the world possibly saved his life. In prison for five years, he continued collecting information, much of it from prominent Afghans of varying political persuasions who were themselves prisoners.Kakar brings firsthand knowledge and a historian's sensibility to his account of the invasion and its aftermath. This is both a personal document and a historical one - Kakar lived through the events he describes, and his concern for human rights rather than party politics infuses his writing. As Afghans and the rest of the world try to make sense of Afghanistan's recent past, Kakar's voice will be one of those most listened to

Mixture and rheological performance of asphalt binders blended with cecabase warm mix additive

Warm mix asphalt (WMA) is gaining popularity due to its lower production and laying temperatures that benefits the environment. This paper presents the effects of a surfactant based warm additive, Cecabase®, on the rheological properties of asphalt binder and mixture compactibility. The rheological properties of asphalt binder were measured using a rotational viscometer and dynamic shear rheometer (DSR). Asphalt mixture compactibility was evaluated during compaction using the gyratory compactor based on the degree of compaction and compaction energy index (CEI). From the viscosity and DSR test results, the surfactant based warm additive has no effect on the binder rheology. The compactibility test results shows that all of the WMA mixtures exhibit better compactibility than the hot mix asphalt (HMA). The results shows that it requires less effort to compact WMA at 140°C compared with HMA compacted at 170°C. The CEI results show that it will take more energy to compact HMA specimens compared with compacting WMA at different temperatures. Mixtures with lower CEI exhibits better constructability and are desirable, while too low CEI could be an indication of a tender mixture and should be avoided