Occult pneumothorax, revisited

Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving. In cases of trauma patients where cervical spine immobilization is mandatory, supine AP chest radiograph is the most practical initial study. It is however not as sensitive as CT chest for early detection of a pneumothorax. "Occult" pneumothorax is an accepted definition of an existing but usually a clinically and radiologically silent disturbance that in most patients can be tolerated while other more urgent trauma needs are attended to. However, in certain patients, especially those on mechanical ventilation (with subsequent increase of intrapleural air with positive pressure ventilation), missing the diagnosis of pneumothorax can be deleterious with fatal consequences. This review will discuss the occult pneumothorax in the context of 3 radiological examples, which will further emphasize the entity. Because a negative AP chest radiograph can dangerously delay its recognition, we recommend that any trauma victim presenting to the emergency department with symptoms of respiratory distress should be screened with either thoracic ultrasonography or chest CT scan to avoid missing a pneumothorax

The pre-breakup stratigraphy and petroleum system of the Southern Jan Mayen Ridge revealed by seafloor sampling

The authors would like to acknowledge the contribution from the vessel’s crew (captain I. Rasmussen) and operator (Thor Ltd), the two surveyors (K. Høysæth and H.B. Bortne), and two sampling assistants (F. Gausepohl and A.-M. Voelsch). Sverre Planke and Dougal Jerram are partly funded through a Norwegian Research Council Centers of Excellence project (project number 223272, CEED). Adriano Mazzini is funded by the European Research Council under the European Union's Seventh Framework Programme Grant agreement n° 308126 (LUSI LAB project, PI A. Mazzini). TGS and VBPR funded the cruise and allowed the publication of the data and interpretation. Steve Killops from APT refined our interpretation of the biomarker data. The reviewers and the editor are also thanked for their constructive comments. Finally, this article is dedicated to the biostratigrapher Haavard Selnes who sadly passed away in 2015.Peer reviewedPostprin

Igneous seismic geomorphology of buried lava fields and coastal escarpments on the Vøring volcanic rifted margin

Voluminous igneous complexes are commonly present in sedimentary basins on volcanic rifted margins, and they represent a challenge for petroleum explorationists. A 2500 km2 industry-standard 3D seismic cube has recently been acquired on the Vøring Marginal High offshore mid-Norway to image subbasalt sedimentary rocks. This cube also provides a unique opportunity for imaging top- and intrabasalt structures. Detailed seismic geomorphological interpretation of the top-basalt horizon, locally calibrated with high-resolution P-Cable wide-azimuth data, reveals new insight into the late-stage development of the volcanic flow fields and the kilometer-high coastal Vøring Escarpment. Subaerial lava flows with compressional ridges and inflated lava lobes cover the marginal high, with a comparable structure and size to modern subaerial lava fields. Pitted surfaces, likely formed by lava emplaced in a wet environment, are present in the western part of the study area near the continent-ocean boundary. The prominent Vøring Escarpment formed when eastward-flowing lava reached the coastline. The escarpment morphology is influenced by preexisting structural highs, and these highs are locally bypassed by the lava. Volcanogenic debris flows are well-imaged on the escarpment horizon, along with large-scale large slump blocks. Similar features exist in active volcanic environments, e.g., on the south coast of Hawaii. Numerous postvolcanic extensional faults and incised channels cut into the marginal high and the escarpment, and we found that the area was geologically active after the volcanism ceased. In summary, igneous seismic geomorphology and seismic volcanostratigraphy are two very powerful methods to understand the volcanic deposits and development of rifted margins. Our study demonstrates great promise for further understanding the igneous development of offshore basins as more high-quality 3D seismic data become available

Pre-breakup magmatism on the Vøring margin: Insight from new sub-basalt imaging and results from Ocean Drilling program hole 642E

Highlights • Sub-basalt imaging improvement on the Vøring Margin • Definition of a new seismic facies unit: the Lower Series Flows • Significant organic carbon content within the melting crustal segment • Apectodinium augustum marker for the PETM is reworked into the Lower Series Flows • The Lower Series Flows, early Eocene in age, predate the Vøring Margin breakup Abstract Improvements in sub-basalt imaging combined with petrological and geochemical observations from the Ocean Drilling Program (ODP) Hole 642E core provide new constraints on the initial breakup processes at the Vøring Margin. New and reprocessed high quality seismic data allow us to identify a new seismic facies unit which we define as the Lower Series Flows. This facies unit is seismically characterized by wavy to continuous subparallel reflections with an internal disrupted and hummocky shape. Drilled lithologies, which we correlate to this facies unit, have been interpreted as subaqueous flows extruding and intruding into wet sediments. Locally, the top boundary of this facies unit is defined as a negative in polarity reflection, and referred as the K-Reflection. This reflection can be correlated with the spatial extent of pyroclastic deposits, emplaced during transitional shallow marine to subaerial volcanic activities during the rift to drift transition. The drilled Lower Series Flows consist of peraluminous, cordierite bearing peperitic basaltic andesitic to dacitic flows interbedded with thick volcano-sedimentary deposits and intruded sills. The peraluminous geochemistry combined with available C (from calcite which fills vesicles and fractures), Sr, Nd, and Pb isotopes data point towards upper crustal rock-mantle magma interactions with a significant contribution of organic carbon rich pelagic sedimentary material during crustal anatexis. From biostratigraphic analyses, Apectodinium augustum was found in the The Lower Series Flows. This species is a marker for the Paleocene – Eocene Thermal Maximum (PETM). However, the absence of very low carbon isotope values (from bulk organic matter), that characterize the PETM, imply that A.augustum was reworked into the early Eocene sediments of this facies unit which predate the breakup time of the Vøring Margin. Finally, a plausible conceptual emplacement model for the Lower Series Flows facies unit is proposed. This model comprises several stages: (1) the emplacement of subaqueous peperitic basaltic andesitic flows intruding and/or extruding wet sediments; (2) a subaerial to shallow marine volcanism and extrusion of dacitic flows; (3) a proto-breakup phase with intense shallow marine to subaerial explosive volcanism responsible for pyroclastic flow deposits which can be correlated with the seismic K-Reflection and (4) the main breakup stage with intense transitional tholeiitic MORB-type volcanism and large subsidence concomitant with the buildup of the Seaward Dipping Reflector wedge

الشركات الناشئة وإدارة رأس المال البشري في مصر: رحلة البحث عن وظائف لائقة

تُعد الشركات الناشئة أحد العناصر التي من الممكن أن تساهم في النمو الاقتصادي في مصر، إلا أنها تواجه تحديات عديدة تعرقل قدرتها على تحقيق إمكاناتها، واستدامتها في السوق، وقدرتها على توفير فرص عمل لائقة. وتشمل التحديات: صعوبة تحديد مصدر التمويل، واستدامته وتعقد الإطار القانوني والتنظيمي الذي ينظمها, بالإضافة إلى المعايير الاجتماعية، والثقافة المحافظة، ونقص البيانات والمعلومات المتعلقة بديناميات السوق والفرص المتاحة. وقد أوضحت نتائج البحث أن العديد من الشركات الناشئة تواجه تحديات في إدارة رأس المال البشري لديها فيما يتعلق بمهام التخطيط ،أو اجتذاب الموارد البشرية أو التطوير ،أو الجزاءات. وتتناول هذه الورقة النظام البيئي الحالي للشركات الناشئة في مصر مع التركيز على إدارة رأس المال البشري، وتطرح الورقة السؤال البحثي الرئيسي التالي: ما هو المطلوب لكي تنجح الشركات الناشئة في مصر، والأهم من ذلك ما الذي يمكن عمله لمساعدتها على توفير وظائف لائقة؟ وتتبنى الورقة إطار العمل اللائق الذي قدمته منظمة العمل الدولية، فيتم تعريف الوظيفة اللائقة وفقا له بأنها وظيفة ذات جودة مقبولة فيما يتعلق بضمان الإنتاجية، والحماية الاجتماعية، وحقوق العمل، والحوار الاجتماعي

Breakup volcanism and plate tectonics in the NW Atlantic

The seismic, magnetic, and gravity data presented in this study were provided by TGS. Seismic interpretation was done using HS Kingdom software. Grid interpolations and map compilations were established using Geosoft Oasis Montaj and ArcGis softwares. We would like thank Craig Magee, Alexander Lewis Peace, the Editor and the Associated Editor for helpful comments and guidance that improved the paper. We acknowledge the support from the Research Council of Norway through its Center of Excellence funding scheme, project 223272 (CEED).Peer reviewedPostprin

Investigation of the Performance of the New Orleans Flood Protection System in Hurricane Katrina on August 29, 2005: Volume 1

This report presents the results of an investigation of the performance of the New Orleans regional flood protection system during and after Hurricane Katrina, which struck the New Orleans region on August 29, 2005. This event resulted in the single most costly catastrophic failure of an engineered system in history. Current damage estimates at the time of this writing are on the order of $100 to$200 billion in the greater New Orleans area, and the official death count in New Orleans and southern Louisiana at the time of this writing stands at 1,293, with an additional 306 deaths in nearby southern Mississippi. An additional approximately 300 people are currently still listed as “missing”; it is expected that some of these missing were temporarily lost in the shuffle of the regional evacuation, but some of these are expected to have been carried out into the swamps and the Gulf of Mexico by the storm’s floodwaters, and some are expected to be recovered in the ongoing sifting through the debris of wrecked homes and businesses, so the current overall regional death count of 1,599 is expected to continue to rise a bit further. More than 450,000 people were initially displaced by this catastrophe, and at the time of this writing more than 200,000 residents of the greater New Orleans metropolitan area continue to be displaced from their homes by the floodwater damages from this storm event. This investigation has targeted three main questions as follow: (1) What happened?, (2) Why?, and (3) What types of changes are necessary to prevent recurrence of a disaster of this scale again in the future? To address these questions, this investigation has involved: (1) an initial field reconnaissance, forensic study and data gathering effort performed quickly after the arrival of Hurricanes Katrina (August 29, 2005) and Rita (September 24, 2005), (2) a review of the history of the regional flood protection system and its development, (3) a review of the challenging regional geology, (4) detailed studies of the events during Hurricanes Katrina and Rita, as well as the causes and mechanisms of the principal failures, (4) studies of the organizational and institutional issues affecting the performance of the flood protection system, (5) observations regarding the emergency repair and ongoing interim levee reconstruction efforts, and (6) development of findings and preliminary recommendations regarding changes that appear warranted in order to prevent recurrence of this type of catastrophe in the future. In the end, it is concluded that many things went wrong with the New Orleans flood protection system during Hurricane Katrina, and that the resulting catastrophe had it roots in three main causes: (1) a major natural disaster (the Hurricane itself), (2) the poor performance of the flood protection system, due to localized engineering failures, questionable judgments, errors, etc. involved in the detailed design, construction, operation and maintenance of the system, and (3) more global “organizational” and institutional problems associated with the governmental and local organizations responsible for the design, construction, operation, maintenance and funding of the overall flood protection system

Design and Organization of the Dexamethasone, Light Anesthesia and Tight Glucose Control (DeLiT) Trial: a factorial trial evaluating the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery

<p>Abstract</p> <p>Background</p> <p>The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia.</p> <p>Methods/Design</p> <p>The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs. conventional glucose control, and light vs deep anesthesia in patients undergoing major non-cardiac surgery. Anesthetic depth will be estimated with Bispectral Index (BIS) monitoring (Aspect medical, Newton, MA). The primary outcome is a composite of major postoperative morbidity including myocardial infarction, stroke, sepsis, and 30-day mortality. C-reactive protein, a measure of the inflammatory response, will be evaluated as a secondary outcome. One-year all-cause mortality as well as post-operative delirium will be additional secondary outcomes. We will enroll up to 970 patients which will provide 90% power to detect a 40% reduction in the primary outcome, including interim analyses for efficacy and futility at 25%, 50% and 75% enrollment.</p> <p>Discussion</p> <p>The DeLiT trial started in February 2007. We expect to reach our second interim analysis point in 2010. This large randomized controlled trial will provide a reliable assessment of the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery. The factorial design will enable us to simultaneously study the effects of the three interventions in the same population, both individually and in different combinations. Such a design is an economically efficient way to study the three interventions in one clinical trial vs three.</p> <p>Trial registration</p> <p><b>This trial is registered at </b>Clinicaltrials.gov <b>#</b>: NTC00433251</p

Mapping health and wellbeing across the firefighting career and assessing the current demands survey data set

This data set collected between June and August 2022 explores the health and wellbeing of staff within the UK Fire and Rescue Sector. Using validated psychological scales the NTU research team designed and distributed the survey to all services across the UK to gather a baseline understanding of health and wellbeing. This was used to support an NFCC, Fire Fighters Chairty and Home Office supported project. It was designed and delivered to inform the development of the next health and wellbeing strategy for the sector. We gathered over 3,084 responses, 2,457 (at up to 71% completed) and 2,224 at 100% completed. This dataset includes all complete responses taken from all services in the UK. Service and responder details have been removed from the raw Qualtrics dataset to avoid triangulation and identification of specific responses within individual services. Therefore, these data offers a fully anonymised, national level data set on the wellbeing of staff across all roles within the sector