The New Pretender: A Large UK Case Series of Retinal Injuries in Children Secondary to Handheld Lasers

Purpose: To characterize a large single-center series of retinal injuries in children secondary to handheld laser devices, with emphasis on potential prognostic factors. / Design: Retrospective case series. / Methods: Sixteen children (24 eyes) with retinal injuries secondary to handheld lasers were identified from our electronic patient record system. Case notes, digital fundus photography, and spectral-domain optical coherence tomography images were reviewed. / Results: The mean age of affected children was 12.7 years (range 9–16 years), with 12 male and 4 female subjects. Mean follow up was 5.4 months (range 1–23 months). Five children (31%) were referred as suspected retinal dystrophies. The mean logMAR visual acuity at presentation was 0.30 (20/40) (range −0.20 [20/12.5] to 1.6 [20/800]). Eleven children (69%; 15 eyes) had “mild” injuries with focal retinal disruption confined to the photoreceptor and ellipsoid layers; such injuries were associated with a better prognosis, the mean visual acuity at presentation being 0.10 (20/25). “Moderate” injuries were seen in 3 eyes of 2 children, with retinal disruption confined to the outer retinal layer but diffuse rather than focal in nature. Three patients (4 eyes) had “severe” injuries, with subfoveal outer retinal architecture loss and overlying hyperreflective material in inner retinal layers. / Conclusion: Retinal injuries secondary to handheld laser devices may be difficult to diagnose and are likely underreported. It is important that such data are in the public domain, so regulatory authorities recognize the importance of laser retinopathy as an avoidable cause of childhood visual impairment and take steps to minimize the incidence and impact of laser injuries

Brittleness of gas shale reservoirs: A case study from the north Perth basin, Australia

Shale reservoirs have gained the attention of many in recent years due to their potential as a major gas resource. Production from this kind of formation, however, requires an accurate estimation of brittleness and employments of hydraulic fracturing. There have been many studies as to how brittleness can be estimated, but few research works were carried out so far indicating how brittleness indices vary in gas shale formations. The aim of this paper is to evaluate the variation of brittleness in one of the gas shale reservoirs located in the north Perth Basin of Australia. The results obtained indicated that the lower part of the Carynginia shale should be selected for a hydraulic fracturing job due to a high brittleness index, although a careful analysis of Total Organic Content (TOC) might be required before initiating any plans. The mineralogical report and interpretations revealed that the space created by cross-plotting the elastic parameters is able to identify dominant minerals contributing into brittleness. Performing a series of true triaxial tests, which are capable of simulating the real field condition by applying three independent principal stresses, implied that as the stress anisotropy increases, a transition takes place from brittle towards the ductile behaviours. However, when this anisotropy becomes significant, samples regain their strength. This study, therefore, recommends more studies to get a practical conclusion on brittleness under true triaxial conditions

Characterizing the hydraulic properties of paper coating layer using FIB-SEM tomography and 3D pore-scale modeling

AbstractPaper used in the printing industry generally contains a relatively thin porous coating covering a thicker fibrous base layer. The three-dimensional pore structure of coatings has a major effect on fluid flow patterns inside the paper medium. Understanding and quantifying the flow properties of thin coating layers is hence crucial. Pore spaces within the coating have an average size of about 180nm. We used scanning electron microscopy combined with focused ion beam (FIB-SEM) to visualize the nano-scale pore structure of the paper coating layer. Post-processing of the FIB-SEM images allowed us to reconstruct the three-dimensional pore space of the coating. The 3D FIB-SEM images were analyzed in detail to obtain pore size distribution and porosity value. The permeability was estimated using the GeoDict software, based on solutions of the Stokes equation. By determining the porosity and permeability of increasingly larger domain sizes, we estimated the size of a representative elementary volume (REV) for the coating layer to be 60µm3, which is well within the volume analyzed using FIB-SEM. The estimated porosity and permeability of the REV domain were 0.34 and 0.09 mDarcy, respectively. Using the pore morphology method, capillary pressure-saturation (Pc-S) and relative permeability curves of the REV domain could be constructed next. The Pc-S curves showed that the coating had a high air entry suction, which is very favorable for printing in that ink will invade the coating as soon as it is applied to the coating. Our results are essential for macroscale modelling of ink penetration into a coating layer during inkjet printing. Macroscopic models can be valuable tools for optimization of the penetration depth and the spreading of ink on and within paper substrates

A nano-particle based approach to improve filtration control of water based muds under high pressure high temperature conditions

There have been many attempts to improve the filtration control of water based muds under High Pressure High Temperature (HPHT) condition using a cost effective approach. Nano particles are perhaps the best option considering their successful applications reported in many studies. However, they are often expensive and pose unfavourably changes on the rheology of the muds. In this paper, an attempt was made to show the application of Nano Glass Flakes (NGFs) as a cheap but effective nano particle to control the filtration of water based muds under HPHT conditions. Performing a series of rheology, filtration and conductivity tests on the mud samples with unmodified NGFs revealed that this nano particle increases the mud rheology, yield point and gel strength of the mud with a slight impact on the filtration loss. However, by modifying the surface charges of NGFs with a cationic surfactant, filtration loss was significantly reduced without any severe impacts on the mud rheology. Considering the conductivity of the mud which increases by adding the modified NGF, this nano particle might be a good choice to improve the overall performance of water based muds under HPHT conditions

Textile-reinforced mortar (TRM) versus fibre-reinforced polymers (FRP) in flexural strengthening of RC beams

The aim of this paper is to compare the flexural performance of reinforced concrete (RC) beams strengthened with textile-reinforced mortar (TRM) and fibre-reinforced polymers (FRP). The investigated parameters included the strengthening material, namely TRM or FRP; the number of TRM/FRP layers; the textile surface condition (coated and uncoated); the textile fibre material (carbon, coated basalt or glass fibres); and the end-anchorage system of the external reinforcement. Thirteen RC beams were fabricated, strengthened and tested in four-point bending. One beam served as control specimen, seven beams strengthened with TRM, and five with FRP. It was mainly found that: (a) TRM was generally inferior to FRP in enhancing the flexural capacity of RC beams, with the effectiveness ratio between the two systems varying from 0.46 to 0.80, depending on the parameters examined, (b) by tripling the number of TRM layers (from one to three), the TRM versus FRP effectiveness ratio was almost doubled, (c) providing coating to the dry textile enhanced the TRM effectiveness and altered the failure mode; (d) different textile materials, having approximately same axial stiffness, resulted in different flexural capacity increases; and (e) providing end-anchorage had a limited effect on the performance of TRM-retrofitted beams. Finally, a simple formula proposed by fib Model Code 2010 for FRP reinforcement was used to predict the mean debonding stress developed in the TRM reinforcement. It was found that this formula is in a good agreement with the average stress calculated based on the experimental results when failure was similar to FRP-strengthened beams

Shear strengthening of concrete members with TRM jackets: Effect of shear span-to-depth ratio, material and amount of external reinforcement

An experimental work on reinforced concrete (RC) rectangular beams strengthened in shear with textile reinforced mortar (TRM) jackets is presented in this paper, with focus on the following investigated parameters: (a) the amount of external TRM reinforcement ratio, ρf, by means of using different number of textile layers and different types of textile fibre materials (carbon, glass, basalt); (b) the textile geometry, and (c) the shear span-to-depth ratio, a/d. In total, 22 tests were conducted on simply supported rectangular RC beams under (three-point bending) monotonic loading. The experimental results revealed that: (1) TRM is very effective when the failure is attributed to debonding of the TRM jacket from the concrete substrate; (2) the trend of effective strains for carbon, glass and basalt TRM jackets is descending for increasing values of the TRM reinforcement ratio, ρf, when failure is associated to debonding of the jacket; (3) the effect of textile geometry is significant only for low values of ρf, resulting in variances in the capacity enhancement and the failure modes, and (4) the shear span-to-depth ratio has practically no effect to the failure mode nor to the TRM jacket contribution to the total shear resistance of the RC beams

Bond between textile-reinforced mortar (TRM) and concrete substrates: experimental investigation

This paper presents an extended experimental study on the bond behaviour between textile-reinforced mortar (TRM) and concrete substrates. The parameters examined include: (a) the bond length (from 50 mm to 450 mm); (b) the number of TRM layers (from one to four); (c) the concrete surface preparation (grinding versus sandblasting); (d) the concrete compressive strength (15 MPa or 30 MPa); (e) the textile coating; and (f) the anchorage through wrapping with TRM jackets. For this purpose, a total of 80 specimens were fabricated and tested under double-lap direct shear. It is mainly concluded that: (a) after a certain bond length (between 200 mm and 300 mm for any number of layers) the bond strength marginally increases; (b) by increasing the number of layers the bond capacity increases in a non-proportional way, whereas the failure mode is altered; (c) concrete sandblasting is equivalent to grinding in terms of bond capacity and failure mode; (d) concrete compressive strength has a marginal effect on the bond capacity; (e) the use of coated textiles alters the failure mode and significantly increases the bond strength; and (f) anchorage of TRM through wrapping with TRM jackets substantially increases the ultimate load capacity

The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement From the Fleischner Society.

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first three months of 2020, the COVID-19 pandemic has emerged as an unprecedented healthcare crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, healthcare delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and healthcare workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. While mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography (CXR) and computed tomography (CT) are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pre-test probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing COVID-19 patients across a spectrum of healthcare environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based upon the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of CXR and CT in the management of COVID-19

Dorsal Root Ganglia Macrophages Maintain Osteoarthritis Pain

Pain is the major debilitating symptom of osteoarthritis (OA), which is difficult to treat. In OA patients joint tissue damage only poorly associates with pain, indicating other mechanisms contribute to OA pain. Immune cells regulate the sensory system, but little is known about the involvement of immune cells in OA pain. Here, we report that macrophages accumulate in the dorsal root ganglia (DRG) distant from the site of injury in two rodent models of OA. DRG macrophages acquired an M1-like phenotype, and depletion of DRG macrophages resolved OA pain in male and female mice. Sensory neurons innervating the damaged knee joint shape DRG macrophages into an M1-like phenotype. Persisting OA pain, accumulation of DRG macrophages, and programming of DRG macrophages into an M1-like phenotype were independent of Nav1.8 nociceptors. Inhibition of M1-like macrophages in the DRG by intrathecal injection of an IL4-IL10 fusion protein or M2-like macrophages resolved persistent OA pain. In conclusion, these findings reveal a crucial role for macrophages in maintaining OA pain independent of the joint damage and suggest a new direction to treat OA pain. SIGNIFICANCE STATEMENT: In OA patients pain poorly correlates with joint tissue changes indicating mechanisms other than only tissue damage that cause pain in OA. We identified that DRG containing the somata of sensory neurons innervating the damaged knee are infiltrated with macrophages that are shaped into an M1-like phenotype by sensory neurons. We show that these DRG macrophages actively maintain OA pain remotely and independent of joint damage. The phenotype of these macrophages is crucial for a pain-promoting role. Targeting the phenotype of DRG macrophages with either M2-like macrophages or a cytokine fusion protein that skews macrophages into an M2-like phenotype resolves OA pain. Our work reveals a mechanism that contributes to the maintenance of OA pain distant from the affected knee joint and suggests that dorsal root ganglia macrophages are a target to treat osteoarthritis chronic pain

Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper.

This Review provides an updated approach to the diagnosis of idiopathic pulmonary fibrosis (IPF), based on a systematic search of the medical literature and the expert opinion of members of the Fleischner Society. A checklist is provided for the clinical evaluation of patients with suspected usual interstitial pneumonia (UIP). The role of CT is expanded to permit diagnosis of IPF without surgical lung biopsy in select cases when CT shows a probable UIP pattern. Additional investigations, including surgical lung biopsy, should be considered in patients with either clinical or CT findings that are indeterminate for IPF. A multidisciplinary approach is particularly important when deciding to perform additional diagnostic assessments, integrating biopsy results with clinical and CT features, and establishing a working diagnosis of IPF if lung tissue is not available. A working diagnosis of IPF should be reviewed at regular intervals since the diagnosis might change. Criteria are presented to establish confident and working diagnoses of IPF