Case History Illustrating the Challenges of Foundation Design and Construction in Karst Terrain

This paper discusses the challenges associated with design and construction of foundation systems for a Corporate Campus located in Chester County, Pennsylvania that is underlain by Karst terrain. A comprehensive subsurface investigation was implemented to develop adequate foundation systems and related site work precautions. Because there was evidence of sinkhole activity prior to any construction work, and the subsoils revealed some variability from a consistency/density standpoint, the selected foundation system design included a combination of soil improvement using compaction grouting for shallow foundations and deep drilled-pier foundations. After construction activities began, several occurrences of solution activity were documented and repaired. During construction of drilled-pier foundations at one of the structure locations, a significant number of voids and discontinuities in the rock were encountered. The impact of these discontinuities and voids was dramatic to the effort and time necessary to complete the drilled pier foundation construction for this structure. After careful consideration of potential cost and schedule impacts, the foundation design for remaining structures was modified to eliminate the use of drilled piers and incorporated only compaction grouting for support of shallow foundation systems. Interaction of the Geotechnical Engineer, Construction Manager, Owner, and Contractor began early in the construction process and this interaction became critical to the project success as work proceeded on this project

Reacciones Adversas Cutáneas de los Fármacos Antipsicóticos

Background: Psychosis is considered a mental disorder characterized by loss of contact with reality. Antipsychotics are a group of very effective medications for the treatment of psychotic episodes. Objective: Recognize adverse cutaneous reactions of antipsychotic drugs Methodology: Bibliographic search in Spanish and English for the most relevant information in the databases pubmed, scielo, medline, national and international libraries specialized in the topics discussed in this review article. Results: 13 articles were found that generally demonstrate that the most frequent cutaneous adverse effects of antipsychotic medications include: exanthematous eruptions, changes in skin pigmentation, photosensitivity, urticaria, pruritus, pigmentation problems, acne, alopecia, fixed drug eruptions and lichenoid reactions. Conclusion: Adverse cutaneous reactions to antipsychotics are rare, most skin lesions are benign and easy to treat. However, more prospective studies are needed in people from different groups to comprehensively confirm such reactions.Antecedentes: La psicosis es considerada un trastorno de la mente caracterizado por la pérdida de contacto con la realidad. Los antipsicóticos son un grupo de medicamentos muy eficaces para el tratamiento de los episodios psicóticos. Objetivo: Reconocer las reacciones adversas cutáneas de los fármacos antipsicóticos Metodología: Búsqueda bibliográfica en español e inglés de la información más relevante en las bases de datos pubmed, scielo , medline, bibliotecas nacionales e internacionales especializadas en los temas tratados en el presente artículo de revisión. Resultados: Se encontraron 13 artículos de los de forma general demuestran que los efectos adversos cutáneos más frecuentes de los medicamentos antipsicóticos incluyen: erupciones exantemáticas, cambios en la pigmentación de la piel, fotosensibilidad, urticaria, prurito, los problemas de pigmentación, el acné, la alopecia, las erupciones fijas por fármacos y las reacciones liquenoides. Conclusión: Las reacciones adversas cutáneas por antipsicóticos son poco frecuentes, la mayoría de las lesiones cutáneas son benignas y fáciles de tratar. Sin embargo, se necesitan más estudios prospectivos en personas de diferentes grupos para confirmar de manera global tales reacciones

Manifestaciones Dermatológicas del VIH en Adultos y Niños

HIV is defined as a disease caused by the human immunodeficiency virus. Data from UNAIDS show that in 2017, 36.9 million people were infected with this virus living in the world, the majority in Sub-Saharan Africa. Currently, HIV is incurable, however, it is treatable and preventable. The clinical manifestations of this pathology include a great variety that are usually divided into acute phase, chronic phase and AIDS, the latter being the most serious phase. Dermatologically speaking, cutaneous signs and symptoms are common in the different stages of HIV/AIDS and manifest as skin infection or inflammation, malignancy or drug-related diseases. Fungal skin expressions are more prevalent in the pediatric population, while Sexually transmitted skin expressions are the most common in adults. In general terms, oral hairy leukoplakia, molluscum contagiosum, oral candidiasis, and chronic ulcerative herpes simplex are usually the most common, are closely related to HIV and have a high progression. The studies reviewed reveal that these manifestations are significant indicators of the presence of HIV, allowing for early diagnosis and timely treatment.El VIH es definido como una enfermedad causada por el virus de la inmunodeficiencia humana. Datos de la ONUSIDA muestran que en 2017 se encontraban viviendo en el mundo 36,9 millones de personas infectadas con este virus, la mayoría en África Subsahariana. En la actualidad el VIH es incurable  sin embargo, es tratable y prevenible.Las manifestaciones clínicas de esta patología comprenden una gran variedad que suelen dividirse en fase aguda, fase crónica y SIDA, siendo esta última la fase de mayor gravedad. Dermatológicamente hablando, los signos y síntomas cutáneos son comunes en las diferentes etapas del VIH/SIDA y se manifiestan como infección o inflamación cutánea, malignidad o enfermedades relacionadas con medicamentos.Las expresiones cutáneas por hongos son más prevalentes en la población pediátrica, mientras que las expresiones cutáneas por transmisión sexual son las más comunes en adultos. En términos generales, la leucoplasia vellosa oral,el molusco contagioso, la candidiasis oral, y el herpes simple ulceroso crónico, suelen ser las más frecuentes, están estrechamente relacionadas con el VIH y presentan una alta progresión. Los estudios revisados revelan que estas manifestaciones son indicadores significativos de la presencia del VIH, lo que permite un diagnóstico temprano y un tratamiento oportuno

Apophis planetary defense campaign

We describe results of a planetary defense exercise conducted during the close approach to Earth by the near-Earth asteroid (99942) Apophis during 2020 December–2021 March. The planetary defense community has been conducting observational campaigns since 2017 to test the operational readiness of the global planetary defense capabilities. These community-led global exercises were carried out with the support of NASA's Planetary Defense Coordination Office and the International Asteroid Warning Network. The Apophis campaign is the third in our series of planetary defense exercises. The goal of this campaign was to recover, track, and characterize Apophis as a potential impactor to exercise the planetary defense system including observations, hypothetical risk assessment and risk prediction, and hazard communication. Based on the campaign results, we present lessons learned about our ability to observe and model a potential impactor. Data products derived from astrometric observations were available for inclusion in our risk assessment model almost immediately, allowing real-time updates to the impact probability calculation and possible impact locations. An early NEOWISE diameter measurement provided a significant improvement in the uncertainty on the range of hypothetical impact outcomes. The availability of different characterization methods such as photometry, spectroscopy, and radar provided robustness to our ability to assess the potential impact risk

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR) 25–75 mL/min per 1·73 m² of body surface area, and a urine albumin-to-creatinine ratio (UACR) of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders) were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days) or end-stage kidney disease (eGFR <15 mL/min per 1·73 m² sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure) in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325) or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%) of 1325 patients in the atrasentan group and 105 (7·9%) of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR] 0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%) of 1325 patients in the atrasentan group and 34 (2·6%) of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%) patients in the atrasentan group and 52 (3·9%) in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding AbbVi

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Cómo documentar un proceso

Para entrar en contexto, primero hay que conocer sobre la documentación de procesos y su importancia en las organizaciones de hoy en día; según Muriel (2014) la documentación de procesos “es describir de manera detallada y precisa toda la información relacionada con el mismo, y luego proceder a registrarla en una serie de documentos o formatos preestablecidosEdición 202