Evaluation of Seismic Stability of Foundation Soils Under Revelstoke Earthfill Dam

The stability of the fine sands underlying the shells of the Revelstoke earthfill dam under earthquake shaking is discussed. The evaluation of liquefaction potential of the deposit was made from the field standard penetration resistance of the material. The dynamic analysis, made by a one-dimensional equivalent visco-elastic method, indicated that the sand under both the upstream and downstream shells had adequate liquefaction resistance and could be left in place. Adequate drainage of downstream fine sands was provided to further reduce its liquefaction potential

Lipoid pneumonia presenting as non resolving community acquired pneumonia: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Extracranial arterio-venous malformation presenting as a scalp swelling

It is a challenge to diagnose and treat extracranial arteriovenous malformations (AVMs) because of complex vascular malformations. AVMs are congenital vascular shunts with long standing expansion of vascular channels, collateralization of microcirculation and localized tissue infiltration. Even though the exact etiopathogenesis of AVMs remains undefined however newer genetic/molecular basis of the same are evolving. Any age can be affected by AVMs however it is seen to increase in dimension after an early period of inactivity. They may present at any age following an early quiescent period. Diagnosis is based on vascular staining, soft tissue expansions, progressive growth/ warmth and pulsations

Digital Inclusion Across the Americas and Caribbean

This research brings together digital inequality scholars from across the Americas and Caribbean to examine efforts to tackle digital inequality in Uruguay, Chile, Peru, Brazil, Mexico, Cuba, Jamaica, the United States, and Canada. As the case studies show, governmental policy has an important role to play in reducing digital disparities, particularly for potential users in rural or remote areas, as well as populations with great economic disparities. We find that public policy can effectively reduce access gaps when it combines the trifecta of network, device, and skill provision, especially through educational institutions. We also note, that urban populations have benefitted from digital inclusion strategies to a greater degree. This underscores that, no matter the national context, rural-urban digital inequality (and often associated economic inequality) is resistant to change. Even when access is provided, potential users may not find it affordable, lack skills, and/or see no benefit in adoption. We see the greatest potential for future digital inclusion in two related approaches: 1) initiatives that connect with hard-to-reach, remote, and rural communities outside urban cores and 2) initiatives that learn from communities about how best to provide digital resources while respecting their diversely situated contexts, while meeting social, economic and political needs

Traumatic fracture of central venous catheter resulting in potential migration of distal fragment: a case report

We report a surgical retrieval of an indwelling portion of a traumatic rupture of the Central venous catheter following hair cutting by a confused patient secondary to Postoperative cognitive dysfunction. He had a dynamic compression screw for fixation of fractured neck of femur after previously failed surgical procedure. The second procedure was complicated with major blood loss, which required central venous and arterial line insertion for intra-operative and post-operative management. The patient was discharged to the ward following an uneventful stay on intensive care. While on the ward, he decided to trim his hair and in the process he inadvertently cut through the right internal jugular catheter. Complications and management resulting from embolisation of central line are reviewed

Context and Implications Document for: School-based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record

A study of empyema thoracis and role of intrapleural streptokinase in its management

BACKGROUND: Clinical spectrum, microbiology and outcome of empyema thoracis are changing. Intrapleural instillation of fibrinolytic agents is being increasingly used for management of empyema thoracis. The present study was carried out to describe the clinical profile and outcome of patients with empyema thoracis including those with chronic empyema and to study the efficacy and safety of intrapleural streptokinase in its management. METHODS: Clinical profile, etiological agents, hospital course and outcome of 31 patients (mean age 40 ± 16 years, M: F 25: 6) with empyema thoracis treated from 1998 to 2003 was analyzed. All patients were diagnosed on the basis of aspiration of frank pus from pleural cavity. Clinical profile, response to therapy and outcome were compared between the patients who received intrapleural streptokinase (n = 12) and those who did not (n = 19). RESULTS: Etiology was tubercular in 42% of the patients (n = 13) whereas the rest were bacterial. Amongst the patients in which organisms could be isolated (n = 13, 42%) Staphylococcus aureus was the commonest (n = 5). Intrapleural streptokinase was instilled in 12 patients. This procedure resulted in increase of drainage of pleural fluid in all patients. Mean daily pleural fluid drainage after streptokinase instillation was significantly higher for patients who received intrapleural streptokinase than those who did not (213 ml vs 57 ml, p = 0.006). Only one patient who was instilled streptokinase eventually required decortication, which had to be done in five patients (16.1%). Mean hospital stay was 30.2 ± 17.6 days whereas two patients died. CONCLUSIONS: Tubercular empyema is common in Indian patients. Intrapleural streptokinase appears to be a useful strategy to preserve lung function and reduce need for surgery in patients with late stage of empyema thoracis

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.

Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ <sup>2</sup> ) test (p < 0·05 was considered as unstable). Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. The study was registered with Clinical trials.gov Identifier: NCT04534569

Collection of tracheal aspirate: safety and microbiological concordance between two techniques

Objective: To evaluate the safety of the performance of the traditional and protected collection techniques of tracheal aspirate and to identify qualitative and quantitative agreement of the results of microbiological cultures between the techniques. Method: Clinical, prospective, comparative, single-blind research. The sample was composed of 54 patients of >18 years of age, undergoing invasive mechanical ventilation for a period of ≥48 hours and with suspected Ventilator Associated Pneumonia. The two techniques were implemented in the same patient, one immediately after the other, with an order of random execution, according to randomization by specialized software. Results: No significant events occurred oxygen desaturation, hemodynamic instability or tracheobronchial hemorrhage (p<0.05) and, although there were differences in some strains, there was qualitative and quantitative agreement between the techniques (p<0.001). Conclusion: Utilization of the protected technique provided no advantage over the traditional and execution of both techniques was safe for the patient