A Unique Case of Bilateral Valsalva Retinopathy

This is a Photo Essay and does not have an abstract

Deltoid, triceps, or both responses improve the success rate of the interscalene catheter surgical block compared with the biceps response

Background The influence of the muscular response elicited by neurostimulation on the success rate of interscalene block using a catheter (ISC) is unknown. In this investigation, we compared the success rate of ISC placement as indicated by biceps or deltoid, triceps, or both twitches. Methods Three hundred (ASA I-II) patients presenting for elective arthroscopic rotator cuff repair were prospectively randomized to assessment by biceps (Group B) or deltoid, triceps, or both twitches (Group DT). All ISCs were placed with the aid of neurostimulation. The tip of the stimulating needle was placed after disappearance of either biceps or deltoid, triceps, or both twitches at 0.3 mA. The catheter was advanced 2-3 cm past the tip of the needle and the block was performed using 40 ml ropivacaine 0.5%. Successful block was defined as sensory block of the supraclavicular nerve and sensory and motor block involving the axillary, radial, median, and musculocutaneous nerves within 30 min. Results Success rate was 98.6% in Group DT compared with 92.5% in Group B (95% confidence interval 0.01-0.11; P<0.02). Supplemental analgesics during handling of the posterior part of the shoulder capsule were needed in two patients in Group DT and seven patients in Group B. Three patients in Group B had an incomplete radial nerve distribution anaesthesia necessitating general anaesthesia. One patient in Group B had an incomplete posterior block extension of the supraclavicular nerve. No acute or late complications were observed. Conclusions Eliciting deltoid, triceps, or both twitches was associated with a higher success rate compared with eliciting biceps twitches during continuous interscalene bloc

Connecting climate action with other sustainable development goals

The international community has committed to combat climate change and achieve 17 Sustainable Development Goals (SDGs). Here we explore (dis)connections in evidence and governance between these commitments. Our structured evidence review suggests that climate change can undermine 16 SDGs, while combatting climate change can reinforce all 17 SDGs but undermine efforts to achieve 12. Understanding these relationships requires wider and deeper interdisciplinary collaboration. Climate change and sustainable development governance should be better connected to maximize the effectiveness of action in both domains. The emergence around the world of new coordinating institutions and sustainable development planning represents promising progress

Designing Products for the Circular Economy

Until recent years, apparel product design has been undertaken with very little reference to environmental sustainability. However, the legislative framework has increasingly constrained design decisions relating to the use of hazardous chemicals, especially with the advent of REACH regulations within the EU. Most companies now recognise a large number of chemical substances that are prohibited in the dyeing and finishing of textiles. This dominates thinking about design for the environment. The increasing adoption of environmental management systems has expanded the vision for initiatives promoting sustainability, including laundering and care. Principles are recognised for product design and development that lead to more sustainable goods and services. In some industries, regulations require producer to take responsibility for the disposal of products companies release to the market. This obligation has triggered thinking about design for disassembly and design for disposal. This development has accelerated the adoption of circular economy concepts. The EU has not implemented producer responsibility in apparel, although some companies have voluntarily championed circular economy initiatives. However, the business models of most apparel companies have nothing to say about end-of-life issues. This chapter is concerned with new product development processes that incorporate Design for Environment and Design for Disassembly and Disposal. As there are numerous technical issues to address, a team-based product development process has many advantages, whereby garment designers work alongside specialists from other disciplines. This process requires culture change to be embraced by most brand owners, and a departure from the practice of separating the design process from the product development process. In most cases, changes of this nature bring disruption to a globalised industrial sector. Case studies will be considered that illustrate the concepts developed in this chapter. In particular, the French experience of adopting producer responsibility for apparel goods is considered. The accredited organisation ECO TLC exhibits strength in the promotion of sustainability projects, but there is a fundamental weakness in that culture change in the design process of brand owners is hard to discern

Up-Cycling Waste Glass to Minimal Water Adsorption/Absorption Lightweight Aggregate by Rapid Low Temperature Sintering: Optimization by Dual Process-Mixture Response Surface Methodology

Mixed color waste glass extracted from municipal solid waste is either not recycled, in which case it is an environmental and financial liability, or it is used in relatively low value applications such as normal weight aggregate. Here, we report on converting it into a novel glass-ceramic lightweight aggregate (LWA), potentially suitable for high added value applications in structural concrete (upcycling). The artificial LWA particles were formed by rapidly sintering (<10 min) waste glass powder with clay mixes using sodium silicate as binder and borate salt as flux. Composition and processing were optimized using response surface methodology (RSM) modeling, and specifically (i) a combined process-mixture dual RSM, and (ii) multiobjective optimization functions. The optimization considered raw materials and energy costs. Mineralogical and physical transformations occur during sintering and a cellular vesicular glass-ceramic composite microstructure is formed, with strong correlations existing between bloating/shrinkage during sintering, density and water adsorption/absorption. The diametrical expansion could be effectively modeled via the RSM and controlled to meet a wide range of specifications; here we optimized for LWA structural concrete. The optimally designed LWA is sintered in comparatively low temperatures (825-835 °C), thus potentially saving costs and lowering emissions; it had exceptionally low water adsorption/absorption (6.1-7.2% w/wd; optimization target: 1.5-7.5% w/wd); while remaining substantially lightweight (density: 1.24-1.28 g.cm-3; target: 0.9-1.3 g.cm-3). This is a considerable advancement for designing effective environmentally friendly lightweight concrete constructions, and boosting resource efficiency of waste glass flows

A Unique Case of Bilateral Valsalva Retinopathy

This is a Photo Essay and does not have an abstract