Search

1.6 Mt of CO2 was injected in the Tubåen Fm. at the Snøhvit field from April 2008 to April 2011. Injection was associated with a pressure build-up, and following a well intervention operation, the Stø Fm. was used for further CO2 injection, avoiding the pressure limitations in the Tubåen Fm. The pressure build-up in Tubåen Fm. was mainly caused by a limited reservoir volume and heterogeneities in the formation. Salt precipitation was evaluated as a possible source that reduced the near wellbore injectivity with associated pressure build-up. Weekly injection of a 90:10 mixture of methyl ethyl glycol and water (MEG) was implemented to mitigate salt precipitation. This paper evaluates the causes for the pressure build-up in more details. Analysis of bottom-hole-pressure measurements (BHP) from periods of shut in indicates a low permeable zone surrounding the well at early stage of injection. The low permeable zone may be caused by precipitated salt reducing the injectivity. Salt precipitation is also observed to reduce the porosity and permeability on core plugs from the injection well in laboratory measurements. The Tubåen Fm. comprise of 4 sandstone units (Tubåen 1-4) separated by interbedded shale units. Comparison between synthetic seismograms and time-lapse seismic data indicate that CO2 propagated into the three lowermost Tubåen sandstone units (Tubåen 1-3), where the pressure also increased. The shale unit above Tubåen 3 sandstone unit appears sealing from the synthetic seismograms. Tubåen 1 sandstone unit has exceptionally good injectivity. This may have a negative impact on the overall storage capacity by channeling the CO2 and increase the pressure locally. A dimming of the time-lapse seismic amplitude is observed that may be associated with the injected MEG. [ABSTRACT FROM AUTHOR]

Background: New interventions are available for the prevention of respiratory syncytial virus (RSV) disease in young infants. We aimed to assess the potential impact and cost-effectiveness of using a long-acting monoclonal antibody (RSV mAb) or maternal RSV vaccine in the Argentine context., Methods: We used a static proportionate outcomes model to calculate the costs and consequences of using RSV mAb or maternal RSV vaccine over a ten-year period (2025-2034) in Argentina, assuming both year-round and seasonal administration. We compared each intervention to no pharmaceutical RSV intervention. The primary outcome was the discounted cost per disability-adjusted life year (DALY) averted from a societal perspective. We assumed willingness-to-pay of US$ 12,285 per DALY averted (0.9 times the national gross domestic product per capita). We used population study data on costs and disease burden and the efficacy of clinical trials of both interventions as inputs. We ran deterministic and probabilistic uncertainty analyses., Findings: Either strategy (RSV mAb or maternal RSV vaccine) could prevent >25% of RSV deaths aged <5 years and ∼30% aged <6 months (the age group where most intervention impact occurs). With a dose price of $US 50, both products have a 100% probability of being cost-effective compared to no intervention (US$ 5283 [95%CI $5203-$5363] and US$ 5522 [95%CI $5427 - $5617] per DALY averted for year-round use of RSV mAb and maternal RSV vaccine, respectively). Similar health impact could be achieved by a six-month seasonal strategy, which could improve cost-effectiveness by around 45% (assuming the dose price is unchanged)., Interpretation: Either RSV mAb or maternal RSV vaccine are worth consideration in Argentina when priced at ≤US$ 50 per dose. A seasonal strategy could improve cost-effectiveness., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mauricio Caballero reports financial support was provided by Bill & Melinda Gates Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Information is scarce regarding the economic burden of respiratory syncytial virus (RSV) disease in low-resource settings. This study aimed to estimate the cost per episode of hospital admissions due to RSV severe disease in Argentina., Methods: This is a prospective cohort study that collected information regarding 256 infants under 12 months of age with acute lower respiratory tract infection (ALRTI) due to RSV in two public hospitals of Buenos Aires between 2014 and 2016. Information on healthcare resource use was collected from the patient's report and its associated costs were estimated based on the financial database and account records of the hospitals. We estimated the total cost per hospitalization due to RSV using the health system perspective. The costs were estimated in US dollars as of December 2022 (1 US dollar = 170 Argentine pesos)., Results: The mean costs per RSV hospitalization in infants was US$587.79 (95% confidence interval [CI] $535.24 - $640.33). The mean costs associated with pediatric intensive care unit (PICU) admission more than doubled from those at regular pediatric wards ($1,556.81 [95% CI $512.21 - $2,601.40] versus $556.53 [95% CI $514.59 - $598.48])., Conclusions: This study shows the direct economic impact of acute severe RSV infection on the public health system in Argentina. The estimates obtained from this study could be used to inform cost-effectiveness analyses of new preventive RSV interventions being developed., (© 2024. The Author(s).)

Objective: To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing., Methods: Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient's father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing., Results: Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son's health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88)., Conclusions: We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents' self-perception of error management was regular and not modified by the debriefing.

A carbonate sample extracted from the depth of about 10 kft was subjected to uniaxial loading while the confining stress remained constant. Post-experiment inspection of the sample showed an inclined crack at an angle less than 20° to the horizontal. This subhorizontal crack orientation was contrary to the expected 45° inclination, the plane of the maximum shear stress. Coincidentally, as shown by CT-scan prior to loading, there was a boundary between two layers of different density inside the sample located almost exactly where the crack appeared. This density difference has arguably translated into the contrast in the elastic properties at the boundary. The hypothesis is that because of this elastic heterogeneity, an incipient crack developed at the boundary due to the unavoidable tensile stressing of the sample as it was brought to the benchtop from its original state of high confining stress at depth. Controlled uniaxial compression made the sample slip along this crack, which then developed into a prominent feature. This assumption was corroborated by a numerical experiment showing a strong von Mises stress concentration at the elastic contrast boundary during hydrostatic tensile loading. Another sample, from the same formation, but without strong density heterogeneity, exhibited a classic 45° crack after uniaxial loading. These results provide a novel and important insight into the mechanics, breakage, and strength of natural rock.

Introduction: The approach to pediatric emergencies requires specialized resources, and medication errors are common., Objectives: To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention., Methods: The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention., Results: The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [Cl]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.275.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurement showed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement., Conclusions: The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Background: Smoking adversely impacts pain-related outcomes of spinal cord stimulation (SCS). However, the proportion of SCS patients at risk of worse outcomes is limited by an incomplete knowledge of smoking prevalence in this population. Thus, the primary aim of this systematic review is to determine the prevalence of smoking in adults with chronic pain treated with SCS., Methods: A comprehensive search of databases from 1 January 1980 to 3 January 2019 was conducted. Eligible study designs included (1) randomized trials; (2) prospective and retrospective cohort studies; and (3) cross-sectional studies. The risk of bias was assessed using a tool specifically developed for prevalence studies. A total of 1619 records were screened, 19 studies met inclusion criteria, and the total number of participants was 10 838., Results: Thirteen studies had low or moderate risk of bias, and six had a high risk of bias. All 19 studies reported smoking status and the pooled prevalence was 38% (95% CI 30% to 47%). The pooled prevalence in 6 studies of peripheral vascular diseases was 56% (95% CI 42% to 69%), the pooled prevalence of smoking in 11 studies of lumbar spine diagnoses was 28% (95% CI 20% to 36%) and the pooled prevalence in 2 studies of refractory angina was 44% (95% CI 31% to 58%)., Conclusions: The estimated prevalence of smoking in SCS patients is 2.5 times greater than the general population. Future research should focus on development, testing and deployment of tailored smoking cessation treatments for SCS patients., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

Objective: Electronic (eHealth) and mobile (mHealth) technologies may be a useful adjunct to clinicians treating patients with chronic pain. The primary aim of this study was to investigate the effects of eHealth and mHealth interventions that do not require clinician contact or feedback on pain-related outcomes recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) guidelines in adults with chronic pain., Methods: We searched four databases and included English language randomized controlled trials of ambulatory adults with chronic pain from January, 1 2000, to January 31, 2018, with interventions that are independent of clinician contact or feedback. In the meta-analysis, outcomes were assessed at short- (three months or less), intermediate- (four to six months), and long-term (seven or more months) follow-up., Results: Seventeen randomized controlled trials (N = 2,496) were included in the meta-analysis. Both eHealth and mHealth interventions had a significant effect on pain intensity at short- and intermediate-term follow-up. Similarly, a significant but small effect was observed for depression at short- and intermediate-term follow-up and self-efficacy at short-term follow-up. Finally, a significant effect was observed for pain catastrophizing at short-term follow-up., Conclusions: eHealth and mHealth interventions had significant effects on multiple short- and intermediate-term outcome measures recommended in the IMMPACT guidelines. Given widespread availability and low cost to patients, clinicians treating patients with chronic pain could consider using eHealth and mHealth interventions as part of a multidisciplinary pain treatment strategy., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Constrictive pericarditis is a rare entity in pediatrics in which there is a limitation for cardiac diastole due to fibrosis of the pericardium. The etiopathogenic origin of this pathology is multiple, finding idiopathic constrictive pericarditis firstly and Mycobacterium tuberculosis infection secondly. Diagnosis is a clinical challenge since it requires a high degree of suspicion. It usually presents as oligosymptomatic or with signs and symptoms of low cardiac output. The presence of edema, ascites and impaired liver function usually guides the study towards primary liver disease. A careful clinical history and physical examination together with adequate imaging studies are the cornerstones of the diagnosis. Surgical treatment is curative in the vast majority of patients. We present the case of a 16-yearold patient with hepatomegaly and dyspnea grade 1-2 found in a routine health check-up., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

Forty-eight radial artery grafts and 22 saphenous vein grafts in 37 patients undergoing coronary bypass procedures were studied early postoperatively. Most of the saphenous vein grafts were patent, but one-half of the radial artery grafts were occluded. Failure of the radial artery grafts could not be attributed to unfavorable runoff in the recipient vessels. Radial arteries carrying higher flows and those to vessels having more severe degrees of proximal stenosis occluded with a higher frequency. The radial artery should not be used for coronary bypass.

A bullet migrated from the heart to the left femoral artery in a youth ten days after he sustained a gunshot wound to the right chest. The bullet apparently traversed the pulmonary venous system at the time of the injury and lodged in the interior of the left ventricle. The production of an embolism in the systemic circulation was a delayed and unanticipated event.

Thirty-six patients, 19 men and 17 women, presented at age 18 or older between 1952 and 1974 with coarctation of the aorta. Of the 14 (39%) who had associated cardiovascular disease, 12 had aortic stenosis or insufficiency or both. Three patients had infections-two, endocarditis (aortic valve) and one, endarteritis. Three of the seven patients who did not undergo an operation are alive, two at more than 50 years of age. Five patients had myocardial infarctions, two at 35 years of age. Twenty-nine (80%) had operations; in eight instances the patient was over age 40. All 18 patients undergoing repair of isolated coarctation survived, while only 7 of the 11 patients with associated cardiovascular lesions who underwent repair recovered. Aortic valvular disease and myocardial infarction are serious complicating factors in coarctation of the aorta.

A lack of respiratory centrogenic drive of undetermined origin is a rare cause of cyanosis. In this condition, voluntary hyperventilation restores arterial oxygen saturation to normal. Secondary changes consist of polycythemia, somnolence, headache and right heart failure. The present report of a 43-year-old thin man with idiopathic alveolar hypoventilation is combined with a review of 12 similar patients reported by others. His resting oxygen saturation increased from 60% to 98% with hyperventilation. The pulmonary artery pressure was 68/26 mm. Hg and cardiac output 12.3 l./min. Death resulted from pulmonary infarction, and no specific abnormalities were found in the brain.