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This article describes the design and construction of a five-storey commercial building featuring a novel steel buckling-restrained brace lateral system framed within its mass timber superstructure.

During the COVID-19 pandemic, cases of influenza drastically decreased in numerous countries around the world. Several non-pharmaceutical health measures were put in place to help mitigate the spread of the virus, including a mask mandate for public spaces. On public transit, there is potential for respiratory virus spread through droplet transmission and common contact fomites between riders. This study investigated how current residents of Metro Vancouver who use transit at least once per week would support optional guidelines for mask-use during annual flu seasons to help continue to mitigate the transmission of respiratory illnesses after COVID-19 mandates have ended.

Context.— A severe third wave of COVID-19 disease affected Ireland in the first 3 months of 2021. In this wave, 1 second-trimester miscarriage and 6 stillbirths were observed in the Irish population because of placental insufficiency as a result of SARS-CoV-2 placentitis. This observation was at odds with the country's previous experience with COVID-19 disease in pregnant mothers. Objective.— To describe the clinical and pathologic features of these pregnancy losses. Design.— Retrospective review of clinical and pathologic data of cases of second-trimester miscarriage, stillbirth, or neonatal death identified by perinatal pathologists as being due to SARS-CoV-2 placentitis during the third wave of COVID-19 in Ireland. Results.— Clinical and pathologic data were available for review in 6 pregnancies. Sequencing or genotyping of the virus identified SARS-CoV-2 alpha (B.1.1.7) in all cases. Three of the 6 cases had maternal thrombocytopenia, and fetal growth restriction was not prominent, suggesting a rapidly progressive placental disease. Conclusions.— The identification of SARS-CoV-2 alpha in all these cases suggests that the emergence of the variant was associated with an increased risk of fetal death due to SARS-CoV-2 placentitis when compared with the original virus. Maternal thrombocytopenia may have potential as a clinical marker of placentitis, but other inflammatory markers need investigation. Three of the 6 women had been assessed for reduced fetal movements in hospital some days before the fetal deaths actually occurred; this could suggest that there may be a window for intervention in some cases.

Context.— Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. Objective.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design.— Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. Results.— Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. Conclusions.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.

Background A rounded intraplacental hematoma (RIH) is a recently delineated placental lesion. Following the observation of two cases of RIH in placentas associated with stillbirth in 2012, we postulated that RIHs were associated with a higher risk obstetric phenotype when compared to other lesions characteristic of maternal vascular malperfusion (MVM). We aimed to investigate this further by reviewing the associated maternal and fetal characteristics in a series of prospectively identified cases. Methods Pregnancies where a RIH was identified on placental examination were prospectively collected from February 2014–July 2016. Comparison was made with pregnancies with placental evidence of MVM but without RIH. Results 26 placentas with a RIH were identified and 26 placentas with MVM were selected for comparison. There was a statistically significantly increased incidence of stillbirth in the RIH group as compared with the MVM-only group (p = 0.022). Also, pregnancies with RIHs had a lower maternal age (p = 0.041), decreased incidence of antenatally diagnosed growth restriction (p = 0.023), a trend to increased incidence of clinical abruption (p = 0.051) and heavier mean infant birthweight (p = 0.034). Both groups had a high incidence of pre-eclampsia, Caesarean section and preterm delivery when compared with the general population. Discussion This is the first study to prospectively identify and collect RIHs using standardised pathological criteria and more than doubles the number of reported cases to date. We present 2 comparable, high-risk cohorts but with a significantly increased incidence of stillbirth in those in which RIHs were seen. Further study of these lesions is justified with an emphasis on the potential for antenatal detection using ultrasound evaluation of placental texture.

Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process.

We present a case of third trimester pregnancy complicated by SARS-CoV-2 infection and subsequent reduced fetal movements, resulting in emergency Caesarean delivery with demonstrable placental SARS-CoV-2 placentitis. We show through illustration of this case and literature review that SARS-Co-V-2 placentitis is an uncommon but readily recognisable complication of maternal SARS-CoV-2 infection that may be a marker of potential vertical transmission and that may have the capacity to cause fetal compromise through a direct injurious effect on the placenta., Highlights • We present a pregnancy complicated by SARS-CoV-2 infection and resultant placentitis. • 25% of the parenchyma comprised a deposition similar to perivillous fibrinoid. • Under microscopy, these areas were predominantly a histiocytic intervillositis. • Immunohistochemistry for SARS-CoV-2 showed extensive, strong positive staining. • Reported COVID-19 chronic intervillositis cases depict virus in syncytiotrophoblast.

Twin placentas are frequently received in pathology laboratories for evaluation of chorionicity and because twin pregnancies have higher rates of pregnancy complications. In addition to pathologies common in singleton pregnancies, twin pregnancies have increased frequencies of complications such as preterm birth and velamentous cord insertions and also are affected by complications unique to multiple pregnancies that are mediated by vascular connections between the placental territories of certain types of twins. This article aims to provide an approach to examination of the twin placenta for practicing pathologists or those interested in placental pathology while outlining the key characteristics of twin complications as seen in the placenta.

Follicular variant papillary thyroid carcinoma (FVPTC) may pose a diagnostic challenge due to higher likelihood of lower risk cytology compared to conventional papillary thyroid carcinoma (CPTC). Recent guidelines have recommended the use of sonographic features to guide decisions to biopsy thyroid nodules. The purpose of this study was to evaluate the sonographic features of CPTC and FVPTC. This is a retrospective study design done in an Academic teaching hospital setting. Preoperative ultrasounds of 79 patients with conventional CPTC (48) and FVPTC (31) were reviewed by a radiologist blinded to histological diagnosis. Sonographic features of nodules were classified according to the British Thyroid Association (BTA) U-classification system as normal (U1), benign (U2), indeterminate (U3), suspicious (U4), and malignant (U5). Pathology slides of patients with FVPTC were reviewed by two pathologists and subclassified into encapsulated, well circumscribed/partly encapsulated, and infiltrative subtypes. FVPTC had a significantly lower incidence of any calcifications (p = 0.0005), microcalcifications (p = 0.002), and irregular or lobulated margins (p = 0.03) than CPTC. Differences in hypoechogenicity (p = 0.06), taller > wide shape (p = 0.17) and presence of halo (p = 0.07) were not significant. FVPTC was significantly less likely to be classified sonographically as malignant (U5) (p = 0.006) or suspicious/malignant (U4/5) (p = 0.009) than conventional PTC. Among FVPTC cases, infiltrative FVPTC were more likely to be sonographically classified as suspicious/malignant (U4/5) than non-infiltrative FVPTC. FVPTC nodules are less likely to show sonographic features of malignancy than conventional PTC. Reliance solely on sonographic features for thyroid nodule evaluation may not be sufficient to exclude FVPTC.

Digital technologies now pervade every aspect of modern Australian society. Almost every aspect of how we live, work and play – from getting an education, accessing health care, communicating with friends to getting a job – is influenced by digital technology. In this era of rapid change, the trajectory of economic development, our future prosperity and our ambitions to be a socially inclusive nation will all be influenced by the increasing growth and reliance on digital technologies as a part of everyday life. Digital inclusion (and equality) is increasingly becoming one of the major social justice challenges of our time. Digital inclusion is vital to employment participation, economic development, educational achievement, social and civic inclusion, health and wellbeing. Many people continue to be digitally excluded in Australia and, importantly, as technology changes there is a growing risk of a participation gap in terms of a person’s ability to engage with technology. At present, the response to such a major issue in Australia is fragmented and only occasionally addressed holistically. Comprehensive national research on this issue is limited, the longer-term costs of digital exclusion have not been fully explored, nor do we have a national plan to mobilise a whole of community effort that ensures that all Australians have the skills and opportunity to benefit from digital citizenship. The purpose of this paper is to explore the current needs, challenges and benefits of digital inclusion in Australia. It explores how the concept of inclusion is evolving with changes in technology and to social structures. This article is a précis of a White Paper commissioned by Telstra. The aim is to advance our understanding of digital inclusion and introduce a more refined conceptual framework for defining and addressing digital equality.

Objectives/Hypothesis Previous studies have reported variable results for the impact of bone invasion on survival in oral cancer. It is unclear whether bone invasion in small (≤4 cm) squamous cell carcinomas (SCC) of the oral cavity is an independent adverse prognosticator. Our objective was to investigate impact on survival of bone invasion in SCC of floor of mouth (FOM), lower alveolus (LA), and retromolar trigone (RMT) ≤4 cm in size. Study Design Retrospective study of 96 patients with SCC of the FOM, LA, and RMT undergoing primary surgical treatment. Methods Original pathology reports and slides were reviewed by three pathologists. Level of bone invasion was categorized as cortical or medullary. Main outcome measures were local control (LC) and overall survival (OS). Results Bone invasion was present in 31 cases (32%). On review of pathology slides, all cases of bone invasion demonstrated medullary involvement. Median follow-up was 36 months for all patients, and 53 months for patients not dying from cancer. Among tumors ≤4 cm, bone invasion was associated with significantly worse LC (P =.04) and OS (P =.0005). Medullary invasion (hazard ratio: 2.2, 95% confidence interval: 1.1-4.4, P =.03), postoperative radiotherapy (hazard ratio: 0.3, 95% confidence interval: 0.1-0.5, P

peer-reviewed Introduction: Individual placental and umbilical cord morphometry have been previously identified to have an association with fetal growth. This study aims to identify which of the morphometric measurements in combination are associated with pregnancies with small for gestational age (SGA) infants using digital imaging of the delivered placenta. Material and methods: This study examined 1005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken. Placental weight and thickness; umbilical cord length and diameter were measured on gross examination. Distance from the placental cord insertion site to placental margin, length and breadth of the placenta and placental chorionic surface area were measured digitally using ImageJ software. Logistic regression models and area under the curve (AUC) were used to identify the best subset of morphometric measurements to classify infants as SGA (

Distal villous hypoplasia is a form of placental villous maldevelopment that has the potential to cause significant intrauterine growth restriction with adverse consequences for fetal viability, neurodevelopmental outcome and adult cardiovascular health. It is characterized by a sparse, poorly developed distal villous tree with abnormally shaped, elongated, slender villi and widening of the intervillous space. Generally, villi show widespread trophoblast abnormalities with thinning of the villous trophoblast layer, reduction in cytotrophoblast numbers, evidence of a widespread increase in syncytiotrophoblast nuclear senescence and wave-like syncytial knots. Investigation of pregnancies with false positive serum screening tests for fetal aneuploidy/structural defects can help identify pregnancies at risk of placental insufficiency, particularly when combined with ultrasound assessment of placental morphology at 19–22 weeks. Identification of pregnancies with multiple abnormal tests of placental function permits high-risk specialist referral to optimize maternal-fetal outcome.

To estimate the relative importance of positive maternal thrombophilia testing compared with additional pathological evidence of abnormal placentation with placental infarction.We performed a retrospective cohort study over a 10-year period in 180 singleton high-risk pregnancies (delivery at 22-34 6/7 weeks of gestation) that had histologic evidence of placental infarction. The rate of positive maternal tests for antiphospholipid syndrome, factor V Leiden, and prothrombin gene mutation were compared with the rate of detection of one or more gross or histological features of abnormal placentation (impaired placental development or differentiation, maternal vascular underperfusion, fetal vascular underperfusion, chronic inflammation, or intervillous thrombosis).Only 14 of 108 (13.0%) of placentas with documented infarction were associated with a positive maternal thrombophilia result. In contrast, 67 of 108 (62.3%) placentas showed features of abnormal placental development or differentiation and 85 of 108 (78.7%) had evidence of noninfarct-related maternal vascular underperfusion (P.001). Only four of 108 (3.7%) infarcted placentas had no other pathologic lesions.Our data indicate that gross and histologic features of abnormal placentation associate strongly with placental infarction in comparison with maternal thrombophilia tests.II.

Previous studies have reported variable results for the impact of bone invasion on survival in oral cancer. It is unclear whether bone invasion in small (≤4 cm) squamous cell carcinomas (SCC) of the oral cavity is an independent adverse prognosticator. Our objective was to investigate impact on survival of bone invasion in SCC of floor of mouth (FOM), lower alveolus (LA), and retromolar trigone (RMT) ≤4 cm in size.Retrospective study of 96 patients with SCC of the FOM, LA, and RMT undergoing primary surgical treatment.Original pathology reports and slides were reviewed by three pathologists. Level of bone invasion was categorized as cortical or medullary. Main outcome measures were local control (LC) and overall survival (OS).Bone invasion was present in 31 cases (32%). On review of pathology slides, all cases of bone invasion demonstrated medullary involvement. Median follow-up was 36 months for all patients, and 53 months for patients not dying from cancer. Among tumors ≤4 cm, bone invasion was associated with significantly worse LC (P =.04) and OS (P =.0005). Medullary invasion (hazard ratio: 2.2, 95% confidence interval: 1.1-4.4, P =.03), postoperative radiotherapy (hazard ratio: 0.3, 95% confidence interval: 0.1-0.5, P.001), and positive pathologic nodal status (hazard ratio: 4.1, 95% confidence interval: 1.9-8.6, P.001) were independent predictors of worse OS among the entire cohort.Mandibular medullary bone invasion is a poor prognosticator in oral cancers, irrespective of small size of primary tumor. Such cases should be considered for postoperative radiotherapy.4. Laryngoscope, 127:849-854, 2017.

Purpose This chapter looks at Australian public libraries and how they have developed and delivered inclusive service to people with disabilities over the past decade or so. As digital technology impacts the public library sector the question of “how are libraries responding?” emerges, especially for the one in five Australians living with disabilities. This chapter is focused on how the public library network is delivering digitally inclusive services to people with disabilities. Methodology/approach The approach was to examine the international obligations, related governance, and professional standards that apply to Australian Public libraries; the current disability and digital inclusion related research from the past decade; and highlight some of the better examples of practice in Australian public library service. Findings This chapter is not a comprehensive examination but rather a summary scan of digital inclusion practice. However, it raises a number of questions for further investigation: research as to how these obligations are put into practice; how they can be better shared and learnt from; and more importantly how the aspiration of “inclusion for all” is being met.

At birth, an otherwise healthy term female infant was noted to have a 3 cm3 blue-coloured tense cyst-like lesion attached by a skin-coloured pedicle to the ulnar aspect of the right hand, adjacent to the fifth metacarpal–phalangeal joint (figure 1). Over the following 48 h, the cystic lesion involuted and appeared necrotic, but …

Importance The follicular variant (FV) of papillary thyroid carcinoma (PTC) is an important subtype that can be difficult to diagnose using preoperative cytologic analysis. Objective To compare conventional and FV PTC with regard to preoperative cytologic diagnosis using a tiered thyroid cytologic reporting system, tumor size at diagnosis, presence of invasion, and implications on prognostic scores. Design, Setting, and Participants This retrospective study was conducted in an academic teaching hospital and included 99 patients with conventional (n = 65) or FV (n = 34) PTC. Interventions Preoperative thyroid cytologic findings, originally reported using the tiered British Thy system, were recategorized according to the Bethesda classification system. Pathologic features recorded included tumor size, presence of extrathyroid extension (ETE), and metastases. Prognostic scores were calculated according to the MACIS system. Main Outcomes and Measures Differences in patient demographics, preoperative cytologic findings, tumor pathologic features, and prognostic risk categories between conventional and FV PTC were studied. Results There were no differences in patient age or sex. Cytologic findings from FV PTC were significantly more likely to be reported in a lower-risk category than those from conventional PTC for (1) malignant vs lower-risk category (22 [56%] vs 2 [8%]); (2) suspected malignant or malignant vs lower-risk category (26 [66%] vs 6 [23%]); and (3) follicular neoplasm or higher-risk category vs lower-risk category (34 [87%] vs 10 [38%]) ( P P = .03). The mean size of FV PTC lesions (25.9 mm) at the time of pathologic diagnosis was significantly greater than that of conventional PTC lesions (15.5 mm) ( P = .02). Even after exclusion of “coincidental” carcinomas, FV PTC tumors were significantly larger than conventional PTC tumors (31.7 vs 22.4 mm; P = .03). In contrast, FV PTC was significantly less likely to show ETE (0 of 34 vs 10 of 65; P = .01). There were no significant differences between FV PTC and conventional PTC in proportion of patients in intermediate- and high-risk prognostic groups combined (21 [62%] vs 38 [58%]) ( P = .83) or in mean MACIS scores (4.68 and 4.38, respectively; P = .18). Conclusions and Relevance Preoperative cytologic findings from FV PTC were more likely than those from conventional PTC to indicate a lower risk category, and FV PTC tumors were larger at time of diagnosis. On the other hand, owing to a lower incidence of ETE in conventional PTC, there was no difference in prognostic score at diagnosis.

Cystic fibrosis (CF) is a multisystemic disease but without a classical disease-specific renal phenotype. A 32-year-old male patient with CF (ΔF508/ΔF508) presented with a nephrotic syndrome. Renal biopsy revealed nodular glomerulosclerosis (NGS) occurring in the absence of diabetes mellitus, amyloidosis and any other known common cause of NGS. He had a progressive decline in estimated glomerular filtration rate (eGFR) to chronic kidney disease stage V (eGFR

The paper will consider the implementation of the Safety Case in the oil and gas industry in Australia, and internationally, post the Macondo and Montara incidents.The National Commission Report into the Deepwater Horizon / Macondo blowout stated: "The immediate causes of the Macondo well blowout ……. that reveal such systematic failures in risk management that they place in doubt the safety culture of the entire industry. "In their letter to Minister Ferguson on 22 March 2011, the NOPSA Board stated: "The Montara and Macondo incidents each demonstrate technical ignorance and a poor safety culture including complacency regarding low probability, high consequence risks. There is a clear need to improve industry safety culture, accountability and leadership. "The paper will examine these criticisms and consider how the industry could improve its process safety and risk management. The implementation of a Safety Case in the USA may only occur "in the typical rule-making process that takes up to two years" (Michael Bromwich, Director of BOEMRE). Knowledge, understanding and application of key aspects of process safety management and the preparation and implementation of the Safety Case process are not uniform. The paper will suggest how, in this context, the Safety Case can be applied to achieve the improved outcomes.The paper will draw from specific findings from the Macondo and Montara incidents. In particular, and of some concern, there are echoes and parallels of the Piper Alpha disaster in the performance of emergency systems on Deepwater Horizon. Inadequate application of hazardous area classification is a key issue which the paper will discuss in order to provide greater understanding. Whilst in Australia, issues of competency, consistency and quality arise with matters such as performance standards. The paper will discuss the need for an industry accepted standard for "performance standards" that goes beyond current regulatory guidelines.Overall, the paper will seek to propose a way forward for the industry in several practical areas.

The paper examines the performance of the oil and gas industry, in particular in Australia and New Zealand, since the introduction of the Safety Case regime. Emphasis is placed on identified project issues and conclusions are drawn related to the current status of the industry, its maturity and its ability to apply the Safety Case regime in the manner required to achieve anticipated results. The paper examines whether issues that have led to project failings in recent years are inherent in the way the industry operates. The paper discusses the experience of the offshore oil and gas industry in Australasia, in comparison with other parts of the world. The experience of other industries that apply the Safety Case approach is also discussed. The core issue that is highlighted relates to the manner in which the Safety Case is applied, including issues of lack of understanding of the Safety Case process by management, the effect of contracting strategy on the effectiveness of the Safety Case and the lack of a common understanding of the role of the Safety Case. The paper is based on cumulative experience since the beginning of the Safety Case in the oil and gas industry, drawing in particular from experience on major projects within the last few years. The paper highlights the manner in which the industry undertakes development projects, in particular, with some observations about the legacy that this leaves for the operating company and its personnel. More than 20 years after Piper Alpha, the industry has moved on and this paper seeks to provide a re-appraisal of the effectiveness with which major accident hazards and risks are managed. The paper also seeks to draw conclusions that illustrate a way forward for the oil and gas industry.

Seckel syndrome is a rare autosomal recessive disorder characterized by intrauterine growth retardation, dwarfism, microcephaly and mental retardation. Pathological descriptions of fetal stage Seckel syndrome are rare and pre-date the evolving understanding of the genetic and molecular mechanisms involved. The autopsy findings in a case of fetal Seckel syndrome at 30 weeks gestation are presented, with detailed description of the neuropathological findings. Severe neurological abnormalities in a male fetus were observed that included microencephaly, cortical neuronal migration disorder, white matter tract hypoplasia/aplasia, premature depletion of the germinal matrix with cystic transformation and patchy absence of the external granular cell layer of the cerebellum. The striking neuropathological finding in this case was evidence of failure of the developing brain’s germinal elements, providing rare morphological insight into the abnormal development of the Seckel syndrome fetal brain. The selective failure of this proliferating cell population correlates with the emerging molecular evidence that Seckel syndrome is caused by defects in ATR-dependent DNA damage signaling with resultant premature death of proliferating cells.