Urban waterlogging is a hydrological cycle problem that seriously affects people’s life and property. Characterizing waterlogging variation and explicit its driving factors are conducive to prevent the damage of such disasters. Conventional methods, because of the high spatial heterogeneity and the non-stationary complex mechanism of urban waterlogging, are not able to fully capture the urban waterlogging spatial variation and identify the waterlogging susceptibility areas. A more robust method is recommended to quantify the variation trend of urban waterlogging. Previous studies have simulated the waterlogging variation in relatively small areas. However, the relationship between variables is often ignored, which cannot comprehensively reveal the dominant drivers affecting urban waterlogging. Therefore, a novel approach is proposed that combined stepwise cluster analysis model (SCAM) and hierarchical partitioning analysis (HPA) within a general framework and verifies the applicability through logistic regresd in identifying and assessing waterlogging susceptibility, which provides original insights that urban waterlogging mitigation strategies should be developed according to different local conditions and future scenarios.

The health effects of air pollution are associated with the concentration of pollutants and ventilation (VE). VE is difficult to measure directly and has been predicted by heart rate (HR). However, it is unclear whether equations between HR and VE obtained from a laboratory cardiopulmonary exercise test (CPET) can be extended to external groups and there is still a gap in their relationship for a Chinese population.

To establish an association between HR and VE in young Chinese individuals and verify the external validity of the model.

Eighty non-smoking participants aged 16-21years underwent incremental tests using a bicycle ergometer, where the HR and minute VE were measured simultaneously. Linear mixed models were constructed with data obtained from a CPET. Ten individuals were chosen randomly as the external validation group. The predictive performance was assessed using an eight-fold cross-validation procedure. Air pollution concentration was monitored during the CPET and the inhaled load was calcunt of the inhaled load in future epidemiology studies. However, inter-individual variations should also be considered when VE is estimated at an individual level.

Intubation in the early postinjury phase can be a high-risk procedure associated with an increased risk of mortality when delayed. Nonroutine events (NREs) are workflow disruptions that can be latent safety threats in high-risk settings and may contribute to adverse outcomes.

We reviewed videos of intubations of injured children (age<17y old) in the emergency department occurring between 2014 and 2018 to identify NREs occurring between the decision to intubate and successful intubation („critical window”).

Among 34 children requiring intubation, the indications included GCS≤8 (n=20, 58.8%), cardiac arrest (n=6, 17.6%), airway protection (n=5, 14.7%), and respiratory failure (n=3, 8.8%). The median duration of the „critical window” was 7.5min (range 1.4-27.5min), with a median of six NREs per case in this period (range 2-30). Most NREs (n=159, 61.9%) delayed workflow, with 31 (12.1%) of these delays each lasting more than one minute. Eighty-seven NREs (33.9%) had a potential for harm but did not lead n this phase.There is growing concern that the COVID-19 crisis may have long-standing mental health effects across society particularly amongst those with pre-existing mental health conditions. In this observational population-based study, we examined how psychological distress changed following the emergence of the COVID-19 crisis in the United States and tested whether certain population subgroups were vulnerable to persistent distress during the crisis. We analyzed longitudinal nationally representative data from eight waves of the Understanding America Study (UAS) collected between March 10th and July 20th, 2020 (N = 7319 Observations = 46,145). Differences in distress trends were examined by age, sex, race/ethnicity, and household income and by the presence of a pre-existing mental health diagnosis. Psychological distress was assessed using the standardized total score on the Patient Health Questionnaire-4 (PHQ-4). On average psychological distress increased significantly by 0.27 standard deviations (95% CI [0.23,0.31], p less then .001) from March 10-18 to April 1-14, 2020 as the COVID-19 crisis emerged and lockdown restrictions began in the US. Distress levels subsequently declined to mid-March levels by June 2020 (d = -0.31, 95% CI [-0.34, -0.27], p less then .001). Across the sociodemographic groups examined and those with pre-existing mental health conditions we observed a sharp rise in distress followed by a recovery to baseline distress levels. This study identified substantial increases in distress in the US during the emergence of the COVID-19 crisis that largely diminished in the weeks that followed and suggests that population level resilience in mental health may be occurring in response to the pandemic.Transthyretin (TTR) cardiac amyloidosis is a severe, progressive, infiltrative disease caused by the deposition of TTR at cardiac level. It may be due to a genetic alteration in its hereditary form (ATTRv) or as a consequence of an age-related degenerative process (ATTRwt). Thanks to advances in imaging techniques and the possibility of achieving a non-invasive diagnosis, we now know that ATTR is more frequent than traditionally considered and that it is particularly relevant in patients over 65 years with heart failure or with aortic stenosis. With the appearance of several treatment options capable of modifying the natural history of ATTR, it is necessary for clinicians to be familiar with the diagnostic process and treatment of this disease. This review will cover the clinical spectrum of presentation of ATTR, its diagnosis and treatment.The idiopathic chronic cholangitides comprise a group of hepatobiliary diseases of probable autoimmune origin that are usually asymptomatic in the initial stages and can lead to cirrhosis of the liver. Elevated cholestatic enzymes on blood tests raise suspicion of these entities. Among the idiopathic cholangitides, the most common is primary sclerosing cholangitis, which is associated with inflammatory bowel disease and with an increased incidence of hepatobiliary and digestive tract tumors. It is important to establish the differential diagnosis with IgG4-associated cholangitis, primary biliary cholangitis, and secondary cholangitides, because the therapeutic management is different. Magnetic resonance cholangiopancreatography (MRCP) is the best test to evaluate the intrahepatic and extrahepatic biliary tract, and MRI also provides information about the liver and other abdominal organs. An appropriate MRCP protocol and knowledge of the different findings that are characteristic of each entity are essential to reach the correct diagnosis.

To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome.

Thirty patients (mean age 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred.

Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure.

Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.

Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.

High peak pressures delivered via bag valve mask (BVM) can be dangerous for patients.

To examine manual ventilation performance among respiratory therapists (RTs) in a simulation model.

Respiratory therapists (n=98) were instructed to ventilate a manikin for 18 breaths. Linear regression was utilized to determine associated predictors with the outcomes delivered tidal volume, pressure and flow rate.

Among all participants, the mean ventilation parameters include a tidal volume of 599.70ml, peak pressure of 26.35cmH

O, and flow rate of 77.20l/min. Higher confidence values were positively associated with delivered peak pressure (p=0.01) and flow rate (p=0.008). Those with the most confidence in using the BVM actually delivered higher peak pressures and flow rates compared to those with lower confidence levels.

Our results emphasize the urgent need to create an intervention that allows providers to deliver safe and optimal manual ventilation.

Our results emphasize the urgent need to create an intervention that allows providers to deliver safe and optimal manual ventilation.

The clinical characteristics of the patients with COVID-19 complicated by pneumothorax have not been clarified.

To determine the epidemiology and risks of pneumothorax in the critically ill patients with COVID-19.

Retrospectively collecting and analysing medical records, laboratory findings, chest X-ray and CT images of 5 patients complicated by pneumothorax.

The incidence of pneumothorax was 10% (5/49) in patients with ARDS, 24% (5/21) in patients receiving mechanical ventilation, and 56% (5/9) in patients requiring invasive mechanical ventilation, with 80% (4/5) patients died. All the 5 patients were male and aged ranging from 54 to 79 years old. Pneumothorax was most likely to occur 2 weeks after the beginning of dyspnea and associated with reduction of neuromuscular blockers, recruitment maneuver, severe cough, changes of lung structure and function.

Pneumothorax is a frequent and fatal complication of critically ill patients with COVID-19.

Pneumothorax is a frequent and fatal complication of critically ill patients with COVID-19.Covid-19 has affected 16Millions people worldwide with 644 K death as of July 26th, 2020. It is associated with inflammation and microvascular thrombosis-anticoagulation in widely used in these patients especially in patients with elevated d-Dimers. The significance of anticoagulation in these patients is not yet established. We aim to define the anticoagulation pattern and its impact on outcomes (28-day survival, LOSICU, DVT, and PE and bleeding complications. We also observe if levels of d-Dimers affect the anticoagulation prescription.

We analyzed data of all consecutive patients with Covid-19 ARDS admitted to ICU retrospectively. The primary variable of interest was anticoagulation. The daily dose of anticoagulant medication for each patient was recorded. Survival (28-day survival), Length of stay in ICU (LOSICU), the occurrence of DVT, PE, or bleeding were primary outcome variables. We also recorded confounding factors with potential impact on clinical outcomes. We assign Patients to one of the four groups based on anticoagulant dosing during the ICU (increasing dose, decreasing dose, increase followed by a decrease, multiple changes).