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A 2-D model which accounts for the effect of coupled sliding and rocking motion and uses strain dependent soil stiffness and material damping for calculating the response of rigid retaining walls subjected to dynamic loads, was developed earlier. This model was used to study the effect inclination of the wall face in contact with the backfill, on its displacement under the effect of ground motions due to Northridge, ElCentro and Loma Prieta earthquakes. The effect of wall inclination on cumulative displacements is discussed and its role in achieving possible cost effectiveness in design of rigid retaining wall is highlighted.

Context Glucose-insulin-potassium (GIK) infusion is a widely applicable, low-cost therapy that has been postulated to improve mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Given the potential global importance of GIK infusion, a large, adequately powered randomized trial is required to determine the effect of GIK on mortality in patients with STEMI. Objective To determine the effect of high-dose GIK infusion on mortality in patients with STEMI. Design, setting, and participants Randomized controlled trial conducted in 470 centers worldwide among 20,201 patients with STEMI who presented within 12 hours of symptom onset. The mean age of patients was 58.6 years, and evidence-based therapies were commonly used. Intervention Patients were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care (n = 10,091) or to receive usual care alone (controls; n = 10,110). Main outcome measures Mortality, cardiac arrest, cardiogenic shock, and reinfarction at 30 days after randomization. Results At 30 days, 976 control patients (9.7%) and 1004 GIK infusion patients (10.0%) died (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.95-1.13; P = .45). There were no significant differences in the rates of cardiac arrest (1.5% [151/10 107] in control and 1.4% [139/10,088] in GIK infusion; HR, 0.93; 95% CI, 0.74-1.17; P = .51), cardiogenic shock (6.3% [640/10 107] vs 6.6% [667/10 088]; HR, 1.05; 95% CI, 0.94-1.17; P = .38), or reinfarction (2.4% [246/10,107] vs 2.3% [236/10,088]; HR, 0.98; 95% CI, 0.82-1.17; P = .81). The rates of heart failure at 7 days after randomization were also similar between the groups (16.9% [1711/10,107] vs 17.1% [1721/10,088]; HR, 1.01; 95% CI, 0.95-1.08; P = .72). The lack of benefit of GIK infusion on mortality was consistent in prespecified subgroups, including in those with and without diabetes, in those presenting with and without heart failure, in those presenting early and later after symptom onset, and in those receiving and not receiving reperfusion therapy (thrombolysis or primary percutaneous coronary intervention). Conclusion In this large, international randomized trial, high-dose GIK infusion had a neutral effect on mortality, cardiac arrest, and cardiogenic shock in patients with acute STEMI.

Systolic time intervals (STI) were measured from simultaneous high speed recordings of electrocardiogram, phonocardiogram, and carotid artery trace in 47 children of anemia with or without congestive heart failure (CHF), and in 20 healthy normal children. Group I comprised 20 healthy controls with a mean Hb level of 13.65±0.73 gm percent, group II of 37 anemic children with a mean Hb level of 7.3±1.01 gm percent, without any evidence of CHF: Group III of 10 severely anaemic children with a mean Hb level of 2.75±0.82 gm percent with overt CHF. Electromechanical systole (QS2) pre-ejection period (PEP), left ventricular ejection time (LVET) and the ratio of PEP/LVET were studied and compared in various groups. PEP/LVET ratio was found to be 0.265±0.04, 0.363±0.07 and 0.407±0.06 in groups I, II, III cases respectively. The mean PEP/LVET ratio was significantly prolonged in groups II and III when compared with group I (p

Various field test (namely vibration tests on blocks or plates, steady-state vibration or Rayleigh wave tests, wave propagation tests, and cyclic load tests) were conducted at a number of sites in India to determine the dynamic shear modulus, G. Data obtained at different sites are described. The values of G obtained from the different tests at a given site vary widely. The rational approach for selecting the value of G from field tests for use in the analysis and design of soil-structure interaction problems under dynamic loads must account for the factors affecting G. The suggested approach, which provides a possible answer, is suitable in cohesionless soils below the water table where it is rather difficult, if not impossible, to obtain undisturbed samples.

We view a treatment protocol as a hierarchical structure of therapeutic modules. The lowest level of this structure consists of individual therapeutic actions. Combinations of individual actions define higher level modules, which we call routines. Routines are designed to manage limited clinical problems, such as the routine for fluid loading to correct hypovolemia. Combinations of routines and additional actions, together with comments, questions, or precautions organized in a branching logic, in turn, define the treatment protocol for a given disorder.Adoption of this modular approach may facilitate the formulation of treatment protocols, since the physician is not required to prepare complex flow charts. This hierarchical approach also allows protocols to be updated and modified in a flexible manner. By use of such a standard format, individual components may be fitted together to create protocols for multiple disorders. The technique is suited for computer implementation. We believe that this hierarchical approach may facilitate standardization of patient care as well as aid in clinical teaching. A protocol for acute pancreatitis is used to illustrate this technique.

A patient is presented in whom pulmonary artery catheter insertion fortutiously demonstrated persistent left superior vena cava on two separate occasions. Further studies with venogram and a first pass nuclear scan demonstrated total absence of the right superior vena cava. Although this anomaly is commonly associated with intracardiac defects and rhythm disturbances only the latter was seen in our patient. Invasive hemodynamic monitoring is frequently performed in the majority of modern intensive care units. The bedside technique used for insertion of a Swan-Ganz catheter using only pressure monitoring for advancing the catheter has relatively few complications. One such complication is misplacement along an anomalous route where the catheter may take to the heart. We have recently treated a patient on two separate occasions who had a persistent left superior vena cava with absent right superior vena cava.

A 56-year-old man developed severe metabolic alkalosis in association with postoperative oliguric renal failure. Marked hypercapnia and metabolic alkalosis were successfully treated by a 17 day infusion of hydrochloric acid. Correction of metabolic alkalosis by intravenous HCL infusion, even as long term therapy, appears to be safe.

Laboratory model test results for the ultimate bearing capacity of strip and square foundations supported by sand reinforced with geogrid layers have been presented. Based on the model test results, the critical depth of reinforcement and the dimensions of the geogrid layers for mobilizing the maximum bearing-capacity ratio have been determined and compared. Key words : bearing capacity, geogrid, model test, reinforced sand, shallow foundation.

In this study the hemodynamic factors which contribute to postoperative mortality and morbidity were evaluated in 41 patients. Preoperative data were prospectively collected over a 5-year period. The patients underwent vascular and general surgical operative procedures. Among them, 23 patients had minor or no postoperative complications (group 1) and 18 patients suffered serious complications or died (group 2). Preoperative cardiac function was better in group 1, but both groups achieved their best cardiac index (CI) with fluids or pharmacologic manipulation preoperatively. Group 2 patients had longer operations, more blood loss, and were significantly hypovolemic postoperatively as indicated by lower pulmonary arterial wedge pressure (PAWP) and CI in comparison to the best preoperative values. When postoperative PAWP was higher than or within 3 mm Hg of the best preoperative level, complication rate was 14 per cent (3 of 21). In 15 of the 19 or 79 per cent of the patients, postoperative complications developed when PAWP decreased by 4 mm Hg or more. The difference in complications was significant (P less than 0.01). However, commonly measured parameters such as the amount of fluid infused, urine output, immediate postoperative heart rate, blood pressure, central venous pressure, and hemoglobin failed to reveal hemodynamically significant hypovolemia or lacticacidemia in group 2. The authors were unable to demonstrate a reduction in mortality or morbidity in group 2 patients in whom serious technical operative difficulties were also encountered.