74 research outputs found

    Opposing forces of cardiogenic shock: left ventricular outflow obstruction, severe mitral regurgitation, and left ventricular dysfunction in Takotsubo cardiomyopathy

    No full text
    Abstract Rates of stress (Takotsubo) cardiomyopathy have increased during the coronavirus pandemic due to social stressors, even in patients who are not infected with the virus. At times, Takotsubo cardiomyopathy (TC) may present as cardiogenic shock. Herein, we present a case during the pandemic of shock from TC secondary to left ventricular outflow tract obstruction (LVOTO), mitral regurgitation (MR), and left ventricular (LV) dysfunction. The contrasting management strategy of LVOTO, MR, and LV failure was cause for clinical challenge, and we highlight the balance of treating these opposing forces

    RESULTS OF HAZARDOUS AND MIXED WASTE EXCAVATION FROM THE CHEMICAL WASTE LANDFILL

    No full text
    ABSTRACT This paper describes the results of the excavation of a 1.9-acre hazardous and mixed waste landfill operated for 23 years at Sandia National Laboratories, Albuquerque, New Mexico. Excavation of the landfill was completed in 2 ½ years without a single serious accident or injury. Approximately 50,000 cubic yards of soil contaminated with volatile and semi-volatile organics, metals, polychlorinated biphenyl compounds, and radioactive constituents was removed. In addition, over 400 cubic yards of buried debris was removed, including bulk debris, unknown chemicals, compressed gas cylinders, thermal and chemical batteries, explosive and ordnance debris, pyrophoric materials and biohazardous waste. Removal of these wastes included negotiation of multiple regulations and guidances encompassed in the Resource Conservation and Recovery Act (RCRA), the Toxic Substances Control Act (TSCA), and risk assessment methodology. RCRA concepts that were addressed include the area of contamination, permit modification, emergency treatment provision, and listed waste designation. These regulatory decisions enabled the project to overcome logistical and programmatic needs such as increased operational area, the ability to implement process improvements while maintaining a record of decisions and approvals

    Effective 1,4-Asymmetric C−C/C−O Stereoinduction in Indium-Promoted Coupling Reactions of Aldehydes to Protected and Unprotected [1-(Bromomethyl)vinyl] Alkanols. The Status of Intramolecular Chelation within Functionalized Allylindium Reagents

    No full text
    The stereochemistry of the coupling reactions of oxygen-substituted bromides 8−10 with isobutyraldehyde, benzaldehyde, and cyclohexanecarboxaldehyde in water is described. The examples involving the O-silylated derivatives 8 exhibit moderate anti stereoselectivity. In contrast, rather high (most often in excess of 80:20) syn diastereofacial bias is observed when hydroxy bromides 10 are involved. Consequently, stereocontrolled 1,4-asymmetric induction under aqueous conditions can be realized in either direction on demand. These results are considered to reflect the fact that the siloxy systems enter into C−C bond formation via conventional Felkin−Anh transition state arrangements. The crossover observed for the unprotected analogues is believed to be a consequence of the preferred adoption of chelated transition states, these interactions likely being fundamental to aqueous organometallic chemistry
    corecore