I go out about twice a month drinking. I drink about seven or eight vodka and cokes, making sure to get as much drink as possible before the bar closes. I then go home, sometimes taking random people with me. I have had some sexual encounters and made some stupid choices when drinking. I joke with people, that I am a night owl as an excuse to keep drinking -- sometimes to 9 the next morning. I have started worrying about the hangover before I even touch a drop, sometimes to the detriment of having a good time.
It is strange that I choose to drink despite this obsessive worry. I try to sleep, but can't after a session of drinking. I feel ashamed, guilty and sluttish -- worthless and suicidal the day after drinking and feel very alone. I have started making myself sick the next morning, and cry and just feel like dying.
This morning, I got so scared to go to sleep upstairs, in case I would inadvertently throw myself out the window in my sleep. I don't want to talk to anyone, not family or friends after a night out. I isolate myself and feel like other people are living out there, in the normal world and I am living on a different planet.
I woke up today thinking and admitting to myself, I have a problem. I feel utterly depressed. When I look back at my life I have been, an extremely heavy drinker. I continually use the excuse that I don't drink as much, as I used to and therefore have this under control.
I used to drink at college to block a social anxiety disorder. I drank 2 bottles of wine a night -- nearly every night. I thought that since I only go out only a few nights a month, I was in control of alcohol. I think I may be able to go off it and felt empowered this morning when I said to my friend "I have had enough. This alcohol has become a problem and I can't cope with life much longer if I keep drinking." I cannot honestly say whether I would find it difficult to stop drinking completely.
Comments for Am I An Alcoholic?
You know and understand that alcohol is bringing you down, depression is the worst feeling and it's major contributor is alcohol and drugs. So try to avoid alcohol for a few months and see how your well-being is.
If you feel down a little, it's because you've spoiled your body and its having a little tantrum. Don't give in, hang in there.. if you still feel low, surround yourself with your family and friends to build yourself up through their unconditional love.
Maybe go to the movies instead of a bar. Have girls night in, do facials, do special things for yourself. Just don't bring yourself down to that level alcohol takes you. You're strong enough to go though it. Now, strengthen up to get out of it. All the best to you.
No one can really answer your question but you. However, I have been taught "if you think you may have a drinking problem, you probably do".
It's not so much the amount or how often, but what happens when you drink. Sounds like you have negative things happen when you drink.
Some simple things to try: stop drinking. Can you do that without trouble, and without thinking about it? Also, try to control it - can you just have a drink and stop?
If not, go to an AA meeting -- just to listen. You don't need to talk, give your name, anything. Just listen and see if you hear anything that makes sense.
You sound like you drink like I used to for 25 years. I am now sober 3 years. Wish I asked the same question you did 20 years ago and that someone told me what I just wrote. But its never too late. Sobriety is a good thing.
You can be proud of yourself for reaching out and admitting to yourself that change is needed, because what you are doing now is not working!
You are on the right path by understanding that you must give up the alcohol. So empower yourself with knowledge and learn about the power of addiction, so that you do not let it take control of your decisions. Addiction will pull you towards what is bad for you, but your brain and instincts will tell you what you need to do!
Trust yourself to do what is right for you and you will begin to see things clearer and the right choices will become easier! Don't defeat yourself by not believing that you are strong enough to do what is best for your own well- being!
It's a lot of work but so worth it!
You are definitely an alcoholic, and you are a binge drinker. I know, because I am one too. You may not be drinking every day, but when you do you lose it. I've been going to AA meetings and have been clean for the last 5 years. You can't do it yourself. I hope you go to AA too.
Things are not great in my life, but at least I'm not drinking and I'm not depressed any more.


The Japanese Government refused to sign the "Joint Statement on the humanitarian impact of nuclear weapons," which was delivered by the representative of South Africa on behalf of 74 State Parties at the Second Preparatory Committee for the 2015 NPT Review Conference in Geneva on April 24.
As to why the government refused to sign the Statement, Ambassador Mari Amano, permanent representative to the Conference on Disarmament, stated as follows: Japan supports the fundamental message regarding the humanitarian impact of nuclear weapons…, taking into account the security environment surrounding Japan…, Japan decided to forgo joining the statement.
According to the press, the reason for the refusal is that the following part of the Statement is not compatible with the policy of nuclear deterrence of Japan: It is in the interest of the very survival of humanity that nuclear weapons are never used again, under any circumstances.
The Joint Statement was issued in the context of a historical process of aiming at the abolition of nuclear weapons in the view of international humanitarian law, and follows the "deep concern at the catastrophic humanitarian consequences of any use of nuclear weapons" expressed in the final document of the 2010 Review Conference of the NPT. The process of reaffirming the illegality of use of nuclear weapons and outlawing and abolishing them based on the international humanitarian law is seen in the Judgment of the Shimoda Case by the Tokyo District Court in 1964, the 1996 Advisory Opinion of the International Court of Justice, the final document of the 2010 NPT Review Conference, and the "Conference of the Humanitarian Impact of Nuclear Weapons" held in Oslo in March this year. The Conference held in Oslo highlighted a new humanitarian viewpoint that "no State or international body could address the immediate humanitarian emergency caused by a nuclear weapon detonation or provide adequate assistance to victims" (the Joint Statement) in addition to the longtime concern at indiscriminate damage caused right after a nuclear weapon is used and its wide-ranging and lasting aftereffect. All of these were the very facts Japan experienced in Hiroshima and Nagasaki, where medical institutions were destroyed and those who went for emergency relief also suffered grave damage.
However, Japanese Government did not agree with this Joint Statement. It is Japan that should lead the abolition of nuclear weapons in the view of inhumane consequence of a nuclear use and international humanitarian law. Nevertheless, the Government refused to sign the Statement. We cannot help feeling strong indignation at this attitude.
Japan Association of Lawyers Against Nuclear Arms (JALANA) strongly protests against Japanese Government, which should play a special role in realizing a world free of nuclear weapons for the survival of humanity but has failed to do so. Such an attitude of the country that has ever suffered nuclear attacks is an obstacle to the international community that desires a world without nuclear weapons. At the same time, JALANA would like to urge the Government, which "wishes to explore seriously the possibility of joining a statement with the same theme in the future (Statement by Ambassador Amano)", to join the Statement as soon as possible.
This December is the 50th anniversary of the Judgment of the Shimoda Case by the Tokyo District Court, which declared for the first time in the world that the use of nuclear weapons (atomic bombs) was illegal under the international law. We would like to convey to the world the significance of Hiroshima and Nagasaki, which are the origin of the inhumanity of the use of nuclear weapons.


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Revere Is An RPG About Choice, Letting Players Dictate Combat Styles, Battle Frequency, & More
By Alistair Wong November 12, 2016
Players will join Troy on a quest for redemption for years spent in service of an evil empire, but it will be up to them to decide how they seek that goal in RPG Revere.
Revere gives players a great deal of freedom with its combat. Players can choose to switch between turn-based and real-time combat, allowing them to pick which one is more comfortable whenever they like. Players can also choose how many random encounters they get into, although the developers don't recommend shutting them off entirely.
Players will also make story choices, from who to help and who to speak with, that will have an effect on the game's outcomes. The developers state that every single one of these decisions will have some influence on the end, so it will be up to the player to decide how they strive to make up for Troy's past misdeeds.
Players looking to try out this customizable RPG experience can pick up the Revere demo from Itch.io. The full game is set to release sometime in 2017.
Alistair Wong
Very avid gamer with writing tendencies. Fan of Rockman and Pokémon and lots more!

redpajama_set_name: RedPajamaCommonCrawl


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California governor vetoes bill to help displaced workers
Adam Beam
California Gov. Gavin Newsom vetoed a bill late Wednesday that would have guaranteed most laid-off hospitality workers would be first in line to get their jobs back once those industries begin rehiring.
When Newsom ordered people to stay home because of the coronavirus, California's airports, hotels, event centers and janitorial services had to lay off many of their low-wage, mostly Latino, workers. The state Legislature passed a bill last month that would have required the companies to offer those workers their jobs back once they begin rehiring.
"I recognize the real problem this bill is trying to fix," Newsom said in his veto message. But he said the bill is written so broadly that it would apply "during any state of emergency for all layoffs, including those that may be unrelated to such emergency."
Moreover, he wrote, the requirements "place too onerous a burden on employers" who also have been hard hit.
The bill was a priority for the state's powerful labor unions, especially after Disney announced Wednesday it would lay off 28,000 workers at its theme parks in Florida and California. But businesses groups, including the California Chamber of Commerce, said the bill would cost jobs by slowing down businesses' efforts to reopen at a time when they are fighting to stay viable.
"We understand these are unprecedented times," the chamber and a number of other business groups wrote to lawmakers last month. "However, it is critical to remember that many businesses and their owners are themselves casualties of this economic shutdown."
The chamber said after Newsom's veto that it was "grateful that the Governor chose not to further burden these industries at a time when they can least afford it."
Glynndana Shevlin, 60, says she has worked at the Disneyland Hotel for 32 years. She's been on furlough since April, living off of unemployment checks. Wednesday, she got an email saying her job is in jeopardy.
She said she was "heartbroken" that Newsom vetoed the bill.
"My life is a little insecure," she said.
Newsom vetoed the bill as his administration has been slowly loosening coronavirus restrictions on businesses. California has relaxed its most restrictive rules for 40 of the state's 58 counties. Wednesday, San Francisco allowed a return to indoor dining for the first time since March.
Since March, California has processed about 13.6 million claims for unemployment benefits, paying out $90.6 billion. The leisure and hospitality industry has been the hardest hit of the state's 11 industry sectors, losing more than 600,000 jobs in the past year.


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Home » World News » Analysts at Goldman Sachs complain of 'inhuman' 100-hour work weeks
Analysts at Goldman Sachs complain of 'inhuman' 100-hour work weeks
First-year analysts at Goldman Sachs earning $91k before bonuses complain they work 'inhuman' 100-hour weeks with regular 20-hour shifts, according to leaked presentation
A group of first-year analysts at Goldman Sachs compiled a Powerpoint presentation about their experiences in the workplace
The group complained of grueling hours and unrealistic deadlines
The young analysts have now proposed a maximum work capacity of 80 hours per week
Goldman Sachs says they are 'listening to the employees' concerns and taking multiple steps to address them'
The investment bank reportedly pays its first-year analysts a cool $91,000, excluding any bonuses
More than a dozen first-year analysts at Goldman Sachs have complained of 'inhumane' conditions they claim to have endured while working at the investment bank.
A Powerpoint presentation compiled by 13 new employees, in which they surveyed themselves about their work environment, leaked to social media on Wednesday.
According to the document, the analysts alleged they were 'very unsatisfied' with the firm, citing grueling hours, unrealistic deadlines and unpleasant senior staff.
'My body physically hurts all the time and mentally I'm in a really dark place,' one of the young employees wrote in the presentation.
Another stated: 'What is not okay to me is 110-120 hours over the course of a week! The math is simple, that leaves 4 hours a day for eating, sleeping, showering, bathroom and general transition time. This is beyond the level of 'hard-working".
More than a dozen first-year analysts at Goldman Sachs have complained about 'inhumane' conditions they claim to have endured while working at the investment bank
'The sleep deprivation, the treatment by senior bankers and physical stress… I've been through foster care and this is arguably worse,' a third person was quoted as saying.
On average, the 13 first-year analysts gave Goldman Sachs a score of 2 out of 10 for workplace satisfaction.
Meanwhile, 83 percent of respondents said they had experienced 'excessive monitoring or micromanagement'. 17 percent said they 'frequently encountered shouting or swearing'.
A majority of the analysts claimed they felt like they had been a victim of workplace abuse, while three-quarters said they had sought or considered counselling due to stress.
The Powerpoint presentation concluded with a slide titled 'Rectifying The Situation', in which the analysts proposed ideas to senior staffers that would help them feel better about the workplace.
The Goldman Sachs headquarters in downtown Manhattan is pictured
The group proposed a maximum work capacity of 80 hours per week, stating: ' In order to do our best work and deliver for the firm's clients we need to be rested and free from juggling an insurmountable amount of conflicting work streams'.
They also stated: 'Junior bankers should not be expected to do any work after 9pm Friday or all day Saturday without a pre-approved exception, as that is the only safe-guarded personal time that we get'.
Goldman Sachs is one of the most prestigious investing banking firms, and first-year analyst jobs are extremely coveted.
According to Business Insider, banks like Goldman Sachs their first-year investment banking analysts a cool $91,000.
The sum does not include any bonuses, which are usually paid toward the end of the year.
A Goldman Sachs spokesperson told the New York Post that they take their employees' concerns seriously
'We recognize that our people are very busy, because business is strong and volumes are at historic levels,' the spokesperson said.
'A year into COVID, people are understandably quite stretched, and that's why we are listening to their concerns and taking multiple steps to address them.'
Goldman Sachs chairman and CEO David M. Solomon is pictured


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It's been awhile since I've opened my heart to write a Capturing Grace post. It's also been a while that it's been such a deep, internal struggle to allow the words to flow. I've sat here day after day, with pen to paper or mouse to mac, while the words have steadfastly refused to come. I've been feeling stuck, sad, overwhelmed with grief-filled emotion pouring through yet lacking the inspiration to share from the heart.
With the 4th of July holiday centering around independence and the beauty of a nation that's a melting pot based in freedom, my heart decided it was time to open up and let you in. We've become a nation divided. A nation lacking any semblance of compassionate leadership. My intention isn't a political one but a human one. This country was founded on immigration. This country was founded on a beautiful tapestry woven together made up of men, women, and children from a variety of cultures entering our borders lured by the American dream and the promise of a free world. Our original leaders and our constitution afforded rights and protections to those who sought the freedom of our shores and the ultimate prize, American citizenship.
As a woman, a Mother, and an empath with an overly sensitive and tender heart, recent events have brought up feelings and emotions that have at times overwhelmed my capacity to function. Many days, I've wanted to curl up in the fetal position or hop on a plane and head to the border to use my voice to fight for those who no longer have one or aren't allowed to be heard. I've felt hopeless, helpless and powerless.
One of the loudest voices out there and a woman I deeply admire is Brene Brown. Another tender heart who's built her platform on courageous vulnerability. She's also a Houstonian living near the border, a Social Scientist and the wife of a pediatrician. Brene and her husband understand the lifelong, indelible pain of childhood trauma. As do I. Trauma has been my companion since the day I was born. Trauma keeps me awake at night and my mind occupied much of the day. Watching children ripped from their Mother's arms and Mother's forcibly taken away from children screaming in terror leaves a mark and opens a gaping wound I've been working a lifetime to heal.
Trauma is a different animal. Trauma is stored in our cells. It's pain that bypasses the conscious memory as it overwhelms our brain's capacity to process the feelings and emotions at the time it happens. Trauma changes who we are at our core. Trauma destroys lives. Trauma destroys families. The trauma of today's immigration policies affects every single of one of us.
These children and families are literally crying out for help. Fleeing terror in their native lands only to arrive on our shores to be treated without compassion, dignity, and grace. Their cries are a collective cry – one for a better world, a kinder world, a world with heart-centered values. My heart cries along with them. I cry along with them. The little girl in me who grew up with terror and trauma cries along with them. The little girl who's spent a lifetime working to heal cries along with them.
The hopelessness, powerlessness, grief and deep despair I've felt over the past few months I thought I'd left behind. What we need now more than ever before isn't to get lost in our grief but to allow that grief to fuel us. What we need is is to listen to the collective cry and join together through our hearts and work toward a solution. It's time to put politics aside as politics only serve to divide our hearts and separate us as human beings. In the end, we are all one and the pain one faces, we must all face together.
Let us let go of the label of "immigrant" and open our hearts, our minds and our consciousness to these human beings who are looking for a better life. These are parents looking to save their children from the pain and terror in their homelands. These are young children whose futures are being etched and shaped by the trauma in their hearts. We are better than this. We are America the free – America the brave. We must be America the compassionate. We must remember the power of our country stems from our cultural differences and the acceptance therein. I'm opening my heart to allow the grief the space it needs to heal. My prayer is for our leaders to open their hearts and to remember that they were once children too.
Thank you for sharing your heart. I had a hard time celebrating the 4th of July this year because of where we are as a nation….truly divided.
Our government treated the Native people of this land much the same way they are now treating others who want/need to join our country – like outsiders who do not belong. It is a selfish model and I too hope it can change.
Very well said! Thank you for continuing to illuminate the harm from this injustice!
So beautifully said and so full of the compassion we desperately need in this country. As Americans, and human beings, we can't let this continue – it's not a political issue, but one of empathy, love, and kindness. Thank you for opening your heart and expressing so eloquently what many of us are feeling.
Catherine, your words here are perfect, and the raw honesty behind them is palpable. Thank you for laying it all out there.
Catherine, thank you for using your voice to shed light on this most sensitive situation. Every human life deserves the same freedom that our country was originally founded on. I can't imagine what these children and their parents are going through. All children, every human… needs to feel safe, secure and loved. It is my prayer that not only our government leaders, but every American…will find it their hearts to end the division, any and all type of racism, and hate…. To accept, embrace and respect every human, race and culture, with kindness, compassion and love.
A country is as strong and its heart is. Plain and simple. When we let fear and the unknown govern our hearts and actions, we all lose.
I couldn't agree with your more. My heart breaks for these families – these children. One child I heard say come back Mommy! I will be good. so so so sad. What they are doing to these children.
Catherine, thank you for speaking out and using your platform to shine a light on what is becoming a defining moment in our country's history.


At Shutter World, we provide an increasing number of windows with shutters across the UK, but we know that a lot of our clients don't leave them as we supply them. Some of the home décor tricks that have been applied to our window shutters have surprised even us!
Although our windows shutters can come in natural wood finishes or a wide choice of colours, many of our customers paint them themselves.
It's a great idea for a child's room. Panels can be painted different bright colours when a child is very young, then switched to their favourite colours as they grow older. Then as their tastes change they can be repainted once more, probably ending up in one colour before they finally leave the nest.
One great example was a child who couldn't decide whether her favourite colour was pink or purple. So the parents painted alternate slats in each colour and the frame white. Of course, she changed her mind within a year!
In the rest of the house, shutters can easily be painted to match your interior design changes. You're effectively making your own designer shutters as you are the one in charge.
Most window shutters are easy to remove and replace so the painting can be done in a garage, shed, or even outside, making it even easier.
Graphic patterns or pictures (also known as decals) of all sorts are available in sticker form that can be applied to shutters as well, although it's a bit more finicky than with walls, which is what they're intended for.
Make sure the shutters are closed and follow the manufacturers' instructions to apply the design. Then carefully cut in between the slats with a sharp craft knife and fold the cut edges around the slats above and below the cut.
Imagine a huge flower spreading across your window shutters that changes shape as you open and close them – you could do almost anything!
If this has inspired you to try something different, have a look at the gallery to pick the shutters that could act as your blank canvas, then get an instant quote to see how cost-effective they are.


The Bredon is a superior four bedroom detached home offering open plan layouts and a quality finish. Settled in Walton Cardiff, Tewkesbury, the home is designed with the family in mind.
The entrance hallway offers a downstairs toilet and ample under-the-stairs storage, leading on to the well lit and cosy lounge. Take advantage of the large bay window bringing in that extra natural light in the lounge, providing a space that the family will love to relax and unwind in. This home provides an open plan kitchen / dining room, big enough to fit a dining table for six, with an extensive TV / family area perfectly placed to enjoy views of the garden through the set of French doors. The kitchen also boasts stylish Symphony kitchen units, integrated Bosch electric double oven and a handy utility room for keeping all the washing out of sight.
Upstairs is the family bathroom, finished with a contemporary white Roca bathroom suite with complementing sleek Hansgrohe chrome fittings, and the four bedrooms, with two being double sized. Parents can embrace their own private luxury in the master bedroom with stylish fitted sliding wardrobes and a private en suite shower room, meaning no queues in the morning rush. And, if you'd like, one of the two single bedrooms could make an ideal home office or perhaps the perfect dressing room for those who enjoy indulging in a little retail therapy.
This home comes complete with a garage and private driveway parking.
Introducing the Bredon, a superb 4 bedroom home. Explore our interactive 360° tour - you can click and drag anywhere to explore. You can also view images in the Photo Gallery.


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VIETNAM NEWS HEADLINES DECEMBER 20 – VietNamNet
Special policies necessary for HCM City's development: NA leader
National Assembly (NA) Chairman Vuong Dinh Hue, Secretary of the Party Delegation at the National Assembly, on December 19 chaired a meeting between the NA Party Delegation and the Standing Board of the Party Committee of Ho Chi Minh City on devising a project to build a draft resolution on pilot mechanisms and policies for the development of the city to replace the NA's Resolution 54.
The mechanisms and policies have been piloted in the city since January 2018 following Resolution 54, with a duration of five years.
In October this year, the Government suggested that the NA allow the city to continue piloting some special mechanisms until the end of 2023 instead of 2022..
Meanwhile, a project to develop an international financial centre in the city is being built, requiring adjustments of policies in finance, technology, banking, foreign exchange and relevant policies to serve as the legal foundation for the project.
Chairman of the municipal People's Committee Phan Van Mai held that a new resolution replacing Resolution 54 is crucial to smooth resources for the city and create a momentum for it to rebounce.
Addressing the meeting, NA Chairman Hue lauded the HCM City Party Committee in building the draft resolution with more than 50 proposed policies.
He asked the city to focus on implementing four major policy groups, including existing policies included in Resolution 54 that have proved their efficiency; policies that are not included in Resolution 54 but are being carried out effectively in other localities; policies allowing the city to apply amended and supplemented contents of some revised laws; and policies exclusively applied for HCM City to remove obstacles facing the city.
Underlining that the draft resolution will bring about both intermediate and long-term benefits for the city and help promote its development and renovation, the NA leader stressed the need to clarify the contents and the authority to implement the resolution, along with a specific plan to realise it after it is issued.
He said that the draft resolution should be finalised for discussion at a NA session in May 2023.
Seminar, photo exhibition opens to support Agent Orange victims
The National Action Centre for Toxic Chemicals and Environmental Treatment (NACCET) opened a seminar and photo exhibition in Hanoi on December 19 in support of Agent Orange (AO) victims.
Participants discussed priority support for the enforcement of policies for people with disabilities, the need for technical assistance in the process of policy enforcement, capacity to mobilise, manage and use resources for the disabled, among others.
The project aims to improve the living conditions of persons with disabilities in provinces heavily sprayed with Agent Orange in the provinces of Quang Tri, Thua Thien-Hue, Quang Nam, Binh Dinh, Kon Tum, Binh Phuoc, Dong Nai and Tay Ninh from 2021-2026.
Managed by the Ministry of National Defence and carried out by NACCET, the project is costing about 65 million USD in non-refundable aid provided by the US Agency for International Development (USAID) and 75 billion VND (3.26 million USD) from Vietnam.
The project aims to expand medical, rehabilitation and social services for the disabled, making it easier for them to integrate into society while improving the capacity of managing and supporting the disabled at all levels.
As of the late November, nearly 12 million people with disabilities and AO/dioxin victims in the above localities had received health check-ups, about 3,500 underwent rehabilitation, 6,000 obtained care services, and about 1,000 could manage themselves with support.
Film project on Southern culture begins
Filming for Dat Rung Phuong Nam (Southern Land), a film on southern history and culture by blockbuster director Nguyen Quang Dung, has begun in HCM City.
The work expected to be completed next year tells the adventures of a boy named Nam, who loses his family in a battle and lives in the southwestern region under the French colonists. He learns new things with the help of poor farmers and children, and travels around the region and witnesses the suffering of farmers during the war. He joins the Viet Minh guerrillas to fight against the French troops.
The producer, HK Film, invited talented director Dung, director of photography Diep The Vinh, and music producer Duc Tri to guarantee the film's high quality in images, sound and light effects.
The film Dat Rung Phuong Nam is based on the famous novel of the same name by late author Doan Gioi, winner of the State Awards for Literature and Arts in 2001. Gioi's book was released by the Kim Dong Publishing House in Hanoi in 1958.
The 255-page work is a song in praise of southern people, their history and culture. It provides readers, particularly children, with new ideas about the nature, animals, rivers, plants and people of the south.
The book has been printed in dozens of languages, such as English, Russian, Chinese, Spanish and Polish. Its chapter titled Song Nuoc Ca Mau (Rivers of Ca Mau) has been used in textbooks for secondary students.
In 1997, the work was adapted into a 11-part TV series called Dat Phuong Nam (Song of the South) by director Nguyen Vinh Son.
Son's work won the first prize for the Year's Best TV Series at the 1997 National Film Festival presented by the Vietnam Cinematography Association.
It was subtitled in English and has been distributed in the US, Australia, Malaysia, Thailand and Singapore.
Director Dung spent five years to prepare for his biggest film project Dat Rung Phuong Nam. He used movie stars Hua Vi Van and Tuan Tran, and Meritorious Artist Nguyen Cong Ninh to play lead roles.
Filming will be shot in southern localities such as An Giang, Can Tho, Soc Trang, Tra Vinh and Dong Thap.
Dung's previous film, Thang Nam Ruc Ro (Splendid Years), a remake of a Korean hit called Sunny, earned more than 65 billion VND (2.85 million USD) in ticket sales in 2018.
Korean culture and tourism days take place in Hanoi
The 2022 Korea Culture and Tourism Days has recently opened in Hanoi as part of activities to celebrate the 30th founding anniversary of diplomatic relations between Vietnam and the Republic of Korea (RoK).
The opening ceremony of the event held on December 17 at Dong Kinh Nghia Thuc Square – part of the walking zones around Hoan Kiem Lake, saw the participation of RoK Ambassador to Vietnam Oh Young-ju, head of the Korean Tourism Organisation (KTO) Kim Jang-sil and representatives from Hanoi's agencies, among others.
At the ceremony, KTO announced "Korean Tourism Year 2023-2024".
A total of 24 booths at the event provided people with information about the Korean culture, tourism, and people. Visitors had a chance to experience food, handicraft products and traditional games of the RoK as well as enjoy performances by Korean and Vietnamese artists.
In the first 11 months of 2022, more than 160,000 Vietnamese tourists visited the RoK, and more than 567,000 Korean tourists came to Vietnam, making the RoK continue to be the largest international visitor market of Vietnam.
Hoi An ready for year-end festival
Closing out the National Tourism Year 2022, Hoi An ancient town in Quang Nam province is set to host a range of unique cultural and tourism activities.
For the first time, "The essence of Vietnamese tea" festival will be held in Hoi An, bringing together a large number of tea researchers, artisans, and tea lovers from around the country.
Taking place over three days from December 30, the festival features interesting activities such as "Tea tasting and exchanges with artisans", "Tea, poetry and photography", and a New Year's tea ceremony, among others. Spaces will be created for visitors to experience tea and meditation, royal tea, folk tea, Hanoi footpath tea, and southern iced tea.
Hoi An is also preparing products with messages on green tourism, such as "Artistic and Creative Road", with a space for artworks made from recycled materials, and the Hoi An marine environment installation art festival and green tourism fair. All aim to inspire and raise awareness among the tourism community and visitors about sustainable tourism.
In addition to new activities mentioned above, end-of-year traditional festivals that are trademarks of Hoi An will also be maintained, such as the lantern festival. This promises to offer visitors from near and far a great experience when visiting the ancient town.
Binh Thuan finalises preparations for National Tourism Year 2023
The south-central coastal province of Binh Thuan is finalising preparations for its hosting of the National Tourism Year 2023, the provincial Department of Culture, Sports and Tourism said on December 19.
Director of the department Bui The Nhan said that the locality has set up and completed an Organising Committee for the Tourism Year 2023 and its sub-committees.
It has issued a communications plan for the event, and a logo for the "Tourism Year 2023 – Binh Thuan – Go Green Come Together," he said.
To date, three localities have registered to respond to the event, including Phan Thiet and Ham Thuan with bicycle races, and Phu Quy with a half-marathon tournament.
The Tourism Year 2023 will comprise more than 200 events, of which 13 are of national scale.
The first highlight of the year will be a countdown event on New Year eve in Phan Thiet city.
The province is home to nearly 600 hotels and resorts with 17,000 rooms, including 45 resorts and hotels of 3-5 star level with nearly 5,000 rooms.
Can Tho, USAID foster partnership in waste treatment, climate change response
Leaders of the Mekong Delta city of Can Tho on December 19 had a working session with a delegation from the United States Agency for International Development (USAID) led by its Director Aler Grubbs, during which the two sides discussed prioritised cooperation areas and collaboration in climate change response and environment.
According to the municipal leaders, currently, only 20% of total urban wastewater has been treated. The city plans to build more wastewater treatment plants in the future.
In 2018, the city launched a waste treatment plant with a capacity of treating 400 tonnes per day and night. In the time to come, it will call for investment in another plant with a capacity of 800 tonnes per day and night and night.
It has constructed two industrial wastewater treatment plants in Tra Noc and Thot Not IPs.
The city leaders said that the locality is facing difficulties in finance, technology and human resources during the treatment of urban and industrial wastewater.
Nguyen Ngoc He, Vice Chairman of the city People's Committee asked the USAID to coordinate with the city in classifying domestic solid waste; deploying circular economic models in the treatment of livestock waste and agricultural by-products; developing models on recycling and reuse of plastic waste as well as scientific research on plastic waste treatment.
He also asked for support in the implementation of communication projects to strengthen the capacity of local stakeholders in plastic waste prevention and control, and assistance in implementing industrial production models with minimised greenhouse gas emissions.
For her part, Aler Grubbs said that the organisation is running a number of prioritised projects and programmes in Vietnam, focusing on overcoming war consequences, reducing epidemics impacts, tertiary training, and economic development.
She said that the USAID pays special attention to projects and programmes related to the environment, climate change, and wildlife trafficking combat.
The USAID will prioritise cooperation with Can Tho in reducing waste, medical waste in the Can Tho General Hospital, and climate change in agriculture.
The city's official pledged that in the time to come, the city will coordinate closely with the USAID to implement two projects on reducing the use and recycling of plastic waste, and minimising greenhouse gas emissions with the goal of mitigating the impact of climate change, thus helping Can Tho cope with climate change.
Can Tho hopes to speed up the two projects and seek new projects, he said.
Capacity building project for Vietnam-Korea university kick-starts
A project on improving the capacity of education-training, governance and research for the Vietnam-Korea University of Information and Communication Technology (VKU) for the 2022-2027 period kick-started in the central city of Da Nang on December 19.
The project costs nearly 8.5 million USD, including 7.7 million USD in non-refundable aid provided by the Government of the Republic of Korea (RoK) via the Korea International Cooperation Agency (KOICA).
It aims to develop VKU into the first digital university in the central region with breakthrough curricula and a contingent of qualified lecturers. It is expected to become a hub for start-ups and innovation as well as cultural and academic exchange with the RoK and the world.
Speaking at the event, VKU Rector Huynh Cong Phap expressed a wish to build VKU into a model of success and a cultural exchange hub between Vietnam and the RoK in the central and Central Highland regions.
In the afternoon the same day, the VKU inaugurated a research and innovation space under the Digital Science and Technology Institute (eSTI).
ASEAN Music Festival 2022 opened in Quang Nam
The ASEAN Music Festival – 2022 was opened in Hoi An city, the central province of Quang Nam, on December 19 with the participation of 14 troupes from ASEAN countries.
The event, to last to 24, is among the activities within the framework of the closing of the National Tourism Year – Quang Nam 2002 and those marking the 55th founding anniversary of ASEAN this year.
Performances by more than 200 artists are conveying a message of "United, Creative – Shining Together".
Ministry informs press on 2022 public security works
The Ministry of Public Security on December 19 held a press conference to brief the media on its works this year, including information on a series of major cases in the public eye.
At the event, Vu Nhu Ha, deputy head of the ministry's investigation police agency on corruption, economy, smuggling (C03), said the agency prosecuted two cases and 27 defendants to investigate violations at the Van Thinh Phat Holdings Group Corporation.
The representative also noted that 29 cases and 102 defendants involved in the COVID-19 test kit overcharging at Viet A Technologies JSC were prosecuted.
The ministry has also found signs of wrongdoings in the management, research and transfer of the scientific project on COVID-19 test kits at the Ministry of Science and Technology and in licensing the circulation of the test kits and the negotiations of its price with the Viet A Company at the Ministry of Health.
A number of matters related to the case are being thoroughly investigated, Ha said, adding that C03 is continuing to collect more evidence and documents.
Regarding the scandal related to "repatriation flights" at the Consular Department under the Ministry of Foreign Affairs, other ministries and localities, C03 said it has so far launched legal proceedings against 35 suspects.
Vietnamese footballers receive encouragement before AFF Cup opening match
Chargé d'Affaires of the Vietnamese Embassy in Laos Phan Minh Chien said that the embassy will provide all necessary support to the Vietnamese national football team at a meeting with the squad members on December 19.
Welcoming the team, who arrived in Laos to prepare for the first match in the AFF Mitsubishi Electric Cup 2022, the diplomat said that a lot of Vietnamese football fans are expected to come to the Lao national stadium to encourage coach Park Hang-seo and his players.
For his part, Park thanked the Vietnamese Embassy in Laos for their attention and encouragement which he said give motivation to the team to obtain the best results.
Captain Do Hung Dung said that at the AFF Cup 2018, the Vietnamese squad also faced Laos in the opening match and then won the championship, adding that they also hope for a similar result this year.
Vietnam will meet Laos at the Laos National Stadium at 7.30pm on December 21.
The AFF Cup 2022 is scheduled to run between December 23 and January 16. Vietnam has been placed into Group B, with games against Malaysia, Singapore, Myanmar, and Laos.
Following the match with Laos, Vietnam will meet Malaysia on December 27, Singapore on December 30 and Myanmar on January 3, 2023.
IOM announces winners of "Migration through my lens" competition
The International Organisation for Migration's Chief of Mission, Park Mihyung, has announced Lê Thảo Hương as the winner of the "Migration Through My Lens" competition.
The IOM Chief of Mission made the announcement at an awards ceremony on December 18 in Hà Nội.
The first edition of the "Migration Through My Lens" asked entrants to describe what migration means to them using their own pictures or short videos.
The competition was part of IOM's efforts to increase interest and knowledge about migrants' rights in the lead up to the commencement of International Migrants Day (December 18).
Commenting on the competition, IOM's Chief of Mission Park explained: "We really wanted to get from the Vietnamese public their ideas on how to better promote safe, regular, and orderly migration in Việt Nam. What is it about the visual or storytelling aspect of migration that draws Vietnamese to want to learn more about the issue?
The second prize winner was Trần Thế Khải, a youth from Vũng Tàu, with his short video entry on a female migrant's journey from Mekong Delta to Hồ Chí Minh City.
The third prize went to Nguyễn Hữu Thống with his impressive photo of ethic Mông seasonal migrant workers in Hà Giang.
According to IOM's World Migration Report 2022, there were around 281 million international migrants in the world in 2020, which equates to 3.6 per cent of the global population.
The estimated number of international migrants has increased over the past five decades. In Việt Nam, over the past decade, the country has become one of the top 20 countries in the world with the highest remittance from its international migrant workers.
According to official data on contracted overseas labour in 2021, Việt Nam has over 600,000 international migrant workers in nearly 40 countries who have sent home around US$3-4 billion of remittance every year.
HCMC prepares for new year's countdown event
The Ho Chi Minh City Department of Culture and Sports has just submitted a report to the municipal People's Committee related to a countdown event and art light decorations on the streets to welcome the new year 2023.
The venue for the countdown event is set to take place at Nguyen Hue Pedestrian Street, a section of Ngo Duc Ke – Nguyen Thiep and Le Duan Street, a section from Nam Ky Khoi Nghia Street to Pasteur Street, with the installation of electronic screens.
The event will start at 5:30 p.m. on December 31, 2022, to 0:30 a.m. on January 1 of 2023.
The countdown event is an annual program of Ho Chi Minh City to welcome the new year, attracting thousands of residents and visitors which is performed in form of socialization.
As for the light decoration on the street, the activities will be implemented by VINAMA Communications Joint Stock Company on three routes of Le Duan Street, a section from Nam Ky Khoi Nghia – Nguyen Binh Khiem, Nam Ky Khoi Nghia Street, a section from Vo Thi Sau – Le Loi and Ton Duc Thang Street, s section from Ham Nghi – Thu Thiem Bridge 2.
Ministry issues regulations to increase use of local drugs in hospitals
The Drug Administration of Vietnam under the Ministry of Health has so far issued regulations to increase the use of domestically produced drugs in medical facilities.
According to the Program to develop the pharmaceutical industry, domestically produced medicinal herbs to 2020, with a vision to 2045 approved by the Prime Minister, by 2025, domestically produced drugs will account for 75 percent of the used output and 60 percent of market value.
However, this goal is a big challenge for the pharmaceutical industry when currently domestically produced drugs only account for more than 50 percent of the pharmaceutical market share in Vietnam.
Amongst regulations issued by the Drug Administration of Vietnam, the most important is the Circular 15/2019/TT on the procurement of drugs at public health facilities. Accordingly, the procurement of drugs by public hospitals will go through a bidding process that is divided according to quality standards. As a result, the two highest drug groups, accounting for about 60 percent of the generic drug package value, are limited to drugs that meet EU-GMP standards of pharmaceutical equivalence and bioequivalence compared with the brand name drug for which it will be substituted.
Source: VNA/SGT/VNS/VOV/Dtinews/SGGP/VGP/Hanoitimes
State Farm Will Start Hiking Auto Rates, Allstate CEO Predicts – Insurance Journal
US Metro Bancorp Declares Interim Dividend on Common Stock – Business Wire


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Interview with the President of the Council of the Brazilian School of Psychoanalysis (EBP-Escuela Brasilera de Psicoanálisis): Rômulo Ferreira da Silva. Interviewed by Gleuza Salomon. Rômulo Ferreira da Silva is a psychiatrist with a Master degree issued by FMUSP, Master 2 and a doctorate at the University of Paris 8. Former General Director of the Brazilian School of Psychoanalysis from 2009 until 2010. Current President of the Brazilian School of Psychoanalysis (EBP). AME (School Member Analyst) and AE (School Analyst) for the period 2012-2015. Co-founder of Clin-a.
By Gleuza Salomon
Author: Rômulo Ferreira da Silva
24:26 minutes | Audio in Portuguese | Recorded 23.01.2014


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[REVIEW] Star Trek: Discovery 210 "The Red Angel": Mystery Solved?
Star Trek: Discovery Episode 210 "The Red Angel" Review
Did your Red Angel theory play out? Probably not! The long-awaited reveal of who the mysterious time-traveling, armor-wearing person is actually somebody nobody could have expected.
Initially, the "reveal" of who the Red Angel is was unceremoniously said to be Michael Burnham (Sonequa Martin-Green), based on a file found in the deceased Airiam (Hannah Cheesman). But that seemed a little too easy, didn't it? Instead, the final moments of the episode reveal the Red Angel to be the person who helped designed the Red Angel suit itself, and a person thought to be long dead: Michael's mother, played by Sonja Sohn.
But we are getting ahead of ourselves. "The Red Angel" began with a moving funeral for Airiam, who met her demise last week after she was corrupted by Section 31's AI, Control. In this scene, we feel the Discovery crew feel more and more like a family, where quite a few crew members lament their loss – including a welcome monologue from Keyla Detmer (Emily Coutts), relating her own augmentation to Airiam. And in case you were wondering, Doug Jones confirmed on Twitter that that was indeed him singing in Kelpien. Later in the episode, we see Airiam's replacement, Lieutenant Nilsson, who is played by Sara Mitich, the actress who played Airiam in season one. We previously saw Nilsson earlier in season two.
Ethan Peck as Spock and Sonequa Martin-Green as Michael Burnham (CBS)
Otherwise, "The Red Angel" was an episode packed with character-driven scenes, most notably a friendlier-than-usual conversation between Spock (Ethan Peck) and Michael as the Vulcan tries to comfort Burnham. And it's here that we should note that Sonequa Martin-Green kills it in this episode. Her character has so much going on – from the faux revelation that she is the Red Angel, to Section 31 (and Leland in particular) being responsible for her parents' death, to Michael being used as bait to attract the Red Angel.
That's a lot of emotion to handle, but Martin-Green juggles these scenes with amazing grace. Let's count the emotions: fear and romance (talking with Ash), anger (talking with Leland), grief (the funeral scene), extreme pain (the episode's climax), and guilt (over the death of her parents). Her exchange with Leland involving her parents is a particular highlight from this episode; she executes a quiet rage that is absolutely appropriate for situation. This is to say nothing of the episode's climax, where Burnham is slowly but very painfully dying as the Red Angel takes its sweet time coming to the rescue. It's an incredibly brave moment for the character, and may very well come to be a signature moment for both Burnham's character arc, and Martin-Green's tenure on Discovery.
Michelle Yeoh as Philippa Georgiou (CBS)
Prominently, and perhaps overdue, we see more movement on the Culber-Stamets front, as the continuing tension between the (former) lovers reaches a new height in a scene involving Philippa Georgiou (Michelle Yeoh). The former Terran empress remarks on the Stamets in her universe as the Prime Universe engineer and doctor maintain and defend their identity and sexual orientation a conversation never explicitly had before on a Star Trek show. It's a scene that will surely satisfy fans who are particularly fond of the Stamet-Culber dynamic, and it grants a quick look into Georgiou's universe, as well. In a follow-up scene, Culber reaches out to Admiral Cornwall (Jayne Brook) about adjusting to what amounts as a new life. It's a scene that's slightly overdue, considering how long ago Culber was recovered from the mycelial network.
The Red Angel (CBS)
Even with all this character movement aside, and with the central mysetry of the seasons solved, "The Red Angel" offers major questions to the audience: has Control taken over Leland's ship (after giving him that thorough eye exam)? What happens now that Burnham's mother is seemingly alive and well (and why is she doing what she is doing?), and why would Airiam's data file identify the Angel as being Burnham, when it's actually her mother? Kudos to Discovery for stringing along fans for most of a season with an engaging mystery, one that has prompted much debate among fans. But the mystery isn't close to being solved. The adventure continues…
Stray thoughts:
If the story beat about Section 31 suspecting Earth's technological progress was impacted by time travel is familiar, that's because the Voyager episode "Future's End" explores the same idea.
Section 31 talks at length about the Klingons and their investigation into time travel. Perhaps this opens the door for the Klingons to come back this season, having only been seen in the third episode, "Point of Light."
Referring to Leland's eye exam: why did he need to use that device anyway. We've never seen that retina scanner before, and at the time, Leland was, what, overriding a security system? Seems like it was just a good excuse to offer a jump scare.
This episode was directed by Hanelle M. Culpepper, who not only directed the season one episode "Vaulting Ambition," but she is also directing the first two episodes of the still-untitled Picard TV show – making her the first African American woman to helm the first episodes of a Star Trek series.
It's the same praise week after week: Ethan Peck continues to impress as Spock. One can hear a bit of Nimoy whenever he talks. If Peck loses the beard and cuts his hair by the end of the season, count it as a great transition heading into The Original Series.
We got some great shots of Discovery this week. It's refreshing having new exterior shots to enjoy each episode, instead of, say, the reused establishing shots in other Star Trek shows.
Stay tuned to TrekNews.net for all the latest news on Star Trek: Discovery. Connect with us on social media: @TrekNewsNet on Twitter, @TrekNews on Facebook, and @TrekNews on Instagram.
[amazon_link asins='B07G2D87C1,B07BDMVY9X,B01M70T4WU,B01IG0H9JU' template='ProductGrid' store='treknenet-20′ marketplace='US' link_id='1ba140eb-b068-11e8-a0c7-a19c0f8f92ee']
In this article:Anson Mount, Doug Jones, Michelle Yeoh, Review, Sonequa Martin-Green, Star Trek: Discovery
Faulivia Olive Dunham
I knew it couldn't be Michael, but they were still careless not realizing that telling present time Michael all the plans to capture the Red Angel. If it was actually her, she'd know their plans! Time travel 101 people!!!
TriggerWarning
That was hilarious when it was revealed that mirror Stammets has sex with pans. WTF is that about? He's not attracted to any other cookware?
theGhostwriter
>>We've never seen that retina scanner before
we've never seen much of anything on that section 31 ship before
>>>Perhaps this opens the door for the Klingons to come back this season
they're in promos for upcoming episodes
>>>Ethan Peck continues to impress as Spock.
He gets a lot of it right, but he often speaks too quickly, and could be just a bit more measured.
>>> It's refreshing having new exterior shots to enjoy each episode, instead of, say, the reused establishing shots in other Star Trek shows.
Agreed. Discovery is cinematic in a way that none of the shows ever were before. I've enjoyed it from the outset of S1.


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2021| May-August | Volume 10 | Issue 2
Online since June 14, 2021
Weaning protocol for severe COVID-19 patients on high-flow nasal cannula oxygen therapy
Anshu Roy, Mohd Saif Khan, Jay Prakash, Srishti Kindo
May-August 2021, 10(2):264-265
DOI:10.4103/ijrc.ijrc_23_21
Challenges with present symptom control and risk reduction of future exacerbations in asthma: Indian patients' perspectives
Raghupathi Narasimhan, Lancelot Pinto, Susmita Roy Choudhary, Nila Velayudhan
Asthma poses a serious burden and remains poorly understood and unrecognized, in lower- and middle-income countries such as India where healthcare resources are already constrained. Several misconceptions exist among Indian patients regarding asthma, including the nature of the disease. Poor adherence to maintenance treatment leads to inadequate control of underlying inflammation which, in turn, increases the chances of subsequent exacerbations. Effective management of asthma should aim to control symptoms, decrease risk of exacerbations, and minimize fixed airflow limitation and side effects. Patient education and counseling also play a key role. A control-based management of asthma is recommended with the adjustment of medications via a stepwise approach. A single inhaler for both maintenance and reliever therapy offers an approach that can provide rapid relief, simplify asthma therapy, and prevent asthma exacerbations, while decreasing the total corticosteroid dose taken over time. For this review, a literature search was conducted using PubMed and other library searches to collate data on the Indian patients' perspectives on the level of asthma control and the associated risk of asthma exacerbations. We discuss the perceptions among Indian asthma patients regarding the disease, the gaps in asthma management, the key aspects of Global Initiative for Asthma Guidelines, and the role of single inhaler for both maintenance and reliever therapy in the management of asthma.
Oxygen Sources and delivery devices: Essentials during COVID-19
Pratibha Mohan Todur, Souvik Chaudhuri, MV Eeshwar, Deepika Teckchandani, Ramkumar Venkateswaran
The coronavirus disease of 2019 (COVID-19) is an ongoing pandemic which is known to predominantly affect the respiratory system. Oxygen (O2) therapy has a profound role in the treatment of COVID-19 patients. The pandemic has drawn special attention to ensure uninterrupted O2 supply to all hospitals, especially those catering to COVID-19 patients. During the pandemic, a rational use of O2 therapy is essential. This includes optimal supplemental O2 therapy, careful monitoring of patients, and escalation as well as de-escalation of O2 therapy when indicated. We summarize the various sources of O2 to health-care establishments and various O2 delivery devices which are of paramount importance to ensure seamless O2 supply in the pandemic scenario.
Effect of supervised home-based training on functional outcome in severe exercise intolerance in post-COVID syndrome
Shraddha Shah
DOI:10.4103/ijrc.ijrc_125_20
Globally, millions of people have been impacted with COVID-19. A fraction of these people develop severe respiratory distress and require prolonged intensive care unit stay. With this, and with the improving recovery rate, the numbers of post-COVID survivors are steeply increasing. This demands an early, effective, inexpensive, and safe post-COVID pulmonary rehabilitation (PR) in a low available resource setting. A 56-year-old female diagnosed to have COVID-19 pneumonitis with acute respiratory distress syndrome developed severe exercise limitation after discharge, and a supervised low resource home-based PR program was initiated. The PR was followed as per the American Thoracic society/European Respiratory Society guidelines for 6 weeks with supplemental oxygen with a progressive metabolic equivalent of task level training. By the end of 6 weeks, the patient was independent in most of her self-care activities and was ambulatory in and around the house. We conclude with this case report that, by maintaining necessary precautions as recommended by the World Health Organization, PR can be delivered to remotest places with minimal resources and the outcome of this can make an individual independent in the self-care activities at the least.
PostCOVID-19 syndrome – The new pandemic
Souvik Chaudhuri
Fostering quality in respiratory therapy education – A need of the hour
Jithin K Sreedharan, Suresh G Nair
Development of safe and effective indigenous intensive care unit ventilators for COVID-19 pandemic
Anup Daniel Varghese, Sanjay Orathi Patangi, Kumar G Belani, Muralidhar Kanchi
Severe acute respiratory syndrome-coronavirus 2 has spread rapidly worldwide infecting ≥4 million people including ≥2.9 million deaths and overwhelming health-care systems globally. It has prompted governments to open field medical facilities to decongest hospitals and triage patients. Governments are preparing for a stage 3 surge in cases leading to a situation of "severe shortage" of mechanical ventilators due to an overwhelming number of cases. Health authorities are looking into measures for mass production of ventilators with locally available materials. However, when deploying these devices on patients, it is imperative to ascertain if they are safe and do not perpetuate a vicious circle of worsening lung injury and death. The Association for the Advancement of Medical Instrumentation and the Medicines and Healthcare Products Regulatory Agency have brought out guidelines that emergency ventilators manufactured for the current epidemic need to satisfy.
An Indian perspective on the use of fluticasone/formoterol in asthma and chronic obstructive pulmonary disease patients
Rahul Sharma, Zafar Ahmad Iqbal, Hemant Kalra, Abhinav Guliani, Anil K Singh, Akshay Budhraja, Gaurav Jain, Bharat Mehrotra, Loveleen Mangla, Avi Kumar, Vinay Purohit, Monika Chinda
Despite rapidly evolving health-care systems, India continues to have a high disease burden for asthma and chronic obstructive pulmonary disease (COPD). The Asia-Pacific Asthma Insights and Management survey clearly revealed that asthma management remains very poor with worst clinical outcomes in India. Potent inhaled corticosteroids (ICS) and quick onset of long-acting beta2-agonist (LABA) are considered to be optimal dual therapy for management of asthma and COPD. Fluticasone's long-term action against inflammation and formoterol's rapid long-term bronchodilator action are vital clinical attributes for optimal asthma maintenance treatment. In an 8- and 12-week trial, dual therapy of fluticasone and formoterol (FF) reported lung function improvements and better control of asthma than its monotherapy. A large clinical study revealed mild adverse events of dual FF than other dual ICS-LABA combinations. Recent pooled analysis of asthma showed that fluticasone shares a lower risk of pneumonia in asthma. Dual ICS-LABA therapies are preferred in COPD individuals with history of exacerbations. Numerous clinical studies showed significant efficacy, dose adjustments/switching, and safety outcomes with dual FF therapy in asthma and COPD. Dual FF inhaler therapy ensures highly potent anti-inflammatory activity and sustained bronchodilation, thus making this a preferred combination in terms of efficacy, safety, and patient adherence in asthma and COPD. This present review focuses on the combination therapy of formoterol and fluticasone for managing asthma and COPD.
Screening for COVID-19 risk using VIEW (COVID-19 early warning) system
Shardul Joshi, Gajanan Sakhare, Aditi R Pais
Background: As COVID-19 continues to spread globally, a safe workforce reentry for people with elevated individual and occupational risk from COVID-19 is essential. Risk stratification may help to identify individuals with COVID-19 risk levels and take appropriate measures. Objectives: (a) To reduce the burden of (COVID-19 among) corporate health-care ecosystem by multiple layers of screening of employees and their families through Nurse Education Health Assistants (NEHA) mobile application and using VIEW (COVID-19 Early Warning System) scores. (b) To offer teleconsultation services to individuals with the assistance of doctors and NEHA coaches (c) To assess accuracy/efficacy of VIEW system. Materials and Methods: A cross-sectional survey using NEHA mobile application was conducted among 2424 employees and their families of a leading multinational company. The human resource staff of the company collected data using NEHA application and uploaded it through a web portal. Further investigation was carried out by NEHA coaches through telephonic consultation using VIEW data. Results: More than half of the participants received the same VIEW scores by system and doctor zone, i.e., A VIEW score (58.54%), B VIEW score (59.63%), and C VIEW score (66.67%). System zone of VIEW system was compatible to categorize participants depending upon the level of risk probability toward COVID-19. Furthermore, NEHA coach and doctor gave the same VIEW scores under A (81.74%), B (67.63%), and C (38.46%). Conclusion: VIEW system is useful to detect risk probability toward COVID-19 infection and stratify patients under different VIEW zones to prioritize medical care, identify isolation needs, identify hospitalization needs at a scale.
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A Prospective observational study of high-flow nasal oxygen therapy and noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure
Prashant Pandurang Jedge, Jignesh Navinchandra Shah, Shivakumar S Iyer, Sampada Sameer Kulkarni
Background: Treatment for acute hypoxemic respiratory failure (AHRF) includes treating the underlying disease, conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow nasal oxygen (HFNO), and invasive mechanical ventilation. Aim: The aim of this study was to compare the use of HFNO and NIV in patients with moderate-to-severe AHRF to the tertiary level intensive care unit (ICU) of a teaching hospital. Methods: All adult patients admitted to the ICU with AHRF and failed COT were included. Administration of HFNO or NIV was protocol-based and targeted improvement in oxygen saturation, respiratory rate, PaO2, and PaCO2. Demographic data, clinical details, vital parameters, and laboratory findings were noted at prespecified intervals. Acute Physiology and Chronic Health Evaluation II at 24 h of ICU admission and daily Sequential Organ Failure Assessment were noted. The primary outcome was failure of treatment modalities defined as need for intubation and invasive ventilation. The secondary outcomes measured at 28 days were differences in ventilator-free days, ICU and hospital length of stay, patient comfort, and mortality. Results: A total of 35 patients were included in the study. Treatment failure was 20.8% (5/24) in the NIV group and 36% (4/11) in the HFNO group (P = 0.32). The number of ventilator-free days at day 28 was 22.67 ± 9.92 and 19.36 ± 12.45 (P = 0.44) in the NIV and HFNO groups, respectively. Mortality at 28 days was 12.5% (3/24) and 27.2% (3/11) in the NIV and HFNO groups, respectively (P = 0.282). Conclusion: Treatment with HFNO is associated with nonsignificant increase in the need for intubation and 28-day mortality compared to NIV. Larger studies are required to assess the utility of HFNO in moderate-to-severe AHRF.
Clinico-demographic, hematological, and comorbidity profile of COVID-19 patients admitted at tertiary care center
Hemant Kumar, Sumeet Dixit, Shobhit Shakya, Manoj Kumar Pandey, Nikhil Gupta, Preeti Gupta, Shyam Murari Kalra, Amiya Pandey
DOI:10.4103/ijrc.ijrc_3_21
Introduction: Severe acute respiratory syndrome coronavirus 2 has caused a worldwide pandemic. This study was aimed to describe the clinico-demographic, hematological, and comorbidity profile in a group of coronavirus disease 2019 (COVID-19) patients at a tertiary care center in north India. Materials and Methods: We conducted a prospective, single-center collection of data regarding clinico-epidemiological, hematological parameters, and comorbidity profile of COVID-19 patients admitted at a tertiary care facility. Results: Data from 200 patients with COVID-19 were collected and analyzed. The median age of the patients was 48 years, with 63% males, and 78% patients were from urban area. Ten patients were smokers while 11 patients were alcoholic. The occupation of 20.6% of patients was related directly or indirectly with medical or allied professions. The most common mode of transmission of COVID-19 was direct close contact with microbiologically confirmed patients. Fever (n = 93; 46.5%) was the most common presenting symptom and the median duration of onset of symptoms before admission were 3.5 days (range 2–6 days). In hematological profile, lymphopenia (n = 48; 24%) had been the most common documented finding. Comorbidities were present in 39 (19.5%) patients, of which diabetes mellitus (n = 25; 12.5%) was the most common. Furthermore, the case fatality rate in our study was 1.5%. Conclusion: Among all patients of COVID-19 at our center, the characteristic findings included high proportion of male patients with younger to middle-age group, diabetes as most common comorbidity and people who were directly or indirectly in contact with the health-care system were more prone for developing the disease.
Use of valved dry seal chest drain in ambulatory management of persistent air leak
Jaykumar Nikulbhai Mehta
CASE SERIES
Anesthetic Challenges during video-assisted thoracoscopic surgeries for pediatric empyema thoracis: A case series
Deepak Dwivedi, Mohit Kumar, Shankar Raman, Vivek Kumar Singh
Video-assisted thoracoscopic surgery (VATS) is a less invasive approach for thoracoscopic surgery providing better visualization through minimal access. In addition, it offers less postoperative pain, fewer operative complications, and shortened hospital stay. These advantages make VATS ideal for the pediatric age group. Various societies recommend the use of VATS for Stage 2 pulmonary empyema and also in some cases of early Stage 3 where the plane of cleavage exists between the pleura and the exudate. A well-executed one-lung ventilation (OLV) is necessary for a successful VATS; however, performance of OLV and postoperative pain management in children poses a challenging task for an anesthesiologist.
Effectiveness of pulmonary rehabilitation in lymphangioleiomyomatosis
Manivel Arumugam, Senthil Dhanasekaran, Kancherla Roopa, Pitchaimani Govindharaj
Lymphangioleiomyomatosis (LAM) is a cystic lung disease frequently associated with reduced exercise capacity, mostly affecting young women. The disease is characterized by progressive pulmonary cystic change, recurrent pneumothorax, chylous pleural collections, and in most cases, progressive respiratory failure. Diagnosis is made by a combination of clinical features and computed tomography scanning or, with lung biopsy. We present a case report of a young woman who suspected of LAM and diagnosed with cystic lung disease, admitted to the intensive care unit in view of worsening hypoxia associated with pneumothorax. She was on ventilator support and placement of repeated intercostal drains and had a tracheostomy to step down to bilevel positive airway pressure support, after the medical stabilization. She was referred for pulmonary rehabilitation, in which she showed good outcomes and recovered well.
Clinical features of patients with asthma, bronchiectasis, and combination of both conditions
Fatih Uzer, Zehra Boztepe, Aykut Cilli
Background: Asthma and bronchiectasis are critical diseases for public health. In some patients, asthma and bronchiectasis exist together, and bronchiectasis negatively affects asthma control. This study aimed to evaluate the clinical impacts of coexisting asthma and bronchiectasis on patients. Methods: This was a retrospective single-center study on data collected from electronic medical records between January 2014 and January 2017. Patients were divided into three groups, wherein asthma (n = 33), bronchiectasis (n = 33), and coexisting asthma and bronchiectasis (n = 33) were compared. Asthma diagnosis was made according to the guidelines of Global Initiative for Asthma. Confirmation of bronchiectasis diagnosis was made by high-resolution computed tomography. Patients with cystic fibrosis and those who have asthma–chronic obstructive pulmonary disease overlap syndrome were excluded from the study. Results: Medical records of 1467 patients were analyzed. Among them, well-matching 99 patients in terms of gender and comorbid diseases were taken (33 of them had only asthma, 33 had only bronchiectasis, and 33 had coexisting asthma and bronchiectasis). Forty (40.5%) men and 59 (59.5%) women with a mean age of 45.0 ± 5.2 were included in the study. Asthma and bronchiectasis coexistence had lower forced expiratory volume in 1 s (FEV1) (%), forced vital capacity (FVC) (%), FEV1/FVC (%), and FEV1 (L) ratios (P = 0.0001). Moreover, total immunoglobulin E levels were the highest in this group (P = 0.0001). The most frequently observed microorganism in the culture tests was Pseudomonas aeruginosa in the bronchiectasis-only as well as in asthma + bronchiectasis groups. Conclusions: Asthmatic patients who have bronchiectasis revealed lower asthma control levels and worse respiratory function test results than other groups.
Self-reported continuous positive airway pressure device compliance of patients with obstructive sleep apnoea syndrome
Fatih Uzer, Ummuhan Okur, Aykut Cilli
Introduction: Patients with obstructive sleep apnoea syndrome (OSAS) are often prescribed the use of continuous positive airway pressure (CPAP) devices to overcome obstruction during sleep. We aimed at assessing the adherence rates to CPAP therapy in two clinical subtypes of OSAS. Patients and Methods: Patients diagnosed with positional or rapid eye movement related OSAS using polysomnography were included. Patients were contacted by telephone calls to collect data. Inclusion criteria were age >18 years, a total apnea-hypopnea index (AHI) >5, and a physician recommendation to initiate therapy with a CPAP device. Patients were excluded if they had known neurological disorders, were unwilling to answer all questions and had no recommendation to use CPAP therapy. Results: A total of 286 patients, 99 females (34.6%) and 187 males (65.4%), with a mean age of 56.5 ± 11.3 years were included. There were 134 (46.9%) CPAP users and 152 (53.1%) CPAP nonusers. Reasons for not using the CPAP device included unwillingness to use the device (n = 73, 48%), reduced patient comfort due to noise, hose, or air pressure (n = 31, 20.3%), reimbursement problems (n = 38, 25%), and reasons such as recovery or operation (n = 10, 6.5%). Age, duration of use/months, number of nights per week during which the device was used and the mean number of hours per night were not significantly different between OSAS types (P > 0.05), while the mean AHI and body mass index were significantly different between OSAS types (P < 0.05). Conclusion: A significant proportion of OSAS patients do not use CPAP devices due to various reasons. Adherence to CPAP therapy was not significantly different between groups.
Wuchereria bancrofti infection causing pleural effusion
Nishant Sinha, Abhishek Kumar, Rashmi Sinha
Presented here is a case of 46-year-old Hindu male with a complaint of progressive shortness of breath, chest discomfort, fever, generalized weakness, and malaise over 6 months. He had a past history of diabetes mellitus (on oral antihyperglycemic agents) and pulmonary tuberculosis, for which he took DOTS category-1 antitubercular treatment for 9 months about 10 years back. On examination, he was febrile with stable vitals; breath sounds diminished over the right side of chest with stony dull percussion note. A provisional diagnosis of right-sided pleural effusion was made, and chest X-ray posteroanterior (PA) view confirmed the same. Diagnostic thoracentesis was done, which showed that the fluid was exudative in nature. The microscopy of centrifuged fluid debris strikingly showed microfilariae of Wuchereria bancrofti. Eosinophils and macrophages were in plenty without any evidence of malignancy or lymphoma. The complete blood count confirmed eosinophil >30% with absolute eosinophil count to be 2400 cells. A diagnosis of filarial pleural effusion was made, and he was started on antihelminthic medication. There was a remarkable improvement in his symptoms over 14 days of starting the therapy. He was maintained on drugs for 6–8 months. There was complete resolution of his effusion and respiratory symptoms.
Miliary tuberculosis-related acute respiratory distress syndrome: Early diagnosis can save life
Divya Sethi, Shivi Goyal
Miliary tuberculosis (TB) is an uncommon cause of acute respiratory distress syndrome (ARDS) with a high mortality. Early diagnosis and timely initiation of treatment are important for good outcome. We report the case of a 23-year-old female who needed admission to intensive care unit (ICU) due to ARDS. On routine investigations, the cause of ARDS could not be ascertained. Finally, high-resolution computed tomography of the chest and bronchoscopic-guided lung biopsy were done which confirmed the etiology to be miliary TB. The patient showed an improvement after starting antitubercular therapy with steroids. One week later, the patient's condition was stabilized and was shifted out of ICU. This case report emphasizes that miliary TB, though difficult to diagnose, should always be considered a differential diagnosis in patients with ARDS, as early initiation of treatment can prove to be lifesaving.
Post total thyroidectomy, isolated right side chylothorax with high output fistula managed with lymphangiography
Dhruva Sharma, Deven Juneja, Omender Singh, Amit Goel, Prashant Singh, Varun Arora
Chylothorax is a rare complication after total thyroidectomy with radical neck dissection, and isolated right side chylothorax is even rarer. Treatment may be conservative or surgical. Besides being helpful in making a diagnosis, thoracic duct lymphangiography (TDL) may be therapeutic in some cases. However, its application in high output chylous leak is not fully explored. Here, we present a rare case of right-sided high output chylothorax, secondary to total thyroidectomy, successfully treated with TDL.
Tuberculosis as a cause of broncho-esophageal fistula
Thara Pratap, Muhammed Jasim Abdul Jalal, Hari P Lakshmanan, AK Vishnu, Antony Paul Chettupuzha
We report a case of broncho-esophageal fistula associated with tuberculosis. A 29-year-old female diagnosed with smear-positive pulmonary tuberculosis on anti-tuberculosis treatment for 2 months presented with complaints of cough on food intake with food particles present in the expectorant. Radiological examination revealed mediastinal lymphadenopathy and upper gastrointestinal endoscopy revealed multiple fistulous tracts in the esophagus. Small fistulae were treated by clipping and large fistulae were treated with self-expandable metallic stents which resulted in the alleviation of symptoms.
Chronic pulmonary aspergillosis - case series and review of Indian literature
Vikas Marwah, Robin Choudhary, Deepu K Peter, Gaurav Bhati, Kunal Kumar, R Akhil, Shafin Babu
Aspergillus species, especially Aspergillus fumigatus, can cause varied pulmonary manifestations depending on the host immune status and duration of infection. Chronic pulmonary aspergillosis (CPA) is an under-reported entity, and its diagnosis remains a diagnostic challenge for clinicians. CPA can have varied presentations including chronic cavitary pulmonary aspergillosis (CCPA), subacute invasive pulmonary aspergillosis, and chronic fibrosing pulmonary aspergillosis. Underlying lung diseases such as chronic obstructive pulmonary disease and sequelae of pulmonary tuberculosis predisposes these individuals to CPA. These cases can present as chronic cough with hemoptysis even requiring emergency bronchial artery embolization. Here, we present a series of four CCPA cases who were diagnosed on the basis of clinico-radiological features and the Aspergillus-specific IgG antibody levels. A review of case series published in India is also presented.
Acute febrile infant with stridor: Rare presentation of pediatric scrub typhus
Dinesh Kumar Narayanasamy, Thirunavukkarasu Arun Babu
High-risk whole lung lavage for an unprecedented oil drowning situation: Management issues from a respiratory therapist's perspective
Anmol Hanamant Thorbole, Hari Prasad, Sameer Bansal, Ravindra Mehta
Bilateral whole lung lavage (WLL), a complex procedure involving large volume saline washes of both lungs is a standard treatment for pulmonary alveolar proteinosis. Uncommonly, following large volume oil aspiration, the ensuing fulminant lipoid pneumonia ("oil drowning") can be fatal, and therapeutic WLL can be lifesaving. In this report, we describe an oil drowning situation salvaged with high-risk WLL and highlight procedural and critical care aspects from a respiratory therapist's perspective.
Intrathoracic extrapleural air mimicking pneumothorax: Secondary to barotrauma in COVID-19
Mayur C Vira, Ramachandra R Rao, Rajeev U Mehta
This case illustrates a potential complication of mechanical ventilation in COVID patients, which can mimic as a pneumothorax on chest X-rays. Recognizing this complication in critically ventilated patients is important to avoid unnecessary surgical intervention, which can further add to the patient's morbidity and increase the duration of hospital stay.
Behind the fire in the COVID wards: A proposition
Sobhana Chindrippu, Sudhir Peter, Sachin Sureshbabu
A device for high-flow nasal oxygen therapy
Prakash K Dubey, Preksha Dubey, Niyati Dubey


The beautiful city of KwaZulu-Natal, in South Africa is already bubbling with life as the prestigious MTV Africa Music Awards (MAMA) holds tomorrow's evening at Durban International Convention Centre (ICC), KwaZulu-Natal.
Top Nigerian musicians joined their counterparts from other parts of the continent as they stormed the rainbow country Wednesday ahead of tomorrow's event. Among them were 2face, Banky W, Darey, Iceberg Slim, Shaydee, Kcee among others.
The event, which will be hosted by American actor and comedian Anthony Anderson, flags-off, this evening with a press conference, holding at Playhouse Theatre, Durban.
The conference, according to the organizers, is for some lively pre-MAMA chat, insights and revelations from the host, performers, nominees as well as partners of MAMA 2015, including representatives of VIMN Africa, MTV Base and KwaZulu Natal Province.
Lined up to thrill guests at this year's MAMAs are 2face, AKA, Black Motion, Bucie, Cassper Nyovest, Davido, Diamond Platnumz, Jhené Aiko, NE-YO, Toofan, Wizkid, Yemi Alade, Seyi Shay, Flavour and Young Thug.
Also, Nigeria's most popular music twins, Psquare joins the list of performers. The Okoye twins, alongside Flavour and Seyi Shay will be lighting up the stage with their hit songs at the colourful event.


Such a tasty vegan salad that is as delicious as it is nutritious! It is very simple to make but it requires some assembling-still, it is so worth it! The combination of my Simply Quinoa with a hint of turmeric (click here for recipe), sautéed kale and grilled corn is absolutely wonderful together and the fresh mint just gives it the perfect final touch!
Place a non-stick grill pan on the stove on high heat an drizzle with 1Tbsp of the canola oil.
Place the ears of corn on the hot grill pan and grill them for 8-10 minutes, turning each over every couple minutes so they are a little browned.
Place the grilled corn on a baking sheet and roast in a preheated oven for 10-12 more minutes.
When the corn is cool, using a sharp knife, cut the kernels right onto the baking sheet and set aside.
Meanwhile, heat the remaining 1 Tbsp of canola oil in a skillet and sauté the kale, uncovered for 8-10 minutes, until soft and set aside.
When ready to assemble, place all the dressing ingredients in a medium serving bowl and whisk together to blend well.
Add 2 cups of "Simply Quinoa", grilled corn kernels and sautéed kale on top of the dressing and gently toss so that it is thoroughly mixed in.
Add the fresh mint, toss again and refrigerate until ready to serve.
My son, for the first time ever, asked me to make him something containing kale. My first stop was cuisinicity because I was serious about optimizing the opportunity.And He likes It!