Does lidocaine gel produce an effective analgesia prior to copper IUD insertion? Randomized clinical trial

Background: IUD is a small contraceptive device, often containing either copper or levonorgestrel, which is inserted into the uterus. Objective of present study was to determine if lidocaine gel prior to intrauterine device (IUD) insertion decreases pain with the insertion procedure among multiparous women choosing the copper T380A-IUD.Methods: It is a randomized double-blind controlled trial carried out at Assiut Women's Health Hospital, Assiut, Egypt. Parous women eligible for Copper IUD insertion attended the Family Planning Clinic were recruited and randomized in a 1:1 ratio to lidocaine gel or placebo. Two ml of the study medications were topically placed on the cervix 3 minutes before IUD insertion. The primary outcome was the difference in pain scores using a 10-cm Visual Analogue Scale (VAS) during IUD insertion. We considered a 1.5 cm difference in VAS scores between study groups as clinically significant.Results: One hundred women consented to participate and randomized either to group I:  lidocaine group or group II: placebo group. Both groups were homogenous in baseline socio-demographic data. There was significant difference in mean pain scores for IUD placement between women who received lidocaine gel and placebo at two steps of insertion (at vulsellum application and at uterine sounding) while the rest of steps show no statistical significant difference (p=0.000). There were no statistical significant differences between both group as regard the ease of insertion, the duration of insertion and the satisfaction score after the procedure (p>0.05).Conclusions: This study depicts that the use of lidocaine gel prior to copper IUD insertion in multiparous women could partially reduce the pain during tenaculum placement and uterine sounding

Big data analytics and innovation performance with the transformational role of management accountant

The purpose of this paper is to contribute to the literature on the impact of Big Data Analytics Capabilities (BDAC) on the Organizational Innovation Performance (OIP) with the transformational role of Management Accountant. By carrying out a literature review, this paper provides information for researchers and scholars to explore the emerging trends and implications of the above-mentioned relationship. A literature review highlights the emerging issues from the research conducted on Organizational Innovative Performance, Big Data and the role of Management Accountant in this relationship by focusing on: role of OIP, the importance of Big Data from the technological to the managerial paradigm as well as the role a Management Accountant can play in the era of Big Data. It is expected that identifying these contributions will help establish future research directions. The paper provides a number of avenues for potential research in this emerging area of investigation. The main aim of the key research questions posed is to further the contribution of Big Data towards research on Organizational Innovative Performance. The paper outlines how the organizations which are developing their approaches for big data analytics capabilities can focus on the factors and variables which are relevant for them to develop their big data analytics capabilities so as to develop their sustainable competitive advantages. This paper investigates the effects and implications which organizations can have by using Big Data to achieve innovative performance. At the same time, it provides an original understanding of the contextual importance of investing in the big data analytics capabilities development. It also considers the role played by management accountant as a bridge between the data scientists and the business requirements in a big data environment. As a result, the current study aims to show the impact which Big Data Analytics (BDA) Capabilities have on the organizational innovation performance with organizational culture and role of management accountant as moderators. The study will use data from surveys of CFOs, CEOs or CIOs of the pharmaceutical companies of Pakistan and will test a proposed model, using bootstrapped moderated analysis. This research considers the resource-based view of the firm as well as the socio-materiality theory. Practical implications for top executives are also discussed. There is a need to convert big data into meaningful information for strategic decision making. Management accountant plays vital role with the help of new skills set to develop newer expertise and make a bridge between data analysts and business executives as a moderator. To this end, this research focuses on identifying the gaps in the existing literature as well as proposing the course of action which can be undertaken for empirical study

Narratives of Space in the Writing of Five Contemporary Canadian Women Writers of Italian Origin

The purpose of this essay is to analyze the English writing of five Canadian authors of Italian origin – Darlene Madott, Maria Ardizzi, Licia Canton, Rosanna Battigelli and Dorina Michelutti – in terms of how they represent personal and inner spaces as a meaningful focal point for interpreting and reflecting on the dislocated subject’s quest for identity. I will show how they use the idea of compensatory spaces as a literary strategy to portray personal, private or inner spaces to articulate their characters’ processes of accepting or resisting cultural hybridity and multiplicity. The works of fiction I consider here embody the shifting perception of inner or personal spaces in the characters’ lives, and how this defines their spatial relationships with the new country in different terms and at different stages of the migrant’s process of accepting his or her new country. My reading is based on Homi Bhabha’s notions of third space and cultural translation and Michel Foucault’s concept of heterotopic spaces; I define these as compensatory spaces, an idea also rooted in Foucault’s view that heterotopies of compensation represent differences that transcend dichotomies and are open to fluidity. In this paper, the idea of third space addresses the process of cultural translation – understood not only as the positive and dialogic creation of a hybridized subject, but also as a narrative of conflicting personal spaces that gives voice to experiences of cultural dislocation.This work was supported by a grant from the Spanish Ministry of Science and Innovation between 2010 and 2014 (FFI2010–20989FILO)

Assessment of platelet function in patients with stroke using multiple electrode platelet aggregometry: a prospective observational study

Background There is a link between high on-treatment platelet reactivity (HPR) and adverse vascular events in stroke. This study aimed to compare multiple electrode platelet aggregometry (MEA), in healthy subjects and ischaemic stroke patients, and between patients naive to antiplatelet drugs (AP) and those on regular low dose AP. We also aimed to determine prevalence of HPR at baseline and at 3–5 days after loading doses of aspirin. Methods Patients with first ever ischaemic stroke were age and sex-matched to a healthy control group. Three venous blood samples were collected: on admission before any treatment given (baseline); at 24 h and 3–5 days after standard treatment. MEA was determined using a Mutliplate® analyser and agonists tested were arachidonic acid (ASPI), adenosine diphosphate (ADP) and collagen (COL). Results Seventy patients (mean age 73 years [SD 13]; 42 men, 28 women) were age and sex-matched to 72 healthy subjects. Thirty-three patients were on antiplatelet drugs (AP) prior to stroke onset and 37 were AP-naive. MEA results for all agonists were significantly increased in AP-naive patients compared to healthy subjects: ADP 98 ± 31 vs 81 ± 24, p < 0.005; ASPI 117 ± 31 vs 98 ± 27, p < 0.005; COL 100 ± 25 vs 82 ± 20, p < 0.005. For patients on long term AP, 33% (10/30) of patients were considered aspirin-resistant. At 3–5 days following loading doses of aspirin, only 11.1% were aspirin resistant based on an ASPI cut-off value of 40 AU*min. Conclusions Many patients receiving low dose aspirin met the criteria of aspirin resistance but this was much lower at 3–5 days following loading doses of aspirin. Future studies are needed to establish the causes of HPR and potential benefits of individualizing AP treatment based on platelet function testing

Elevated 17β-Estradiol Protects Females from Influenza A Virus Pathogenesis by Suppressing Inflammatory Responses

Studies of the 1918 H1N1 influenza pandemic, the H5N1 avian influenza outbreak, and the 2009 H1N1 pandemic illustrate that sex and pregnancy contribute to severe outcome from infection, suggesting a role for sex steroids. To test the hypothesis that the sexes respond differently to influenza, the pathogenesis of influenza A virus infection was investigated in adult male and female C57BL/6 mice. Influenza infection reduced reproductive function in females and resulted in greater body mass loss, hypothermia, and mortality in females than males. Whereas lung virus titers were similar between the sexes, females had higher induction of proinflammatory cytokines and chemokines, including TNF-α, IFN-γ, IL-6, and CCL2, in their lungs than males. Removal of the gonads in both sexes eliminated the sex difference in influenza pathogenesis. Manipulation of testosterone or dihydrotestosterone concentrations in males did not significantly impact virus pathogenesis. Conversely, females administered high doses of estradiol had a ≥10-fold lower induction of TNF-α and CCL2 in the lungs and increased rates of survival as compared with females that had either low or no estradiol. The protective effects of estradiol on proinflammatory cytokines and chemokines, morbidity, and mortality were primarily mediated by signaling through estrogen receptor α (ERα). In summary, females suffer a worse outcome from influenza A virus infection than males, which can be reversed by administration of high doses of estradiol to females and reflects differences in the induction of proinflammatory responses and not in virus load

Platelet reactivity influences clot structure as assessed by fractal analysis of viscoelastic properties

<p>Despite the interwoven nature of platelet activation and the coagulation system in thrombosis, few studies relate both analysis of protein and cellular parts of coagulation in the same population. In the present study, we use matched ex vivo samples to determine the influences of standard antiplatelet therapies on platelet function and use advanced rheological analyses to assess clot formation. Healthy volunteers were recruited following fully informed consent then treated for 7 days with single antiplatelet therapy of aspirin (75 mg) or prasugrel (10 mg) or with dual antiplatelet therapy (DAPT) using aspirin (75 mg) plus prasugrel (10 mg) or aspirin (75 mg) plus ticagrelor (90 mg). Blood samples were taken at day 0 before treatment and at day 7 following treatment. We found that aspirin plus prasugrel or aspirin plus ticagrelor inhibited platelet responses to multiple agonists and reduced P-selectin expression. Significant platelet inhibition was coupled with a reduction in fractal dimension corresponding to reductions in mean relative mass both for aspirin plus prasugrel (−35 ± 16% change, p = 0.04) and for aspirin plus ticagrelor (−45 ± 14% change, p = 0.04). Aspirin alone had no effect upon measures of clot structure, whereas prasugrel reduced fractal dimension and mean relative mass. These data demonstrate that platelets are important determinants of clot structure as assessed by fractal dimension (d_<i>f</i>) and that effective platelet inhibition is associated with a weaker, more permeable fibrin network. This indicates a strong association between the therapeutic benefits of antiplatelet therapies and their abilities to reduce thrombus density that may be useful in individual patients to determine the functional relationship between platelet reactivity, eventual clot quality, and clinical outcome. d_<i>f</i> could represent a novel risk stratification biomarker useful in individualizing antiplatelet therapies.</p

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection