Wczesne versus opóźnione odżywianie po cięciu cesarskim z różnymi metodami znieczulenia – badanie randomizowane

Objective: The aim of the study was to evaluate the safety and efficacy of early feeding after cesarean delivery under different anesthetic methods. Study design: Two hundred women with elective cesarean delivery were randomly assigned to early oral feeding (EOF) or routine oral feeding (ROF) groups. EOF patients were informed that they could begin taking fluids orally (regime I) as soon as 2 hours after the delivery and then gradually progress to solid foods (regime III), if tolerated. ROF patients were informed that they could start regime I right after bowel sounds were heard on examination and then gradually move on to regime III. Hospitalization time and total time to ambulation (primary outcomes), gasstool discharge time and onset of bowel sounds (secondary outcomes) were compared in groups A [EOF patients after regional anesthesia (n=49)], B [EOF patients after general anesthesia (n=48)], C [ROF patients after regionalanesthesia (n=47)] and D [ROF patients after general anesthesia (n=48)]. Results: There were significant differences in primary and secondary outcomes between group A and the remaining groups, especially group D. The status of patients from group B was not better than group C. In fact, the latter were discharged home sooner and passage of gas, as well as initiation of regime I occurred earlier as compared to the former. Conclusions: Cesarean section under regional anesthesia and encouragement of oral feeding 2 hours after the operation should be recommended in order to achieve postoperative recovery and early hospital discharge. Routine oral feeding (right after bowel sounds are heard on examination) after cesarean section under general anesthesia should be the last choice.Cel: Celem badania była ocena bezpieczeństwa i skuteczności wczesnego włączenia odżywiania po cesarskim wykonanym przy różnych metodach znieczulenia. Do badania włączono 200 kobiet po elektywnym cięciu cesarskim. Po randomizacji pacjentki przydzielano do grupy wczesnego odżywiania dojelitowego (EOF) lub grupy zwykłego włączania jedzenia (ROF). Pacjentkom z grupy EOF pozwolono pić płyny już 2 godziny po porodzie (reżim I) a następnie stopniowo przechodzić do pokarmów stałych (reżim III). Pacjentki z grupy ROF mogły rozpocząć odżywianie wg reżimu I gdy w badaniu osłuchiwaniem obecna była perystaltyka a następnie stopniowo przechodzić do reżimu III. Czas hospitalizacji, całkowity czas do uruchomienia (pierwotny punkt końcowy), czas do oddania gazów i stolca i czas do rozpoczęcia perystaltyki (wtórny punkt końcowy) porównano pomiędzy grupami A [pacjentki EOF ze znieczuleniem przewodowym, n=49], B [EOF ze znieczuleniem ogólnym, n=48], C [ROF ze znieczuleniem przewodowym, n=47] i D [ROF ze znieczuleniem ogólnym, n=48]. Wyniki: Zaobserwowano istotne różnice pomiędzy grupą A a pozostałymi grupami, zwłaszcza grupą D, w odniesieniu do pierwotnego i wtórnego punktu końcowego. Status pacjentek z grupy B nie był lepszy niż z grupy C. W rzeczywistości pacjentki z grupy C były zwalniane do domu wcześniej, również pasaż gazów i włączenie diety wg reżimu I następowały wcześniej niż w grupie B. Wnioski: Cięcie cesarskie ze znieczuleniem przewodowym i włączeniem odżywiania 2 godziny po operacji powinno być zalecane ze względu na szybszą rekonwalescencję oraz wczesny wypis ze szpitala. Jako ostatnie powinno się wybierać cięcie cesarskie ze znieczuleniem ogólnym i rutynowym włączeniem odżywiania po usłyszeniu perystaltyki jelit

Three-Terminal Noise Source Extraction From A Qi-Based Wireless Power Transfer System For Predicting Conducted Emissions

An equivalent method to extract a three-terminal noise source from a Qi-based wireless power transfer system is proposed in this article. This method is capable of extracting a source for both the positive (P) and negative (N) lines with respect to the third terminal (the ground chassis or reference plane). The extracted sources are independent of the setup configuration and can be used to predict currents or voltages on the P and N lines on a setup that is different from the extraction setup. In the following article, a three-terminal model independent of the setup configuration is first extracted. The extracted sources are then verified by predicting currents on a setup that is different from the original setup (such as a different load impedance and height of the device above reference plane). Finally, the extracted sources are used to predict the voltages on a 1-m cable harness. The predicted currents and voltages agree within 5 dB against measurement data over a frequency range from 0.5 to 30 MHz. The proposed method can be used to predict currents and voltages on any power converter with a single-phase input configuration

BONE MINERAL DENSITY AND THYROID-STIMULATING HORMONE ASSOCIATION IN POSTMENOPAUSAL HEALTHY WOMEN

Amaç: Postmenopozal sağlıklı kadınlarda femoral ve lomber kemik mineralyoğunluğunun tiroid stimülan hormon düzeyi ile ilişkisini araştırmak.Gereç ve yöntem: Çalışmaya 152 postmenopozal sağlıklı kadın dahil edilmiştir.Kemik mineral yoğunluğu, DEXA ile anterior-posterior lomber (L1-L4) spine'ler ve femurüzerinden yapıldı ve TSH düzeyi kemilüminesans yöntemi kullanılarak ölçüldü.İstatistiksel analizde Pearson korelasyonu, t - testi, tek yönlü varyans analizi (ANOVA),multiple regresyon analizi kullanıldı p < 0,05 anlamlı kabul edildi.Bulgular: Tiroid stimülan hormon düzeyi ile kemik mineral yoğunluğu arasında anlamlıbir ilişki saptanmadı (toplam lomber spinal (L1-4) T skoru için p = 0,11 ve toplam femurT skoru için p = -0,03). Toplam femur T skoru ile yaş, menopoz yılı, vücut kitle indeksiarasındaki ilişki anlamlı bulundu (p<0,05) Toplam lomber spinal (L1-4) T skoru ile vücutkitle indeksi, menopoz yılı ve hormon replasman tedavisi kullanım süresi arasındakiilişki anlamlı bulundu (p < 0,05). Doğal menopozda, cerrahi menopoza göre toplamfemur T skoru ölçümleri anlamlı olarak daha düşük bulundu (p=0,04). Toplam femur vetoplam lomber spinal (L1-4) T skoru ölçümlerinin her ikisi ile VKI arasında anlamlı birilişki saptandı (p < 0,01) (femur için r2 = 0,15, lomber vertebra spine için r2 =0,12).Sonuç: Postmenopozal sağlıklı kadınlarda kemik mineral yoğunluğu ile iroid stimülanhormon değerleri arasında anlamlı bir korelasyon saptanmadı. Tiroid stimülan hormondeğerinin kemik mineral yoğunluğunu göstermek için iyi bir marker olmadığı düşünüldü.Vücut kitle indeksi ile hem spinal hem de femur T skorları arasında anlamlı bir ilişkiolması ile birlikte vücut kitle indeksinin kemik mineral yoğunluğu için iyi bir göstergeolabileceği görüldü. Benzer çalışmalar menopozal ve premenopozal dönemlerde de yapılarakkemik mineral yoğunluğunun tiroid stimülan hormon düzeyi ve vücut kitle indeksiile ilişkisi daha geniş profilde değerlendirilebilir ve tekrarlayan ölçümlerle bu değişimdaha iyi gösterilebilir.Objective: To investigate the association between bone mineral density (BMD) andserum Thyroid-Stimulating Hormone levels in postmenopausal healthy women.Postmenopozal sağlıklı kadınlarda kemik mineral yoğunluğu-tiroid stimülan 2 hormon ilişkisiMaterial and method: 152 postmenopausal healthy women were included in ourstudy. We measured BMD at the lumbar spine (L1-L4) and femur using dual energy Xrayabsorptiometry and serum TSH concentration using chemiluminisence. Pearson'sCorrelation, t-test, analysis of variance (ANOVA), multiple regression analysis wereused in statistical analysis and p<0.05 was considered statistically significant.Results: There was no significant relation between TSH levels and BMD scores (forlumbar spine p = 0,11 and femur p = -0,03). A significant relation was determinedbetween the total femur T score and age, years since menopause, body mass index(VKI) (p<0.05 ). Also there was a significant relation between total lumbar spine T scoreand VKI, years since menopause, duration for hormone replacement therapy (p<0.05).Total femur T score was lower in natural menopause group than surgical menopausegroup (p=0.04). There was a significant correlation between VKI and both T scores (p <0.01) (for femur r2 = 0.15, for lumber spine r2 =0.12)Conclusion: We did not determine a significant relation between BMD and TSH. TSHvalue seems not a good predictive marker for detecting bone mineral density. Therewas a close relation between VKI and BMD, so we conclude that VKI is a usefulindicator for detecting BMD. Similar studies can be performed in premenopausal andmenopausal women to show the association between TSH, VKI and BMD

Fetal Circulatory Variation in an Acute Incident Causing Bradycardia

Umbilical artery\vein, middle cerebral artery, and ductus venosus Doppler velocimetry were performed at 33 weeks of gestation in the settings of an intrauterine growth restricted fetus during a heart rate deceleration. Interestingly, we recorded a sudden onset redistribution of fetal blood flow with fetal bradycardia. Spontaneous normalization of waveforms was observed once fetal heart rate returned to normal. Our case provides evidence to circulatory variation of a human fetus resulting from an acute incident causing bradycardia

A Randomised Placebo-Controlled Trial of a Traditional Chinese Herbal Formula in the Treatment of Primary Dysmenorrhoea

BACKGROUND: Most traditional Chinese herbal formulas consist of at least four herbs. Four-Agents-Decoction (Si Wu Tang) is a documented eight hundred year old formula containing four herbs and has been widely used to relieve menstrual discomfort in Taiwan. However, no specific effect had been systematically evaluated. We applied Western methodology to assess its effectiveness and safety for primary dysmenorrhoea and to evaluate the compliance and feasibility for a future trial. METHODOLOGY/PRINCIPAL FINDINGS: A randomised, double-blind, placebo-controlled, pilot clinical trial was conducted in an ad hoc clinic setting at a teaching hospital in Taipei, Taiwan. Seventy-eight primary dysmenorrheic young women were enrolled after 326 women with self-reported menstrual discomfort in the Taipei metropolitan area of Taiwan were screened by a questionnaire and subsequently diagnosed by two gynaecologists concurrently with pelvic ultrasonography. A dosage of 15 odorless capsules daily for five days starting from the onset of bleeding or pain was administered. Participants were followed with two to four cycles for an initial washout interval, one to two baseline cycles, three to four treatment cycles, and three follow-up cycles. Study outcome was pain intensity measured by using unmarked horizontal visual analog pain scale in an online daily diary submitted directly by the participants for 5 days starting from the onset of bleeding or pain of each menstrual cycle. Overall-pain was the average pain intensity among days in pain and peak-pain was the maximal single-day pain intensity. At the end of treatment, both the overall-pain and peak-pain decreased in the Four-Agents-Decoction (Si Wu Tang) group and increased in the placebo group; however, the differences between the two groups were not statistically significant. The trends persisted to follow-up phase. Statistically significant differences in both peak-pain and overall-pain appeared in the first follow-up cycle, at which the reduced peak-pain in the Four-Agents-Decoction (Si Wu Tang) group did not differ significantly by treatment length. However, the reduced peak-pain did differ profoundly among women treated for four menstrual cycles (2.69 (2.06) cm, mean (standard deviation), for the 20 women with Four-Agents-Decoction and 4.68 (3.16) for the 22 women with placebo, p = .020.) There was no difference in adverse symptoms between the Four-Agents-Decoction (Si Wu Tang) and placebo groups. CONCLUSION/SIGNIFICANCE: Four-Agents-Decoction (Si Wu Tang) therapy in this pilot post-market clinical trial, while meeting the standards of conventional medicine, showed no statistically significant difference in reducing menstrual pain intensity of primary dysmenorrhoea at the end of treatment. Its use, with our dosage regimen and treatment length, was not associated with adverse reactions. The finding of statistically significant pain-reducing effect in the first follow-up cycle was unexpected and warrants further study. A larger similar trial among primary dysmenorrheic young women with longer treatment phase and multiple batched study products can determine the definitive efficacy of this historically documented formula. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN23374750

Integration and miniaturization of antennas for system-on-package applications

Wireless communications have been an indispensable aspect of everyday life, and there is an increasing consumer demand for accessing several wireless communication technologies from a single, compact, mobile device. System-on-package (SOP) technology is an advanced packaging technology that has been proven to realize the convergence of multiple functions into miniaturized, high-performance systems to meet this demand. With the advancements in the SOP technology, the miniaturization of the front-end module has been achieved using embedded passives in multilayer packages. However, the integration of the antenna directly on the module package is still the barrier to achieve a fully-integrated, high-performance RF SOP system. The main reason for this missing link is that integrating the antenna on the package requires miniaturizing the antenna, which is a difficult task. The focus of this dissertation is to design high-performance antennas along with developing techniques for miniaturization and system-on-package (SOP) integration of these antennas to achieve fully-integrated SOP systems using advanced multilayer organic substrates and thin-film magneto-dielectric materials. The targeted spectrum for the antenna designs are 2.4/5 GHz WLAN/WiMAX and 60 GHz WPAN bands. Several novel antenna designs and configurations to integrate the antenna on the package along with the module are discussed in this dissertation. The advanced polymers used in this research are Liquid Crystalline Polymer (LCP), RXP, and thin-film magneto-dielectrics.Ph.D.Committee Chair: Swaminathan, Madhavan; Committee Member: Ayazi, Farrokh; Committee Member: Kohl, Paul; Committee Member: Peterson, Andrew; Committee Member: Tentzeris, Mano

Organizational Effectiveness of Google Inc.

I think Google is a very good example for organizational effectiveness. The study showed that the company’s culture is not the only fact about the effeciency. Its business strategy and financial success also indicates how an effective organization can help a company to increase its market share and product/service lines. Google grows as a family, in a democratic environment.BscBA in MBAv