Managing spinal hypotension during caesarean section: An update

Hypotension is common after spinal local anaesthesia for caesarean section. However, the substandard treatment of spinal hypotension and associated complications are responsible for up to two-thirds of deaths that occur in South Africa (SA) for caesarean section under spinal anaesthesia. In some cases, spinal hypotension may be predicted by simple parameters such as age >25 years, preoperative heart rate >90 bpm and preoperative mean arterial pressure <90 mmHg. Heart rate variability and point-of-care echocardiography also predict hypotension with greater accuracy, but are limited by equipment and training issues. Spinal anaesthesia is absolutely contraindicated if the parturient is hypovolaemic. Left lateral tilt is still advised, despite the absence of strong supporting evidence. The dose of spinal bupivacaine should not be reduced in obese patients. Crystalloid co-loading is an adequate fluid strategy in most cases, but is of limited efficacy in the prevention of hypotension. It is imperative that immediately after the patient is placed supine, close attention is paid to communication with her, heart rate changes and pulse volume. Early intervention with phenylephrine is the first-line approach for hypotension if heart rate is preserved under spinal anaesthesia. Phenylephrine infusions (25 - 50 μg/min) are easy to administer, maintain baseline maternal haemodynamics and are applicable to the SA context. The vigilant use of phenylephrine boluses (50 - 100 μg), targeting maternal heart rate as a surrogate for cardiac output, is also effective. Noradrenaline has been used successfully to prevent spinal hypotension, but evidence does not yet suggest practice change. Local and international guidelines have recently been published

Distinct Magnetic Phase Transition at the Surface of an Antiferromagnet

In the majority of magnetic systems the surface is required to order at the same temperature as the bulk. In the present Letter, we report a distinct and unexpected surface magnetic phase transition at a lower temperature than the Néel temperature. Employing grazing incidence x-ray resonant magnetic scattering, we have observed the near-surface behavior of uranium dioxide. UO2 is a noncollinear, triple-q, antiferromagnet with the U ions on a face-centered cubic lattice. Theoretical investigations establish that at the surface the energy increase—due to the lost bonds—is reduced when the spins near the surface rotate, gradually losing their component normal to the surface. At the surface the lowest-energy spin configuration has a double-q (planar) structure. With increasing temperature, thermal fluctuations saturate the in-plane crystal field anisotropy at the surface, leading to soft excitations that have ferromagnetic XY character and are decoupled from the bulk. The structure factor of a finite two-dimensional XY model fits the experimental data well for several orders of magnitude of the scattered intensity. Our results support a distinct magnetic transition at the surface in the Kosterlitz-Thouless universality class

Innovative organotypic in vitro models for safety assessment: aligning with regulatory requirements and understanding models of the heart, skin, and liver as paradigms

The development of improved, innovative models for the detection of toxicity of drugs, chemicals, or chemicals in cosmetics is crucial to efficiently bring new products safely to market in a cost-effective and timely manner. In addition, improvement in models to detect toxicity may reduce the incidence of unexpected post-marketing toxicity and reduce or eliminate the need for animal testing. The safety of novel products of the pharmaceutical, chemical, or cosmetics industry must be assured; therefore, toxicological properties need to be assessed. Accepted methods for gathering the information required by law for approval of substances are often animal methods. To reduce, refine, and replace animal testing, innovative organotypic in vitro models have emerged. Such models appear at different levels of complexity ranging from simpler, self-organized three-dimensional (3D) cell cultures up to more advanced scaffold-based co-cultures consisting of multiple cell types. This review provides an overview of recent developments in the field of toxicity testing with in vitro models for three major organ types: heart, skin, and liver. This review also examines regulatory aspects of such models in Europe and the UK, and summarizes best practices to facilitate the acceptance and appropriate use of advanced in vitro models

The Vlasov limit and its fluctuations for a system of particles which interact by means of a wave field

In two recent publications [Commun. PDE, vol.22, p.307--335 (1997), Commun. Math. Phys., vol.203, p.1--19 (1999)], A. Komech, M. Kunze and H. Spohn studied the joint dynamics of a classical point particle and a wave type generalization of the Newtonian gravity potential, coupled in a regularized way. In the present paper the many-body dynamics of this model is studied. The Vlasov continuum limit is obtained in form equivalent to a weak law of large numbers. We also establish a central limit theorem for the fluctuations around this limit.Comment: 68 pages. Smaller corrections: two inequalities in sections 3 and two inequalities in section 4, and definition of a Banach space in appendix A1. Presentation of LLN and CLT in section 4.3 improved. Notation improve

Online peer assessment in higher education: a systematic review of literature in educational practices

Neste artigo procedemos a uma revisão sistemática da literatura sobre Online Peer Assessment (OPA) no Ensino Superior, mediadas por Tecnologias Digitais de Informação e Comunicação (TIC). Identificamos suas características, centrais e opcionais e mapeamos exemplos práticos (procedimentos e TIC) de OPA que poderão ser transversais, adaptáveis e aplicáveis em diversas unidades curriculares e regimes educacionais. Os resultados apontam para a utilização da OPA como uma estratégia que potencia a “avaliação para a aprendizagem”. Os referenciais teóricos subjacentes, os métodos de avaliação e os tipos de TIC utilizadas indicam seu direcionamento para um maior envolvimento e responsabilidade do aluno na sua aprendizagem. Evidenciamos na literatura que se busca desenvolver essas competências, dando ao aluno oportunidades com alguma regularidade para autoavaliar-se e avaliar seus pares por meio de feedback construtivo. Há também evidências de que dar ou produzir feedback é mais benéfico para a aprendizagem do que apenas recebê-lo, como também é cognitivamente mais exigente e envolve os alunos de forma mais ativa e os direciona ao pensamento crítico e a processos metacognitivos. A partir dos resultados alcançados, consideramos que a OPA, enquanto ferramenta cognitiva, contribui para a construção do conhecimento e para a reflexão sobre a aprendizagem. Um desafio que se coloca diz respeito ao desenvolvimento criativo com foco na diversificação e na inovação das práticas de avaliação no sentido de potenciar aprendizagens e resultados acadêmicos, em atenção às necessidades de aprendizagem que se manifestam frente às expectativas da educação atual e futura e às exigências da sociedade.In this research a systematic review of literature about Online Peer Assessment (OPA) in higher education, mediated by Information and Communication Technology (ICT), was carried out. Optional and central characteristics and its practices (procedures and ICT) were identified and mapping. These procedures and practices may be transversal, adaptable and applied in several curriculum units and educational regimes. The results point to the use of OPA as a strategy that enhances “assessment for learning”. The theoretical framework, the methods of assessment and the kinds of ICT used indicate directions for greater involvement and responsibility from the part of the student in his/her learning. Theoretical framework identifies the need to develop students’ skills, providing them with opportunities for self-assessment and peer assessment on a regular basis through constructive feedback. There is also evidence that to give or receive feedback is more beneficial for learning than just receiving it. It is also cognitively more demanding and directs the students to critical thinking and metacognitive processes. From the results obtained, OPA is seen as a cognitive tool, contributing to the building of knowledge and to reflection about learning. Issues for further reflection are also identified such as the creative development of assessment methods with a focus on diversity and innovation in order to enhance students’ learning and academic results, taking into account their learning needs in face of the expectations of current and future education and the demands of society.CIEC - Centro de Investigação em Estudos da Criança, IE, UMinho (UI 317 da FCT), PortugalFundos Nacionais através da FCT (Fundação para a Ciência e a Tecnologia) e cofinanciado pelo Fundo Europeu de Desenvolvimento Regional (FEDER) através do COMPETE 2020 – Programa Operacional Competitividade e Internacionalização (POCI) com a referência POCI-01-0145-FEDER-007562info:eu-repo/semantics/publishedVersio

Novel genetic loci associated with hippocampal volume

The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (rg =-0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness

Integrating sequence and array data to create an improved 1000 Genomes Project haplotype reference panel

A major use of the 1000 Genomes Project (1000GP) data is genotype imputation in genome-wide association studies (GWAS). Here we develop a method to estimate haplotypes from low-coverage sequencing data that can take advantage of single-nucleotide polymorphism (SNP) microarray genotypes on the same samples. First the SNP array data are phased to build a backbone (or 'scaffold') of haplotypes across each chromosome. We then phase the sequence data 'onto' this haplotype scaffold. This approach can take advantage of relatedness between sequenced and non-sequenced samples to improve accuracy. We use this method to create a new 1000GP haplotype reference set for use by the human genetic community. Using a set of validation genotypes at SNP and bi-allelic indels we show that these haplotypes have lower genotype discordance and improved imputation performance into downstream GWAS samples, especially at low-frequency variants. © 2014 Macmillan Publishers Limited. All rights reserved

A cytotoxic analysis of antiseptic medication on skin substitutes and autograft

Background: There is an increasing demand for the clinical application of human skin substitutes (HSSs) for treating ulcers, burns and surgical wounds. Due to this increasing demand and due to the simultaneous requirement for the administration of topical antiseptic medications, there is a need to determine potential cytotoxic effects of these medications on HSSs compared with autograft skin. Objectives: To perform such an evaluation. Methods: Two different HSSs were used (autologous reconstructed epidermis on fibroblast-populated human dermis and allogeneic reconstructed epidermis on a fibroblast-populated rat collagen gel) and were compared with conventional full-thickness autograft. Twelve different antiseptics were applied topically to the stratum corneum in vitro for 24 h. The degree of cytotoxicity was analysed as detrimental changes in histology, metabolic activity (MTT assay) and RNA staining of tissue sections. Results: The antiseptic medications tested showed different degrees of cytotoxicity. Acticoat®, Aquacel Ag®, Dermacyn®, Fucidin®, 0.5% silver nitrate solution and chlorhexidine digluconate were not cytotoxic for either HSS or autograft, and can therefore be used as required. Flamazine® and zinc oxide cream resulted in moderate cytotoxicity. However, application of Betadine®, cerium-silver sulfadiazine cream, silver sulfadiazine cream with 1% acetic acid and Furacine® resulted in a substantial decrease in cell viability and a detrimental effect on tissue histology when applied to autograft and especially to HSS. Conclusions: Due to the potential cytotoxic effect of some antiseptics on HSS, it is advised that clinicians balance the cytotoxicity of the medication, its antiseptic properties and the severity of colonization in choosing which one to apply