Management considerations of massive hemoptysis while on extracorporeal membrane oxygenation.

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a life-saving procedure in patients with both respiratory and cardiac failure. Bleeding complications are common since patients must be maintained on anticoagulation. Massive hemoptysis is a rare complication of ECMO; however, it may result in death if not managed thoughtfully and expeditiously. METHODS: A retrospective chart review was performed of consecutive ECMO patients from 7/2010-8/2014 to identify episodes of massive hemoptysis. The management of and the outcomes in these patients were studied. Massive hemoptysis was defined as an inability to control bleeding (\u3e300 mL/day) from the endotracheal tube with conventional maneuvers, such as bronchoscopy with cold saline lavage, diluted epinephrine lavage and selective lung isolation. All of these episodes necessitated disconnecting the ventilator tubing and clamping the endotracheal tube, causing full airway tamponade. RESULTS: During the period of review, we identified 118 patients on ECMO and 3 (2.5%) patients had the complication of massive hemoptysis. One case was directly related to pulmonary catheter migration and the other two were spontaneous bleeding events that were propagated by antiplatelet agents. All three patients underwent bronchial artery embolization in the interventional radiology suite. Anticoagulation was held during the period of massive hemoptysis without any embolic complications. There was no recurrent bleed after appropriate intervention. All three patients were successfully separated from ECMO. CONCLUSIONS: Bleeding complications remain a major issue in patients on ECMO. Disconnection of the ventilator and clamping the endotracheal tube with full respiratory and cardiac support by V-A ECMO is safe. Early involvement of interventional radiology to embolize any potential sources of the bleed can prevent re-hemoptysis and enable continued cardiac and respiratory recovery

The role of guanxi networks in the performance of women-led firms in China

This exploratory paper examines how knowledge acquired via guanxi (networks and connections) have enabled women-led firms in China to overcome a number of significant barriers and challenges in order to start and grow a successful business. We draw upon two case studies, in order to illustrate how they have utilized guanxi as a means of overcoming these barriers. We investigate the way in which guanxi facilitates the business owner in engaging in a process of entrepreneurial learning (Harrison and Leitch 2005; Politis, 2008) – and making connections and contacts – by which she is able to improve the firm’s performance. Further research is necessary to build upon a small number of studies that have already cleared the ground in terms of guanxi. More reliable and country-wide, but disaggregated, statistics on small businesses would be a welcome start, including information on their owner-manager’s or owner-managers’ gender

"Enter the dragoness": Firm growth, finance, guanxi, and gender in China

Purpose: The purpose of this exploratory paper is to theorise and examine gender differences in the impact of financial capital on Chinese firms' growth, and investigate the role of guanxi (connections and networks) in the process of obtaining finance. Design/methodology/approach: A structured questionnaire is used to collect comprehensive financial data from 18 women to 69 men, which is analysed empirically. Findings: Women appear to be no more disadvantaged from obtaining finance than men in China and in some respects appear to be in a better position. Both women- and men-led firms are significantly stronger in relation to having access to enough finance to grow than at the start-up phase. A majority of participants in this study used guanxi to access finance. Furthermore, the paper finds that guanxi is used equally by men and women, and that guanxi-sourced finance comprised a significant proportion of the overall capital obtained. Research limitations/implications: One major limitation of the study is that, of the 87 questionnaires returned, 21 per cent are women and 79 per cent are men and, although the findings are not representative or generalisable, the results do suggest a number of possible avenues for future research. Originality/value: The paper has illuminated the under-explored area of the financing of growth in women-led firms in China. This research agenda is particularly important because small- and medium-sized enterprise finance in China is a key need-to-know area, there is a paucity of specific research on financing women entrepreneurs in China and of the phenomenal rise of women's entrepreneurship in China. © Emerald Group Publishing Limited

Community Emergency Management During the 2005 Ambae Eruption, Vanuatu, SW Pacific.

No abstract availabl

Translating the Concept of Goal Setting into Practice -- What 'Else' does it Require than a Goal Setting Tool?

This conceptual paper reviews the current status of goal setting in the area of technology enhanced learning and education. Besides a brief literature review, three current projects on goal setting are discussed. The paper shows that the main barriers for goal setting applications in education are not related to the technology, the available data or analytical methods, but rather the human factor. The most important bottlenecks are the lack of students goal setting skills and abilities, and the current curriculum design, which, especially in the observed higher education institutions, provides little support for goal setting interventions.Comment: This paper has been accepted to be published in the proceedings of CSEDU 2020 by SciTePres

Dip coating process: Silicon sheet growth development for the large-area silicon sheet task of the low-cost silicon solar array project

The technical and economic feasibility of producing solar cell quality sheet silicon by dip-coating one surface of carbonized ceramic substrates with a thin layer of large grain polycrystalline silicon was investigated. The dip-coating methods studied were directed toward a minimum cost process with the ultimate objective of producing solar cells with a conversion efficiency of 10% or greater. The technique shows excellent promise for low cost, labor-saving, scale-up potentialities and would provide an end product of sheet silicon with a rigid and strong supportive backing. An experimental dip-coating facility was designed and constructed, several substrates were successfully dip-coated with areas as large as 25 sq cm and thicknesses of 12 micron to 250 micron. There appears to be no serious limitation on the area of a substrate that could be coated. Of the various substrate materials dip-coated, mullite appears to best satisfy the requirement of the program. An inexpensive process was developed for producing mullite in the desired geometry

Interpopulation hybridization results in widespread viability selection across the genome in Tigriopus californicus

<p>Abstract</p> <p>Background</p> <p>Genetic interactions within hybrids influence their overall fitness. Understanding the details of these interactions can improve our understanding of speciation. One experimental approach is to investigate deviations from Mendelian expectations (segregation distortion) in the inheritance of mapped genetic markers. In this study, we used the copepod <it>Tigriopus californicus</it>, a species which exhibits high genetic divergence between populations and a general pattern of reduced fitness in F2 interpopulation hybrids. Previous studies have implicated both nuclear-cytoplasmic and nuclear-nuclear interactions in causing this fitness reduction. We identified and mapped population-diagnostic single nucleotide polymorphisms (SNPs) and used these to examine segregation distortion across the genome within F2 hybrids.</p> <p>Results</p> <p>We generated a linkage map which included 45 newly elucidated SNPs and 8 population-diagnostic microsatellites used in previous studies. The map, the first available for the Copepoda, was estimated to cover 75% of the genome and included markers on all 12 <it>T. californicus </it>chromosomes. We observed little segregation distortion in newly hatched F2 hybrid larvae (fewer than 10% of markers at p < 0.05), but strikingly higher distortion in F2 hybrid adult males (45% of markers at p < 0.05). Hence, segregation distortion was primarily caused by selection against particular genetic combinations which acted between hatching and maturity. Distorted markers were not distributed randomly across the genome but clustered on particular chromosomes. In contrast to other studies in this species we found little evidence for cytonuclear coadaptation. Instead, different linkage groups exhibited markedly different patterns of distortion, which appear to have been influenced by nuclear-nuclear epistatic interactions and may also reflect genetic load carried within the parental lines.</p> <p>Conclusion</p> <p>Adult male F2 hybrids between two populations of <it>T. californius </it>exhibit dramatic segregation distortion across the genome. Distorted loci are clustered within specific linkage groups, and the direction of distortion differs between chromosomes. This segregation distortion is due to selection acting between hatching and adulthood.</p

Achieving Acetylcholine Receptor Clustering in Tissue-Engineered Skeletal Muscle Constructs In vitro through a Materials-Directed Agrin Delivery Approach

Volumetric muscle loss (VML) can result from trauma, infection, congenital anomalies, or surgery, and produce permanent functional and cosmetic deficits. There are no effective treatment options for VML injuries, and recent advances toward development of muscle constructs lack the ability to achieve innervation necessary for long-term function. We sought to develop a proof-of-concept biomaterial construct that could achieve acetylcholine receptor (AChR) clustering on muscle-derived cells (MDCs) in vitro. The approach consisted of the presentation of neural (Z+) agrin from the surface of microspheres embedded with a fibrin hydrogel to muscle cells (C2C12 cell line or primary rat MDCs). AChR clustering was spatially restricted to areas of cell (C2C12)-microsphere contact when the microspheres were delivered in suspension or when they were incorporated into a thin (2D) fibrin hydrogel. AChR clusters were observed from 16 to 72 h after treatment when Z+ agrin was adsorbed to the microspheres, and for greater than 120 h when agrin was covalently coupled to the microspheres. Little to no AChR clustering was observed when agrin-coated microspheres were delivered from specially designed 3D fibrin constructs. However, cyclic stretch in combination with agrin-presenting microspheres led to dramatic enhancement of AChR clustering in cells cultured on these 3D fibrin constructs, suggesting a synergistic effect between mechanical strain and agrin stimulation of AChR clustering in vitro. These studies highlight a strategy for maintaining a physiological phenotype characterized by motor endplates of muscle cells used in tissue engineering strategies for muscle regeneration. As such, these observations may provide an important first step toward improving function of tissue-engineered constructs for treatment of VML injuries

Optical Light Curve of the Type Ia Supernova 1998bu in M96 and the Supernova Calibration of the Hubble Constant

We present the UBVRI light curves of the Type Ia supernova SN 1998bu which appeared in the nearby galaxy M96 (NGC 3368). M96 is a spiral galaxy in the Leo I group which has a Cepheid-based distance. Our photometry allows us to calculate the absolute magnitude and reddening of this supernova. These data, when combined with measurements of the four other well-observed supernovae with Cepheid based distances, allow us to calculate the Hubble constant with respect to the Hubble flow defined by the distant Calan/Tololo Type Ia sample. We find a Hubble constant of 64.0 +/- 2.2(internal) +/- 3.5(external) km/s/Mpc, consistent with most previous estimates based on Type Ia supernovae. We note that the two well-observed Type Ia supernovae in Fornax, if placed at the Cepheid distance to the possible Fornax spiral NGC 1365, are apparently too faint with respect to the Calan/Tololo sample calibrated with the five Type Ia supernovae with Cepheid distances to the host galaxies.Comment: AAS LaTeX, 20 pages, 4 figures, 6 tables, accepted for publication in the Astronomical Journal. Figure 1 (finding chart) not include

AMI-LA Observations of the SuperCLASS Super-cluster

We present a deep survey of the SuperCLASS super-cluster - a region of sky known to contain five Abell clusters at redshift $z\sim0.2$ - performed using the Arcminute Microkelvin Imager (AMI) Large Array (LA) at 15.5$~$GHz. Our survey covers an area of approximately 0.9 square degrees. We achieve a nominal sensitivity of $32.0~\mu$Jy beam$^{-1}$ toward the field centre, finding 80 sources above a $5\sigma$ threshold. We derive the radio colour-colour distribution for sources common to three surveys that cover the field and identify three sources with strongly curved spectra - a high-frequency-peaked source and two GHz-peaked-spectrum sources. The differential source count (i) agrees well with previous deep radio source count, (ii) exhibits no evidence of an emerging population of star-forming galaxies, down to a limit of 0.24$~$mJy, and (iii) disagrees with some models of the 15$~$GHz source population. However, our source count is in agreement with recent work that provides an analytical correction to the source count from the SKADS Simulated Sky, supporting the suggestion that this discrepancy is caused by an abundance of flat-spectrum galaxy cores as-yet not included in source population models.Comment: 17 pages, 14 figures, 3 tables. Accepted for publication in MNRA