The introduction of a surgical safety checklist in a tertiary referral obstetric centre

Background: Surgery-related adverse events remain a significant and often under-reported problem. In a recent study, the introduction of a perioperative checklist by the WHO reduced deaths and complications by 46% and 36% respectively. The authors wished to evaluate the introduction of a surgical safety checklist in a busy obstetric tertiary referral centre by assessing staff attitudes, checklist compliance and effects upon patients. Methods: A questionnaire-based assessment was performed on staff working in obstetric theatres before and after the introduction of the surgical safety checklist. Checklist compliance was assessed at 3 months and 1 year. Patients were asked questions relating to the performance of the surgical safety checklist in order to evaluate any anxiety caused. Results: Non-medical staff were significantly more likely than medical staff to feel familiar with other team members both before (p<0.001) and after (

Randomized crossover comparison between the i-gel and the LMA-Unique in anaesthetized, paralysed adults

<b>Background</b>: The i-gel differs from other supraglottic airway devices, in that it has a softer, non-inflatable cuff. This study was designed to compare the performance of the i-gel and the LMA-Unique (LMA-U) when used during anaesthesia in paralysed patients. <b>Methods</b>: Both devices were studied in 39 anaesthetized, paralysed patients in a randomized crossover trial. The primary outcome was airway leak pressure. Secondary outcomes included time to insertion, the number of insertion and reposition attempts, leak volumes, and leak fractions. <b>Results</b>: There was no significant difference between the airway leak pressures of the two devices [median (IQR) leak pressures 25 (22–30) vs 22 (20–28) cm H2O for the i-gel and LMA-U, respectively; P=0.083, 95% CI of the mean difference –0.32 to 4.88 cm H2O]. The median (IQR) insertion time for the i-gel was significantly less than for the LMA-U [12.2 (9.7–14.3) vs 15.2 (13.2–17.3) s; P=0.007]. All the LMA-U devices and 38 of 39 i-gel airways were inserted at the first attempt. The number of manipulations required after insertion to achieve a clear airway was the same in both the groups (four in each). There were no statistically significant differences in leak volumes or leak fractions during controlled ventilation. <b>Conclusions</b>: We found no difference in leak pressures and success rate of first-time insertion between the i-gel and the LMA-U. Time to successful insertion was significantly shorter for the i-gel. We conclude that the i-gel provides a reasonable alternative to the LMA-U for controlled ventilation during anaesthesia

Financialization and Speculative Bubbles – International Evidence

This paper tests the possible presence of nonlinear speculative bubbles in 23 international markets using daily data from January 1993-March 2015, and its possible link to the financialization phenomenon. To estimate fundamental values, we estimate VAR. Residuals from these VAR are tested for significant movements away from the fundamentals using Hamilton regime switching and Hurst rescaled range tests. We also test the data for nonlinearities using BDS statistics. Our results indicate the presence of speculative bubbles in all 23 of these markets with increasing incidence over time, which suggest a linkage with the phenomenon of financialization in these economies

Novasure as a mechanical endometrial preparation agent in large uteri.

OBJECTIVE: We evaluated Novasure ablation as a mechanical endometrial preparation agent before Roller Ball endometrial ablation in lieu of GnRH agonists in large uteri. METHODS: A retrospective chart review of 20 consecutive patients undergoing Novasure ablation for mechanical endometrial preparation before Roller Ball ablation (RBNovasure group) was conducted and the results compared to that of 23 consecutive patients who received GnRH agonist (Leuprolide acetate) as a medical endometrial preparation before Roller Ball ablation (RB-Lupron group). The postoperative follow-up time frame was divided into immediate (3 mo), intermediate (3 to 12 mo) and long-term (12 to 32 mo). Rates of amenorrhea, heavy bleeding, cramping, and failure (repeat ablation or hysterectomy for heavy bleeding or persistent pain) were compared between the 2 groups. RESULTS: The mean rates of amenorrhea for the patients not lost to follow-up at 3 mo, 3 to 12 mo, and 12 to 32 mo visits were 45.5%, 58.8%, and 44.4% for the RB-Lupron group, and 80%, 86.7%, and 100% for the RB-Novasure group (P = .02, P = .08, and P = .02). Failure rates were 4.8%, 6.2%, and 55.6% for the RB-Lupron group; and 0 (0/20), 12.5% (2/16) and 0 (0/8) for the RB-Novasure group (P = .51, P = .50, and P = .02). The RB-Novasure group had a significantly lower rate of heavy bleeding and cramping. 86.4%, 58.8%, and 33.3% patients reported satisfaction with their treatment in the RB-Lupron group and 100%, 87.5%, and 75% in RB-Novasure group (P = .13, P = .07, and P = .11). CONCLUSION: Novasure ablation, for mechanical endometrial preparation before Roller Ball ablation, appears to be a superior alternative to medical preparation with GnRH agonists in patients with large uteri

The Neural Dynamics of Somatosensory Processing and Adaptation Across Childhood: a High-Density Electrical Mapping Study

Young children are often hyperreactive to somatosensory inputs hardly noticed by adults, as exemplified by irritation to seams or labels in clothing. The neurodevelopmental mechanisms underlying changes in sensory reactivity are not well understood. Based on the idea that neurodevelopmental changes in somatosensory processing and/or changes in sensory adaptation might underlie developmental differences in somatosensory reactivity, high-density electroencephalography was used to examine how the nervous system responds and adapts to repeated vibrotactile stimulation over childhood. Participants aged 6–18 yr old were presented with 50-ms vibrotactile stimuli to the right wrist over the median nerve at 5 blocked interstimulus intervals (ranging from 7 to 1 per second). Somatosensory evoked potentials (SEPs) revealed three major phases of activation within the first 200 ms, with scalp topographies suggestive of neural generators in contralateral somatosensory cortex. Although overall SEPs were highly similar for younger, middle, and older age groups (6.1–9.8, 10.0 –12.9, and 13.0 –17.8 yr old), there were significant age-related amplitude differences in initial and later phases of the SEP. In contrast, robust adaptation effects for fast vs. slow presentation rates were observed that did not differ as a function of age. A greater amplitude response in the later portion of the SEP was observed for the youngest group and may be related to developmental changes in responsivity to somatosensory stimuli. These data suggest the protracted development of the somatosensory system over childhood, whereas adaptation, as assayed in this study, is largely in place by 7 years of age

Growth of brown trout in the wild predicted by embryo stress reaction in the laboratory.

Laboratory studies on embryos of salmonids, such as the brown trout (Salmo trutta), have been extensively used to study environmental stress and how responses vary within and between natural populations. These studies are based on the implicit assumption that early life-history traits are relevant for stress tolerance in the wild. Here we test this assumption by combining two data sets from studies on the same 60 families. These families had been experimentally produced from wild breeders to determine, in separate samples, (1) stress tolerances of singly kept embryos in the laboratory and (2) growth of juveniles during 6 months in the wild. We found that growth in the wild was well predicted by the larval size of their full sibs in the laboratory, especially if these siblings had been experimentally exposed to a pathogen. Exposure to the pathogen had not caused elevated mortality among the embryos but induced early hatching. The strength of this stress-induced change of life history was a significant predictor of juvenile growth in the wild: the stronger the response in the laboratory, the slower the growth in the wild. We conclude that embryo performance in controlled environments can be a useful predictor of juvenile performance in the wild

Weak radiative hyperon decays, Hara's theorem and the diquark

Weak radiative hyperon decays are discussed in the diquark-level approach. It is pointed out that in the general diquark formalism one may reproduce the experimentally suggested pattern of asymmetries, while maintaining Hara's theorem in the SU(3) limit. At present, however, no detailed quark-based model of parity-violating diquark-photon coupling exists that would have the necessary properties.Comment: 10 pages, LaTe

CMR2009: 5.04: Post-mortem analysis of gadolinium distribution in NSF subjects

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64915/1/323_ftp.pd