Management of failed spinal anaesthesia for caesarean section

Background. Failed spinal anaesthesia for caesarean section (CS) may be partial or complete and the subsequent discomfort is the most commonly cited cause of litigation in obstetric anaesthesia.Objectives. To determine if there is a standardised approach to: (i) testing the level of block of spinal anaesthesia; and (ii) the management of failed spinal anaesthesia for CS.Methods. A structured questionnaire to ascertain the current practice of testing the level of block and management of three different scenarios of failed spinal anaesthesia was distributed to 51 government hospitals in KwaZulu-Natal, South Africa (SA). All obstetric anaesthetic service providers, ranging from interns to specialist anaesthetists, were invited to complete the questionnaire.Results. A total of 375 responses were received from 42 of the 51 hospitals surveyed. Specialist anaesthetists managed failure of spinal anaesthesia significantly differently than other anaesthetic service providers. Specialists were more likely to convert to a general anaesthetic (GA), while others were more likely to repeat spinal anaesthesia or administer intravenous ketamine, midazolam and opioids. Only 212 respondents (56%) tested the level of block and there was no difference between the groups with regard to the method of assessment of height (p=0.15). Nonspecialists, however, accepted a significantly lower level of block, using pinprick, than specialists (p=0.027), which could lead to a higher failure rate. More than one-third of non-specialists did not consider themselves competent to perform a GA and >90% of respondents agreed that a ‘failed’ spinal algorithm would be useful.Conclusion. There is a need for standardised assessment of the adequacy of spinal anaesthesia for CS in SA, as well as a failed spinal algorithm

Uniqueness and Non-uniqueness in the Einstein Constraints

The conformal thin sandwich (CTS) equations are a set of four of the Einstein equations, which generalize the Laplace-Poisson equation of Newton's theory. We examine numerically solutions of the CTS equations describing perturbed Minkowski space, and find only one solution. However, we find {\em two} distinct solutions, one even containing a black hole, when the lapse is determined by a fifth elliptic equation through specification of the mean curvature. While the relationship of the two systems and their solutions is a fundamental property of general relativity, this fairly simple example of an elliptic system with non-unique solutions is also of broader interest.Comment: 4 pages, 4 figures; abstract and introduction rewritte

Disease threats to farmed green-lipped mussels Perna canaliculus in New Zealand: Review of challenges in risk assessment and pathway analysis

The endemic green-lipped mussel (GLM) Perna canaliculus is a key cultural and economic species for New Zealand. Unlike other cultured shellfish species, GLMs have experienced relatively few disease issues. The apparent absence of diseases in both wild and farmed GLM populations does not preclude risks from environmental changes or from the introduction of overseas mussel pathogens and parasites. Potential for disease exchange between the GLM and other mytilid species present in New Zealand has yet to be elucidated. After reviewing and discussing relevant scientific literature, we present an initial assessment of GLM vulnerability to disease threats and the potential risk pathways for mussel pathogens and parasites into New Zealand and highlight a number of challenges. These include knowledge gaps relevant to GLM susceptibility to exotic pathogens and parasites, risk pathways into New Zealand and biosecurity risk associated with domestic pathways. Considerations and findings could potentially apply to other farmed aquatic species with limited distribution range and/or low disease exposure

135 MeV Proton Scattering from 13-C

This work was supported by the National Science Foundation Grant NSF PHY 78-22774 A02 & A03 and by Indiana Universit

A meta-analysis of multiple stressors on seagrasses in the context of marine spatial cumulative impacts assessment

Published online: 20 July 2020Humans are placing more strain on the world’s oceans than ever before. Furthermore, marine ecosystems are seldom subjected to single stressors, rather they are frequently exposed to multiple, concurrent stressors. When the combined effect of these stressors is calculated and mapped through cumulative impact assessments, it is often assumed that the effects are additive. However, there is increasing evidence that different combinations of stressors can have non-additive impacts, potentially leading to synergistic and unpredictable impacts on ecosystems. Accurately predicting how stressors interact is important in conservation, as removal of certain stressors could provide a greater benefit, or be more detrimental than would be predicted by an additive model. Here, we conduct a meta-analysis to assess the prevalence of additive, synergistic, and antagonistic stressor interaction effects using seagrasses as case study ecosystems. We found that additive interactions were the most commonly reported in seagrass studies. Synergistic and antagonistic interactions were also common, but there was no clear way of predicting where these non-additive interactions occurred. More studies which synthesise the results of stressor interactions are needed to be able to generalise interactions across ecosystem types, which can then be used to improve models for assessing cumulative impacts.Jackson Stockbridge, Alice R. Jones and Bronwyn M. Gillander

Inelastic Proton Scattering to Unnatural Parity States in Even Mass Nuclei

This work was supported by National Science Foundation Grant PHY 76-84033 and Indiana Universit

Studies of Knock-Out Reactions

This work was supported by National Science Foundation Grant PHY 75-00289 and Indiana Universit

Blood feeding in juvenile Paragnathia formica (Isopoda: Gnathiidae): biochemical characterization of trypsin inhibitors, detection of anticoagulants, and molecular identification of fish hosts

SUMMARYThe 3 post-marsupial juvenile stages of the gnathiid isopod, Paragnathia formica, are haematophagous ectoparasites of fishes that may, in heavy infestations, cause host mortality. Protein digestion in fed stage 3 juveniles is accomplished by cysteine proteinases, but what bioactive compounds attenuate host haemostatic, inflammatory and immunological responses during feeding is unknown. Trypsin inhibitory activity and anticoagulant activity were detected in crude extracts of unfed P. formica stage 1 juveniles; fractionation of stage 1 crude extracts by ion exchange chromatography resulted in 3 preparations each displaying these bioactivities. Further characterization revealed anti-thrombin activity in 2 of these preparations, whilst the third displayed the strongest anticoagulant activity that targeted a factor of the intrinsic coagulation pathway. Three trypsin inhibitors (18 kDa, 21 kDa, and 22 kDa) were also detected using reverse zymography. In parallel, homogenates of fed stage 2 and 3 juveniles were used to identify their fish hosts by amplifying the 16S mitochondrial rDNA and 18S genomic rDNA vertebrate gene regions. Blood from at least 4 fish families had been ingested by separate individuals during feeding. This study demonstrates that trypsin inhibitors and anticoagulants are present in P. formica juveniles which could suppress host haemostatic, inflammatory and immunological responses during feeding, and that juveniles are not host specific