23 research outputs found
Role of Factor VII in Correcting Dilutional Coagulopathy and Reducing Re-operations for Bleeding Following Non-traumatic Major Gastrointestinal and Abdominal Surgery
Objective The objective of this study is to evaluate the effectiveness of rfVIIa in reducing blood product requirements and re-operation for postoperative bleeding after major abdominal surgery. Background Hemorrhage is a significant complication after major gastrointestinal and abdominal surgery. Clinically significant bleeding can lead to shock, transfusion of blood products, and re-operation. Recent reports suggest that activated rfVIIa may be effective in correcting coagulopathy and decreasing the need for re-operation. Methods This study was a retrospective review over a 4-year period of 17 consecutive bleeding postoperative patients who received rfVIIa to control hemorrhage and avoid re-operation. Outcome measures were blood and clotting factor transfusions, deaths, thromboembolic complications, and number of re-operations for bleeding. Results Seventeen patients with postoperative hemorrhage following major abdominal gastrointestinal surgery (nine pancreas, four sarcoma, two gastric, one carcinoid, and one fistula) were treated with rfVIIa. In these 17 patients, rfVIIa was administered for 18 episodes of bleeding (dose 2,400-9,600 mcg, 29.8-100.8 mcg/kg). Transfusion requirement of pRBC and FFP were each significantly less than pre-rfVIIa. Out of the 18 episodes, bleeding was controlled in 17 (94%) without surgery, and only one patient returned to the operating room for hemorrhage. There were no deaths and two thrombotic complications. Coagulopathy was corrected by rfVIIa from 1.37 to 0.96 (p<0.0001). Conclusion Use of rfVIIa in resuscitation for hemorrhage after non-traumatic major abdominal and gastrointestinal surgery can correct dilutional coagulopathy, reducing blood product requirements and need for re-operation
LSST: from Science Drivers to Reference Design and Anticipated Data Products
(Abridged) We describe here the most ambitious survey currently planned in
the optical, the Large Synoptic Survey Telescope (LSST). A vast array of
science will be enabled by a single wide-deep-fast sky survey, and LSST will
have unique survey capability in the faint time domain. The LSST design is
driven by four main science themes: probing dark energy and dark matter, taking
an inventory of the Solar System, exploring the transient optical sky, and
mapping the Milky Way. LSST will be a wide-field ground-based system sited at
Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m
effective) primary mirror, a 9.6 deg field of view, and a 3.2 Gigapixel
camera. The standard observing sequence will consist of pairs of 15-second
exposures in a given field, with two such visits in each pointing in a given
night. With these repeats, the LSST system is capable of imaging about 10,000
square degrees of sky in a single filter in three nights. The typical 5
point-source depth in a single visit in will be (AB). The
project is in the construction phase and will begin regular survey operations
by 2022. The survey area will be contained within 30,000 deg with
, and will be imaged multiple times in six bands, ,
covering the wavelength range 320--1050 nm. About 90\% of the observing time
will be devoted to a deep-wide-fast survey mode which will uniformly observe a
18,000 deg region about 800 times (summed over all six bands) during the
anticipated 10 years of operations, and yield a coadded map to . The
remaining 10\% of the observing time will be allocated to projects such as a
Very Deep and Fast time domain survey. The goal is to make LSST data products,
including a relational database of about 32 trillion observations of 40 billion
objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures
available from https://www.lsst.org/overvie
The Detectability of Earth's Biosignatures Across Time
Over the past two decades, enormous advances in the detection of exoplanets
have taken place. Currently, we have discovered hundreds of earth-sized
planets, several of them within the habitable zone of their star. In the coming
years, the efforts will concentrate in the characterization of these planets
and their atmospheres to try to detect the presence of biosignatures. However,
even if we discovered a second Earth, it is very unlikely that it would present
a stage of evolution similar to the present-day Earth. Our planet has been far
from static since its formation about 4.5 Ga ago; on the contrary, during this
time, it has undergone multiple changes in it's atmospheric composition, it's
temperature structure, it's continental distribution, and even changes in the
forms of life that inhabit it. All these changes have affected the global
properties of Earth as seen from an astronomical distance. Thus, it is of
interest not only to characterize the observables of the Earth as it is today,
but also at different epochs. Here we review the detectability of the Earth's
globally-averaged properties over time. This includes atmospheric composition
and biosignatures, and surface properties that can be interpreted as sings of
habitability (bioclues). The resulting picture is that truly unambiguous
biosignatures are only detectable for about 1/4 of the Earth's history. The
rest of the time we rely on detectable bioclues that can only establish an
statistical likelihood for the presence of life on a given planet.Comment: To appear in "Handbook of Exoplanets", eds. Deeg, H.J. & Belmonte,
J.A, Springer (2018). arXiv admin note: text overlap with
arXiv:astro-ph/0609398 by other author
Earth: Atmospheric Evolution of a Habitable Planet
Our present-day atmosphere is often used as an analog for potentially
habitable exoplanets, but Earth's atmosphere has changed dramatically
throughout its 4.5 billion year history. For example, molecular oxygen is
abundant in the atmosphere today but was absent on the early Earth. Meanwhile,
the physical and chemical evolution of Earth's atmosphere has also resulted in
major swings in surface temperature, at times resulting in extreme glaciation
or warm greenhouse climates. Despite this dynamic and occasionally dramatic
history, the Earth has been persistently habitable--and, in fact,
inhabited--for roughly 4 billion years. Understanding Earth's momentous changes
and its enduring habitability is essential as a guide to the diversity of
habitable planetary environments that may exist beyond our solar system and for
ultimately recognizing spectroscopic fingerprints of life elsewhere in the
Universe. Here, we review long-term trends in the composition of Earth's
atmosphere as it relates to both planetary habitability and inhabitation. We
focus on gases that may serve as habitability markers (CO2, N2) or
biosignatures (CH4, O2), especially as related to the redox evolution of the
atmosphere and the coupled evolution of Earth's climate system. We emphasize
that in the search for Earth-like planets we must be mindful that the example
provided by the modern atmosphere merely represents a single snapshot of
Earth's long-term evolution. In exploring the many former states of our own
planet, we emphasize Earth's atmospheric evolution during the Archean,
Proterozoic, and Phanerozoic eons, but we conclude with a brief discussion of
potential atmospheric trajectories into the distant future, many millions to
billions of years from now. All of these 'Alternative Earth' scenarios provide
insight to the potential diversity of Earth-like, habitable, and inhabited
worlds.Comment: 34 pages, 4 figures, 4 tables. Review chapter to appear in Handbook
of Exoplanet