Challenges of “Reverse” Aortic Arch Debranching for Repair of the Ascending Aorta by Thoracic Endovascular Aortic Repair

IntroductionAscending aortic pathology presents a unique challenge for treatment by thoracic endovascular aortic repair (TEVAR), because of lack of adequate endograft landing zones. This report describes a unique “reverse” extra-anatomical aortic arch debranching procedure performed to enable TEVAR of the ascending aorta.ReportA 71-year-old male presented with a large ascending aortic pseudoaneurysm secondary to previous arch repair anastomosis. This pathology was treated by TEVAR of the ascending aorta. To create a sufficient landing zone for the endovascular stent graft, a “reverse” extra-anatomical aortic arch debranching procedure was performed. This involved a left subclavian artery to left carotid artery bypass, left to right carotid-to-carotid bypass, ligation of proximal left common carotid artery, and embolization of the innominate artery origin.DiscussionTEVAR of the ascending aorta can be made feasible through a novel debranching procedure that creates sufficient landing zones for the endograft. This surgical approach may prove useful in patients who present with aortic arch pathology and comorbidities that prevent open surgical repair

On Some Optimal Multiple Root-Finding Methods and their Dynamics

Finding multiple zeros of nonlinear functions pose many difficulties for many of the iterative methods. In this paper, we present an improved optimal class of higher-order methods for multiple roots having quartic convergence. The present approach of deriving an optimal class is based on weight function approach. In terms of computational cost, all the proposed methods require three functional evaluations per full iteration, so that their efficiency indices are 1.587 and, are optimal in the sense of Kung-Traub conjecture. It is found by way of illustrations that they are useful in high precision computing enviroments. Moreover, basins of attraction of some of the higher-order methods in the complex plane are also given

To study the outcome of previous one cesarean pregnancies in a rural tertiary center of Haryana, India

Background: Rising rates of caesarean section is a matter of great concern and TOLAC is an attractive alternative. Analysing outcome of previous one caesarean pregnancies will provide an insight for reducing the caesarean rates and formulating protocols and policies for TOLAC.Methods: A retrospective study of patients of previous one caesarean pregnancy was done from February 2015 to January 2016 and 3 groups were made, ERCS group, failed TOLAC group and successful TOLAC group. The rates of elective repeat caesarean, failed TOLAC, successful TOLAC, maternal complications, neonatal morbidity and mortality in all three groups were studied.Results: There were 5177 total deliveries with 488 (9.43%) previous one caesarean pregnancies. Out of 488 patients 161 (33%) underwent elective repeat caesarean and 327 (67%) underwent trial of labour. Out of 327 patients 234 (71.56%) had a successful TOLAC and 93 (28.44%) had failed TOLAC. Breech (23%) followed by foetal distress (20%) were the most common indications of previous caesarean. Commonest indication of elective repeat caesarean was short interval (33%) and that of failed TOLAC was foetal distress (38.7%) followed by failed induction (23.6%). There were 4 morbidly adherent placentas (0.82%), 1 scar rupture, 3 scar dehiscence, no maternal mortality and 10 neonatal deaths.Conclusions: Previous one caesarean section is not only a risk factor for repeat caesareans and complications like morbidly adherent placenta, uterine rupture but also a financial burden on health facilities. Encouraging the patients for trial of labour and emphasizing the usage of contraception is the need of the hour

Challenges and opportunities associated with waste management in India

India faces major environmental challenges associated with waste generation and inadequate waste collection, transport, treatment and disposal. Current systems in India cannot cope with the volumes of waste generated by an increasing urban population, and this impacts on the environment and public health. The challenges and barriers are significant, but so are the opportunities. This paper reports on an international seminar on ‘Sustainable solid waste management for cities: opportunities in South Asian Association for Regional Cooperation (SAARC) countries’ organized by the Council of Scientific and Industrial Research-National Environmental Engineering Research Institute and the Royal Society. A priority is to move from reliance on waste dumps that offer no environmental protection, to waste management systems that retain useful resources within the economy. Waste segregation at source and use of specialized waste processing facilities to separate recyclable materials has a key role. Disposal of residual waste after extraction of material resources needs engineered landfill sites and/or investment in waste-to-energy facilities. The potential for energy generation from landfill via methane extraction or thermal treatment is a major opportunity, but a key barrier is the shortage of qualified engineers and environmental professionals with the experience to deliver improved waste management systems in India

Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation

Objective To assess the cost-effectiveness of dabigatran etexilate, a new oral anticoagulant, versus warfarin and other alternatives for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation (AF). Methods A Markov model estimated the cost-effectiveness of dabigatran etexilate versus warfarin, aspirin or no therapy. Two patient cohorts with AF (starting age of <80 and ≥80 years) were considered separately, in line with the UK labelled indication. Modelled outcomes over a lifetime horizon included clinical events, quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs). Results Patients treated with dabigatran etexilate experienced fewer ischaemic strokes (3.74 dabigatran etexilate vs 3.97 warfarin) and fewer combined intracranial haemorrhages and haemorrhagic strokes (0.43 dabigatran etexilate vs 0.99 warfarin) per 100 patient-years. Larger differences were observed comparing dabigatran etexilate with aspirin or no therapy. For patients initiating treatment at ages <80 and ≥80 years, the ICERs for dabigatran etexilate were £4831 and £7090/QALY gained versus warfarin with a probability of cost-effectiveness at £20 000/QALY gained of 98% and 63%, respectively. For the patient cohort starting treatment at ages <80 years, the ICER versus aspirin was £3457/QALY gained and dabigatran etexilate was dominant (ie, was less costly and more effective) compared with no therapy. These results were robust in sensitivity analyses. Conclusions This economic evaluation suggests that the use of dabigatran etexilate as a first-line treatment for the prevention of stroke and systemic embolism is likely to be cost-effective in eligible UK patients with AF

An antiinflammatory active furochromone, norcimifugin from Cimicifuga foetida: Isolation, characterization, total synthesis and antiinflammatory activity of its Analogues

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Lipoprotein(a) and the Risk for Recurrent Atherosclerotic Cardiovascular Events Among Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study

Rationale & Objective: Many adults with chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) have high lipoprotein(a) levels. It is unclear whether high lipoprotein(a) levels confer an increased risk for recurrent ASCVD events in this population. We estimated the risk for recurrent ASCVD events associated with lipoprotein(a) in adults with CKD and prevalent ASCVD. Study Design: Observational cohort study. Setting & Participants: We included 1,439 adults with CKD and prevalent ASCVD not on dialysis enrolled in the Chronic Renal Insufficiency Cohort study between 2003 and 2008. Exposure: Baseline lipoprotein(a) mass concentration, measured using a latex-enhanced immunoturbidimetric assay. Outcomes: Recurrent ASCVD events (primary outcome), kidney failure, and death (exploratory outcomes) through 2019. Analytical Approach: We used Cox proportional-hazards regression models to estimate adjusted HR (aHRs) and 95% CIs. Results: Among participants included in the current analysis (mean age 61.6 years, median lipoprotein(a) 29.4 mg/dL [25th-75th percentiles 9.9-70.9 mg/dL]), 641 had a recurrent ASCVD event, 510 developed kidney failure, and 845 died over a median follow-up of 6.6 years. The aHR for ASCVD events associated with 1 standard deviation (SD) higher log-transformed lipoprotein(a) was 1.04 (95% CI, 0.95-1.15). In subgroup analyses, 1 SD higher log-lipoprotein(a) was associated with an increased risk for ASCVD events in participants without diabetes (aHR, 1.23; 95% CI, 1.02-1.48), but there was no evidence of an association among those with diabetes (aHR, 0.99; 95% CI, 0.88-1.10, P comparing aHRs = 0.031). The aHR associated with 1 SD higher log-lipoprotein(a) in the overall study population was 1.16 (95% CI, 1.04-1.28) for kidney failure and 1.02 (95% CI, 0.94-1.11) for death. Limitations: Lipoprotein(a) was not available in molar concentration. Conclusions: Lipoprotein(a) was not associated with the risk for recurrent ASCVD events in adults with CKD, although it was associated with a risk for kidney failure

EFEKTIVITAS DESENTRALISASI PENDIDIKAN DALAM MENINGKATKAN PROFESIONALISME GURU DI SMA NEGERI 1 LAKEA

Skripsi ini membahas tentang efektivitas desentralisasi pendidikan dalammeningkatkan profesionalisme guru di SMA Negeri 1 Lakea dengan pokok pembahasana bagaimana deskripsi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea? dan bagaimana implikasi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea. Tujuan penelitian ini untuk mengetahuideskripsi dan implikasi desentralisasi pendidikan dalam meningkatkan prodfesionalisme guru di sekolah tersebut.Untuk menjawab permsalahan tersebut, penelitian ini menggunakan metode kualitatif dengan teknik pengumpulan data melalui observasi, wawancara dan dokumentasi, serta menggunakan teknik analisis data melalui reduksi data, penyajian data, verifikasi data dan penarikan kesimpulan.Hasil penelitian skripsi ini yaitu: deskripsi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Desentralisasi pendidikan merupakan pemberian kewenangan kepada daerah untuk mengelola pendidikannya, lalu daerah melimpahkan kepada masing-masing sekolah (2) Pemerintah pusat tetap mengontrol pendidikan yang diselenggarakan oleh pemerintah daerah dan masing-masing sekolah melalui akreditasi nasional yang dilaksanakan oleh BAN-SM (3) Aspek-aspek yang menjadi kewenangan sekolah dalam melaksanakan desentralisai pendidikan yakni: (a) Perencanaan dan evaluasi program sekolah dalam hal ini sekolah berupaya meningkatkan mutu pendidikan dengan cara merencanakan kegiatan-kegiatan yang dapat meningkatkan profesionalisme guru, misalnya mengutus guru untuk mengikuti Musyawarah Guru Mata Pelajaran (MGMP) dan merencanakan bimbingan teknis untuk meningkatkan keterampilan guru dan mengevaluasi berbagai perencaan kegiatan program sekolah (b) Aspek pengelolaan proses belajar, memberikan kewenangan kepada masing-masing guru untuk mengelola proses pembelajaran pada mata pelajaran yang dipegangnya dan kepala sekolah melukan supervisi kepada guru untuk mengevaluasi dan membimbing pelaksanaan proses pembelajaran guru tersebut (c) Aspek pengelolaan ketenagaan, SMA Negeri 1 Lakea mengelola 25 orang guru dan 3 orang tenaga administrasi, pengelolaan yang dilakukan misalnya memberikan guru mata pelajaran yang sesuai dengan keahliannya, dan mengutus guru sebagai perwakilannya dalam kegiatan seminar mapun workshop (d) Aspek pengelolaan keuangan, sekolah mengelola dana BOS dengan prosedur sesuai dengan aturan penggunaan dana tersebut yakni sebagai operasional sekolah, misalnya mengupayakan pembayaran honor guru honorer yang tidak pernah terlambat dibayarkan. Implikasi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Program sekolah dalam meningkatkan profesionalisme dapat terlaksana dengan baik (2) Masing-masing guru berupaya meningkatkan pengelolaan proses belajarnya sebagai implikasi dari pelaksanaan supervisi (3) Sekolah memiliki tenaga pendidik sesuai dengan kebutuhan dan (4) Pengelolaan keuangan yang dilaksanakan oleh sekolah dapat memotivasi guru untuk melaksanakan tugasnya dengan baik.Kata Kunci        :    Desentralisasi pendidikan, profesionalisme gur