Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice

Adaptation de Contenu Multimédia avec MPEG-21: Conversion de Ressources et Adaptation Sémantique de Scènes

L'objectif de la thèse de doctorat présentée dans ce mémoire est de proposer des techniques et des méthodologies nouvelles, simples et efficaces pour l'adaptation de contenu multimédia à diverses contraintes de contexte d'utilisation. Le travail est basé sur des parties de la norme MPEG-21 en cours de définition, qui vise à définir les différents composants d'un système de distribution de contenus multimédia. Le travail de cette thèse est divisé en deux parties principales: l'adaptation de médias uniques, et l'adaptation sémantique de documents multimédia composés. Dans l'adaptation de médias uniques, le média est adapté aux contraintes du contexte de consommation, telles que les capacités du terminal, les préférences de l'utilisateur, les capacités du réseau, les recommandations de l'auteur, etc... Dans cette forme d'adaptation, le média est considéré hors de tout contexte de présentation multimédia structurée, ou indépendamment de la composition multimédia (scène) dans laquelle il est utilisé. Nous avons défini des outils et descripteurs, étendant les outils et descripteurs MPEG-21 DIA, pour la description des suggestions d'adaptation de médias (également appelée Conversion de Ressource), et la description des paramètres correspondants. Nous avons réalisé un moteur d'adaptation de médias qui fonctionne selon ces suggestions ainsi que selon les contraintes du contexte, et qui applique au media, la forme la plus appropriée d'adaptation avec des valeurs optimales des paramètres d'adaptation, afin d'obtenir la meilleure qualité d'utilisation. Durant cette partie du travail, nous avons apporté plusieurs contributions à la norme MPEG-21 DIA. Dans l'adaptation sémantique de documents multimédia structurés, nous avons considéré l'adaptation selon les relations temporelles, spatiales et sémantiques entre les objets média de la scène. En adaptant une présentation multimédia afin de préserver l'uniformité et la logique de la scène adaptée, le processus d'adaptation doit avoir accès à l'information sémantique de la présentation. Nous avons défini un langage d'extension de la description de scène pour l'expression de cette information sémantique, à base de descripteurs. Ces descripteurs contiennent des informations fournies par l'auteur de la scène multimédia, ou par n'importe quelle autre entité dans la chaîne de livraison multimédia. L'information incluse dans ces descripteurs aide le moteur d'adaptation à décider de la forme et de la nature optimales des adaptations qui doivent être appliquées au document. Cette information consiste en une information sémantique indépendante de chaque objet média, les dépendances sémantiques entre les objets média de la scène et les préférences sémantiques sur la fragmentation de scène. Pour la réalisation d'un tel système d'adaptation, nous avons utilisé SMIL 2.0 pour décrire nos scènes multimédia. Cependant, la méthodologie est indépendante de ce choix et peut être appliquée à d'autres types de documents multimédia, tels que MPEG-4 XMT. Nous avons implémenté un moteur d'adaptation sémantique expérimental, qui manipule et adapte des documents SMIL, en utilisant les informations sémantiques et physiques du contenu, ainsi que des contraintes de contexte

Fully successful resuscitation despite prolonged cardiac arrest

Sudden cardiac arrest following spinal anesthesia is a relatively common and often fatal complication. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring and prompt intervention at the first sign of cardiovascular instability should improve outcomes

The assessment of the malnutrition in traumatic ICU patients in Iran

Background: Despite recognition of the importance of nutritional feedings, the delivery of optimal nutrition remains difficult to achieve in most intensive care units (ICU). Objective: To assess the status of malnutrition in traumatically ill patients hospitalized in an ICU in Iran. Methods: This descriptive, cross-sectional study was conducted in Hamadan, Iran, on 123 patients in an ICU ward over six months with the purpose of assessing malnutrition status. Malnutrition and its severity were assessed based on the defined chemical parameters on admission and the end of stay times. Also, body mass index (BMI), weight (W), and height (H) anthropometric indices were assessed simultaneously to be compared with the chemical results. For statistical analysis we used SPSS version 16 software. Results: Overall, 83% of patients had malnutrition on admission to ICU, which was 90% on discharge or near- death condition, indicating increase of the prevalence of malnutrition within hospitalization in this ward. On admission, 11% of patients had mild, 61% moderate, and 11% severe malnutrition that reached to 4%, 63%, and 23%, respectively, by the end of the stay. BMI was significantly different in the patients who completed two weeks in the ICU (p<0.05). Assessment of the correlation between admission and two week completed stay showed that BMI, H, and W were positively correlated (r=0.85), (r=1.0), and (r=0.638), (p<0.05), respectively. There were no significant correlations in these parameters in the fourth week. Assessing the changes in anthropometric parameters showed downward trends of both weight and body mass index within ICU hospitalization. Conclusion: As shown in our study, inattention to needs of critically ill patients or lack of facilities results in developing and worsening of malnutrition, which, in turn, considerably worsens the outcome. To supply the needs of these in-hypermetabolic state patients, the importance of nutrition and its effect on outcome must be understood by medical staff; close monitoring of the nutritional status of these patients, along with meticulous calculations and team work, must be done and appropriate supportive routs be used

Adaptation de contenu multimedia avec MPEG 21 (conversion de ressources et adaptation sémantique de scènes)

L'objectif de cette thèse de doctorat est de proposer des techniques et des méthodologies nouvelles, simples et efficaces pour l'adaptation de contenu multimédia à diverses contraintes de contexte d utilisation. Le travail est basé sur la norme MPEG-21 qui vise à définir les différents composants d'un système de distribution de contenus multimédia. Le travail de cette thèse est divisé en deux parties principales : l'adaptation de médias uniques, et l'adaptation sémantique de documents multimédia composé. Dans l'adaptation de médias uniques, le média est adapté aux contraintes du contexte de consommation, telles que les capacités du terminal, les préférences de l'utilisateur, les capacités du réseau, les recommandations de l'auteur, etc... Dans cette forme d'adaptation, le média est considéré hors de tout contexte de présentation multimédia structurée. Nous avons défini des outils et descripteurs, étendant les outils et descripteurs MPEG-21 DIA, pour la description des suggestions d adaptation et la description des paramètres correspondants. Dans l'adaptation sémantique de documents multimédia structurés, adaptation est considérée selon les relations temporelles, spatiales et sémantiques entre les objets média de la scène. En adaptant une présentation multimédia afin de préserver l'uniformité et la logique de la scène adaptée, le processus d'adaptation doit avoir accès à l'information sémantique de la présentation. Nous avons défini un langage d extension de la description de scène pour l'expression de cette information sémantique. Pour la réalisation d un tel système d adaptation, nous avons utilisé SMIL 2.0 pour décrire nos scènes multimédia.The objective of this Ph.D. thesis is to propose new, simple and efficient techniques and methodologies for support of multimedia content adaptation to constrained contexts. The work is based on parts of the on-going MPEG-21 standard that aims at defining different components of a multimedia distribution framework. The thesis is divided into two main parts: single media adaptation and semantic adaptation of multimedia composed documents. In single media adaptation, the media is adapted to the context constraints, such as terminal capabilities, user preferences, network capacities, author recommendations and etc. In this type of adaptation, the media is considered solely, i.e. as mono media. We have defined description tools extending the MPEG-21 DIA schema, for description of hints and suggestions on different media adaptations and their corresponding parameters. In semantic adaptation of structured multimedia documents, we addressed the question of adaptation based on temporal, spatial and semantic relationships between the media objects. When adapting a multimedia presentation, in order to preserve the consistency and meaningfulness of the adapted scene, the adaptation process needs to have access to the semantic information of the presentation. We have defined a language as a set of descriptors, for the expression of semantic information of composed multimedia content. In our implementations, we used SMIL 2.0 for describing multimedia scenes.PARIS-Télécom ParisTech (751132302) / SudocSudocFranceF

The analgesic effect of nitroglycerin added to lidocaine on quality of intravenous regional anesthesia in patients undergoing elective forearm and hand surgery

PURPOSE: To evaluate the effect of nitroglycerine (NTG) on sensory and motor block onset and recovery time as well as the quality of tourniquet pain relief, when added to lidocaine (LID) for intravenous regional anesthesia in elective forearm and hand surgery. METHODS: A randomized double-blinded clinical trial was performed on 40 patients that were randomly allocated into two groups received lidocaine 3 mg/kg with NTG 200 µg or received only lidocaine 3 mg/kg as the control. RESULTS: There was no difference between the two study groups in hemodynamic parameters before tourniquet inflation, at any time after inflation and after its deflation. There was no difference in the mean of pain score over time between the two groups. The onset time of sensory and motor blockades was shorter in the group received both LID and NTG. The mean recovery time of sensory blockade was longer in the former group. The frequency of opioid injections was significantly lower in those who administered LID and NTG. CONCLUSION: The adjuvant drug of NTG when added to LID is effective in improving the overall quality of anesthesia, shortening onset time of both sensory and motor blockades, and stabling homodynamic parameters in hand and forearm surgery

Investigating the Effectiveness of Life Skills Training Using Synectics Method on Social Tolerance, Wisdom, and Emotion Control in Junior High School Male Students

Background and Objectives: Teaching life skills to children and adolescents is one of the key responsibilities of the education systems and families. Synectics teaching method is a new training approach to enhance creativity in individuals. These exercises are designed to enable the person to use creativity to understand metaphors and analogies for creating new (“groundbreaking”) alternatives. The present study aimed to assess the effectiveness of life skills training using the Synectics method on social tolerance, wisdom, and emotion control in junior high school male students. Materials and Methods: The statistical population in this quasi-experimental study included all the first-year high school male students (n=5,000) in Hamadan, Iran, of whom 50 students (2 groups of 25 students) were selected using a multi-stage cluster sampling method. Social tolerance, wisdom, and emotion control questionnaires were used to collect data. The multivariate analysis of covariance and Scheffé’s post hoc test were used to analyze the collected data. Results: Based on the obtained results from Scheffé's test, the mean post-test scores in the group who were trained in social tolerance, wisdom, and emotion control for anger control, positive emotion control, depressed mood control, and adolescent anxiety control, using the Synectics method, were higher than the control group by 10.08, 28.16, 12.32,1.8, 11.64 and 96.13 scores, respectively. Conclusion: Teaching life skills through Synectics method is considered an effective method in improving social tolerance, wisdom, and emotion control of adolescents, and it is suggested to use this method in designing educational interventions

Effectiveness of the Intraperitoneal Irrigation using Sodium Bicarbonate on Postoperative Pain Severity after Midline Laparotomy

Background and Objectives: Sodium bicarbonate may be effective in reducing the pain since it creates an alkaloid environment and prevents acidosis. Therefore, this study aimed to investigate the effect of intraperitoneal irrigation using sodium bicarbonate on postoperative pain severity.   Methods: This non-randomized, double-blind clinical trial was performed on 50 candidates for elective surgery with midline laparotomy at Besat Hospital in Hamadan, Iran, during 2017-18. The patients were assigned into an intervention (underwent intraperitoneal irrigation using sodium bicarbonate solution) and a control group (underwent intraperitoneal irrigation using the normal saline solution). The severity of the pain 12 and 24 h after the surgery in patients was measured using a Visual Analog Scale (VAS).   Results: The mean ages of the patients were 48.87±11.68 and 49.56±15.44 years in the intervention and control groups, respectively. Regarding gender distribution, 52% of the participants were male. Moreover, the mean pain scores 12 h after the surgery were 6±1.71 and 7.56±1.47 in the intervention and control groups, respectively. Additionally, the mean pain scores obtained from VAS 24h after the surgery were 20.20±1.15 and 3.68±1.62 in the intervention and control groups, respectively. According to the results, the mean score of pain was significantly lower in the intervention group, compared to the control group (P<0.05). However, there was no significant difference between the two groups regarding the frequency of complications and the amount of opioid consumption.   Conclusion: The combination of sodium bicarbonate and normal saline solution for intraperitoneal irrigation is a simple method with no complication. This can help reduce postoperative pain up to 24 h after surgery

3D printing and properties of cellulose nanofibrils-reinforced quince seed mucilage bio-inks

The authors would like to acknowledge the Academy of Finland funding; No. 327248 (ValueBiomat) and 327865 (Bioeconomy). This work was a part of the Academy of Finland's Flagship Programme under Projects No. 318890 and 318891 (Competence Center for Materials Bioeconomy, FinnCERES). The authors would also like to thank Ms. Marja Kärkkäinen for providing TEMPO-CNF and the Biohybrid Materials Research Group (Aalto University) for providing the HepG2 cells.Plant-based hydrogels have attracted great attention in biomedical fields since they are biocompatible and based on natural, sustainable, cost-effective, and widely accessible sources. Here, we introduced new viscoelastic bio-inks composed of quince seed mucilage and cellulose nanofibrils (QSM/CNF) easily extruded into 3D lattice structures through direct ink writing in ambient conditions. The QSM/CNF inks enabled precise control on printing fidelity where CNF endowed objects with shape stability after freeze-drying and with suitable porosity, water uptake capacity, and mechanical strength. The compressive and elastic moduli of samples produced at the highest CNF content were both increased by ~100% (from 5.1 ± 0.2 kPa and 32 ± 1 kPa to 10.7 ± 0.5 and 64 ± 2 kPa, respectively). These values ideally matched those reported for soft tissues; accordingly, the cell compatibility of the printed samples was evaluated against HepG2 cells (human liver cancer). The results confirmed the 3D hydrogels as being non-cytotoxic and suitable to support attachment, survival, and proliferation of the cells. All in all, the newly developed inks allowed sustainable 3D bio-hydrogels fitting the requirements as scaffolds for soft tissue engineering.Peer reviewe