Intraoperative Use of Epsilon Amino Caproic Acid and Tranexamic Acid in Surgeries Performed Under Cardiopulmonary Bypass: a Comparative Study To Assess Their Impact On Reopening Due To Postoperative Bleeding

BACKGROUND: Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires reoperation. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There are limited studies primarily showing the impact of these drugs on the incidence of reopening following open heart surgical procedures. The goal of this study was to compare incidence of reopening following open heart surgeries in patients who were administered either epsilon amino caproic acid or tranexamic acid for control of perioperative bleeding.METHODS: A prospective, randomized, controlled trial was performed among seventy-eight patients of either sex in the age group of 18 to 65 years scheduled for open heart surgeries under cardiopulmonary bypass. They were randomly allocated into three groups where group A (n=26) received epsilon aminocaproic acid, group B (n=26) received tranexamic acid and group C (control group, n=26) received intravenous 0.9% normal saline. Patients had similar anaesthetic protocols, and were monitored for twenty-four hours postoperatively to assess reopening rates because of excessive bleeding.RESULTS: Two patients in each group receiving either tranexamic acid or epsilon aminocaproic acid had excessive bleeding requiring reopening after surgery whereas three patients in the control group had undergone reopening for excessive bleeding (p>0.05).CONCLUSIONS: Epsilon aminocaproic acid and tranexamic acid exhibit similar and comparable effect to placebo on incidence of reopening for excessive bleeding following open heart surgeries under cardiopulmonary bypassKEYWORDS: Bleeding, CPB, CABG, antifibrinilytic

Sciatic nerve palsy associated with intramuscular quinine injections in children

The purpose of this paper is to show that, in children, gluteal injection of quinine dihydrochloride (QDH) may result in damage to the sciatic nerve. Forty-six children were seen with foot drop following intramuscular injections in the same limb. They were analyzed for the type of injection, injection site, route of injection, the Health Unit where the drug was administered and the personnel that administered the prescription, the type of paralysis and its duration. In 22 children, QDH was the principle drug  administered. Of these, five (23%) had a sciatic palsy that persisted for at least one year. As well as the sciatic nerve palsy, some of the children developed other  complications including equinovarus deformity, leg length discrepancy and trophic ulcers. We conclude that intramuscular injections of quinine dihydrochloride into the gluteal muscles in ildren can cause sciatic nerve palsies and that Lfortunately some of these may be permanent

Channeling diverse innovation pressures to support European sustainability transitions

Innovation patterns and processes must be aligned, and harnessed and accelerated across multiple domains to address our climate objectives and wider sustainability challenges. In this Perspective, we draw from original case studies on specific technologies and their related innovation systems in agriculture, buildings, electricity, ICT, industry, and transport across Germany, Italy, Poland, and the United Kingdom. Across these innovation systems, the Research Note discusses the technologies, infrastructure, actors, policies and institutions that may lead to, or prevent, successful and unsuccessful technology transitions. We synthesize this diverse evidence to offer five key findings on technology costs and configurations, diversity and multiplicity of actors, diversity of value systems, and countervailing pressures. These insights support the design of effective innovation and decarbonization policies to promote low-carbon transitions

Color-coordinate system from a 13th-century account of rainbows.

We present a new analysis of Robert Grosseteste’s account of color in his treatise De iride (On the Rainbow), dating from the early 13th century. The work explores color within the 3D framework set out in Grosseteste’s De colore [see J. Opt. Soc. Am. A 29, A346 (2012)], but now links the axes of variation to observable properties of rainbows. We combine a modern understanding of the physics of rainbows and of human color perception to resolve the linguistic ambiguities of the medieval text and to interpret Grosseteste’s key terms

A Review of the Iraqi Housing Sector Problems

Housing is one of the important necessities for people. It comes after food and drink according to Maslow’s pyramid of human needs. It also influences countries’ social cohesion, stability and development and at the same time is affected by their general conditions. Iraq has a housing sector crisis. The county experiences a large housing shortage. The Iraqi National Housing Policy identifies critical challenges in seven housing-related fields: housing production, land management, housing finance, infrastructure, construction materials, housing stock status and slums. This paper aims to present a better understanding of these housing challenges as a first step to the development of appropriate solutions. It presents a critical investigation of the housing sector’s issues through exploring a wide range of literature to build a framework that critically evaluates and identifies the problems. The paper also quantifies the current housing shortage at around 1 million dwellings. Based on the extrapolation of trends towards 2030, it is estimated that Iraq has to build around 230000 dwellings annually to satisfy future demand. Results confirm the importance of the issues identified in the National Housing Policy, which gives it more validity. The paper concludes by proposing a series of measures to address Iraq’s housing challenges

Distributed diagnostics, prognostics and maintenance planning: Realizing industry 4.0

In this paper, a novel distributed yet integrated approach for diagnostics and prognostics is presented. An experimental study is conducted to validate the performance. Results showed that distributed prognostics give better performance in leaser computational time. Also, the proposed approach helps in making the results of the machine learning techniques comprehensible and more accurate. These results will be handy in arriving at predictive maintenance schedule considering the criticality of the system, the dependency of the components, available maintenance resources and confidence level in the results of the prognostic.Royal Academy of Engineering London, UK (IAPP 18-19/31

Best Practices in Second Stage Labor Care: Maternal Bearing Down and Positioning

Despite evidence of adverse fetal and maternal outcomes from the use of sustained Valsalva bearing down efforts, current second-stage care practices are still characterized by uniform directions to “push” forcefully upon complete dilatation of the cervix while the woman is in a supine position. Directed pushing might slightly shorten the duration of second stage labor, but can also contribute to deoxygenation of the fetus; cause damage to urinary, pelvic, and perineal structures; and challenge a woman’s confidence in her body. Research on the second stage of labor care is reviewed, with a focus on recent literature on maternal bearing down efforts, the “laboring down” approach to care, second-stage duration, and maternal position. Clinicians can apply the scientific evidence regarding the detrimental effects of sustained Valsalva bearing down efforts and supine positioning by individualizing second stage labor care and supporting women’s involuntary bearing down sensations that can serve to guide her behaviors

Noncommutative geometry and stochastic processes

The recent analysis on noncommutative geometry, showing quantization of the volume for the Riemannian manifold entering the geometry, can support a view of quantum mechanics as arising by a stochastic process on it. A class of stochastic processes can be devised, arising as fractional powers of an ordinary Wiener process, that reproduce in a proper way a stochastic process on a noncommutative geometry. These processes are characterized by producing complex values and so, the corresponding Fokker-Planck equation resembles the Schroedinger equation. Indeed, by a direct numerical check, one can recover the kernel of the Schroedinger equation starting by an ordinary Brownian motion. This class of stochastic processes needs a Clifford algebra to exist. In four dimensions, the full set of Dirac matrices is needed and the corresponding stochastic process in a noncommutative geometry is easily recovered as is the Dirac equation in the Klein-Gordon form being it the Fokker--Planck equation of the process.Comment: 16 pages, 2 figures. Updated a reference. A version of this paper will appear in the proceedings of GSI2017, Geometric Science of Information, November 7th to 9th, Paris (France