Analgesic efficacy of remifentanil patient-controlled analgesia versus combined spinal-epidural technique in multiparous women during labour

Objectives: To compare the analgesic profile of remifentanil patient-controlled analgesia (RPCA) and combined spinal-epidural analgesia technique (CSEA) in multiparous women during the entire labour. We hypothesized that CSEA would provide a better and more sustained pain reduction than RPCA.Material and methods: A prospective observational trial under ID NCT02963337 at a university hospital in Slovenia 2017–2018. Analgesic efficacy, satisfaction with pain-relief, adverse effects, labour progress, and outcomes between RPCA (80) and CSEA (81) were compared.Results: CSEA provided significantly lower pain scores during the entire labour. Compared to baseline, significant pain reduction was recorded in both groups after 15 min. No difference was recorded compared to baseline with RPCA and CSEA after 45 and 90 mins, respectively. CSEA provided higher satisfaction than RPCA (5 [5–5] vs 5 [4–5], p < 0.0001). More patients with CSEA opted for the same technique for the next labour [CSEA; 77 (95%) vs RPCA; 65 (81%), p = 0.003]. No crossovers were observed. RPCA was associated with desaturation (34%), bradypnea (21%) and apnoea (25%), which were transitional and easily managed. None had severe sedation. No differences were recorded in labour progress and outcomes. Apgar scores were reassuring in all neonates (> 8). None had umbilical artery pH < 7.0.Conclusions: In multiparas, CSEA provided superior analgesia and satisfaction than RPCA. Nevertheless, RPCA provided a satisfactory experience, suggesting it could be used when neuraxial analgesia is not available, preferred, or contraindicated. In that case, constant presence of midwife is mandatory for management of clinically significant hypoventilation

Direct Introduction of a Dimesitylboryl Group Using Base-Mediated Substitution of Aryl Halides with Silyldimesitylborane

The first dimesitylboryl substitution of aryl halides with a silylborane bearing a dimesitylboryl group in the presence of alkali-metal alkoxides is described. The reactions of aryl bromides or iodides with Ph2MeSi-BMes(2) and Na(OtBu) afforded the desired aryl dimesitylboranes in good to high yields and with high borylation/silylation ratios. Selective reaction of the sterically less-hindered C-Br bond of dibromoarenes provided monoborylated products. This reaction was used to rapidly construct a D-pi-A aryl dimesityl borane with a non-symmetrical biphenyl spacer

Validation of SPARCC MRI-RETIC e-tools for increasing scoring proficiency of MRI sacroiliac joint lesions in axial spondyloarthritis

BACKGROUND The Spondyloarthritis Research Consortium of Canada (SPARCC) developers have created web-based calibration modules for the SPARCC MRI sacroiliac joint (SIJ) scoring methods. We aimed to test the impact of applying these e-modules on the feasibility and reliability of these methods. METHODS The SPARCC-SIJ $_{RETIC}$ e-modules contain cases with baseline and follow-up scans and an online scoring interface. Visual real-time feedback regarding concordance/discordance of scoring with expert readers is provided by a colour-coding scheme. Reliability is assessed in real time by intraclass correlation coefficient (ICC), cases being scored until ICC targets are attained. Participating readers (n=17) from the EuroSpA Imaging project were randomised to one of two reader calibration strategies that each comprised three stages. Baseline and follow-up scans from 25 cases were scored after each stage was completed. Reliability was compared with a SPARCC developer, and the System Usability Scale (SUS) assessed feasibility. RESULTS The reliability of readers for scoring bone marrow oedema was high after the first stage of calibration, and only minor improvement was noted following the use of the inflammation module. Greater enhancement of reader reliability was evident after the use of the structural module and was most consistently evident for the scoring of erosion (ICC status/change: stage 1 (0.42/0.20) to stage 3 (0.50/0.38)) and backfill (ICC status/change: stage 1 (0.51/0.19) to stage 3 (0.69/0.41)). The feasibility of both e-modules was evident by high SUS scores. CONCLUSION The SPARCC-SIJ $_{RETIC}$ e-modules are feasible, effective knowledge transfer tools, and their use is recommended before using the SPARCC methods for clinical research and tria

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

EDI- Electronic Data Interchange- ur ett säkerhetsmässigt perspektiv och en juridisk synvinkel

Syftet med detta arbete är att försöka utforska vilka säkerhetsaspekter som bör användas vid EDI. Finns det idag teknisk och juridisk säkerhet, för att två näringsidkare kan använda sig av EDI på ett tillfredsställande sätt? Jag skall även försöka att förklara hur EDI är uppbyggt och utforska vilka nackdelar samt fördelar det finns med detta förfarande. Mitt tillvägagångssätt har mestadels bestått av litteraturstudier. I uppsatsen har jag förklarat några speciellt utvalda säkerhetsmetoder som jag själv valt ut efter eget initiativ t ex Message Authentication Code och digitala signaturer. Uppsatsen behandlar även symmetriska och asymmetriska krypterings algoritmer som jag bedömer som grundläggande för att få ett tillförlitligt skydd vid elektroniska transaktioner. För att utforska huruvida det går att utföra EDI rent juridiskt har jag använt mig av relevant kurslitteratur, EDI-avtal 96 samt aktuella SOU:er och propositioner. EDI är utbytet av relevanta juridiska dokument mellan två eller flera handelsparters datorer på applikationsnivå. Med hjälp av EDI kan ett företag bl a effektivisera dokumenthanteringen, automatisera informationsflödet samt öka produktiviteten och flexibiliteten i företaget. Eftersom det inte finns några formkrav och avtal för viljeförklaringar är avtal och transaktioner som sluts elektroniskt accepterade juridiskt under förutsättning att inga juridiska problem uppkommer. Rent säkerhetsmässigt är digital signatur en av flera tekniker som finns för att underlätta EDI handeln mellan näringsidkare

An Adaptive Thresholding Algorithm for the Augmented Reality Toolkit

It is well known that fixed global thresholds have adverse effects on the reliability of marker-based optical trackers under non-uniform lighting conditions. Mobile Augmented Reality applications, by their very nature, demand a certain level of robustness against varying external illumination from visual tracking algorithms. Currently, ARToolKit depends on fixed-threshold image-binarization in order to detect candidate fiducials for further processing. In an effort to minimize tracking failure due to uniform shadows and reflections on a marker surface, we propose a fast algorithm for selecting adaptive threshold values, based on the arithmetic mean of pixel intensities over a regionof -interest around candidate fiducials

Effect of air-powder abrasion on titanium dental implant surface roughness and topography alterations: an in vitro study

OBJECTIVE: This in vitro study was conducted to analyze the effect of air-powder abrasion on implant surface roughness change. The main goal was to determine if it is possible to achieve (Ra) surface roughness of 0.2 m on titanium dental implant surface using different air-powder abrasive systems under pre-determent working distance, pressure, angle and time? Additionally, gaining values for average surface roughness (Sa) was the focus of interest as it represents the only parameter that could predict oral tissue response in peri-implant healing. MATERIALS AND METHODS: 30 Classic® titanium alloy (TiAl6V4) implants (Green Implant System Technologie GmbH & CO.KG, Berlin, Germany) were used for the purpose of this study. Air-Powder abrasion systems selected were AIRFLOW® Classic Handy 3.0, PROPHYFLEX 3® Handy and RONDOFLEX Plus 360® with corresponding powders. Working settings were selected according to the literature proving the efficacy of working condition in eliminating bacterial contamination from titanium surface. The surfaces of threads (valleys and peaks) were analysed with green-light optical interferometry (Sa, Ssk, Sds, Sds) and stylus analysis (Ra and Rsk). RESULTS: All of the powders used decreased the average surface roughness (Sa) on the peaks of the threads in comparison with the reference samples. Aluminium oxide powders were the only ones to modify the macrodesign of an implant. CONCLUSIONS: Surface decontamination using selected powders and systems, save for Aluminum oxide, under chosen working conditions does not adversely change surface roughness values optimal for osseointegration. Abrasion with Aluminium oxide as a possible alternative to standard procedure of implantoplasty should be further investigated.Medizinische Universität Wien, Masterarbeit, 2018(VLID)283779

Ut pictura tempus : le temps et la prophétie dans Les Tragiques

Les Tragiques de D’Aubigné apparaissent comme l’œuvre d’un auteur qui a atteint l’âge de la maturité, et avec lui la conscience que le temps est précieux et qu’il doit être consacré à Dieu. Exit donc le temps de l’éparpillement qui avait présidé à sa jeunesse, et qui n’était que temps perdu. C’est désormais l’éternité céleste qui seule doit compter : Dieu, qui est Vérité, est la fin vers laquelle doit tendre toute existence humaine. Et c’est désormais un poète-prophète qui prend la plume pour annoncer le jugement divin intemporel. Le temps est alors perçu comme une catégorie morale qui permet de juger les hommes à l’aune de leurs expériences passées (morales et immorales), définissant soit la récompense, soit les peines éternelles pour chacun d’entre eux. Dans l’Éternité en effet, le temps sera remplacé par la seule durée, qui sera ressentie comme la profusion infinie de l’Amour – ou comme l’essence même du châtiment infernal. Il revient au poète inspiré de transmettre la vérité divine aux hommes