Lung Rest During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure-Practice Variations and Outcomes.

OBJECTIVE: Describe practice variations in ventilator strategies used for lung rest during extracorporeal membrane oxygenation for respiratory failure in neonates, and assess the potential impact of various lung rest strategies on the duration of extracorporeal membrane oxygenation and the duration of mechanical ventilation after decannulation. DATA SOURCES: Retrospective cohort analysis from the Extracorporeal Life Support Organization registry database during the years 2008-2013. STUDY SELECTION: All extracorporeal membrane oxygenation runs for infants less than or equal to 30 days of life for pulmonary reasons were included. DATA EXTRACTION: Ventilator type and ventilator settings used for lung rest at 24 hours after extracorporeal membrane oxygenation initiation were obtained. DATA SYNTHESIS: A total of 3,040 cases met inclusion criteria. Conventional mechanical ventilation was used for lung rest in 88% of cases and high frequency ventilation was used in 12%. In the conventional mechanical ventilation group, 32% used positive end-expiratory pressure strategy of 4-6 cm H2O (low), 22% used 7-9 cm H2O (mid), and 43% used 10-12 cm H2O (high). High frequency ventilation was associated with an increased mean (SEM) hours of extracorporeal membrane oxygenation (150.2 [0.05] vs 125 [0.02]; p \u3c 0.001) and an increased mean (SEM) hours of mechanical ventilation after decannulation (135 [0.09] vs 100.2 [0.03]; p = 0.002), compared with conventional mechanical ventilation among survivors. Within the conventional mechanical ventilation group, use of higher positive end-expiratory pressure was associated with a decreased mean (SEM) hours of extracorporeal membrane oxygenation (high vs low: 136 [1.06] vs 156 [1.06], p = 0.001; mid vs low: 141 [1.06] vs 156 [1.06]; p = 0.04) but increased duration of mechanical ventilation after decannulation in the high positive end-expiratory pressure group compared with low positive end-expiratory pressure (p = 0.04) among survivors. CONCLUSIONS: Wide practice variation exists with regard to ventilator settings used for lung rest during neonatal respiratory extracorporeal membrane oxygenation. Use of high frequency ventilation when compared with conventional mechanical ventilation and use of low positive end-expiratory pressure strategy when compared with mid positive end-expiratory pressure and high positive end-expiratory pressure strategy is associated with longer duration of extracorporeal membrane oxygenation. Further research to provide evidence to drive optimization of pulmonary management during neonatal respiratory extracorporeal membrane oxygenation is warranted

Donor demographic and laboratory predictors of single donor platelet yield

Background: Platelet transfusions are essential to prevent morbidity and mortality in patients who are severely thrombocytopenic and are at risk of spontaneous bleeding. Platelets are currently obtained either by fractionation of whole blood or by platelet apheresis. The quality of single donor platelets (SDP) in terms of yield influences platelet recovery in the recipient and allows prolonging intervals between transfusions. Material and Methods: Donor demographic and laboratory data were analyzed prior to performing plateletpheresis to identify donor factors that influence platelet yield. The study was conducted on 130 healthy, first-time plateletpheresis donors over a period of 4 years. The plateletpheresis procedures were performed using Fresenius Kabi COM.TEC and Hemonetics MCS plus separator. A relationship between pre-donation donor variables and yield of platelets was studied using the Pearson correlation. Results: The mean platelet yield was 3.160.62x1011 per unit. A positive correlation was observed between platelet yield and pre-donation platelet count, body mass index (BMI; Kg/m2) of the donor, while a negative correlation was observed between age and the platelet yield. Conclusion: Donor pre-donation platelet count, BMI and donor age influence platelet yield. Young healthy donors with a high platelet count and better BMI can give a better platelet yield in the SDP

Impact of Self Help Groups in Gender Mainstreaming: A Case Study on Fish Amino Enterprise in Vypin, Kerala

A study for assessing the impact of SHGs in gender mainstreaming was undertaken on the fish amino acid producing units operating at Vypin located at Ernakulam District of Kerala. The analysis included specific aspects such as performance assessment of the SHGs, gender analysis, empowerment analysis and economic feasibility analysis which were carried out based on socio-economic surveys and personal interviews using pre-tested and structured data gathering protocols with standardized scales and indices involving the members of the SHGs. The male and female counterparts of the families were separately interviewed to assess the gender mainstreaming aspects in terms of equity and equality to access to resources, participation profile, decision making aspects, gender need analysis etc. Though majority of activities are female dominated, the male counterparts of the households also have definite role in decision making, purchase of accessories, sales, marketing etc. The indicative economics worked out for the economic feasibility analysis of the SHGs suggests that, the unit takes just one year to break even. A success case study was elucidated and documented as a documentary movie which can be used as a case model for promoting group action for mobilizing SHGs on a sustainable basis

Gender Mainstreaming and Impact of Self-Help Groups: A Study on Social Entrepreneurship through Fish Aggregating Devices in Mannancheri of Alappuzha, Kerala

A research study for assessing the impact of fisher folk Self Help Groups in gender mainstreaming was undertaken on social entrepreneurship venture on fish aggregating devices at Mannancheri gramapanchayath, located at Alappuzha district of Kerala. The analysis included specific aspects such as performance assessment of the SHGs, gender analysis and empowerment analysis which were carried out based on socio-economic surveys and personal interviews using pre-tested and structured data gathering protocols with standardized scales and indices involving the members of the SHGs. The male and female counterparts of the families were separately interviewed to assess the gender mainstreaming aspects in terms of equity and equality to access to resources, participation profile, decision making aspects, gender need analysis etc. Though majority of activities are male dominated, the female counterparts of the households also have definite role in decision making, purchase of accessories etc. A success case study was elucidated and documented as a documentary which can be used as a case model for promoting group action for mobilizing SHGs on a sustainable basis

Using post-measurement information in state discrimination

We consider a special form of state discrimination in which after the measurement we are given additional information that may help us identify the state. This task plays a central role in the analysis of quantum cryptographic protocols in the noisy-storage model, where the identity of the state corresponds to a certain bit string, and the additional information is typically a choice of encoding that is initially unknown to the cheating party. We first provide simple optimality conditions for measurements for any such problem, and show upper and lower bounds on the success probability. For a certain class of problems, we furthermore provide tight bounds on how useful post-measurement information can be. In particular, we show that for this class finding the optimal measurement for the task of state discrimination with post-measurement information does in fact reduce to solving a different problem of state discrimination without such information. However, we show that for the corresponding classical state discrimination problems with post-measurement information such a reduction is impossible, by relating the success probability to the violation of Bell inequalities. This suggests the usefulness of post-measurement information as another feature that distinguishes the classical from a quantum world.Comment: 10 pages, 4 figures, revtex, v2: published version, minor change