The relationship of social support and quality of life with the level of stress in pregnant women using the PATH model

Background: Lack of adequate social support, stress, and generally poor quality of life during pregnancy leads to adverse pregnancy outcomes for both the mother and the baby. Objectives: This study aimed to investigate the relationship of social support and quality of life with level of stress during pregnancy. Materials and Methods: This was a descriptive-correlative study conducted on 210 pregnant women (meeting study criteria), attending Shahriar Social Services Hospital during 2012. Purposive convenient sampling was used. Study subjects completed questionnaires of obstetrics and demographics, VAUX social support, World Health Organization quality of life, and stress during pregnancy. Data were analyzed with SPSS-19 and Lisrel 8.8, utilizing statistical path analysis. Results: The final path model fitted well (CF1 = 1, RMSEA = 0.00) and showed that direct quality of life paths with β = -0.2, and indirect social support with β = -0.088 had the most effects on reduction of stress during pregnancy. Conclusion: Social support indirectly and quality of life directly affect stress during pregnancy. Thus, health officials should attempt to establish measures to further enhance social support and quality of life of pregnant women to reduce stress and its consequences during this time. © 2013, Iranian Red Crescent Medical Journal

A critical review on polydopamine surface-modified scaffolds in musculoskeletal regeneration

Increasing concern about age-related diseases, particularly musculoskeletal injuries and orthopedic conditions, highlights the need for strategies such as tissue engineering to address them. Surface modification has been developed to create pro-healing interfaces, personalize scaffolds and provide novel medicines. Polydopamine, a mussel-inspired adhesive polymer with highly reactive functional groups that adhere to nearly all substrates, has gained attention in surface modification strategies for biomaterials. Polydopamine was primarily developed to modify surfaces, but its effectiveness has opened up promising approaches for further applications in bioengineering as carriers and nanoparticles. This review focuses on the recent discoveries of the role of polydopamine as a surface coating material, with focus on the properties that make it suitable for tackling musculoskeletal disorders. We report the evolution of using it in research, and discuss papers involving the progress of this field. The current research on the role of polydopamine in bone, cartilage, muscle, nerve, and tendon regeneration is discussed, thus giving comprehensive overview about the function of polydopamine both in-vitro and in-vivo. Finally, the report concludes presenting the critical challenges that must be addressed for the clinical translation of this biomaterial while exploring future perspectives and research opportunities in this area

Fluid-structure interaction simulation of prosthetic aortic valves : comparison between immersed boundary and arbitrary Lagrangian-Eulerian techniques for the mesh representation

In recent years the role of FSI (fluid-structure interaction) simulations in the analysis of the fluid-mechanics of heart valves is becoming more and more important, being able to capture the interaction between the blood and both the surrounding biological tissues and the valve itself. When setting up an FSI simulation, several choices have to be made to select the most suitable approach for the case of interest: in particular, to simulate flexible leaflet cardiac valves, the type of discretization of the fluid domain is crucial, which can be described with an ALE (Arbitrary Lagrangian-Eulerian) or an Eulerian formulation. The majority of the reported 3D heart valve FSI simulations are performed with the Eulerian formulation, allowing for large deformations of the domains without compromising the quality of the fluid grid. Nevertheless, it is known that the ALE-FSI approach guarantees more accurate results at the interface between the solid and the fluid. The goal of this paper is to describe the same aortic valve model in the two cases, comparing the performances of an ALE-based FSI solution and an Eulerian-based FSI approach. After a first simplified 2D case, the aortic geometry was considered in a full 3D set-up. The model was kept as similar as possible in the two settings, to better compare the simulations' outcomes. Although for the 2D case the differences were unsubstantial, in our experience the performance of a full 3D ALE-FSI simulation was significantly limited by the technical problems and requirements inherent to the ALE formulation, mainly related to the mesh motion and deformation of the fluid domain. As a secondary outcome of this work, it is important to point out that the choice of the solver also influenced the reliability of the final results

Interlaminar Fracture Toughness Evaluation in Glass/Epoxy Composites Using Acoustic Emission and Finite Element Methods

© 2014, ASM International. Delamination is one of the most common modes of failure in laminated composites and it leads to the loss of structural strength and stiffness. In this paper, mode I, mode II, and mixed of these pure modes were investigated using mechanical data, Finite Element Method (FEM) and Acoustic Emission (AE) signals. Experimental data were obtained from insitu monitoring of glass/epoxy laminated composites with different lay-ups when subjected to different modes of failure. The main objective was to investigate the behavior of delamination propagation and to evaluate the critical value of the strain energy which is required for onset of the delamination (GC). For the identification of interlaminar fracture toughness of the specimens, four methods were used: (a) ASTM standard methods, (b) FEM analysis, (c) AE method, and (d) sentry function method which is a function of mechanical and AE behaviors of the specimens. The results showed that the GC values obtained by the sentry function method and FEM analysis were in a close agreement with the results of nonlinearity methods which is recommended in the ASTM standards. It was also found that the specimens under different loading conditions and various lay-up have different GC values. These differences are related to different stress components distribution in the specimens which induce various damage mechanisms. Accordingly, stress components distribution obtained from FEM analyses were in agreement with SEM observations of the damaged surfaces of the specimens

The Northern Route for Human dispersal in Central and Northeast Asia: New evidence from the site of Tolbor-16, Mongolia.

The fossil record suggests that at least two major human dispersals occurred across the Eurasian steppe during the Late Pleistocene. Neanderthals and Modern Humans moved eastward into Central Asia, a region intermittently occupied by the enigmatic Denisovans. Genetic data indicates that the Denisovans interbred with Neanderthals near the Altai Mountains (South Siberia) but where and when they met H. sapiens is yet to be determined. Here we present archaeological evidence that document the timing and environmental context of a third long-distance population movement in Central Asia, during a temperate climatic event around 45,000 years ago. The early occurrence of the Initial Upper Palaeolithic, a techno-complex whose sudden appearance coincides with the first occurrence of H. sapiens in the Eurasian steppes, establishes an essential archaeological link between the Siberian Altai and Northwestern China . Such connection between regions provides empirical ground to discuss contacts between local and exogenous populations in Central and Northeast Asia during the Late Pleistocene

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery:a systematic review and meta-analysis

Background - Postcardiotomy cardiogenic shock (PCCS) refractory to inotropic support and intra-aortic balloon pump (IABP) occurs rarely but is almost universally fatal without mechanical circulatory support. In this systematic review and meta-analysis we looked at the evidence behind the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in refractory PCCS from a patient survival rate and determinants of outcome viewpoint. Methods - A systematic review was performed in January 2017 using PubMed (with no defined time period) using the keywords “postcardiotomy”, “cardiogenic shock”, “extracorporeal membrane oxygenation” and “cardiac surgery”. We excluded papers pertaining to ECMO following paediatric cardiac surgery, medical causes of cardiogenic shock, as well as case reports, review articles, expert opinions, and letters to the editor. Once the studies were collated, a meta-analysis was performed on the proportion of survivors in those papers that met the inclusion criteria. Meta-regression was performed for the most commonly reported adverse prognostic indicators (API). Results - We identified 24 studies and a cumulative pool of 1926 patients from 1992 to 2016. We tabulated the demographic data, including the strengths and weaknesses for each of the studies, outcomes of VA ECMO for refractory PCCS, complications, and APIs. All the studies were retrospective cohort studies. Meta-analysis of the moderately heterogeneous data (95% CI 0.29 to 0.34, p 70 years, 95% CI −0.057 to 0.001, P = 0.058), and long ECMO support (95% CI −0.068 to 0.166, P = 0.412). Postoperative renal failure, high EuroSCORE (>20%), diabetes mellitus, obesity, rising lactate whilst on ECMO, gastrointestinal complications had also been reported. Conclusion - Haemodynamic support with VA ECMO provides a survival benefit with reasonable intermediate and long-term outcomes. Many studies had reported advanced age, renal failure and prolonged VA ECMO support as the most likely APIs for VA ECMO in PCCS. EuroSCORE can be utilized to anticipate the need for prophylactic perioperative VA ECMO in the high-risk category. APIs can be used to aid decision-making regarding both the institution and weaning of ECMO for refractory PCCS

Epidural anesthesia and postoperative analgesia with ropivacaine and fentanyl in off-pump coronary artery bypass grafting: a randomized, controlled study

<p>Abstract</p> <p>Background</p> <p>Our aim was to assess the efficacy of thoracic epidural anesthesia (EA) followed by postoperative epidural infusion (EI) and patient-controlled epidural analgesia (PCEA) with ropivacaine/fentanyl in off-pump coronary artery bypass grafting (OPCAB).</p> <p>Methods</p> <p>In a prospective study, 93 patients were scheduled for OPCAB under propofol/fentanyl anesthesia and randomized to three postoperative analgesia regimens aiming at a visual analog scale (VAS) score < 30 mm at rest. The control group (n = 31) received intravenous fentanyl 10 μg/ml postoperatively 3-8 mL/h. After placement of an epidural catheter at the level of Th₂-Th₄before OPCAB, a thoracic EI group (n = 31) received EA intraoperatively with ropivacaine 0.75% 1 mg/kg and fentanyl 1 μg/kg followed by continuous EI of ropivacaine 0.2% 3-8 mL/h and fentanyl 2 μg/mL postoperatively. The PCEA group (n = 31), in addition to EA and EI, received PCEA (ropivacaine/fentanyl bolus 1 mL, lock-out interval 12 min) postoperatively. Hemodynamics and blood gases were measured throughout 24 h after OPCAB.</p> <p>Results</p> <p>During OPCAB, EA decreased arterial pressure transiently, counteracted changes in global ejection fraction and accumulation of extravascular lung water, and reduced the consumption of propofol by 15%, fentanyl by 50% and nitroglycerin by a 7-fold, but increased the requirements in colloids and vasopressors by 2- and 3-fold, respectively (<it>P </it>< 0.05). After OPCAB, PCEA increased PaO₂/FiO₂at 18 h and decreased the duration of mechanical ventilation by 32% compared with the control group (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>In OPCAB, EA with ropivacaine/fentanyl decreases arterial pressure transiently, optimizes myocardial performance and influences the perioperative fluid and vasoactive therapy. Postoperative EI combined with PCEA improves lung function and reduces time to extubation.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01384175">NCT01384175</a></p

Failure Mechanisms and Local Scour at Coastal Structures induced by Tsunamis

On March 11 2011, an exceptionally large tsunami event was triggered by a massive earthquake offshore, the northeast coast of Japan, which affected coastal infrastructure such as seawalls, coastal dikes and breakwaters in the Tohoku region. Such infrastructure was built to protect against the Level 1 tsunamis that previously hit the region, but not for events as significant as the 2011 Tohoku tsunami, which was categorized as a Level 2 tsunami [Shibayama et al. 2013]. The failure mechanisms of concrete-armoured dikes, breakwaters and seawalls due to Level 2 tsunamis are still not fully understood by researchers and engineers. This paper investigates the failure modes and mechanisms of damaged coastal structures in Miyagi and Fukushima Prefectures, following the authors' post-disaster field surveys carried out between 2011 and 2013. Six significant failure mechanisms were identified for the coastal dikes and seawalls affected by this tsunami: 1) Leeward toe scour failure, 2) Crown armour failure, 3) Leeward slope armour failure, 4) Seaward toe and armour failure, 5) Overturning failure, and 6) Parapet wall failure, in which leeward toe scour being recognized as the major failure mechanism in most surveyed locations. The authors also propose a simple practical mathematical model for predicting the scour depth at the leeward toe of the coastal dikes, by considering the effects of the tsunami hydrodynamics, the soil properties and the type of structure. The key advantage of this model is that it depends entirely on quantities that are measurable in the field. Furthermore this model was further refined by conducting a series of hydraulic model experiments aimed to understand the governing factors of the leeward toe scour failure. Finally, based on the results obtained, key recommendations are given for the design of resilient coastal defence structures that can survive a level 2 tsunami event