Smoking and ethnic group, not epidural use, determine breast feeding outcome

No abstract available

The introduction of a surgical safety checklist in a tertiary referral obstetric centre

Background: Surgery-related adverse events remain a significant and often under-reported problem. In a recent study, the introduction of a perioperative checklist by the WHO reduced deaths and complications by 46% and 36% respectively. The authors wished to evaluate the introduction of a surgical safety checklist in a busy obstetric tertiary referral centre by assessing staff attitudes, checklist compliance and effects upon patients. Methods: A questionnaire-based assessment was performed on staff working in obstetric theatres before and after the introduction of the surgical safety checklist. Checklist compliance was assessed at 3 months and 1 year. Patients were asked questions relating to the performance of the surgical safety checklist in order to evaluate any anxiety caused. Results: Non-medical staff were significantly more likely than medical staff to feel familiar with other team members both before (p<0.001) and after (

Randomized crossover comparison between the i-gel and the LMA-Unique in anaesthetized, paralysed adults

<b>Background</b>: The i-gel differs from other supraglottic airway devices, in that it has a softer, non-inflatable cuff. This study was designed to compare the performance of the i-gel and the LMA-Unique (LMA-U) when used during anaesthesia in paralysed patients. <b>Methods</b>: Both devices were studied in 39 anaesthetized, paralysed patients in a randomized crossover trial. The primary outcome was airway leak pressure. Secondary outcomes included time to insertion, the number of insertion and reposition attempts, leak volumes, and leak fractions. <b>Results</b>: There was no significant difference between the airway leak pressures of the two devices [median (IQR) leak pressures 25 (22–30) vs 22 (20–28) cm H2O for the i-gel and LMA-U, respectively; P=0.083, 95% CI of the mean difference –0.32 to 4.88 cm H2O]. The median (IQR) insertion time for the i-gel was significantly less than for the LMA-U [12.2 (9.7–14.3) vs 15.2 (13.2–17.3) s; P=0.007]. All the LMA-U devices and 38 of 39 i-gel airways were inserted at the first attempt. The number of manipulations required after insertion to achieve a clear airway was the same in both the groups (four in each). There were no statistically significant differences in leak volumes or leak fractions during controlled ventilation. <b>Conclusions</b>: We found no difference in leak pressures and success rate of first-time insertion between the i-gel and the LMA-U. Time to successful insertion was significantly shorter for the i-gel. We conclude that the i-gel provides a reasonable alternative to the LMA-U for controlled ventilation during anaesthesia

Bilateral Non-Syndromic Multiple Supernumerary Teeth- A Rare Case Report

Hyperdontia or supernumerary teeth is the development of an increased number of teeth, other than the normal dentition. Supernumerary teeth can be single or multiple, unilateral or bilateral. Supernumerary teeth are mostly associated with syndromes and their presence in a non-syndromic patient is not common. Early diagnosis and management should be done to reduce complications caused by this developmental anomaly

Smart integrated adaptive centralized controller for islanded microgrids under minimized load shedding

In this paper, a smart integrated adaptive centralized controller is proposed for monitoring and controlling integrated renewable energy sources (RESs), both for intentional and unintentional islanding modes of operation for microgrids, as well as, for a variable range of transient load shedding and fault scenarios corresponding to electrical power system outages. It is demonstrated that the proposed smart adaptive controller is capable of instructing fast frequency response by proper coordination of the dispatch of RESs units such as, mini-hydro, Photovoltaic (PV), Battery Energy Storage System (BESS) and standby diesel generators. In particular, the BESS used as power reserve, at the early stage of fault events can prevent detrimental and uncontrollable system frequency decline and the extent of load shedding. In summary, the performance of a centralized controller in terms of a fast frequency response recovery feature is validated for an actual microgrid distribution network of Malaysia. The demonstration of this intelligent control scheme highlights the advantage of utilizing the fast power recovery response of energy storage and standby generator, which fulfil the criteria for minimal load shedding from the main grid, during the unintentional microgrid islanding conditions

CMR2009: 5.04: Post-mortem analysis of gadolinium distribution in NSF subjects

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64915/1/323_ftp.pd

Can competition increase profits in factor investing?

The increasing number of institutions exploiting factor-investing strategies raises concerns that competition may erode profits. We use a game-theoretic model to show that, while competition among investors exploiting a particular factor erodes profits because of the negative externality of their price impact on each other, competition to exploit other factors can increase profits from the first factor because of the positive externality from trading diversification (netting of trades across factors). We calibrate our model using the investment and profitability factors and find that competition to exploit the profitability factor leads to a 68% increase in the capacity and a 143% increase in the profit from the investment factor. Supplemental Material: The online appendix and data files are available at [https://doi.org/10.1287/mnsc.2022.02684](https://doi.org/10.1287/mnsc.2022.02684

Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation

Background. The i-gel (Intersurgical Ltd) is a novel device that differs from other supraglottic airway devices in that it has a softer and a non-inflatable cuff. Our study was designed to assess whether the i-gel is suitable to provide pressure-controlled ventilation (PCV) during anaesthesia by measuring the gas leaks and comparing these values with that of the tracheal tube. Methods. Twenty-five patients, ASA I–II, were recruited to the study. Patients received a standard anaesthetic technique followed by an initial placement of the i-gel. The lungs were then ventilated at three different pressures (15, 20, 25 cm H2O) using PCV. The difference between the inspired and expired tidal volumes was used to calculate the leak volume. The leak fraction was defined as the leak volume divided by the inspired tidal volume. Following these observations, the i-gel was removed and replaced with the conventional tracheal tube and the recordings repeated. Results. There was no significant difference between the leak fractions of the i-gel and the tracheal tube at 15 and 20 cm H2O PCV. At 25 cm H2O, the median difference in leak fraction was 0.02 (P¼0.014) and the median difference in leak volume was 26.5 ml (P¼0.006). There was no evidence of gastric insufflations with any of the pressures used during PCV. Conclusions. We suggest that the i-gel can be used as a reasonable alternative to tracheal tube during PCV with moderate airway pressures. Br J Anaesth 2009; 102: 264–8 Keywords: equipment, airway; ventilation, mechanical Accepted for publication: November 4, 200