Factors affecting “decision to delivery interval” in emergency caesarean sections in a tertiary care hospital: a cross sectional observational study

Background: The objective was to assess the waiting time and factors affecting the decision to delivery interval in an emergency caesarean section and to correlate it with neonatal and maternal outcomes.Methods: This study was conducted in the Department of Obstetrics & Gynaecology at UCMS and GTB Hospital, Delhi which is a government supported tertiary care hospital located in East Delhi. Data of 275 emergency caesarean sections was collected and analyzed for decision to delivery interval (DDI) along with the causes of delay and maternal and fetal outcomes.Results: The mean DDI was 183.24 minutes for all 275 cases and was 122 ± 89min for category I caesarean sections (crash caesareans). The major cause of delay was non availability of operation theatres due to long list of waiting caesareans sections. When the mean DDI exceeded 75 minutes, there was a 4.6 fold increase in the risk to the life of neonate while the maternal outcome was not significantly affected.Conclusion: DDI of 30 minutes is difficult to achieve even for urgent caesarean sections in government based set up of a developing nation, therefore a more reasonable time frame of 60-75 min may be justified for emergency caesarean sections under similar set up

Role of blood and blood components transfusion in obstetric emergencies

Background: Common obstetric emergencies require blood and blood components transfusion. The use of blood and its components has become a lifesaving strategy in management of obstetric haemorrhage. This study was aimed to know the prevalence, indications and adverse reactions of blood and its components transfusion.Methods: A review of 405 patients of obstetric emergencies requiring blood and its component transfusion was done.Results: Prevalence of blood and blood components transfusion in obstetric emergencies in one-year period was 18.4%. Mostly women who received blood transfusions were multiparous (50.12%) and belonged to rural areas (62%). Anemia is a risk factor for obstetric emergencies and the mean pre transfusion hemoglobin ±SD was 8.04±1.38 (g/dl). Obstetric hemorrhage (68.6%) was the most common indication for transfusion and packed red cells were most commonly (54.07%) transfused. The overall percentage of adverse reactions seen during transfusion was 1.95%.Conclusions: The present study reinforces the importance of appropriate use of blood and its components in obstetric emergencies. Appropriate use of blood components avoids many of the hazards associated with use of whole blood. All blood components should be made available at peripheral hospitals as most of the patients require specific blood component and they are referred to tertiary care centre in emergencies which can be avoided

Clinical and pathological correlation in benign breast diseases in women

Background: Benign breast diseases are a common problem presenting in a day to day surgical practice. A combination of three tests i.e. clinical examination, radiological imaging and pathological examination is commonly used to accurately diagnose breast diseases. This study was aimed to know the clinico-pathological correlation in diagnosing benign breast diseases in women.Methods: A study of 30 female patients of benign breast disease was conducted by clinical examination and comparing its accuracy with the pathological findings.Results: The highest incidence of benign breast diseases was in the age group of 30-39 years (33.3%). The most common presenting symptom was lump (53.3%) in the breast. The most common quadrant involved was the upper outer quadrant (60%). Fibroadenoma (53.3%) was the most common lesion in this study. The clinical examination in cases of fibroadenoma had sensitivity and specificity of 87.5 % and 92.8% respectively. In cases of fibrocystic disease, clinical examination had sensitivity and specificity of 85.7 % and 91.3% respectively.Conclusions: Overall clinical breast examination had a sensitivity of 90% and specificity of 98% in this study. Hence, combination of all three diagnostic modalities i.e. clinical, radiological and pathological examination should be used. But in rural areas where radiological and pathological facilities are not available, clinical examination can also give us a fair amount of idea in diagnosing benign breast diseases

Creative thought: An investigation of conceptual structures and processes

This is an edited collection.American Psychological Associatio

Divergence and overlap in bilingual concept representations

A research study of conceptual representation in bilinguals.Chinese-English bilingual participants listed exemplars of 10 common categories on two occasions, one week apart. Half responded in the same language in both sessions (Chinese or English) and half responded in one language in one session and the other language in the other session. There was substantial overlap in the exemplars listed across the sessions, but those responding in different languages showed less overlap than those responding in the same language. The results indicate differences in graded structure of the categories across the participants’ languages; the exemplars associated with translation equivalent category labels in bilinguals’ two languages differ in how representative they are of the category

Local Void vs Dark Energy: Confrontation with WMAP and Type Ia Supernovae

It is now a known fact that if we happen to be living in the middle of a large underdense region, then we will observe an "apparent acceleration", even when any form of dark energy is absent. In this paper, we present a "Minimal Void" scenario, i.e. a "void" with minimal underdensity contrast (of about -0.4) and radius (~ 200-250 Mpc/h) that can, not only explain the supernovae data, but also be consistent with the 3-yr WMAP data. We also discuss consistency of our model with various other measurements such as Big Bang Nucleosynthesis, Baryon Acoustic Oscillations and local measurements of the Hubble parameter, and also point out possible observable signatures.Comment: Minor numerical errors and typos corrected, references adde

"Swiss-Cheese" Inhomogeneous Cosmology & the Dark Energy Problem

We study an exact swiss-cheese model of the Universe, where inhomogeneous LTB patches are embedded in a flat FLRW background, in order to see how observations of distant sources are affected. We find negligible integrated effect, suppressed by (L/R_{H})^3 (where L is the size of one patch, and R_{H} is the Hubble radius), both perturbatively and non-perturbatively. We disentangle this effect from the Doppler term (which is much larger and has been used recently \cite{BMN} to try to fit the SN curve without dark energy) by making contact with cosmological perturbation theory.Comment: 35 pages, 6 figure

Left gaze bias in humans, rhesus monkeys and domestic dogs

While viewing faces, human adults often demonstrate a natural gaze bias towards the left visual field, that is, the right side of the viewee’s face is often inspected first and for longer periods. Using a preferential looking paradigm, we demonstrate that this bias is neither uniquely human nor limited to primates, and provide evidence to help elucidate its biological function within a broader social cognitive framework. We observed that 6-month-old infants showed a wider tendency for left gaze preference towards objects and faces of different species and orientation, while in adults the bias appears only towards upright human faces. Rhesus monkeys showed a left gaze bias towards upright human and monkey faces, but not towards inverted faces. Domestic dogs, however, only demonstrated a left gaze bias towards human faces, but not towards monkey or dog faces, nor to inanimate object images. Our findings suggest that face- and species-sensitive gaze asymmetry is more widespread in the animal kingdom than previously recognised, is not constrained by attentional or scanning bias, and could be shaped by experience to develop adaptive behavioural significance

A Survey of Volunteered Open Geo-Knowledge Bases in the Semantic Web

Over the past decade, rapid advances in web technologies, coupled with innovative models of spatial data collection and consumption, have generated a robust growth in geo-referenced information, resulting in spatial information overload. Increasing 'geographic intelligence' in traditional text-based information retrieval has become a prominent approach to respond to this issue and to fulfill users' spatial information needs. Numerous efforts in the Semantic Geospatial Web, Volunteered Geographic Information (VGI), and the Linking Open Data initiative have converged in a constellation of open knowledge bases, freely available online. In this article, we survey these open knowledge bases, focusing on their geospatial dimension. Particular attention is devoted to the crucial issue of the quality of geo-knowledge bases, as well as of crowdsourced data. A new knowledge base, the OpenStreetMap Semantic Network, is outlined as our contribution to this area. Research directions in information integration and Geographic Information Retrieval (GIR) are then reviewed, with a critical discussion of their current limitations and future prospects