Placenta Percreta; A Report On Surviving Death From The Bleeding Disaster!

A 34 year old G6P5 diagnosed with placenta previa percreta (fig 1) in her 2nd trimester was reviewed by a multidisciplinary team. Baby delivery was planned at 34 weeks gestation by cesarean hysterectomy(CH) immediately preceded by bilateral ureteral stents for anticipated surgical complexity. Patient received combined spinal and epidural (not activated) for the ureteric stenting with an aim to use the epidural for post-operative analgesia followed by general anesthesia and establishment of invasive lines and monitoring prior to start of CH. Soon after baby delivery, patient became hypotensive from severe hemorrhage. Massive transfusion protocol was instituted. After completion of hysterectomy, patient continued to bleed from multiple intraabdominal sites. While surgical hemostasis remained a challenge, patient developed PEA arrest. CPR was started with return of spontaneous circulation (ROSC) after chest compression for 2 minutes and 1mg of epinephrine. Following this, abdomen was packed with a decision to close secondarily after interventional radiology (IR) assisted intervention if necessary and hemodynamic stabilization. Intraoperatively, patient received a total of 29pRBCs, 22FFP, 4platelet & 3Cryo units with 21 L of crystalloids, 3.25 L of 5% albumin and 1.8L of cell saver with an estimated blood loss of 25L. Tranexamic acid and prothrombin complex concentrate was given. Thromboelastogram (TEG) and lab based coagulation profile was used intraoperatively to guide blood component transfusion. Serial blood gas analyses guided volume and electrolyte correction. In the ICU patient improved with no neurological insult or DIC. On postop day 1 IR found no active extravasations and surgical abdominal closure was performed. Epidural catheter was used for postoperative pain control and was removed on day 4. Patient was discharged on postop day 10.https://scholarlycommons.henryford.com/merf2020caserpt/1124/thumbnail.jp

Placenta Percreta: A Report On Surviving Death From The Bleeding Disaster!

https://scholarlycommons.henryford.com/merf2020caserpt/1001/thumbnail.jp

The influence of historical climate changes on Southern Ocean marine predator populations:A comparative analysis

The Southern Ocean ecosystem is undergoing rapid physical and biological changes that are likely to have profound implications for higher-order predators. Here, we compare the long-term, historical responses of Southern Ocean predators to climate change. We examine palaeoecological evidence for changes in the abundance and distribution of seabirds and marine mammals, and place these into context with palaeoclimate records in order to identify key environmental drivers associated with population changes. Our synthesis revealed two key factors underlying Southern Ocean predator population changes; (i) the availability of ice-free ground for breeding and (ii) access to productive foraging grounds. The processes of glaciation and sea ice fluctuation were key; the distributions and abundances of elephant seals, snow petrels, gentoo, chinstrap and Adélie penguins all responded strongly to the emergence of new breeding habitat coincident with deglaciation and reductions in sea ice. Access to productive foraging grounds was another limiting factor, with snow petrels, king and emperor penguins all affected by reduced prey availability in the past. Several species were isolated in glacial refugia and there is evidence that refuge populations were supported by polynyas. While the underlying drivers of population change were similar across most Southern Ocean predators, the individual responses of species to environmental change varied because of species specific factors such as dispersal ability and environmental sensitivity. Such interspecific differences are likely to affect the future climate change responses of Southern Ocean marine predators and should be considered in conservation plans. Comparative palaeoecological studies are a valuable source of long-term data on species' responses to environmental change that can provide important insights into future climate change responses. This synthesis highlights the importance of protecting productive foraging grounds proximate to breeding locations, as well as the potential role of polynyas as future Southern Ocean refugia.</p

“A Supernova that Sparks in Every Direction”: A Long-Term Assessment of the Research Sprints Faculty Engagement Program

Article will be published in College & Research Libraries in March 2024. This is the accepted version of the manuscript prior to copyediting.PREPRINT: Article to be published in College & Research Libraries in March 2024. This is the accepted version of the manuscript prior to copyediting. The Research Sprints program offers faculty partners the opportunity to collaborate intensively and exclusively for one week with a team of librarians to achieve significant progress on research or teaching projects. This longitudinal study extends previous immediate and short-term assessments by interviewing Research Sprints participants at two research-intensive institutions 2-4 years after their concentrated week. The authors evaluate the enduring impact of the program on the participants’ projects, research/teaching practices, and relationships with the library. Participants report achieving project goals, improved skills and student success, and greater awareness and appreciation of librarians’ work

Clinical evaluation of magnetic resonance imaging in coronary heart disease: The CE-MARC study

<p>Abstract</p> <p>Background</p> <p>Several investigations are currently available to establish the diagnosis of coronary heart disease (CHD). Of these, cardiovascular magnetic resonance (CMR) offers the greatest information from a single test, allowing the assessment of myocardial function, perfusion, viability and coronary artery anatomy. However, data from large scale studies that prospectively evaluate the diagnostic accuracy of multi-parametric CMR for the detection of CHD in unselected populations are lacking, and there are few data on the performance of CMR compared with current diagnostic tests, its prognostic value and cost-effectiveness.</p> <p>Methods/design</p> <p>This is a prospective diagnostic accuracy cohort study of 750 patients referred to a cardiologist with suspected CHD. Exercise tolerance testing (ETT) will be preformed if patients are physically able. Recruited patients will then undergo CMR and single photon emission tomography (SPECT) followed in all patients by invasive X-ray coronary angiography. The order of the CMR and SPECT tests will be randomised. The CMR study will comprise rest and adenosine stress perfusion, cine imaging, late gadolinium enhancement and whole-heart MR coronary angiography. SPECT will use a gated stress/rest protocol. The primary objective of the study is to determine the diagnostic accuracy of CMR in detecting significant coronary stenosis, as defined by X-ray coronary angiography. Secondary objectives include an assessment of the prognostic value of CMR imaging, a comparison of its diagnostic accuracy against SPECT and ETT, and an assessment of cost-effectiveness.</p> <p>Discussion</p> <p>The CE-MARC study is a prospective, diagnostic accuracy cohort study of 750 patients assessing the performance of a multi-parametric CMR study in detecting CHD using invasive X-ray coronary angiography as the reference standard and comparing it with ETT and SPECT.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN77246133</p

The challenges of detecting subtle population structure and its importance for the conservation of emperor penguins

Understanding the boundaries of breeding populations is of great importance for conservation efforts and estimates of extinction risk for threatened species. However, determining these boundaries can be difficult when population structure is subtle. Emperor penguins are highly reliant on sea ice, and some populations may be in jeopardy as climate change alters sea-ice extent and quality. An understanding of emperor penguin population structure is therefore urgently needed. Two previous studies have differed in their conclusions, particularly whether the Ross Sea, a major stronghold for the species, is isolated or not. We assessed emperor penguin population structure using 4,596 genome-wide single nucleotide polymorphisms (SNPs), characterized in 110 individuals (10–16 per colony) from eight colonies around Antarctica. In contrast to a previous conclusion that emperor penguins are panmictic around the entire continent, we find that emperor penguins comprise at least four metapopulations, and that the Ross Sea is clearly a distinct metapopulation. Using larger sample sizes and a thorough assessment of the limitations of different analytical methods, we have shown that population structure within emperor penguins does exist and argue that its recognition is vital for the effective conservation of the species. We discuss the many difficulties that molecular ecologists and managers face in the detection and interpretation of subtle population structure using large SNP data sets, and argue that subtle structure should be taken into account when determining management strategies for threatened species, until accurate estimates of demographic connectivity among populations can be made.</p