Potential Perioperative Complications Due To Difference In Timing Of Systemic Heparinization During Ruptured Aneurysm Coiling

Potential Perioperative Complications Due To Differences in Timing Of Systemic Heparin Distribution During Ruptured Aneurysm Coiling Introduction: In general, systematic heparin anticoagulation is standard in regards to neurovascular intervention. When coiling ruptured aneurysms, many neurointerventionalists have their own protocol as to timing of systemic heparinization. There is ample research and literature reviewing the frequency of perioperative events, predictors and outcomes, as well as the efficacy in the use of anticoagulants and/or antiplatelets before, during, and after neurovascular procedures to prevent adverse outcomes. However, there currently exists a dearth of research in regards to timing of distribution of heparin intraoperatively and its potential effects on adverse patient outcomes. We performed this analysis to evaluate the effect on the frequency of perioperative complications in relation to when systemic heparin is given to patients intraoperatively, particularly if earlier administration increases bleeding diathesis and if later administration increases ischemic events. Methods: We used a single hospital retrospective study of patients with a primary diagnosis of subarachnoid hemorrhage due to ruptured aneurysm to assess the relationship between the timing of intraoperative systemic heparin distribution during coiling. Patients were subdivided into two groups: those who received heparin at the start of the procedure and those that received heparin after deployment of first coil. Outcomes of interest were perioperative re-rupture of aneurysm and/or stroke. Other factors analyzed were age, sex, Hunt and Hess Scale, modified Fisher Scale, and aneurysm size at presentation. Continuous variables were expressed as the mean with standard error of the mean (±SE). Categorical variables are expressed as percentages. Comparisons between groups were performed using ANOVA for continuous variables and either the Chi-squared test or the Fisher’s exact test for categorical parameters. P \u3c 0.05 was considered statistically significant. Results: We analyzed 246 patients with ruptured aneurysms undergoing endovascular coiling (mean age 57.70 ± 1.00). Perioperative complications were seen in a total of 17 patients (6.91%). In univariate analysis, patients who received systemic heparin at the beginning of the procedure vs. those who received it after placement of first coil did not have worse outcomes both in re-rupture of aneurysm (1.08% vs. 6.54%, p= 0.056) or perioperative stroke (2.15% vs. 2.61%, p= 1). In our analysis, timing of systemic heparin did not seem to influence the rate of intraoperative complications regardless of hemorrhagic vs, thromboembolic. Conclusion: Timing of systemic heparin distribution and its potential effects on perioperative events remains an understudied area of interventional neurology. However, our data suggests that the different timepoints that are currently regarded as standard for its distribution have little bearing on adverse patient outcomes intraoperatively. This can lead us to rethink time guidelines for patients and decrease the apprehension in heparin distribution with regards to adverse outcomes

An exploration of how therapists experience erotic feelings in therapy

Aims and objectives This study has three aims. The first aim is to explore how therapists experience erotic feelings in therapy. The second aim is to examine how therapists’ experience of the erotic is constructed, and the third aim is to identify how therapists’ accounts construct the social world. The objectives of the study are to (1) make meaning of therapists’ experience, (2) theorise the basic social processes, contexts and structural conditions that influence the construction of their experience, and (3) suggest practical applications (Braun & Clarke, 2006, 2013, 2014). Methodology The Constructionist model of Thematic Analysis (Braun & Clarke, 2006, 2013) is used to analyse the collected qualitative data. Method Data were collected by conducting semi-structured interviews with thirteen therapists. The participants were six male and seven female who had more than five years of post-qualification experience. Interviews were audio recorded, transcribed and analysed. Results The findings suggest that the majority of participants are not prepared for their encounter with the erotic. Most of them perceive it as a mysterious phenomenon, view it as a professional taboo, and argue that it has personal and sensitive meaning for both themselves and their clients. The majority of participants appear to encounter a series of challenges, which they process internally while they handle the erotic explicitly, implicitly or not at all. Participants’ understanding of the erotic is mostly influenced by their clinical experience and the quality of supervision they receive. Their experience of the erotic is constructed through their interaction with society, training institutions, the profession and the regulation of clinical practice. At the same time, due to the inter-relationship between social systems and therapeutic practice, participants’ accounts construct the social world. Participants understand the erotic as a product of therapy and highlight that it can be either constructive or destructive. At last, they advocate that a practical approach to learning, open conversations on the subject and strategies to overcome the restrictions set by society, culture and regulation are required to enable their work with the erotic. Discussion Research findings and implications for practice are discussed. The methodology used to conduct the study is evaluated. Suggestions for further research are provided

The electronic transport properties and microstructure of carbon nanofiber/epoxy composites

Carbon nanofibres (CNF) were dispersed into an epoxy resin using a combination of ultrasonication and mechanical mixing. The electronic transport properties of the resulting composites were investigated by means of impedance spectroscopy. It was found that a very low critical weight fraction (pc = 0.064 wt %) which may be taken to correspond to the formation of a tunneling conductive network inside the matrix. The insulator-to-conductor transition region spanned about one order of magnitude from 0.1 to 1 wt %. Far from the transition, the conductivity increased by two orders of magnitude. This increase and the low value of the conductivity were explained in terms of the presence of an epoxy film at the contact between CNF. A simple model based on the CNF-CNF contact network inside the matrix was proposed in order to evaluate the thickness of that film.Comment: 7 page

Raman tensor analysis of hexagonal polyoxymethylene and its application to study the molecular arrangement in highly crystalline electrospun nanofibers

The orientation dependence in space of Raman-active vibrations in the hexagonal structure of polyoxymethylene (POM) is discussed in terms of Raman tensor elements as intrinsic physical parameters of the lattice. The variation of polarized intensity for the A1 and the E1 vibrational modes with respect to the POM molecular orientation is systematically studied, from both theoretical and experimental viewpoints, according to the symmetry assignments of each vibrational mode. A set of working equations including the Raman selection rules associated with the A1 and the E1 modes and the orientation distribution function are explicitly formulated and validated by means of a least-square fitting procedure on experimental data. In addition, an approach based on the introduction of orientation distribution functions is applied to quantitatively assess and compare on a statistical base the molecular orientation of two different types of electrospun POM nanofibers. Copyright (c) 2012 John Wiley & Sons, Ltd

指定都市・中核市・特例市を対象とした駅前広場に関する計画論的研究

13301甲第4426号博士(工学)金沢大学博士論文本文Ful

Development of high duty operation RF photoinjector

A RF photoinjector for the high duty operation was designed and constructed by the BNL/KEK/SHI international collaboration and installed at the S-band linear accelerator of the University of Tokyo. Subpicosecond electron bunches compressed by a magnetic compression is planned to be used for the subpicosecond X-ray generation and the laser acceleration. Preliminary experiments of the RF photoinjector were performed. The measured value of the Cu cathode`s quantum efficiency was 5x10(exp -5

指定都市・中核市・特例市を対象とした駅前広場に関する計画論的研究

13301甲第4426号博士(工学)金沢大学博士論文要旨Abstrac

腸管のリンパ組織における免疫応答に関わる細胞の機能についての研究

学位の種別: 課程博士審査委員会委員 : （主査）東京大学准教授 八村 敏志, 東京大学教授 田之倉 優, 東京大学教授 高橋 直樹, 東京大学教授 佐藤 隆一郎, 東京大学准教授 戸塚 護University of Tokyo(東京大学

The Emergence of HIV-1 Transmitted Drug Resistance Mutations Among Antiretroviral Therapy-naive Individuals in Buleleng, Bali, Indonesia

Background: the global scale-up of antiretroviral therapy (ART) is the primary factor contributing to the decline in deaths from acquired immune deficiency syndrome (AIDS)-related illnesses. However, the emergence of transmitted drug resistance (TDR) compromises the effects of ART in treatment-naïve individuals, which may hinder treatment success. The present study aimed to identify the presence of TDR among treatment-naive individuals in Buleleng, Bali, which is currently ranked sixth among Indonesian provinces with the highest cumulative human immunodeficiency virus type 1 (HIV-1) infection cases. Methods: thirty-nine ART-naive individuals in Buleleng Regency General Hospital were enrolled in the present study. Blood samples from participants were subjected to a genotypic analysis. Results: 28 protease (PR) and 30 reverse transcriptase (RT) genes were successfully amplified and sequenced from 37 samples. HIV-1 subtyping revealed CRF01_AE as the dominant circulating recombinant form in the region. No TDR for PR inhibitors was detected; however, TDR for RT inhibitors was identified in five out of 30 samples (16.7%). Conclusion: these results indicate the emergence of TDR among ART-naive individuals in Buleleng, Bali. This issue warrants serious consideration because TDR may hamper treatment success and reduce ART efficacy among newly diagnosed individuals. Continuous surveillance with a larger sample size is necessary to monitor TDR among ART-naive individuals