Timing and volume of fluid administration for patients with bleeding

Original article can be found at: http://www3.interscience.wiley.com Copyright John Wiley & Sons. ‘This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2003, Issue 3. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’ Kwan, I. , Bunn, F. and Roberts, I. 'Timing and volume of fluid administration for patients with bleeding.' Cochrane Database Systematic Reviews 2003, (3) CD002245. DOI: 10.1002/14651858.CD002245 http://dx.doi.org/10.1002/14651858.CD002245Background: Treatment of haemorrhagic shock involves maintaining blood pressure and tissue perfusion until bleeding is controlled. Different resuscitation strategies have been used to maintain the blood pressure in trauma patients until bleeding is controlled. However, while maintaining blood pressure may prevent shock, it may worsen bleeding. Objectives: To assess the effects of early versus delayed, and larger versus smaller volume of fluid administration in trauma patients with bleeding. Search strategy: We searched the CENTRAL (The Cochrane Library 2008, Issue 4), the Cochrane Injuries Group's Specialised Register (searched October 2008), MEDLINE (to October 2008), EMBASE (to October 2008), the National Research Register (in Current controlled trials.gov; searched October 2008) and the Science Citation Index (to October 2008). We checked reference lists of identified articles and contacted authors and experts in the field. Selection criteria: Randomised trials of the timing and volume of intravenous fluid administration in trauma patients with bleeding. Trials in which different types of intravenous fluid were compared were excluded. Data collection and analysis: Two authors independently extracted data and assessed trial quality. Main results: We did not combine the results quantitatively because the interventions and patient populations were so diverse. Early versus delayed fluid administration Three trials reported mortality and two coagulation data. In the first trial (n=598) relative risk (RR) for death with early fluid administration was 1.26 (95% confidence interval of 1.00−1.58). The weighted mean differences (WMD) for prothrombin time and partial thromboplastin time were 2.7 (95% CI 0.9−4.5) and 4.3 (95% CI 1.74−6.9) seconds respectively. In the second trial (n=50) RR for death with early blood transfusion was 5.4 (95% CI 0.3−107.1). The WMD for partial thromboplastin time was 7.0 (95% CI 6.0−8.0) seconds. In the third trial (n=1309) RR for death with early fluid administration was 1.06 (95% CI 0.77−1.47). Larger versus smaller volume of fluid administration Three trials reported mortality and one coagulation data. In the first trial (n=36) RR for death with a larger volume of fluid resuscitation was 0.80 (95% CI 0.28−22.29). Prothrombin time and partial thromboplastin time were 14.8 and 47.3 seconds in those who received a larger volume of fluid, as compared to 13.9 and 35.1 seconds in the comparison group. In the second trial (n=110) RR for death with a high systolic blood pressure resuscitation target (100mmHg) maintained with a larger volume of fluid, as compared to low systolic blood pressure resuscitation target (70mmHg) maintained with a smaller volume of fluid was 1.00 (95% CI 0.26−3.81). In the third trial (n=25) there were no deaths. Authors' conclusions: We found no evidence from randomised controlled trials for or against early or larger volume of intravenous fluid administration in uncontrolled haemorrhage. There is continuing uncertainty about the best fluid administration strategy in bleeding trauma patients. Further randomised controlled trials are needed to establish the most effective fluid resuscitation strategy.Peer reviewe

Evaluation of Half-metallic Antiferromagnetism in A2{\cal A}_2CrFeO6_6 ({A\cal A}=La, Sr

The nearly well-ordered double perovskite La$_2$CrFeO$_6$ has been synthesized recently. Contrary to previous theoretical predictions, but in agreement with experimental observations, our first principle calculations indicate an insulating ferrimagnet La$_2$CrFeO$_6$ with antialigned S=3/2 Cr$^{3+}$ and S=5/2 Fe$^{3+}$ ions,using the local spin density approximation (LSDA), a correlated band theory LDA+U, and a semilocal functional modified Becke-Johnson method. Additionally, we investigated the double perovskite Sr$_2$CrFeO$_6$, which is as yet unsynthesized. In LSDA calculations, this system shows formally tetravalent Cr and Fe ions both having antialigned $S$=1 moments, but is a simple metal. Once applying on-site Coulomb repulsion U on both Cr and Fe ions, this system becomes half-metallic and the moment of Fe is substantially reduced, resulting in zero net moment. These results are consistent with our fixed spin moment studies. Our results suggest a precisely compensated half-metallic Sr$_2$CrFeO$_6$.Comment: 7 page

Electron and phonon band-structure calculations for the antipolar SrPt3_{3}P antiperovskite superconductor: Evidence of low-energy two-dimensional phonons

SrPt3P has recently been reported to exhibit superconductivity with Tc = 8.4 K. To explore its superconducting mechanism, we have performed electron and phonon band calculations based on the density functional theory, and found that the superconductivity in SrPt3P is well described by the strong coupling phonon-mediated mechanism. We have demonstrated that superconducting charge carriers come from pd\pi-hybridized bands between Pt and P ions, which couple to low energy (~ 5 meV) phonon modes confined on the ab in-plane. These in-plane phonon modes, which do not break antipolar nature of SrPt3P, enhance both the electron-phonon coupling constant \lambda and the critical temperature Tc. There is no hint of a specific phonon softening feature in the phonon dispersion, and the effect of the spin-orbit coupling on the superconductivity is found to be negligible.Comment: 5 pages, 5 figures, 1 tabl

Residents with Alzheimer’s Disease in Long-Term Care Facilities in Hong Kong: Patterns of Hospitalization and Emergency Room Use

postprin

Noncoding RNAs and Intranuclear Positioning in Monoallelic Gene Expression

Mammalian X inactivation, imprinting, and allelic exclusion are classic examples of monoallelic gene expression. Two emerging themes are thought to be critical for monoallelic expression: (1) noncoding, often antisense, transcription linked to differential chromatin marks on otherwise homologous alleles and (2) physical segregation of alleles to separate domains within the nucleus. Here, we highlight recent progress in identifying these phenomena as possible key regulatory mechanisms of monoallelic expression

Automatic boundary extraction and rectification of bony tissue in CT images using artificial intelligence techniques

A novel approach is presented for fully automated boundary extraction and rectification of bony tissue from planar CT data. The approach extracts and rectifies feature boundary in a hierarchical fashion. It consists of a fuzzy multilevel thresholding operation, followed by a small void cleanup procedure. Then a binary morphological boundary detector is applied to extract the boundary. However, defective boundaries and undesirable artifacts may still be present. Thus two innovative anatomical knowledge based algorithms are used to remove the undesired structures and refine the erroneous boundary. Results of applying the approach on lumbar CT images are presented, with a discussion of the potential for clinical application of the approach.published_or_final_versio

Tell me more?: the effects of mental model soundness on personalizing an intelligent agent

What does a user need to know to productively work with an intelligent agent? Intelligent agents and recommender systems are gaining widespread use, potentially creating a need for end users to understand how these systems operate in order to fix their agent's personalized behavior. This paper explores the effects of mental model soundness on such personalization by providing structural knowledge of a music recommender system in an empirical study. Our findings show that participants were able to quickly build sound mental models of the recommender system's reasoning, and that participants who most improved their mental models during the study were significantly more likely to make the recommender operate to their satisfaction. These results suggest that by helping end users understand a system's reasoning, intelligent agents may elicit more and better feedback, thus more closely aligning their output with each user's intentions

The impact of post-abortion care family planning counselling and services in low-income countries: a systematic review of the evidence

Unsafe abortions account for around 70,000 deaths each year, almost all of them in the developing world. Millions of women suffer permanent injury or chronic illness, adding a high cost to both individual families and health systems. Since the mid 1990s, post-abortion care has become a central part of the international strategy to address this problem. Although most attention has been paid to improving emergency treatment of abortion complications, the other elements of post-abortion care, including providing family planning counselling and services, have also been promoted and can be found in many health-care settings around the world. Although greater use of contraception will not produce direct, immediate effects on maternal mortality or morbidity, over time it should reduce women's recourse to unsafe abortion by preventing unplanned pregnancies, thereby putting women at less risk of lifelong injury or death. In 2010, the UK government strengthened its commitment to family planning as a strategy to reduce maternal mortality, marking a significant shift in the UK‟s approach to addressing the most off-track Millennium Development Goal: to improve material health. Addressing the unmet need for post-abortion family planning counselling and services to prevent repeat unplanned pregnancies remains a key part of the new developments in policy. It is therefore both vital and timely to increase understanding of the impacts of such programmes, in order to ensure that they are effective in delivering positive outcomes for women and provide value for money. This systematic review aimed to identify and synthesise the relevant research literature, thereby contributing to what is a relatively unexamined field. It addressed the question: What is the impact of post-abortion care family planning counselling and services in low-income countries on maternal mortality or morbidity, repeat induced abortions or unplanned pregnancies, or acceptance or use of contraception

Large-Scale Structure in Brane-Induced Gravity II. Numerical Simulations

We use N-body simulations to study the nonlinear structure formation in brane-induced gravity, developing a new method that requires alternate use of Fast Fourier Transforms and relaxation. This enables us to compute the nonlinear matter power spectrum and bispectrum, the halo mass function, and the halo bias. From the simulation results, we confirm the expectations based on analytic arguments that the Vainshtein mechanism does operate as anticipated, with the density power spectrum approaching that of standard gravity within a modified background evolution in the nonlinear regime. The transition is very broad and there is no well defined Vainshtein scale, but roughly this corresponds to k_*~ 2 at redshift z=1 and k_*~ 1 at z=0. We checked that while extrinsic curvature fluctuations go nonlinear, and the dynamics of the brane-bending mode C receives important nonlinear corrections, this mode does get suppressed compared to density perturbations, effectively decoupling from the standard gravity sector. At the same time, there is no violation of the weak field limit for metric perturbations associated with C. We find good agreement between our measurements and the predictions for the nonlinear power spectrum presented in paper I, that rely on a renormalization of the linear spectrum due to nonlinearities in the modified gravity sector. A similar prediction for the mass function shows the right trends. Our simulations also confirm the induced change in the bispectrum configuration dependence predicted in paper I.Comment: 19 pages, 13 figures. v2: corrected typos, added more simulations, better test of predictions in large mass regime. v3: minor changes, published versio