Sugammadex for reversal of neuromuscular blockade: A retrospective analysis of clinical outcomes and cost-effectiveness in a single center

OBJECTIVE: The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen for neuromuscular block (NMB) management. METHODS: We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium-sugammadex) and as rescue therapy after neostigmine reversal (rocuronium-neostigmine-sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen was carried out. To such purpose, two periods were compared: 2011-2012, without sugammadex available; 2013-2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective. RESULTS: The introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen reduced the average cost of NMB management by 36%, from €20.8/case to €13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be €2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium-neostigmine-sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013-2014 period was estimated at an average value of €13,548 (€9,316-€23,845). CONCLUSION: Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost

The Arabic Reception of Pagan Greek Poetry and Poets in the ʿAbbāsid Period

Il presente studio indaga le dinamiche di ricezione della poesia greca pagana in lingua araba durante l’epoca ʿabbāside, nel contesto del cosiddetto movimento di traduzione e della tradizione filosofico-letteraria che si sviluppò a partire da esso. Questo specifico fenomeno di ricezione è avvenuto sia per via di traduzione passiva di testi greci in siriaco e in arabo sia attraverso un’assimilazione più libera di frammenti testuali e motivi narrativi, ma ha avuto, in generale, una portata piuttosto limitata. La poesia greca sembra essere stata ai margini degli interessi degli intellettuali arabofoni di epoca ʿabbāside e, infatti, non si conservano né sono attestate traduzioni integrali di opere di poesia greca (ad eccezione di alcuni poemi di argomento scientifico o moralistico-filosofico). Dunque, la trasmissione di questa parte della letteratura greca è avvenuta per lo più per via indiretta, attraverso frammenti sparsi provenienti da fonti eterogenee. Queste possono essere ricondotte a due macrocategorie che corrispondono a due canali di trasmissione principali. La prima macrocategoria è costituita dai riferimenti poetici contenuti in trattati filosofici, medici e scientifici tradotti in arabo. Data la vastità di questo campo di indagine ci siamo concentrati sull’esame delle versioni arabe del Corpus Aristotelicum. Il secondo canale di trasmissione è la letteratura dosso-gnomologica, cioè compilazioni di aneddoti e detti che mescolano materiali di diversa origine, non solo greca e arabo-islamica. Oltre a questi corpora di testi, sono state esaminate importanti fonti documentarie che attestino una conoscenza e una trasmissione, almeno parzialmente orale, di elementi narrativi e topoi letterari.This study investigates the dynamics of reception of pagan Greek poetry in Arabic during the ʿAbbāsid era, in the context of the so-called translation movement and the philosophical-literary tradition that developed from it. This specific phenomenon of reception took place either through passive translation of Greek texts into Syriac and Arabic or through a freer assimilation of textual fragments and narrative motifs, but it had, in general, a rather limited scope. Greek poetry seems to have been at the margins of the interests of Arabic-speaking intellectuals of the ʿAbbāsid period, and, in fact, no full translations of works of Greek poetry are preserved or attested (with the exception of a few poems on scientific or moralistic-philosophical subjects). Thus, the transmission of this part of Greek literature took place mostly indirectly, through scattered fragments from heterogeneous sources. These can be reduced to two macrocategories corresponding to two main channels of transmission. The first macrocategory consists of poetic references contained in philosophical, medical and scientific treatises translated into Arabic. Given the vastness of this field of investigation, we have concentrated on examining the Arabic versions of the Corpus Aristotelicum. The second channel of transmission is the doxo-gnomological literature, i.e., compilations of anecdotes and sayings mixing materials of different origins, not only Greek and Arabic-Islamic. In addition to these corpora of texts, important documentary sources attesting to an at least partially oral knowledge and transmission of narrative elements and literary topoi were examined

Robust high fidelity microwave near-field entangling quantum logic gate

Trapped ions, together with superconducting qubits, are one of the two leading hardware platforms for scalable quantum information processing. The development of quantum computers represents a major technological breakthrough comparable to the introduction of classical computing. The benefits of this technology are currently limited by the technical capability to perform high fidelity entangling operations on the qubits. When gate fidelities surpass the fault-tolerance threshold it becomes possible, through error correction, to increase the system size to an arbitrary number of qubits. In this cumulative thesis we address some of the issues in the scalability of the trapped-ion quantum computer based on microwave near-fields. In this approach, gate operations on one or multiple ions are driven by an oscillating magnetic field generated by a current flowing through a conductor. In the first part of this work we discuss the design of traps toward the implementation of large scale systems. We introduce the basic design of a surface-electrode ion trap with embedded microwave conductors. The oscillating magnetic field required to perform the operations is generated by a single optimized conductor. We discuss the simulation and characterization of the magnetic field pattern, which is fixed by the microwave conductor design. In addition, we demonstrate the capability to simulate, fabricate and characterize a multilayer surface ion trap. Multilayer traps are a key aspect for scalability since they are necessary to achieve large system sizes, with many `ion registers', where the registers are interconnected by physically transporting ions between them. In the second part of this thesis we demonstrate the implementation of a two-qubit entangling gate and we explore the possibilities offered by quantum control methods to improve its fidelity. We perform an entangling gate on two 9Be+ ions and measure a Bell state fidelity of 98.2(1.2)%. Error characterization shows that the gate result is limited by technical issues connected to the ions' motional states. To reduce these errors we apply amplitude modulation of the gate microwave drive. After stabilization of the ions' radial modes, we obtain an amplitude modulated gate with infidelity in the 10^-3 range. The result is confirmed by analyzing the data using three different methods. Using additional dynamic decoupling techniques, these results could bring microwave near-field gates past the fault-tolerance threshold

A broader view on brands’ growth and decline

What does it take to grow a brand? How to avoid its decline? Some popular answers to these questions can be found in the research by Byron Sharp and others from the Ehrenberg-Bass (EB) Institute on “how brands grow.” In this article, we propose that such an approach, despite its strengths, lends itself to some limitations when taken too literally. We maintain that a broader notion and role of branding—encompassing brand equity, brand portfolio, and circular relationship of attitudes and behaviors—should be adopted by marketeers to derive better managerial implications for sustainable brand growth. We, therefore, invite marketers to not oversimplify Dirichlet evidences by thinking of availability as the only (costly) response to all marketing challenges

How valuable are your customers in the brand value co-creation process? The development of a customer co-creation value (CCCV) scale

Despite an increasing amount of research on co-creation of value, in general, research on brand value co-creation remains limited. Particularly, how much value customers contribute to the brand value co-creation process remains unclear. This research develops in a series of eight studies the Customer Co-Creation Value (CCCV) measurement scale that helps firms assess the value of customers in the brand value co-creation process. The findings reveal that CCCV is a multidimensional construct consisting of two higher-order factors and seven dimensions: customer-owned resources (including brand knowledge, brand skills, brand creativity, and brand connectedness) and customer motivation (comprising brand passion, brand trust, and brand commitment). Further, the CCCV scale reliably and validly gauges the value customers contribute to a firm's brand. The CCCV framework helps marketing managers understand how customers can contribute to a firm's brand value cocreation efforts and how much value customers contribute to a brand in the co-creation process