7,219 research outputs found
Projection transparencies from printed material
Method for preparing project transparencies, or view graphs, permits the use of almost any expendable printed material, pictures, charts, or text, in unlimited color or black and white. The method can be accomplished by either of two techniques, with a slight difference in materials
Automorphism groups of polycyclic-by-finite groups and arithmetic groups
We show that the outer automorphism group of a polycyclic-by-finite group is
an arithmetic group. This result follows from a detailed structural analysis of
the automorphism groups of such groups. We use an extended version of the
theory of the algebraic hull functor initiated by Mostow. We thus make
applicable refined methods from the theory of algebraic and arithmetic groups.
We also construct examples of polycyclic-by-finite groups which have an
automorphism group which does not contain an arithmetic group of finite index.
Finally we discuss applications of our results to the groups of homotopy
self-equivalences of K(\Gamma, 1)-spaces and obtain an extension of
arithmeticity results of Sullivan in rational homotopy theory
EVIDENCE--CRIMINAL LAW--CROSS-EXAMINATION OF ACCUSED\u27S CHARACTER WITNESS CONCERNING ACCUSED\u27S PRIOR ARREST
On trial in a district court for bribing a federal revenue agent, defendant called five witnesses to testify to his good reputation. During cross-examination by the district attorney, the character witnesses were asked: \u27\u27Did you ever hear that on October 11, 1920, the defendant was arrested for receiving stolen goods? The trial judge overruled the objection to the question, and the witnesses answered in the negative. The prosecutor exhibited a paper record of this arrest to the court. The judge instructed the jury that the question was to test the standard of the character evidence only, not to establish the incident of arrest as a fact affecting the probability of defendant\u27s guilt. On certiorari to the United States Supreme Court, following affirmance by the circuit court of appeals held, affirmed. Michelson v. United States, (U.S. 1948) 69 S.Ct. 213
Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005
Aim
The objective of the thesis was to describe the most common causes of
substandard care during labour contributing to severe asphyxia or
neonatal death, to study risk factors related to asphyxia associated with
substandard care and to explore the occurrence of substandard care during
labour.
Background
There are about 100 000 infants born every year in Sweden. Most infants
are born healthy after uncomplicated deliveries. However, 20-50 claims
for financial compensation are made annually to the Patients Advisory
Committee (PA C) on suspicion that substandard care during labour has
contributed to severe asphyxia causing cerebral palsy or death. Even if
this group of patients is notably small, asphyxia causes life-long
impairment and immeasurable suffering to the patients and their families.
In addition, the insurance costs are substantial and amount to 25% of all
costs related to substandard care in Sweden. With the exception of this
group of patients, and claims to the Health Services Disciplinary Board,
the frequency of substandard care in relation to childbirth is fairly
unknown.
Material and methods
Inclusion criteria were pregnancies with a gestational length ≥ 33 weeks,
a spontaneous or induced start of labour, a normal CTG at admission for
labour, and Apgar score < 7 at 5 minutes of age (Papers I-IV). 472 case
records of deliveries from 1990-2005, filed at the PAC were scrutinised.
In Paper I and II the deliveries and acts of neonatal resuscitation
procedures are described. In Paper III, maternal characteristics, factors
related to care and infant characteristics for patients receiving
lifelong financial compensation from PAC are compared with all infants
with full Apgar score at 5 minutes of age born after a vaginal start
during the same time period in Sweden (n=1.141 059). In Paper IV
deliveries and risk factors from 313 infants with Apgar score < 7at 5
minutes of age, born in the Stockholm County are compared with 313
infants with full Apgar score at five minutes of age, matched for year of
birth.
Results
One-hundred and seventy-seven infants were considered to have been
severely asphyxiated due to substandard care during labour (Paper I-III).
The most common occurrences of malpractice in conjunction with labour
were neglecting to supervise fetal well-being (98%), neglecting signs of
fetal asphyxia (71%), including incautious use of oxytocin (71%) and
choosing a non-optimal mode of delivery (52%) (Paper I). Resuscitation of
the 177 severely asphyxiated infants was unsatisfactory in 47%. The most
important flaw was the defective compliance with the guidelines
concerning ventilation and prompt paging for skilled personnel in cases
of imminent asphyxia (Paper II). Risk factors associated with asphyxia
included maternal age ≥ 30 years, short maternal stature (< 159 cm),
previous caesarean delivery, insulin-dependent diabetes, induced
deliveries and night deliveries, where the increases in risk were doubled
to a four-fold. In addition, dystocia of labour was associated with a
five-fold increase in risk, which was further increased if epidural
anaesthesia or opioids were used. Small- and large-for-gestational age
infants, post-term (> 42 weeks) births, twins and breech deliveries had a
three to eight-fold increase in risk of asphyxia when there was
substandard care during labour (Paper III). Two thirds of infants born in
the Stockholm region 2004-2006, with Apgar score < 7 at 5 minutes but
also one third of the healthy controls were subjected to some kind of
substandard care during labour (Paper IV). The main causes of substandard
care during labour were related to misinterpretation of CTG, not acting
timely on abnormal CTG, and incautious use of oxytocin. The risk of
asphyxia increased with duration of abnormal CTG and was increased
fifteen-fold when this was abnormal for ≥ 90 minutes. Oxytocin was
provided without sign of inertia in 20% of cases and controls and the
risk of asphyxia was increased more than fivefold in cases of
tachysystole. Infants born after a spontaneous vaginal delivery with
abnormal CTG for more than 45 minutes had a more than sevenfold risk of
low Apgar score. In instrumental deliveries that were considered complex,
there was a more than seventeen-fold risk of an Apgar score < 7 at 5
minutes of age. Assuming that substandard care is causative for low Apgar
score, we estimate that 42% of the cases could be prevented by avoiding
substandard care (Paper IV).
Conclusion
It is possible to improve patient safety during labour by applying
educational efforts on fetal surveillance and increasing awareness of
risk factors associated with asphyxia. The main causes of substandard
care during labour are related to misinterpretation of CTG, not acting
timely on abnormal CTG, misinterpretation of guidelines and misuse of
oxytocin. Low Apgar score at 5 minutes of age can substantially, be
prevented by avoiding substandard care
An Integrated Inventory-Transportation System with Periodic Pick-Ups and Leveled Replenishment
In this paper we develop a combined inventory-transportation system. The general idea is to integrate a simple replenishment policy with a routing component to derive operationally consistent standard routes as a basis for milk run design. The most interesting feature of the approach is that we combine stochastic vehicle routing with a replenishment policy which makes use of inventory to level the variability propagated into transportation operations. To evaluate the approach, we compare its performance with stochastic vehicle routing as well as sequential vehicle routing and replenishment planning. With respect to these approaches, substantial gains are achieved
British Neurotoxin Network recommendations for managing cervical dystonia in patients with a poor response to botulinum toxin
Botulinum toxin (BoNT) injections are an effective
treatment for cervical dystonia. Approximately
20% of patients eventually stop BoNT treatment,
mostly because of treatment failure. These
recommendations review the different
therapeutic interventions for optimising the
treatment in secondary poor responder patients.
Immunoresistance has become less common over
the years, but the diagnosis has to be addressed
with a frontalis test or an Extensor Digitorum
Brevis test. In case of immunoresistance to BoNTA,
we discuss the place the different therapeutic
options (BoNT-A holidays, BoNT-B injections,
alternative BoNT-A injections, deep brain
stimulation). When poor responders are not
immunoresistant, they benefit from reviewing (1)
injections technique with electromyography or
ultrasound guidance, (2) muscles selection and
(3) dose of BoNT. In addition, in both scenarios,
a holistic approach including drug treatment,
retraining and psychological support is valuable
in the management of these complex and severe
cervical dystonia
Successful elimination of factor VIII inhibitor using cyclosporin A
No abstract available
Association of Antenatal COVID-19-Related Stress with Postpartum Maternal Mental Health and Negative Affectivity in Infants
IMPORTANCE Antenatal stress is a significant risk factor for poor postpartum mental health. The association of pandemic-related stress with postpartum outcomes among mothers and infants is, however, less well understood. OBJECTIVE To examine the association of antenatal COVID-19-related stress with postpartum maternal mental health and infant outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among 318 participants in the COVID-19 Risks Across the Lifespan study, which took place in Australia, the UK, and the US. Eligible participants reported being pregnant at the first assessment wave between May 5 and September 30, 2020, and completed a follow-up assessment between October 28, 2021, and April 24, 2022. MAIN OUTCOMES AND MEASURES COVID-19-related stress was assessed with the Pandemic Anxiety Scale (score range, 0-4, with higher scores indicating greater COVID-19-related stress). The 8-item Patient Health Questionnaire (score range, 0-3, with higher scores indicating more frequent symptoms of depression) was used to measure maternal depression at each time point, and the 7-item General Anxiety Disorder scale (score range, 0-3, with higher scores indicating more frequent symptoms of anxiety) was used to measure generalized anxiety at each time point. At follow-up, postpartum distress was assessed with the 10-item Postpartum Distress Measure (score range, 0-3, with higher scores indicating greater postpartum distress), and infant outcomes (negative and positive affectivity and orienting behavior) were captured with the Infant Behavior Questionnaire (score range, 1-7, with higher scores indicating that the infant exhibited that affect/behavior more frequently). RESULTS The study included 318 women (mean [SD] age, 32.0 [4.6] years) from Australia (88 [28%]), the US (94 [30%]), and the UK (136 [43%]). Antenatal COVID-19-related stress was significantly associated with maternal postpartum distress (β = 0.40 [95%CI, 0.28-0.53]), depression (β = 0.32 [95%CI, 0.23-0.41]), and generalized anxiety (β = 0.35 [95%CI, 0.26-0.44]), as well as infant negative affectivity (β = 0.45 [95%CI, 0.14-0.76]). The findings remained consistent across a range of sensitivity analyses. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that targeting pandemic-related stressors in the antenatal period may improve maternal and infant outcomes. Pregnant individuals should be classified as a vulnerable group during pandemics and should be considered a public health priority, not only in terms of physical health but also mental health
AdS Strings with Torsion: Non-complex Heterotic Compactifications
Combining the effects of fluxes and gaugino condensation in heterotic
supergravity, we use a ten-dimensional approach to find a new class of
four-dimensional supersymmetric AdS compactifications on almost-Hermitian
manifolds of SU(3) structure. Computation of the torsion allows a
classification of the internal geometry, which for a particular combination of
fluxes and condensate, is nearly Kahler. We argue that all moduli are fixed,
and we show that the Kahler potential and superpotential proposed in the
literature yield the correct AdS radius. In the nearly Kahler case, we are able
to solve the H Bianchi using a nonstandard embedding. Finally, we point out
subtleties in deriving the effective superpotential and understanding the
heterotic supergravity in the presence of a gaugino condensate.Comment: 42 pages; v2. added refs, revised discussion of Bianchi for N
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