Retrospective study of anaesthetic management of pregnancy patients with mechanical heart valve prosthesis and anticoagulants

Pregnancies among patients with a mechanical prosthetic valve and receiving anticoagulant medication are rare. Informations about their anesthetic management is poor. The objective of this study was to investigate the anaesthetic management of these patients in a reference medical centre as well as to identify possible ways for improvement. To this aim, the medical records of patients with a mechanical heart valve prosthesis having given birth at our center were analysed. In particular, the characteristics of patients and deliveries, the management of anticoagulation, as well as the type of anaesthesia performed, were collected and analysed. Eighteen cases were studied and compared to 36 controls. All studied cases were being administered anticoagulants. Five of these 8 patients delivered vaginally, one with epidural analgesia. Three of them have had a caesarean during labor, all under general anaesthesia. During the anticoagulation window, the teams had to perform an epidural in 3 (37%) of these 8 patients. Ten cases (55%) had a planned caesarean delivery, all performed under general anaesthesia. The anticoagulation interruption allowed spinal anaesthesia for 4 out of 10 caesarean delivery. The reoperation rate for secondary haemorrhage was significantly higher (P=0.0032) and the duration of the hospitalisation was extended (P<0.001). A context of anticoagulant overdose was identified in 60% of the bleeding cases. Progress can be made in the anaesthetic management of those patients by optimising the use of neuraxial anaesthesia and by improving the management of bleeding risk after delivery

Laparoscopic repair for perforated peptic ulcers with U-CLIP®

<p>Abstract</p> <p>Background</p> <p>The literature established that, in patients without Boey's risk factors, laparoscopic repair of perforated peptic ulcers, compared to open repair, is associated to lower wound infection rate, less analgesic use, reduction in post operative pain, shorter hospital stay. Some of the main drawbacks are length of operative time and laparoscopic surgeon's experience in intracorporeal knotting.</p> <p>We, for first, report our preliminary experience of perforated peptic ulcers' laparoscopic repair using Medtronic U-Clip^®.</p> <p>Methods</p> <p>From January 2008 to June 2008 we performed laparoscopic repair of perforated peptic ulcers using Medtronic U-Clip^®in 10 consecutive patients (6 men and 4 women, from 20 to 65 years-old of age). All the patients presented with iuxtapyloric perforated peptic ulcer, not greater than 10 mm, without signs of sepsis, free from major illnesses. The mini-invasive procedure was performed both by skilled and non-skilled laparoscopic surgeons under experts' surveillance. After it was recognized, perforation was sutured using U-Clip^®in a full-thickness manner.</p> <p>Results and Discussion</p> <p>We reported no surgical complications in the peri-operative period. The clinical outcome and time needed to perform the intervention didn't change between skilled and non-skilled surgeons. The follow-up at 30 days was good.</p> <p>Conclusion</p> <p>In our experience, the anastomotic device U-Clip^®simplifies laparoscopic repair of perforated peptic ulcer, avoiding the need to perform knots and making the procedure safe and easier.</p

I Came to America, Crying : Rebuilding a Life, Redefining the Self—Ethiopian Women Refugees in Denver (Colorado) (2012–2013)

The purpose of this study is to examine the challenges faced by Ethiopian women in the Denver community to reach harmony within their new social and cultural space and to examine what they feel they have lost and gained in their self-identity as a result of their immigration. Refugees face a multitude of dilemmas when they are compelled to relocate from their home countries to a new, foreign-host society. Ethiopian refugees have been arriving in the US since the 1970s and feel the uprootedness of being away from their homeland. Being uprooted is losing one’s culture and ways of life. Therefore, for these refugees to integrate into an unknown social space is highly challenging, as they have to relearn how to live their quotidian life in a new cultural and social context. Relocation requires an active negotiation of situations and behaviors; therefore, it is paramount to understand the refugees’ agency in the processes of integration and in rebuilding their lives. By analyzing these processes we can learn about the struggles of negotiating different cultural and social aspects ---that is, those from the culture of origin and those of the receiving communities--in order to successfully rebuild continuities and find a sense of belonging. In this study, I use the terms refugee and migrant interchangeably because the majority of first generation informants arrived as refugees, but after living for decades in the US, many no longer identify as such, but rather as migrants. I examine three main aspects of becoming a refugee/migrant: (1) the metamorphosis of the family structure, including the transformation of power relations between husband and wife; (2) the cultural differences between Ethiopians and their receiving community, which often fosters the idea that refugees and migrants represent a cultural and economic threat to the nation; and (3) the construction of the category of refugee/migrant, which provokes a loss of identity among these Ethiopian women. I found that Ethiopian women refugees/migrants assert their authority through traditional gender roles rather than through western-centric worldview of success. Ethiopian women refugees/migrants’ agency permits them to negotiate between the two cultures, enabling them to choose features from both cultures that bestow upon them power, and actively engage them in decision making in the household and in the community. This study results from fieldwork conducted from June 2012 until December 2013 among Denver Ethiopians who have constructed social spaces of belonging around perceived traditional family and religious values, and who congregate at the Tewahedo Kidane Meheret, Kidane-Mehret and Medhane-Alem Curches, and the now closed Ethiopian Community Center. This thesis contributes to the general body of literature on migration and fills a lacuna on anthropological research concerning Ethiopian refugees/migrants in the United States

3D Reconstruction and Presentation of Cultural Heritage: AR and VR Experiences at the Museo d’Arte Orientale di Torino

For years, virtual reconstruction in the figurative arts, and sculpture, in particular, has been developing and consolidating. The workflow from the acquisition to three-dimensional modelling and to the integration of missing parts, has been optimized through processes entirely implemented in the digital dimension. The most recent developments in augmented reality and virtual reality technologies, together with the possibility of using low-cost and widely available devices, have made it possible to establish new links between the real and the virtual. The experiences presented in this paper comes up within the agreement between the Politecnico di Torino and the Museo d’Arte Orientale (MAO). The workflow set up for this research involves: structure from motion (SfM) survey, 3D modelling, and 3D philological reconstruction, then develops a proposal to implement augmented and virtual reality experiences aimed at the communication and fruition of the exhibits. The case study concerns two Japanese statues, and proposes their visualisation with the respective weapons virtually reconstructed, and through VR, involving the reconstruction of the interior space of a temple recognised as philologically compatible with the location of the statues within a statuary complex

Assessment of pain during labor with pupillometry: a prospective observational study.: Pupillometry and labor pain

International audienceBACKGROUND: Pain intensity is usually self-rated by patients with a numeric rating scale (NRS) but this scale cannot be used for noncommunicating patients. In anesthetized patients, experimental noxious stimulus increases pupillary diameter (PD) and pupillary light reflex amplitude (PLRA), the difference between PD before and after light stimulation. Labor pain is an intense acute nonexperimental stimulus, effectively relieved by epidural analgesia. In this prospective observational study, we therefore describe the effects of labor pain and pain relief with epidural analgesia on PD and PLRA, determine their association with pain intensity and determine the ability of a single measurement of PD or PLRA to assess pain. METHODS: In the first stage, pain (11-point NRS), PD, and PLRA were measured in 4 conditions in 26 laboring women: before and after epidural analgesia and in the presence and absence of a uterine contraction. Pupillometry values among the 4 conditions were compared, and the strength of the association between absolute values of pain and PD or PLRA and between pain and changes in PD or PLRA brought about by uterine contraction was assessed with r(2). In the second stage, 1 measurement was performed in 104 laboring women. The strength of the association between pain and PD or PLRA was assessed with r(2). The ability of PD or PLRA to discriminate pain (NRS > 4) was also assessed. RESULTS: In the first stage, a statistically significant increase in pain, PD, and PLRA was observed during a contraction, and this change was abolished after epidural analgesia. The r(2) for the association between pain and changes in PD (r(2) = 0.25 [95% confidence interval, 0.07-0.46] or PLRA (r(2) = 0.34 [0.14-0.56]) brought about by a uterine contraction was higher than the r(2) for the association between pain and absolute values of PD (r(2) = 0.14 [0.04-0.28]) or PLRA (r(2) = 0.22 [0.10-0.37]) suggesting a stronger association for changes than for absolute values. In the second stage, r(2) was 0.23 [0.10-0.38] for PD and 0.26 [0.11-0.40] for PLRA and the area under the receiver operating characteristics curve was 0.82 [0.73-0.91] and 0.80 [0.71-0.89], respectively. CONCLUSIONS: Changes in PD and PLRA brought about by a uterine contraction may be used as a tool to assess analgesia in noncommunicating patients

Potencialidades de la agenda de cooperación sur-sur en tecnología espacial: Entre las proyecciones y las posibilidades para la Argentina (2003-2015)

Hasta el año 2015, la ciencia y la tecnología argentinas fueron potenciadas en un contexto de revitalización económica general y uno de los ámbitos más beneficiados en ese marco fue la espacial; Argentina se ha convertido actualmente en un líder regional, lo cual le permite posicionarse en un rol protagónico en la agenda de cooperación espacial del hemisferio sur. El artículo se propone dar cuenta de la expansión del sector y realizar una prospección sobre los potenciales relacionamientos en materia espacial con países pertenecientes al “sur”, tratando de responder a las preguntas sobre si es posible llevar una cooperación sur - sur exitosa, y de la que pueda sacar provecho el área. &nbsp; AbstractUp until 2015, the science and technology agenda in Argentina was empowered in a context of general economic revitalization and one of the most benefited areas in that framework was the space sector; Argentina is actually a regional leader, which allows it to position itself in a central role in the space cooperation agenda for the south hemisphere. This article proposes a brief summary about the expansion of the sector and a prospection on the potential relations en the space sector with countries belonging to the South, trying to answer the question about the possibilities of carrying on a successful south – south cooperation agenda. Key words: cooperation, science and technology, space, Argentina

Degradation analysis of thin film photovoltaic modules under outdoor long term exposure in Spanish continental climate conditions.

The present study analyses the degradation of thin film photovoltaic modules corresponding to four technologies: a-Si:H, a-Si:H/µc-Si:H, CIS and CdTe, under 5 years of outdoor long term exposure in Leganés, Spain. The period of outdoor exposure ranges from January 2011 to December 2015. The degradation rate and the stabilization period are analysed by using two different techniques. Moreover, the evolution of the fill factor and performance ratio is assessed. The CdTe module was found to have the highest degradation rate:-4.45 %/year, while the CIS module appears to be the most stable with a degradation rate of -1.04 %/year. The a-Si:H and a-Si:H/µc-Si:H modules present stabilization periods of 24 and 6 months respectively. The CdTe module degrades significantly for a period of 32 months, while the CIS module is the least degraded PV specimen over the whole experimental campaign.Peer ReviewedPostprint (author's final draft

Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Background The cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics. However, no study has examined the prevalence of MH susceptibility in obstetrics. This study aimed to assess the prevalence of MH diagnosis and associated factors in obstetric patients. Methods Data for this study came from the National Inpatient Sample from 2003 to 2014, a 20% nationally representative sample of discharge records from community hospitals. A diagnosis of MH due to anesthesia was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 995.86. MH prevalence was estimated according to the delivery mode and patient and hospital characteristics. Results During the 12-year study period, 47,178,322 delivery-related discharges [including 15,175,127 (32.2%) cesarean deliveries] were identified. Of them, 215 recorded a diagnosis of MH, yielding a prevalence of 0.46 per 100,000 [95% confidence interval (CI), 0.40 to 0.52]. The prevalence of MH diagnosis in cesarean deliveries was 0.81 per 100,000 (95% CI, 0.67 to 0.97), compared with 0.29 per 100,000 (95% CI, 0.23 to 0.35) in vaginal deliveries (P <  0.001). Multivariable logistic regression revealed that cesarean delivery was associated with a significantly increased risk of MH diagnosis [adjusted rate ratio (aOR) 2.88; 95% CI, 2.19 to 3.80]. Prevalence of MH diagnosis was lower in Hispanics than in non-Hispanic whites (aOR 0.47; 95% CI, 0.29 to 0.76) and higher in the South than in the Northeast census regions (aOR 2.44; 95% CI, 1.50 to 3.96). Conclusion The prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified

Comparison of two PV array models for the simulation of PV systems using five different algorithms for the parameters identification

Simulation is of primal importance in the prediction of the produced power and automatic fault detection in PV grid-connected systems (PVGCS). The accuracy of simulation results depends on the models used for main components of the PV system, especially for the PV module. The present paper compares two PV array models, the five-parameter model (5PM) and the Sandia Array Performance Model (SAPM). Five different algorithms are used for estimating the unknown parameters of both PV models in order to see how they affect the accuracy of simulations in reproducing the outdoor behavior of three PVGCS. The arrays of the PVGCS are of three different PV module technologies: Crystalline silicon (c-Si), amorphous silicon (a-Si:H) and micromorph silicon (a-Si:H/µc-Si:H). The accuracy of PV module models based on the five algorithms is evaluated by means of the Route Mean Square Error (RMSE) and the Normalized Mean Absolute Error (NMAE), calculated for different weather conditions (clear sky, semi-cloudy and cloudy days). For both models considered in this study, the best accuracy is obtained from simulations using the estimated values of unknown parameters delivered by the ABC algorithm. Where, the maximum error values of RMSE and NMAE stay below 6.61% and 2.66% respectively.Peer ReviewedPostprint (author's final draft

Desarrollo científico-tecnológico y nuevo paradigma tecnoproductivo global : Argentina, Brasil y la cooperación MERCOSUR-Unión Europea en biotecnología

El objetivo del presente trabajo es analizar comparativamente el desarrollo del campo de la biotecnología en Argentina y Brasil, particularizando su análisis en los programas implementados en el marco de los acuerdos suscriptos entre el MERCOSUR y la Unión Europea. El estudio parte del reconocimiento que la industria biotecnológica conforma una de las ramas más importantes del actual paradigma tecnoproductivo y que, simultáneamente constituye una de las áreas prioritarias para desarrollo científico y tecnológico de la región.Instituto de Relaciones Internacionales (IRI