Benefits of using intrathecal buprenorphine

Background: General anesthesia draws attention to the most commonly used modalities for post cesarean delivery pain relief in systemic administration of opioids, while the administration of small dose of intrathecal opioid during spinal anesthesia can be a possible alternative. The aim of this study was to evaluate the effects of buprenorphine on cesarean section prescribed intrathecally. Methods: This double blind randomized clinical trial study was conducted in patients for cesarean section under spinal anesthesia. The patients were randomly divided into case and control groups. Case group (208 patients) received 65-70 mg of 5% lidocaine plus 0.2 ml of buprenorphine while the same amount of 5% lidocaine diluted with 0.2 ml of normal saline was given to 234 cases in the control group. Hemodynamic changes and neonatal APGAR scores (Appearance, Pulse, Grimace, Activity, Respiration) were recorded. Pain score was recorded according to the visual analog scale. This study was registered in the Iranian Registry of clinical Trials; IRCT2013022112552N1. Results: The mean age of case and control groups was 24.4±5.38 and 26.84±5.42 years, respectively. Systolic blood pressure was not significantly different until the 45th minute but diastolic blood pressure showed a significant difference at the 15th and the 60th minutes (P<0.001). Heart rate changes were significantly different between cases and controls at the initial 5th, 15th and after 60th minutes (P<0.001). Pain-free period was significantly different between two groups (1.25 h versus 18.73 h) (P<0.001). Conclusion: The results show that prescription of intratechal buprenorphine prolongs the duration of analgesia without any significant considerable side effects

Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method

Background: Lactic acidosis in cardiac surgical patients is a manifestation of systemic inflammation and excess pro-inflammatory cytokine production. This investigation was designed to integrate basic concepts about lactate acidosis with a clinically used of serum lactate in patients under coronary artery bypass surgery (CABG) by on pump method. Methods: From August to September 2012, 15 patients scheduled for routine cardiac surgery entered to our sample and followed up two weeks. Lactate concentration in arterial blood sample was studied. Method of surgery duration of cardiopulmonary bypass, aorta cross clamp timing, hemodynamic parameters, inotrope dosage and patient outcome were documented. The data were collected and analyzed. Results: The mean age of the patients was 62±14 years. The patients with a poor outcome had significantly higher lactate levels in ABG samples (p0.05). The PH of ABG samples did not generally correlate with the ABG lactate concentration (r=0.116, p=0.68). Increased lactate concentration was reliably associated with patient hemodynamic parameters, inotrope dosage, duration of on pump time and aorta cross clamp time. Conclusion: This study demonstrates a correlation between serum lactate levels and patient prognosis after CABG surgery by on pump method

Genetic Relationship of Body Energy and Blood Metabolites with Reproduction in Holstein Cows

Body condition score (BCS), energy content (EC), cumulative effective energy balance (CEEB), and blood serum concentrations of glucose, beta-hydroxybutyrate (BHBA), and nonesterified fatty acids ( NEFA) were measured throughout first lactation in 497 Holstein cows raised on a large commercial farm in northern Greece. All these traits are considered to be indicators of a cow's energy balance. An additional measure of BCS, EC, and blood serum glucose, BHBA, and NEFA concentrations were taken approximately 2 mo (61 +/- 23 d) before first calving. During first lactation, first service conception rate, conception rate in the first 305 d of lactation, interval from calving to conception, number of inseminations per conception, incidence of metritis, and incidence of reproductive problems of these cows were recorded; interval between first and second calving, and second lactation first service conception rate were also recorded. Random regression models were used to calculate weekly animal breeding values for first lactation BCS, EC, CEEB, glucose, BHBA, and NEFA. Single trait animal models were used to calculate breeding values for these traits measured on pregnant heifers before calving. Reproductive records were then regressed on animal breeding values for these energy balance-related traits to derive estimates of their genetic correlations. Several significant estimates were obtained. In general, traits that are known to be positively correlated with energy balance (BCS, EC, CEEB, and glucose) were found to have a favorable genetic relationship with reproduction, meaning that increased levels of the former will lead to an enhancement of the latter. On the other hand, traits known to be negatively correlated with energy balance (BHBA and NEFA) were found to have an unfavorable genetic association with reproductive traits. Body condition score, BHBA, and NEFA recorded early in lactation, and glucose concentrations measured in pregnant heifers had the highest genetic correlation with future reproductive performance. Results suggest that genetic selection for body energy and blood metabolites could facilitate the genetic improvement of fertility and overall reproductive efficiency of dairy cows.</p

Research review: young people leaving care

This paper reviews the international research on young people leaving care. Set in the context of a social exclusion framework, it explores young people's accelerated and compressed transitions to adulthood, and discusses the development and classification of leaving care services in responding to their needs. It then considers the evidence from outcome studies and argues that adopting a resilience framework suggests that young people leaving care may fall into three groups: young people 'moving on', 'survivors' and 'victims'. In concluding, it argues that these three pathways are associated with the quality of care young people receive, their transitions from care and the support they receive after care

Doing research with children and young people who do not use speech for communication

Despite emphasis in policy on participation of disabled children, we still know relatively little about how to obtain the views of disabled children with significant communication impairment and their views are often overlooked in planning and service provision. This article describes how the views of children who do not use speech were accessed in research aiming to identify disabled children and young people's priorities regarding outcomes of social care and support services. The main challenge was to develop a method that was reliable, non-threatening, enjoyable and relevant to individual children, as well as enabling children to think beyond their everyday life and express what they aspire to

Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study

Background: Increasing routine HIV testing among key populations is a public health imperative, so improving access to acceptable testing options for those in need is a priority. Despite increasing targeted distribution and uptake of HIV self-sampling kits (SSKs) among men who have sex with men in the UK, little is known about why targeted SSK interventions for black African users are not as wide-spread or well-used. This paper addresses this key gap, offering insight into why some groups may be less likely than others to adopt certain types of SSK interventions in particular contexts. These data were collected during the development phase of a larger study to explore the feasibility and acceptability of targeted distribution of SSKs to black African people. Methods: We undertook 6 focus groups with members of the public who self-identified as black African (n = 48), 6 groups with specialists providing HIV and social services to black African people (n = 53), and interviews with HIV specialist consultants and policy-makers (n = 9). Framework analysis was undertaken, using inductive and deductive analysis to develop and check themes. Results: We found three valuable components of targeted SSK interventions for this population: the use of settings and technologies that increase choice and autonomy; targeted offers of HIV testing that preserve privacy and do not exacerbate HIV stigma; and ensuring that the specific kit being used (in this case, the TINY vial) is perceived as simple and reliable. Conclusions: This unique and rigorous research offers insights into participants’ views on SSK interventions, offering key considerations when targeting this population.. Given the plethora of HIV testing options, our work demonstrates that those commissioning and delivering SSK interventions will need to clarify (for users and providers) how each kit type and intervention design adds value. Most significantly, these findings demonstrate that without a strong locus of control over their own circumstances and personal information, black African people are less likely to feel that they can pursue an HIV test that is safe and secure. Thus, where profound social inequalities persist, so will inequalities in HIV testing uptake – by any means

An Advanced State Estimation Method Using Virtual Meters

-  Power system state estimation is a central component in energy management systems of power system. The goal of state estimation is to determine the system status and power flow of transmission lines. This paper presents an advanced state estimation algorithm based on weighted least square (WLS) criteria by introducing virtual meters. For each bus of network, except slack bus, a virtual meter is considered, using the concept of KCL law. Regarding virtual meter, an improved state estimation algorithm is obtained with higher accuracy and lower computation burden. In the case study, at first, a simple 6-bus test system is presented and the proposed state estimation algorithm is followed step by step. Then, in order to evaluate the effectiveness and applicability of algorithm, IEEE 30-bus and IEEE 118-bus test systems are also taken into consideration. The obtained results verify the usefulness of the proposed method in large size power systems including thousands of buses

Structural cost-optimal design of sensor networks for distributed estimation

In this letter we discuss cost optimization of sensor networks monitoring structurally full-rank systems under distributed observability constraint. Using structured systems theory, the problem is relaxed into two subproblems: (i) sensing cost optimization and (ii) networking cost optimization. Both problems are reformulated as combinatorial optimization problems. The sensing cost optimization is shown to have a polynomial order solution. The networking cost optimization is shown to be NP-hard in general, but has a polynomial order solution under specific conditions. A 2-approximation polynomial order relaxation is provided for general networking cost optimization, which is applicable in large-scale system monitoring

Metal-containing polymers bearing pendant nickel(II) complexes of Goedken\u27s macrocycle

The design, synthesis, and polymerization of a norbornene-based monomer bearing a nickel(II) complex of Goedken\u27s macrocycle (endo-13) and the characterization of the resulting polymer are described. Detailed studies of the ring-opening metathesis polymerization of endo-13 using the 3-bromopyridine adduct of Grubbs\u27 3rd generation catalyst revealed that the polymerization shares many characteristics associated with a living polymer, but deviated from ideal behavior when high degrees of polymerization were targeted. The installation of a 3-hexylphenyl substituent at the macrocyclic backbone allowed for the realization of soluble polymers (14) and shut down an oxidative dimerization pathway commonly associated with metal complexes of Goedken\u27s macrocycle. The cyclic voltammogram of the polymer 14 was comprised of two one-electron oxidation waves (0.21 V and 0.70 V relative to ferrocene/ferrocenium) associated with the stepwise oxidation of the macrocyclic ligand backbone and a one electron reduction wave associated with the reduction of nickel(II) to nickel(I) (-2.07 V). Solution and solid-state UV-vis absorption spectra recorded for polymer 14 revealed a strong p®p* absorption (lmax = 390 nm) and a ligand-to-metal charge transfer band (lmax = 590 nm) typical of nickel(II) complexes of Goedken\u27s macrocycle, and confirmed the absence of macrocycle-macrocycle interactions. This work has ultimately led to the development of a controlled polymerization route to a rare example of a side-chain nickel-containing polymer with potentially useful properties