scholarly journals Amniodrainage-Induced Circulatory Dysfunction in Women Treated for Twin-To-Twin Transfusion Syndrome

2020 ◽  
Vol 9 (7) ◽  
pp. 2085
Author(s):  
Patrick Greimel ◽  
Philipp Klaritsch ◽  
Holger Simonis ◽  
Bence Csapó ◽  
Maximilian Pohl ◽  
...  
Keyword(s):  
High Volume ◽  
Maternal Blood ◽  
Hemodynamic Changes ◽  
Intrauterine Pressure ◽  
Blood Characteristics ◽  
Relative Blood Volume ◽  
The Impact ◽  
Twin Pregnancies ◽  
Underlying Pathophysiology ◽  
Placental Thickness

Twin-to-twin transfusion syndrome (TTTS) in monochorionic-diamniotic twin pregnancies usually requires fetoscopic laser ablation (FLA) followed by amniodrainage (AD). Perioperative maternal hemodynamic changes and hemodilution have been observed. Little is known about the underlying pathophysiology. We aimed to evaluate the impact of high volume amniodrainage on intrauterine pressure, placental thickness and maternal blood characteristics. A total of 18 cases of TTTS were included in this prospective pilot study. All patients were treated with FLA and subsequent AD. Intrauterine pressure and placental thickness were assessed before, during and after amniodrainage. Maternal hemoglobin, hematocrit and serum albumin were measured at admission and 24 h after the intervention. Amniodrainage led to a decrease in mean intrauterine pressure (from 30.1 ± 8.1 mmHg to 17.6 ± 3.6 mmHg (p < 0.001)) and an increase in mean placental thickness (from 16.8 ± 6.4 mm to 31.83 ± 8.64 mm (p < 0.001)). There was a positive correlation between changes in placental thickness and the amount of amniodrainage during intervention (Pearson’s Rho 0.73; p = 0.001). Hematocrit decreased from 33.4 ± 3.8 (%) to 28.4 ± 3.5 (%), i.e., an increase in relative blood volume by 18 ± 10.2% (p < 0.001). Albumin decreased from 37.9 ± 0.9 g/L to 30.7 ± 2.2 g/L, i.e., an increase in relative plasma volume by 24 ± 8.1% (p < 0.001). Amniodrainage leads to uterine decompression, increased placental thickness and subsequent maternal hemodilution. We propose the term “amniodrainage-induced circulatory dysfunction” for these specific maternal hemodynamic changes in the treatment of twin-to-twin transfusion syndrome.

scholarly journals Maternal Complications and Hemodynamic Changes Following Intrauterine Interventions for Twin-to-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies

2019 ◽  
Vol 8 (5) ◽  
pp. 605 ◽  
Author(s):  
Patrick Greimel ◽  
Angela Zenz ◽  
Bence Csapó ◽  
Martin Haeusler ◽  
Uwe Lang ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Clinical Findings ◽  
Hemodynamic Changes ◽  
Maternal Complications ◽  
Maternal Heart Rate ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Blood Characteristics ◽  
The Impact ◽  
Twin Pregnancies

Twin-to-twin transfusion syndrome (TTTS) is a challenging complication in monochorionic diamniotic (MCDA) twins. Intrauterine interventions, such as fetoscopic laser ablation and cord occlusion followed by amniodrainage, are established treatments. Little is known about maternal complications and hemodynamics following these interventions. We performed a retrospective analysis of maternal procedure-related complications and the impact of such procedures on maternal hemodynamics and blood characteristics. Within the study period, 100 women with severe TTTS treated by fetoscopic laser ablation (FLA) or cord occlusion (CO) were identified. Clinically relevant maternal complications were reported in four (4%) cases. There was a significant decrease in hemoglobin, hematocrit, and albumin between admission and postoperative measurements (all p < 0.001). Systolic and diastolic blood pressure, as well as maternal heart rate, decreased from time of skin suture to postoperative measurements (all p < 0.001). Within a 24 h interval, there was a positive correlation between hematocrit (Spearman’s rho 0.325; p = 0.003), hemoglobin (Spearman’s rho 0.379; p < 0.001), and albumin (Spearman’s rho 0.360; p = 0.027), and the amount of amniodrainage during the intervention. Maternal procedure-related complications are relatively rare. Significant hemodynamic alterations and maternal hemodilution are common clinical findings following intrauterine interventions.

scholarly journals INFLUENCE OF THE DEGREE OF OBESITY AND HIGH-VOLUME LIPOSUCTIONON BODY COMPOSITION, HEMODYNAMIC CHANGES, BLOOD OXYGEN

2014 ◽  
Vol 6 (4) ◽  
pp. 32-38
Author(s):  
I P Nikolaeva ◽  
A S Kapranova ◽  
V B Popova ◽  
A N Lodyagin ◽  
T A Frolova
Keyword(s):  
Body Composition ◽  
Blood Volume ◽  
Large Volume ◽  
Myocardial Dysfunction ◽  
Extracellular Fluid ◽  
High Volume ◽  
Stroke Index ◽  
Blood Oxygen ◽  
Hemodynamic Changes ◽  
The Impact

To evaluate the influence of the degree of obesity and high-volume liposuction on body composition, hemodynamic, blood oxygen. The actual values of the cardiac index and stroke index, as well as the calculation of these indicators on a body surface area of the "ideal subject" showed a significant correlation with body mass index, which confirms the impact of obesity on hemodynamic changes, myocardial dysfunction and the development of severe arterial hypoxemia. Analysis of the parameters of liquid sectors body showed insufficient increase in total, extracellular fluid and blood volume by a significant rise of fat and muscle mass. It is believed that the increase in blood volume in obesity is adaptive in nature and occurs in response to expansion of the vascular bed with increasing body weight. After liposuction large volume of significant hemodynamic changes were not obtained. In the late period against reduction in fat mass oxygenizing improved lung function. Carrying a large volume liposuction are not adversely impact on the reserve possibilities myocardial hemodynamics in the long term. Timely diagnosis of adaptive changes in hemodynamics and fluid sectors organism, which can be considered as prognostic risk factors must be considered when choosing the volume lipoaspiration.

The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
R Patel ◽  
CL Kemp ◽  
M Hafejee ◽  
N Peckham ◽  
...  
Keyword(s):  
Scoping Review ◽  
High Volume ◽  
Cardiovascular Outcomes ◽  
High Dose ◽  
Funding Sources ◽  
Review Protocol ◽  
The Mean ◽  
The Impact ◽  
Over Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.

scholarly journals A Comparative UAV Forensic Analysis: Static and Live Digital Evidence Traceability Challenges

Drones ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 42
Author(s):  
Fahad E. Salamh ◽  
Umit Karabiyik ◽  
Marcus K. Rogers ◽  
Eric T. Matson
Keyword(s):  
High Volume ◽  
Forensic Analysis ◽  
Digital Evidence ◽  
Incident Response ◽  
Scientific Contribution ◽  
Response Plan ◽  
Technical Challenges ◽  
And Control ◽  
The Impact ◽  
Categorization Model

The raising accessibility of Unmanned Aerial Vehicles (UAVs), colloquially known as drones, is rapidly increasing. Recent studies have discussed challenges that may come in tow with the growing use of this technology. These studies note that in-depth examination is required, especially when addressing challenges that carry a high volume of software data between sensors, actuators, and control commands. This work underlines static and live digital evidence traceability challenges to further enhance the UAV incident response plan. To study the live UAV forensic traceability issues, we apply the `purple-teaming’ exercise on small UAVs while conducting UAV forensic examination to determine technical challenges related to data integrity and repeatability. In addition, this research highlights current static technical challenges that could pose more challenges in justifying the discovered digital evidence. Additionally, this study discusses potential drone anti-forensic techniques and their association with the type of use, environment, attack vector, and level of expertise. To this end, we propose the UAV Kill Chain and categorize the impact and complexity of all highlighted challenges based on the conducted examination and the presented scientific contribution in this work. To the best of our knowledge, there has not been any contribution that incorporates `Purple-Teaming’ tactics to evaluate UAV-related research in cybersecurity and digital forensics. This work also proposes a categorization model that classifies the discovered UAV static and live digital evidence challenges based on their complexity and impact levels

scholarly journals The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Giorgia Gon ◽  
Abdunoor M. Kabanywanyi ◽  
Petri Blinkhoff ◽  
Simon Cousens ◽  
Stephanie J. Dancer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Study Design ◽  
Low Income ◽  
High Volume ◽  
Surface Cleaning ◽  
Low Income Countries ◽  
Training Period ◽  
Future Research ◽  
Environmental Hygiene ◽  
The Impact

Abstract Background Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. Methods This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. Results Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. Conclusions The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

scholarly journals Effects of COVID-19 Pandemic on the Treatment of Pancreatic Cancer: A Perspective from Central Europe

2021 ◽  
Vol 38 (2) ◽  
pp. 158-165
Author(s):  
Ilaria Pergolini ◽  
I. Ekin Demir ◽  
Christian Stöss ◽  
Klaus Emmanuel ◽  
Robert Rosenberg ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Central Europe ◽  
Pancreatic Surgery ◽  
Online Survey ◽  
Viral Infections ◽  
High Volume ◽  
Tumor Board ◽  
Standards Of Care ◽  
The Impact

Background: This survey aimed to register changes determined by the COVID-19 pandemic on pancreatic surgery in a specific geographic area (Germany, Austria, and Switzerland) to evaluate the impact of the pandemic and obtain interesting cues for the future. Methods: An online survey was designed using Google Forms focusing on the local impact of the pandemic on pancreatic surgery. The survey was conducted at 2 different time points, during and after the lockdown. Results: Twenty-five respondents (25/56) completed the survey. Many aspects of oncological care have been affected with restrictions and delays: staging, tumor board, treatment selection, postoperative course, adjuvant treatments, outpatient care, and follow-up. Overall, 60% of respondents have prioritized pancreatic cancer patients according to stage, age, and comorbidities, and 40% opted not to operate high-risk patients. However, for 96% of participants, the standards of care were guaranteed. Discussion/Conclusions: The first wave of the COVID-19 pandemic had an important impact on pancreatic cancer surgery in central Europe. Guidelines for prompt interventions and prevention of the spread of viral infections in the surgical environment are needed to avoid a deterioration of care in cancer patients in the event of a second wave or a new pandemic. High-volume centers for pancreatic surgery should be preferred and their activity maintained. Virtual conferences have proven to be efficient during this pandemic and should be implemented in the near future.

Twin Pregnancies Complicated by a Single Malformed Fetus: Chorionicity, Outcome and Management

2010 ◽  
Vol 13 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Ali Gedikbasi ◽  
Alpaslan Akyol ◽  
Gokhan Yildirim ◽  
Ali Ekiz ◽  
Ahmet Gul ◽  
...  
Keyword(s):  
Gestational Age ◽  
Statistical Significance ◽  
Expectant Management ◽  
Control Group ◽  
Study Group ◽  
Preliminary Evaluation ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Twin Pregnancies ◽  
Age At Birth

The objective of this study was to evaluate the impact of one abnormal fetus in a twin pregnancy, to compare impact of chorionicity and clinical outcome of intervention and expectant management. Thirty-seven dichorionic (DC) twins and 18 monochorionic (MC) twins complicated with one malformed fetus were evaluated for gestational age, birthweight and perinatal outcome. Six hundred and forty-two twin pregnancies were evaluated in the database. The control groups consisted of 429 DC and 86 MC twins without anomalous fetus. Mean birthweight and gestational age at birth for DC control group were (n= 429; 2137g and 34.71 weeks), DC study group,n= 37; 2117g (p= .338) and 33.97 weeks (p= .311), and DC study group with major malformations,n= 30; 2019g (p= .289) and 33.3 weeks (p= .01), and showed only significance for gestational age. There was no statistical significance between MC control group,n= 86; 2097g and 34.93 weeks, and MC study group,n= 18; 2237g (p= .338), and 34.42 weeks (p= .502). Because of limited data, the preliminary evaluation for expectant management and intervention, and survival of at least one normal fetus showed no impact. We conclude that, although, all DC twin pregnancies have a risk for preterm delivery, DC twins complicated with major malformation of one twin, have a lower mean gestational age at birth. Preliminary results for intervention does not improve fetal outcome for DC and MC twins and needs further evaluation with greater studies of impact or review.

Analysis of Big Data Analytics in Healthcare Sector: Applications and Tools

2020 ◽  
Vol 17 (12) ◽  
pp. 5605-5612
Author(s):  
A. Kaliappan ◽  
D. Chitra
Keyword(s):  
Big Data ◽  
Data Analytics ◽  
Health Sector ◽  
Big Data Analytics ◽  
High Volume ◽  
Healthcare Sector ◽  
Genome Database ◽  
Tremendous Amount ◽  
The Impact ◽  
Different Sources

In today’s world, an immense measure of information in the form of unstructured, semi-structured and unstructured is generated by different sources all over the world in a tremendous amount. Big data is the termed coined to address these enormous amounts of data. One of the major challenges in the health sector is handling a high-volume variety of data generated from diverse sources and utilizing it for the wellbeing of human. Big data analytics is one of technique designed to operate with monstrous measures of information. The impact of big data in healthcare field and utilization of Hadoop system tools for supervising the big data are deliberated in this paper. The big data analytics role and its theoretical and conceptual architecture include the gathering of diverse information’s such as electronic health records, genome database and clinical decisions support systems, text representation in health care industry is investigated in this paper.

An investigation of the mass-market fashion design process

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prabod Dharshana Munasinghe ◽  
D.G.K. Dissanayake ◽  
Angela Druckman
Keyword(s):  
Design Process ◽  
Market Design ◽  
High Volume ◽  
Design Stage ◽  
Fashion Design ◽  
Structured Interviews ◽  
Mass Market ◽  
Content Type ◽  
Responsible Consumption ◽  
The Impact

Purpose The process of fashion design varies between market segments, yet these variations have not yet been properly explored. This study aims to examine the fashion design process as practised at the mass-market level, as this is the most vibrant and the largest market segment in terms of production volumes and sales. Design/methodology/approach It is observed that 15 semi-structured interviews were conducted with mass-market fashion designers. Key activities of the mass-market design process were identified and a comparative analysis was conducted with the general design process. Findings The mass-market design process is found to prioritise profits rather than aesthetic aspects, with the buyer exercising more power than the designer. This hinders creativity, which, in turn, may impede a move towards more environmentally benign designs. Originality/value The clothing industry is responsible for high environmental impacts and many of these impacts arise through decisions made in the design stage. In particular, the mass-market for clothing because of its high volume of sales and fast throughput, accounts for a great deal of the impact. However, little is understood about the design process that is practised in the mass-fashion market. This paper fills the gap by developing a framework that describes the mass-market design process. Understanding the design process will enable progress to be made towards achieving the United Nations Sustainable Development Goal 12: Responsible Consumption and Production.

Abstract P141: Global Impact of Covid-19 Pandemic on Acute Stroke and Mechanical Thrombectomy - An International Survey

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dileep R Yavagal ◽  
Vasu Saini ◽  
Violiza Inoa ◽  
Hannah E Gardener ◽  
Sheila O Martins ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
High Volume ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Treatment Practices ◽  
Global Impact ◽  
Significant Difference ◽  
The World ◽  
The Impact

Introduction: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on thrombectomy practice. Methods: A 19-item questionnaire survey aimed to identify the changes in stroke volumes and treatment practices seen during COVID-19 pandemic was designed using Qualtrics software. It was sent to stroke and neuro-interventional physicians around the world who are part of the executive committee of a global coalition, Mission Thrombectomy 2020 (MT2020) between April 5 th to May 15 th , 2020. Results: There were 113 responses across 25 countries. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during COVID-19 pandemic compared to immediately preceding months (Figure 1A-B). This overall median decrease was despite a median increase in stroke volume in 4 European countries which diverted all stroke patients to only a few selected centers during the pandemic. The intubation policy during the pandemic for patients undergoing MT was highly variable across participating centers: 44% preferred intubating all patients, including 25% centers that changed their policy to preferred-intubation (PI) vs 27% centers that switched to preferred-conscious-sedation (PCS). There was no significant difference in rate of COVID-19 infection between PI vs PCS (p=0.6) or if intubation policy was changed in either direction (p=1). Low-volume (<10 stroke/month) compared with high-volume stroke centers (>20 strokes/month) are less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers are more likely to report them to be inadequate (58% vs 92%). Conclusion: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic.

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