•Maternal and fetal survival was favorable after severe COVID-19.•Prone positioning was feasible and well tolerated.•Proning or delivery had unclear impacts on maternal ventilation and ...oxygenation.•Airway management preparation includes contingency planning for emergent delivery.
We present the care of 17 consecutive pregnant patients who required mechanical ventilation for Coronavirus Disease 2019 (COVID-19) pneumonia at a quaternary referral center in the United States. We retrospectively describe the management of these patients, maternal and fetal outcomes, as well as the feasibility of prone positioning and delivery.
Between March 2020 and June 2021, all pregnant and postpartum patients who were mechanically ventilated for COVID-19 pneumonia were identified. Details of their management including prone positioning, maternal and neonatal outcomes, and complications were noted.
Seventeen pregnant patients required mechanical ventilation for COVID-19. Thirteen patients received prone positioning, with a total of 49 prone sessions. One patient required extracorporeal membrane oxygenation. All patients in this series survived until at least discharge. Nine patients delivered while mechanically ventilated, and all neonates survived, subsequently testing negative for SARS-CoV-2. There was one spontaneous abortion. Four emergent cesarean deliveries were prompted by refractory maternal hypoxemia or non-reassuring fetal heart rate after maternal intubation.
Overall, maternal and neonatal survival were favorable even in the setting of severe COVID-19 pneumonia requiring mechanical ventilation. Prone positioning was well tolerated although the impact of prone positioning or fetal delivery on maternal oxygenation and ventilation are unclear.
•Quantitative assessment of blood loss (QBL) systems are available.•Introduction of a QBL system suggested differences compared with simple estimation of blood loss.•Differences were in the timing ...and volume of peripartum blood loss.•Recognition of postpartum haemorrhage was enhanced but blood loss lower.•Differences in outcomes associated with QBL varied according to mode of delivery.
Imprecise visual estimates of blood loss contribute to morbidity from postpartum hemorrhage. We examined the impact of quantitative assessment of postpartum blood loss on clinical practice and outcomes.
An observational study comparing blood loss, management and outcomes between two historical cohorts (August 2016 to January 2017 and August 2017 to January 2018) at an academic tertiary care center. Patients in the intervention group (second period) had blood loss quantified compared with visual estimation for controls.
We included 7618 deliveries (intervention group n=3807; control group n=3811). There was an increase in the incidence of hemorrhage (blood loss >1 L) in the intervention group for both vaginal (2.2% vs 0.5%, P <0.001) and cesarean delivery (12.6% vs 6.4%, P <0.001). There was also a difference in median blood loss for vaginal (258 mL 151–384 vs 300 mL 300–350, P <0.001); and for cesarean delivery (702 mL 501–857 vs 800 mL 800–900, P <0.001). The median red blood cell units transfused was different in the intervention group having cesarean delivery (2 units 1–2 vs 2 units 2–2, P=0.043). Secondary uterotonic usage was greater in the intervention group for vaginal (22% vs 17.3%, P <0.001) but not cesarean delivery (7.0% vs 6.0%, P=0.177). Laboratory costs were different, but not the re-admission rate or length of stay.
Quantifying blood loss may result in increased vigilance for vaginal and cesarean delivery. We identified an association between quantifying blood loss and improved identification of postpartum hemorrhage, patient management steps and cost savings.
The ATLAS muon Cathode Strip Chamber (CSC) backend readout system has been upgraded during the LHC 2013-2015 shutdown to be able to handle the higher Level-1 trigger rate of 100 kHz and the higher ...occupancy at Run-2 luminosity. The readout design is based on the Reconfigurable Cluster Element (RCE) concept for high bandwidth generic DAQ implemented on the Advanced Telecommunication Computing Architecture (ATCA) platform. The RCE design is based on the new System on Chip XILINX ZYNQ series with a processor-centric architecture with ARM processor embedded in FPGA fabric and high speed I/O resources. Together with auxiliary memories, all these components form a versatile DAQ building block that can host applications tapping into both software and firmware resources. The Cluster on Board (COB) ATCA carrier hosts RCE mezzanines and an embedded Fulcrum network switch to form an online DAQ processing cluster. More compact firmware solutions on the ZYNQ for high speed input and output fiberoptic links and TTC allowed the full system of 320 input links from the 32 chambers to be processed by 6 COBs in one ATCA shelf. The full system was installed in September 2014. We will present the RCE/COB design concept, the firmware and software processing architecture, and the experience from the intense commissioning for LHC Run 2.
The ATLAS Cathode Strip Chamber system consists of two end-caps with 16 chambers each. The CSC Readout Drivers (RODs) are purpose-built boards encapsulating 13 DSPs and around 40 FPGAs. The principal ...responsibility of each ROD is for the extraction of data from two chambers at a maximum trigger rate of 75 KHz. In addition, each ROD is in charge of the setup, control and monitoring of the on-detector electronics. This paper introduces the design of the CSC ROD software. The main features of this design include an event flow schema that decentralizes the different dataflow streams, which can thus operate asynchronously at its own natural rate; an event building mechanism that associates data transferred by the asynchronous streams belonging to the same event; and a sparcification algorithm that discards uninteresting events and thus reduces the data occupancy volume. The time constraints imposed by the trigger rate have made paramount the use of optimization techniques such as the curiously recurrent template pattern and the programming of critical code in assembly language. The behaviour of the CSC RODs has been characterized in order to validate its performance.
Many models of physics beyond the standard model predict the existence of new Abelian forces with new gauge bosons mediating interactions between "dark sectors" and the standard model. We report a ...search for a dark boson Z' coupling only to the second and third generations of leptons in the reaction e super(+) e super(?)arrowrightmu super(+)mu super(?)Z',Z'arrowrightmu super(+) mu? using 514fb super(?1) of data collected by the BABAR experiment. No significant signal is observed for Z' masses in the range 0.212-10 GeV. Limits on the coupling parameter g' as low as 7x10 super(?4) are derived, leading to improvements in the bounds compared to those previously derived from neutrino experiments.
Solid-phase iron concentrations and generalized composite surface complexation models were used to evaluate procedures in determining uranium sorption on oxidized aquifer material at a proposed U in ...situ recovery (ISR) site. At the proposed Dewey Burdock ISR site in South Dakota, USA, oxidized aquifer material occurs downgradient of the U ore zones. Solid-phase Fe concentrations did not explain our batch sorption test results, though total extracted Fe appeared to be positively correlated with overall measured U sorption. Batch sorption test results were used to develop generalized composite surface complexation models that incorporated the full generic sorption potential of each sample, without detailed mineralogic characterization. The resultant models provide U sorption parameters (site densities and equilibrium constants) for reactive transport modeling. The generalized composite surface complexation sorption models were calibrated to batch sorption data from three oxidized core samples using inverse modeling, and gave larger sorption parameters than just U sorption on the measured solid-phase Fe. These larger sorption parameters can significantly influence reactive transport modeling, potentially increasing U attenuation. Because of the limited number of calibration points, inverse modeling required the reduction of estimated parameters by fixing two parameters. The best-fit models used fixed values for equilibrium constants, with the sorption site densities being estimated by the inversion process. While these inverse routines did provide best-fit sorption parameters, local minima and correlated parameters might require further evaluation. Despite our limited number of proxy samples, the procedures presented provide a valuable methodology to consider for sites where metal sorption parameters are required. These sorption parameters can be used in reactive transport modeling to assess downgradient metal attenuation, especially when no other calibration data are available, such as at proposed U ISR sites.
The process e+e−→π+π−2π0γ is investigated by means of the initial-state radiation technique, where a photon is emitted from the incoming electron or positron. Using 454.3 fb−1 of data collected ...around a center-of-mass energy of s=10.58 GeV by the BABAR experiment at SLAC, approximately 150000 signal events are obtained. The corresponding nonradiative cross section is measured with a relative uncertainty of 3.6% in the energy region around 1.5 GeV, surpassing all existing measurements in precision. Using this new result, the channel’s contribution to the leading order hadronic vacuum polarization contribution to the anomalous magnetic moment of the muon is calculated as (gμπ+π−2π0−2)/2=(17.9±0.1stat±0.6syst)×10−10 in the energy range 0.85 GeV<ECM<1.8 GeV. In the same energy range, the impact on the running of the fine-structure constant at the Z0-pole is determined as Δαπ+π−2π0(MZ2)=(4.44±0.02stat±0.14syst)×10−4. Furthermore, intermediate resonances are studied and especially the cross section of the process e+e−→ωπ0→π+π−2π0 is measured.
Patients with advanced chronic renal disease (CRD) suffer from excessive morbidity and mortality due to complications of accelerated atherosclerosis. Approximately 90% of dialysis-dependent end stage ...renal disease patients suffer from anemia. Recombinant human erythropoietin (EPO) in combination with iron has become widely used to treat anemic CRD patients. While treatment with EPO results in improved quality of life it may also contribute to the development of atherosclerosis. Recent studies suggest that a reduction in nitric oxide (NO) availability may be linked to EPO-induced vascular dysfunction. Furthermore, CRD per se is thought to result in a state of NO deficiency. The present study suggests that EPO may exert proatherogenic activity by augmenting the cytokine-induced expression of monocyte-chemoattractant protein-1 (MCP-1) in human umbilical vein endothelial cells (HUVECs) and by stimulating the proliferation of HUVECs and human vascular smooth muscle cells (HVSMCs). Augmentation of MCP-1 expression appears to be linked to EPO-induced downregulation of endothelial NO synthase (ecNOS). NO released from a series of synthetic donor compounds suppressed the EPO-mediated augmentation of cytokine-induced MCP-1 expression. In vitro studies revealed that EPO reduces ecNOS expression at both the protein and mRNA levels and that EPO also mediates a reduction in ecNOS enzymatic activity. These observations suggest potential mechanisms through which EPO may contribute to the development of accelerated atherosclerosis, particularly in the setting of CRD where NO availability may already be compromised.
We study the process e + e − → e + e − η ′ in the double-tag mode and measure for the first time the γ * γ * → η ′ transition form factor F η′ ( Q 2 1 , Q 2 2 ) in the momentum-transfer range 2 < Q 2 ...1 , Q 2 2 < 60 GeV 2 . The analysis is based on a data sample corresponding to an integrated luminosity of around 469 fb − 1 collected at the PEP-II e + e − collider with the BABAR detector at center-of-mass energies near 10.6 GeV.
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