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To assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation.
Fifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear.
The Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences.
Tranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.
Introduction: Head injury is a common presentation to all emergency departments. Previous research has shown that such injuries may be complicated by delayed intracranial hemorrhage (D-ICH) after the initial scan is negative. Exposure to anticoagulant or anti-platelet medications (ACAP) may be a risk factor for D-ICH. We have conducted a systematic review and meta-analysis to determine the incidence of delayed traumatic intracranial hemorrhage in patients taking anticoagulants, anti-platelets or both. Methods: The literature search was conducted in March 2017 with an update in April 2017. Keyword and MeSH terms were used to search OVID Medline, Embase and the Cochrane database as well as grey literature sources. All cohort and experimental studies were eligible for selection. Inclusion criteria included pre-injury exposure to oral anticoagulant and / or anti-platelet medication and a negative initial CT scan of the brain (CT1). The primary outcome was delayed intracranial hemorrhage present on repeat CT scan (CT2) within 48 hours of the presentation. Only patients who were rescanned or observed minimally were included. Clinically significant D-ICH were those that required neurosurgery, caused death or necessitated a change in management strategy, such as admission. Results: Fifteen primary studies were ultimately identified, comprising a total of 3801 patients. Of this number, 2111 had a control CT scan. 39 cases of D-ICH were identified, with the incidence of D-ICH calculated to be 1.31% (95% CI [0.56, 2.27]). No more than 12 of these patients had a clinically significant D-ICH representing 0.09% (95% CI [0.00, 0.31]). 10 of them were on warfarin and two on aspirin. There were three deaths recorded and three patients needed neurosurgery. Conclusion: The relatively low incidence suggests that repeat CT should not be mandatory for patients without ICH on first CT. This is further supported by the negligibly low rate of clinically significant D-ICH. Evidence-based assessments should be utilised to indicate the appropriate discharge plan, with further research required to guide the balance between clinical observation and repeat CT.
New simultaneous X-ray and radio observations of the archetypal mode-switching pulsar PSR B0943+10 have been carried out with XMM-Newton and the LOFAR, LWA and Arecibo radio telescopes in November 2014. They allowed us to better constrain the X-ray spectral and variability properties of this pulsar and to detect, for the first time, the X-ray pulsations also during the X-ray-fainter mode. The combined timing and spectral analysis indicates that unpulsed non-thermal emission, likely of magnetospheric origin, and pulsed thermal emission from a small polar cap are present during both radio modes and vary in a correlated way.
The evolution of the multipolar structure of the magnetic field of isolated neutron stars is studied assuming the currents to be confined to the crust. Lower orders (≤ 25) of multipole are seen to evolve in a manner similar to the dipole suggesting little or no evolution of the expected pulse shape. We also study the multifrequency polarization position angle traverse of PSR B0329+54 and find a significant frequency dependence above 2.7 GHz. We interpret this as an evidence of strong multipolar magnetic field present in the radio emission region.
The advent of aberration correction for transmission electron microscopy has transformed atomic resolution imaging into a nearly routine technique for structural analysis. Now an emerging frontier in electron microscopy is the development of in situ capabilities to observe reactions at atomic resolution in real time and within realistic environments. Here we present a new in situ gas cell holder that is designed for compatibility with a wide variety of sample type (i.e., dimpled 3-mm discs, standard mesh grids, various types of focused ion beam lamellae attached to half grids). Its capabilities include localized heating and precise control of the gas pressure and composition while simultaneously allowing atomic resolution imaging at ambient pressure. The results show that 0.25-nm lattice fringes are directly visible for nanoparticles imaged at ambient pressure with gas path lengths up to 20 μm. Additionally, we quantitatively demonstrate that while the attainable contrast and resolution decrease with increasing pressure and gas path length, resolutions better than 0.2 nm should be accessible at ambient pressure with gas path lengths less than the 15 μm utilized for these experiments.
We agree whole-heartedly with Ruggs et al. (2013) call to focus more research attention on the workplace experiences of marginalized employees. Indeed, the authors raised many valid points concerning the needed contributions of industrial and organizational (I–O) psychology to both research and public policy as it relates to marginalized groups. However, we believe that the authors also missed an opportunity to highlight the workplace discrimination experienced by those individuals who are marginalized by their darker skin tones. This form of discrimination is more commonly known as colorism. Subsequently, our commentary focuses on defining this form of discrimination that is not well known among I–O psychologists, explaining why our field should be concerned with studying colorism, and making recommendations regarding how our field can better study colorism, affect jurisprudence on the issue, and ameliorate colorism's effects in workplace settings.
IC443 is a relatively large Galactic (≈45 arcmin) SNR with a high radio surface brightness. It has fine scale structure down to arcsec scales, and so is difficult to image on all angular scales with a single instrument. Here observations of IC443 at 151 MHz made with both the GMRT and the CLFST are combined to give a composite image of IC443 on all scales from >45 arcmin down to ≈20 arcsec.
We present the key assumptions and results of a newly developed theory in
order to account for the self-consistent cascade effects of counterion
condensation and volume collapse of polyeletrolyte gels. In the present
theory, the role of the specificity and valency of counterions on the volume
transitions are also treated. These features and the fluctuations of monomer
concentration and local electrolyte charge density are included on top of
the familiar features of the Flory-Huggins theory and the classical rubber
elasticity theory in the previously used Flory-Dusek-Patterson-Tanaka theory
of polyelectrolyte gels. We have computed the swelling equilibria by
satisfying the multicomponent nature of the system and the Donnan
equilibria. A few major effects are illustrated in terms of the dependence
of volume transition on the solvent quality, temperature, salt
concentration, valency and specificity of the counterion, and polymer charge
density. Criteria for the emergence of a reentrant volume transition are
Two different atmospheric pressure microplasma systems are discussed and used for the synthesis and surface engineering of a range of nanomaterials. Specifically a gas-phase approach from vaporized tetramethylsilane has been used to synthesize silicon carbide nanoparticles with diameters below 10 nm. A different microplasma system that interfaces with a liquid solution has then been used for the synthesis of surfactant-free electrically stabilized gold nanoparticles with varying size. A similar microplasma-liquid system has been finally successfully used to tailor surface properties of silicon nanoparticles and to reduce graphene oxide into graphene. The synthesis and surface engineering mechanisms are also discussed.
The material characterization toolbox has recently experienced a number of parallel revolutionary advances, foreshadowing a time in the near future when material scientists can quantify material structure evolution across spatial and temporal space simultaneously. This will provide insight to reaction dynamics in four-dimensions, spanning multiple orders of magnitude in both temporal and spatial space. This study presents the authors’ viewpoint on the material characterization field, reviewing its recent past, evaluating its present capabilities, and proposing directions for its future development. Electron microscopy; atom probe tomography; x-ray, neutron and electron tomography; serial sectioning tomography; and diffraction-based analysis methods are reviewed, and opportunities for their future development are highlighted. Advances in surface probe microscopy have been reviewed recently and, therefore, are not included [D.A. Bonnell et al.: Rev. Modern Phys. in Review]. In this study particular attention is paid to studies that have pioneered the synergetic use of multiple techniques to provide complementary views of a single structure or process; several of these studies represent the state-of-the-art in characterization and suggest a trajectory for the continued development of the field. Based on this review, a set of grand challenges for characterization science is identified, including suggestions for instrumentation advances, scientific problems in microstructure analysis, and complex structure evolution problems involving material damage. The future of microstructural characterization is proposed to be one not only where individual techniques are pushed to their limits, but where the community devises strategies of technique synergy to address complex multiscale problems in materials science and engineering.
This paper investigates the effect of solute in Al alloys on grain boundary character and mobility based on experiments in which individual boundaries migrate under a stored energy driving pressure acquired from prior plastic strain; among those studied are Zr, Fe and Si. A compensation effect is noted for both alloys studied with respect to both temperature and solute content. As supported by the literature, boundaries exhibit a maximum mobility for a 38-39°<111> misorientation in initial annealing experiments; this mobility maximum is asymmetric with a sharp cutoff below 38-39° but a more gradual decrease at misorientations beyond 40°. The presence of a minimum at 38-39° is found at both higher temperatures and higher solute concentrations. A shift in texture dependency with solute and temperature is also observed. This transition from a local mobility maximum to a minimum is discussed within the context of recent developments in solute drag theory.
a-Si:H films rf sputtered in 10 mT He and 0.5 mT H2, in contrast to those prepared in Ar/H2 or Xe/H2, exhibit port depositional oxidation when sputtered at power levels of 0.55 – 3.3 W/cm2 (100 – 600W). SEM measurements show that the morphology of the films evolves from a cracked, microcrystalline, glassy one at higher rf power levels to a porous one at low power levels. This trend is also correlated with a sharply increasing density of Si-H2 dihydride bonds at decreasing rf levels. Auger depth profiles of the oxygen concentration in the films agree with a diffusion controlled process of a source solute of O2 molecules into a semi-infinite solid solvent. Yet IR absorption measurements indicate that the oxygen is confined to the internal surfaces of the microvoids. The diffusion constant is a very sensitive functi n of the sputtering conditions. At low rf power levels, it is as low as 10−16 – 10−1 cm2 /sec at room temperature, but increases to ∼10−13 at 250 – 350°C.These results are discussed in terms of a porous network of microvoids, through which the O2 “squeezes” into the film.
The effect of substrate bias on the properties of rf sputtered boron nitride films on Si and GaAs substrate were investigated. IR transmission and reflectivity of films with different substrate bias were measured with Perkin Elmer 983 IR spectroscopy. From the IR reflectivity data, transverse optical mode(TO) and longitudinal optical mode(LO) frequencies were derived by fitting Kramer-Kronig model. Absorption coefficient was determined from IR transmission data. The resultant TO and LO modes showed that substrate bias caused broadening of reststrahlen band of rf sputtered boron nitride. We also tried to dope boron nitride films with silicon by alternate sputtering of BN and Si targets controlling sputtering time of each target followed by annealing. Electrical resistivity was measured over the temperature range between 175 K to 370 K for both intrinsic and Si-doped boron nitride films. Intrinsic rf sputtered boron nitride showed Little change in resistivity (109 Ω cm - 1011 Ω cm ) over the temperature range studied. While Si doped BN showed linear change in resistivity with increasing temperature and its activation energy was about 0.22 eV. The effect of substrate bias was also investigated by monitoring the XPS core level spectra of both Bis and N Is peaks, respectively. Substrate bias caused the shift of both B ls and N ls peak to higher binding energy. The effect of substrate bias on refractive index was also studied.