Quantifying Maternal Blood Loss from the Hysterotomy at Cesarean Delivery

Authors: Rebecca M. Reimers, Daniela Carusi, Michaela K. Farber, James A. Greenberg

Background: With newer protocols, such as delayed cord clamping, becoming routine practice, determining the potential maternal consequences is important. In particular, establishing normative values for blood loss from the hysterotomy would be helpful in addressing techniques to minimize total blood loss for cesarean deliveries. Objective: Blood loss from the hysterotomy during cesarean delivery has not been reported using quantitative methods. We aimed to quantify the rate of blood loss during cesarean delivery from the hysterotomy between creation and closure. Methods: This single center, prospective, case series was collected in 2018. Women with singleton pregnancies undergoing cesarean delivery at ≥37 0/7 weeks at Brigham and Women’s Hospital were included. Delayed cord clamping was performed which allowed for quantification of blood loss through gravimetric methods and descriptive statistics were performed. Results: Twenty patients were included. The mean hysterotomy closure delay for cord blood collection was 47 seconds (SD 10.2) and the mean maternal blood volume collected was 110.8 mL (SD 53.4 mL). Blood loss per minute was calculated with a median of 150 mL/minute (IQR 88.8 mL, 95% CI 109.2 – 190.4 mL). The mean post-operative hematocrit drop was 4.4%, and there were no blood transfusions. There was a single hysterotomy extension and a quantified blood loss of 413 mL per minute. Conclusion: We found a mean blood loss of 150 mL/min without hysterotomy extension. With a hysterotomy extension, the blood lost per minute was more profound. This normative data can be helpful for surgical planning with regards to delayed cord clamping or cord blood collection for banking.


Journal: Open Journal of Obstetrics and Gynecology
DOI: 10.4236/ojog.2020.1080091(PDF)
Paper Id: 101930 (metadata)

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The Rise and Fall of Small Business Enterprises

Authors: Falih M. Alsaaty, Hany H. Makhlouf

Small business is universally recognized as the engine of the world economy. It is praised for adding substantially to every country’s gross domestic product (GDP), employment, innovative ability, and tax base. However, the survival rate of small businesses in their first ten years of operation is not high. Only about 20 percent of new business enterprises survive beyond their first ten years. Of those few are referred to as gazelles because they grow fast into medium and large corporations, but many prefer to remain small. This study, which is written to students and potential entrepreneurs, explores the strengths and weaknesses of small business enterprises and the factors that contribute to their success or failure. Hopefully, it would contribute to the literature in the fields of entrepreneurship and small business administration.


Journal: Open Journal of Business and Management
DOI: 10.4236/ojbm.2020.84116(PDF)
Paper Id: 101924 (metadata)

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Transition States for Shock Induced Chemical Reactions in Binary Energetic Materials

Authors: Vindhya Narayanan, Sathya Hanagud

In this paper, numerical simulation of shock induced chemical reactions of a thermite mixture of binary energetic material, aluminum and iron oxide, are discussed. To initiate the chemical reactions, the impact or the shockwave should supply the energy to take the reactants, aluminum and iron oxide, to the transition state. Thus, for any numerical simulation of the shock or impact induced chemical reaction in a continuum or mesoscale, it is necessary to identify the transition state. The transition state for the thermite mixture, of aluminum and iron oxide, is identified in this paper and a result from a numerical simulation of the shock induced chemical reaction, in a continuum scale is presented.


Journal: Journal of Materials Science and Chemical Engineering
DOI: 10.4236/msce.2020.87003(PDF)
Paper Id: 101854 (metadata)

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Reduced Life Expectancy Model Analyses of Exposure Time Effects of Endocrine Disruptors to Teleost Fishes Based on Effect Concentration of Hepatic Biomarkers

Authors: Mengtian Sun, Hualong Chen, Ling Zhao

In this current paper, the exposure time effects on four endocrine disruptors and teleost fishes were evaluated using the reduced life expectancy (RLE) model based on the effect concentration (EC50) of available literature published. The result on the regression analysis over different exposure times has demonstrated that the EC50 of hepatic biomarkers falls with increasing exposure times in a predictable manner. The slopes of the regression equations reflect the strength of the toxic effects on the various teleost fish. The EC50 reduction over time can be interpreted based on the bioconcentration process, which can be used to understand transfer routes of the compounds from water to fish body. RLE model also provides useful information in assessing the toxic effects on fish life expectancy as a result of the occurrence of compounds.


Journal: Journal of Environmental Protection
DOI: 10.4236/jep.2020.117032(PDF)
Paper Id: 101812 (metadata)

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Improving the Accuracy of Under-Fog Driving Assistance System

Author: Bedine Kerim

Driving in fog condition is dangerous. Fog causes poor visibility on roads leading to road traffic accident (RTA). RTA in Albaha is common because of its rough terrain, in addition to the climate that is mainly rainy and foggy. The rain season in Albaha region begins in October to February characterized by rainfall and fog. Many studies have reported the adverse effects of the rain on RTA which results in an increased rate of crashes. On the other hand, Albaha region is not supported by a proper intelligent transportation system and infrastructure. Thus, a Driver Assistance System (DAS) that requires minimum infrastructure is needed. A DAS under fog called No_Collision has been developed by a researcher in Albaha University. This paper discusses an implementation of adaptive Kalman Filter by utilizing Fuzzy logic system with the aim to improve the accuracy of position and velocity prediction of the No_Collision system. The experiment results show a promising adaptive system that reduces the error percentage of the prediction up to 56.58%.


Journal: Journal of Signal and Information Processing
DOI: 10.4236/jsip.2020.112002(PDF)
Paper Id: 101784


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A Qualitative Assessment of a Modified Multilevel Converter Topology M2LeC for Lightweight Low-Cost Electric Propulsion

Authors: Paul H. Riley, Obrad Dordevic, Keith Pullen, Liliana DeLilo, Massimo De Giorgio

A Cascade H Bridge (CHB) is evaluated for both electric vehicle motor traction control and off-vehicle charging against the Power ElectronicsUK Automotive Challenge for cost and mass for the year 2035. By combining the power electronics with batteries using low-voltage MOSFET transistors in a series cascade arrangement the cost and mass targets could be met 12 years earlier (in 2023 and 20 times lighter if an application specific integrated circuit (ASIC) is used. A 200 kW peak reference car was used to evaluate cost and mass benefits using four different topologies of power electronics. Vehicle installation is shown to be simplified as only passive cooling is required removing the need for liquid cooling systems and the arrangement is inherently safe; no high voltages are present when the vehicle is stationary. The inherently higher efficiency of CHB increases vehicle range. The converter with integrated batteries can also behave as an integrated on-board battery charger delivering additional off-vehicle benefits by removing the need for costly external chargers.


Journal: Engineering
DOI: 10.4236/eng.2020.127035(PDF)
Paper Id: 101749 (metadata)

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Instituting Pandemic Plans in a Singapore Anaesthesia Unit: The Challenges and Learning Points

Authors: Lydia Weiling Li, Prit Anand Singh, Chou Liang Mah, Ong Lay Teng,
Qian Jun Tong, Xiang Long Louis Ng

The World Health Organization declared COVID-19 as a pandemic on 11 March 2020. Its rapid spread has put a strain on healthcare systems globally. Singapore ranked the highest in terms of reported cases outside of China in the first few weeks of this outbreak. The management of a patient with COVID-19 in the Operating Theatre (OT) presents a unique set of challenges to the Anaesthetist. Delivery of timely and quality care must be upheld while reducing the risk of transmission to healthcare staff and other patients. This article describes our Anaesthesia Unit’s experiences and challenges in instituting our pandemic plans. The authors hope that the sharing of our experience and practical approach would be useful to other Anaesthesia Units worldwide.


Journal: Open Journal of Anesthesiology
DOI: 10.4236/ojanes.2020.107023(PDF)
Paper Id: 101700 (metadata)

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Research on the Development Path of Cultural and Creative Industries in the Digital Economy Era

Author: Lijuan Mao

In November 2016, the “Thirteenth Five-Year Plan for the Development of National Strategic Emerging Industries” issued by the State Council added digital creative industries. It was the first time that digital creative industries were included in the national strategic emerging industries, which means the development of digital creative industries entered a new stage. The rapid development of the digital economy has affected and impacted the cultural and creative industries. This article explains the connotation and characteristics of the cultural and creative industries in the digital economy era, and analyzes the development path of the cultural and creative industries. The cultural and creative industries in the digital economy era is based on the cultural industry, combined with digital technology, with the creative knowledge of individuals or enterprises as the core, the production creation process and results have added value of the cultural industry; the cultural and creative industries in the digital economy era is innovative, economic and networking. After a brief analysis of the current problems in the cultural and creative industries, this article proposes to strengthen the intellectual property protection of the cultural and creative industries, improve the cultural and creative industries talent training system, improve the cultural and creative industries policies and management mechanisms, gain a foot on the global cultural and creative market, and open minds to develop cultural and creative industries.


Journal: American Journal of Industrial and Business Management
DOI: 10.4236/ajibm.2020.107082(PDF)
Paper Id: 101685 (metadata)

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The Hidden Life of the Historical System of Rural Roads in a Sector of the Guadarrama Mountains, Central Spain

Author: Ángel Paniagua

Historical geography has had as a preferred area of study of rural landscapes and societies in the past. In the context of the new rural geography, a road system is analyzed and its historical evolution is used as the source to make a narrative interpretation of the landscape. This narrative interpretation is understood as the evolutionary expression of different values, traditions, actions and hopes of the inhabitants of the area in the course of history. From this perspective, the paths can be used to establish an adequate continuity between the past and the present. The methodology combines the use of cartography, territorial recognition and in-depth surveys. The case study is a sector of the Sierra de Guadarrama located in central Spain.


Journal: Advances in Applied Sociology
DOI: 10.4236/aasoci.2020.107016(PDF)
Paper Id: 101640 (metadata)

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Behavior of Antibiotic-Resistant Fecal Coliforms in the Stream of a Sewage Treatment Plant in Tokyo

Authors: Naoto Urano, Masahiko Okai, Yusuke Tashiro, Azusa Takeuchi, Rintaro Endo, Masami Ishida, Masachika Takashio

We are confronting a new threat in the prevalence of antibiotic-resistant bacteria followed by epidemic spread in aquatic environments in metropolitan areas because damage from river floods is increasing remarkably in Japan due to global extreme weather. The sewer penetration rate is about 100% in Tokyo and reclaimed water from sewage treatment plants accounts for over 50% of all water in both the down- and mid-stream areas of local rivers. The water quality of these rivers, which contain microflora, seems to be seriously affected by reclaimed water. In this study, we collected water samples on July 17, 2018 and examined the behavior of antibiotic-resistant fecal coliforms in the stream of a sewage treatment plant in Tokyo. Extended-spectrum β-lactamase (ESBL)-producing fecal coliforms with encoding genes were found; the CTX-M-1, CTX-M-9, TEM, and SHV groups were found to have survived in the final effluent to the river after sterilization with sodium hypochlorite.


Journal: Advances in Microbiology
DOI: 10.4236/aim.2020.107023(PDF)
Paper Id: 101620 (metadata)

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