Since July, 1970, 8 patients with acute dissecting aneurysms of the ascending aorta producing aortic insufficiency have undergone immediate operation employing a technique in which the origin of the dissection is resected, the dissected base of the aorta is lined with nondistensible prosthetic cloth for support, and the native aortic valve is resuspended. Aortic continuity is then reestablished with end-to-end anastomosis or use of a short segment of woven graft (not necessarily circumferential). There were no operative deaths. Mean follow-up has been 60 months (range, 25 to 82 months). One late death has occurred (cerebral hemorrhage at 48 months); of the remaining 7 patients, 2 have faint murmurs of aortic insufficiency, but all are in New York Heart Association Functional Class I. This technique of aortic reconstruction in acute ascending dissections allows preservation of the native aortic valve while preventing late aortic root dilatation or major valve insufficiency.

Improving the solubility of conductive polymers to facilitate processing usually decreases their conductivity, and they suffer from poor cycling stability due to swelling-shrinking during charging cycles. We circumvent these problems with a novel preparation method for nitrogen-doped graphene (NG) enhanced polyacrylic acid/polyaniline (NG-PAA/PANI) composites, ensuring excellent processibility for scalable production. The content of PANI is maximized under the constraint of still allowing defect-free coatings on filaments of carbon cloth (CC). The NG content is then adjusted to optimize specific capacitance. The optimal CC electrodes have 32 wt.% PANI and 1.3 wt.% NG, thus achieving a high capacitance of 521 F/g at 0.5 F/g. A symmetric supercapacitor made from 20 wt.% PANI CC electrodes has more than four times the capacitance (68 F/g at 1 A/g) of previously reported flexible capacitors based on PANI-carbon nanotube composites, and it retains the full capacitance under large bending angles. The capacitor exhibits high energy and power densities (5.8 Wh/kg at 1.1 kW/kg), a superior rate capability (still 81% of the 1 A/g capacitance at 10 A/g), and long-term electrochemical stability (83.2% retention after 2000 cycles).

BACKGROUND

While survival rates for preterm infants have increased, the risk for adverse long-term neurodevelopmental and behavioral outcomes remains very high. In response to the need for novel, evidence-based interventions that prevent such outcomes, we have assessed Family Nurture Intervention (FNI), a novel dual mother-infant intervention implemented while the infant is in the Neonatal Intensive Care Unit (NICU). Here, we report the first trial results, including the primary outcome measure, length of stay in the NICU and, the feasibility and safety of its implementation in a high acuity level IV NICU.

METHODS

The FNI trial is a single center, parallel-group, randomized controlled trial at Morgan Stanley Children's Hospital for mothers and their singleton or twin infants of 26-34 weeks gestation. Families were randomized to standard care (SC) or (FNI). FNI was implemented by nurture specialists trained to facilitate affective communication between mother and infant during specified calming interactions. These interactions included scent cloth exchange, sustained touch, vocal soothing and eye contact, wrapped or skin-to-skin holding, plus family-based support interactions.

RESULTS

A total of 826 infants born between 26 and 34 weeks during the 3.5 year study period were admitted to the NICU. After infant and mother screening plus exclusion due to circumstances that prevented the family from participating, 373 infants were eligible for the study. Of these, we were unable to schedule a consent meeting with 56, and consent was withheld by 165. Consent was obtained for 150 infants from 115 families. The infants were block randomized to groups of N = 78, FNI and N = 72, SC. Sixteen (9.6%) of the randomized infants did not complete the study to home discharge, 7% of those randomized to SC and 12% of FNI infants. Mothers in the intervention group engaged in 3 to 4 facilitated one- to two-hour sessions/week. Intent to treat analyses revealed no significant difference between groups in medical complications. The mean length of stay was not significantly affected by the intervention.

CONCLUSIONS

There was no significant effect demonstrated with this intervention amount on the primary short-term outcome, length of stay. FNI can be safely and feasibly implemented within a level IV NICU.

BACKGROUND

Clinicaltrials.gov: NCT01439269.

Agarose beads containing immobilized enzymes or affinity ligands have been made magnetically responsive by adsorbing freshly precipitated magnetite on their surface. These beads are used for affinity adsorption of proteins from complex mixtures containing suspended solids. The magnetically responsive beads and the unwanted (diamagnetic) solids are then separated by magnetic filtration. This magnetic adsorption scheme for direct affinity separation of enzymes from mixtures containing suspended solids is compared with a similar, but nonmagnetic, scheme in which the affinity matrix is supported on fiberglass cloth. The enzyme is allowed to adsorb in this matrix, and the matrix is simply removed physically from the suspension to achieve separation from the unwanted solids. The two methods seem comparable in their ability to separate a desired enzymatic activity. The magnetic methods are technically the more complex of the two, but are significantly the more rapid. The efficiency of separation of diamagnetic and ferrimagnetic solids in these biological systems by high gradient magnetic filtration is good.

A facile and fruitful CVD method is reported for the first time, to synthesize high-quality hexagonal SnS2 nanosheets on carbon cloth via in situ sulfurization of SnO2. Moreover, highly sensitive phototransistors based on SnS2 with an on/off ratio surpassing 10(6) under ambient conditions and a rising time as short as 22 ms under vacuum are fabricated, which are superior than most phototransistors based on LMDs. Electrical transport measurements at varied temperatures together with theoretical calculations verify that sulfur vacancies generated by the growth process would induce a defect level near the bottom of the conduction band, which significantly affects the performance of the SnS2 device. These findings may open up a new pathway for the synthesis of LMDs, shed light on the effects of defects on devices and expand the building blocks for high performance optoelectronic devices.

Flexible perovskite photodetectors are usually constructed on indium-tin-oxide-coated polymer substrates, which are expensive, fragile, and not resistant to high temperature. Herein, for the first time, a high-performance flexible perovskite photodetector is fabricated based on low-cost carbon cloth via a facile solution processable strategy. In this device, perovskite microcrystal and Spiro-OMeTAD (hole transporting material) blended film act as active materials for light detection, and carbon cloth serves as both a flexible substrate and a conductive electrode. The as-fabricated photodetector shows a broad spectrum response from ultraviolet to near-infrared light, high responsivity, fast response speed, long-term stability, and self-powered capability. Flexible devices show negligible degradation after several tens of bending cycles and at the extremely bending angle of 180°. This work promises a new technique to construct flexible, high-performance photodetectors with low cost and self-powered capability.

OBJECTIVE

To estimate the economic value of dispensing preoperative home-based chlorhexidine bathing cloth kits to orthopedic patients to prevent surgical site infection (SSI).

METHODS

A stochastic decision-analytic computer simulation model was developed from the hospital's perspective depicting the decision of whether to dispense the kits preoperatively to orthopedic patients. We varied patient age, cloth cost, SSI-attributable excess length of stay, cost per bed-day, patient compliance with the regimen, and cloth antimicrobial efficacy to determine which variables were the most significant drivers of the model's outcomes.

RESULTS

When all other variables remained at baseline and cloth efficacy was at least 50%, patient compliance only had to be half of baseline (baseline mean, 15.3%; range, 8.23%-20.0%) for chlorhexidine cloths to remain the dominant strategy (ie, less costly and providing better health outcomes). When cloth efficacy fell to 10%, 1.5 times the baseline bathing compliance also afforded dominance of the preoperative bath.

CONCLUSIONS

The results of our study favor the routine distribution of bathing kits. Even with low patient compliance and cloth efficacy values, distribution of bathing kits is an economically beneficial strategy for the prevention of SSI.

The efficacy of various pyrethroid insecticides for use on odour-baited targets to control tsetse was compared in Zimbabwe. Formulations were applied to cotton cloth and polyester net and, at various intervals, the materials were bioassayed by exposing fed female Glossina pallidipes (Austen) (Diptera: Glossinidae) to cloth for 45 s or by inducing them to collide briefly with net. Trial formulations were compared with deltamethrin suspension concentrate (s.c.), the insecticide currently used in tsetse control operations in Zimbabwe. Applying 0.8% suspension of alphacypermethrin to cloth or net produced high mortalities for 9 months which was similar in performance to 0.4% suspension of deltamethrin s.c. Deltamethrin s.c. and beta-cyfluthrin s.c. applied to cloth as 0.1% suspensions were equally effective, producing high mortalities for 2 months during the wet season, and 0.8% suspension of beta-cyfluthrin was effective for 12 months. Suspensions of 0.1% lambdacyhalothrin capsule suspension or 0.1% lambdacyhalothrin wettable powder were significantly less effective than 0.1% deltamethrin s.c. Chemical analyses showed that increasing the concentration of insecticide applied to material increased the initial amount of insecticide on the material and decreased the subsequent rate of loss; 0.1% suspension of beta-cyfluthrin s.c. applied to cloth produced an initial concentration of approximately 280 mg/m2 which declined by 94% in 12 months whereas 0.8% suspension showed no significant decrease in concentration (mean= 1304 mg/m2) over the same period. For controlling tsetse by means of pyrethroid-treated targets, it is suggested that beta-cyfluthrin s.c. is as effective as deltamethrin s.c. but that alphacypermethrin s.c. should be used at twice the concentration of deltamethrin s.c. to obtain the same performance.

The organization of infants' reaching skill for stationary and moving targets was examined. While 58 term, healthy infants at 5.5, 8.5, and 11.5 months of age reached for and grasped a cloth-covered dowel, their reaches were videotaped for later slow-motion analysis. Analyses addressed infants' anticipatory adjustment of hand alignment, use of information from spinning and oscillating targets to update ongoing reaches, and ability to capture targets moving in depth. Infants at all ages made anticipatory adjustments of hand alignment, although the effectiveness of these adjustments improved with age. Regardless of age, infants also used dynamic information from spinning and oscillating targets to update ongoing reaches, but the way infants used this information was related to age. Developmental constancy characterized infants' reaches for approaching targets. By observing infants' reaches for stationary, spinning, and approaching targets, the study expands the range of conditions under which adaptive reaching skill has been examined and provides insight into the roles of anticipation and updating in the development of early manual skill.

Ultraviolet (UV) radiation (UVR) has well-known adverse effects on the skin and eyes. Little attention is given to physical means of photoprotection, namely glass, window films, sunglasses, and clothing. In general, all types of glass block UV-B. For UV-A, the degree of transmission depends on the type, thickness, and color of the glass. Adding window films to glass can greatly decrease the transmission of UV-A. Factors that can affect the transmission of UVR through cloth include tightness of weave, thickness, weight, type of fabrics, laundering, hydration, stretch, fabric processing, UV absorbers, color, and fabric-to-skin distance.

Guineaworm is a tropical helminthic disease which is responsible for much disability in rural areas from African to South Asia. Control interventions focus mainly on improving the quality of water supply at the health promotion level of prevention. This includes such technologies as dug wells, cloth filters, and chemicals added to pond water. Each technology has an appropriate health education strategy to aid in its promotion. The community of Idere in rural Nigeria was chosen to test the social acceptability of a new monofilament nylon cloth water filter. A social marketing strategy was used that built upon an existing primary health care program that utilized volunteer primary health workers (PHWs). The PHWs proved effective in marketing the filters in Idere as one-third of households in monitored areas purchased a filter during the six-month sales period in 1985-86. Those who bought filters were more likely to live in hamlets/family compounds where PHWs resided, belong to a modern religion, and have a preventive orientation toward health. Those who did not buy complained mostly of lack of money, but other overt and inferred reasons included attitudes that filters were inferior to wells, traditional beliefs that guinea-worm cannot be prevented and availability of cheaper but ineffective alternatives. Filters were found to be a particularly useful technology in the smaller, isolated farm hamlets surrounding the main town. Recommendations are made to improve the marketing strategy through modifications in filter design, price, distribution, and promotion.

OBJECTIVE

To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination.

METHODS

Randomized, controlled trial.

METHODS

County Jail, Dallas, Texas.

METHODS

A total of 4,196 detainees in 68 detention tanks.

METHODS

Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months.

RESULTS

At baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [-4.8% to 7.1%]; P = .655). At 6 months, carriage of any S. aureus was 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%-20.1%]; P = .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [-1.4% to 18.0%]; P = .099) in group 2.

CONCLUSIONS

Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage of S. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use.

BACKGROUND

ClinicalTrials.gov identifier NCT00785200.

A simple technique to transfer aligned multi-walled carbon nanotubes (MWCNTs) is demonstrated in this work. With polydimethylsiloxane (PDMS) as the transfer medium, as-grown or patterned MWCNT arrays are directly transferred onto a wide variety of Pt-coated substrates such as glossy paper, cloth, polymers, glass slides, and metal foils at low temperatures. The surface of the transferred CNTs is cleaner with better alignment, compared with the as-grown one. Furthermore, the transferred CNTs show strong adhesion and good electric contact with the target substrates. A maximal current density of ∼10(4) A cm(-2) has been achieved from the CNT interconnects prepared with this technique. Because of the lower density and open-ended structures, improved field emission performance has been obtained from CNTs transferred on polymers, based on which flexible emitter devices can be fabricated. In addition, the surface of transferred CNTs becomes more hydrophilic, with an averaged contact angle of 93.4 ± 5.8°, in contrast to the super-hydrophobic as-grown CNT surface (contact angle 151.6 ± 5.5°). With versatile properties and flexible applications, the technique provides a simple and cost-effective way towards future nanodevices based on CNTs.

The manta pouch--a caretaking practice of tightly swaddling and enclosing the infant in a set of cloths and blankets--and other caretaking practices are described for high-altitude resident >> 4,000 m) Quechua mother-infant pairs (N = 14). The manta pouch modifies the microenvironment inside the pouch so that, compared to the ambient environment, the temperature is higher and more stable, the humidity is higher, the partial pressure of O2 is lower, and stimulation levels are reduced. As the infant gets older, the characteristics of the pouch are modified such that the infant is increasingly exposed to ambient conditions. These caretaking practices may benefit the infant by buffering the infant from the multiple ecological stressors of high altitude, but they may also incur costs by exposing the infant to additional microenvironmental stressors (e.g., higher CO2 levels) and by reducing stimulation and limiting infant movement.

The effect of ox skin secretions (sebum) on the behaviour of tsetse flies, Glossina spp., was investigated in the field using electrified targets, some of which operated intermittently, and by direct observations of flies landing on treated and untreated cloth. As the off-period of an intermittently operating electrified target increased, the catch decreased both with and without the sebum present. Targets with sebum always caught more flies than targets without sebum, but there was no evidence to suggest that sebum increased the duration of stay on a target. Direct observations of flies on cloth targets revealed that for both species the presence of sebum reduced the duration of contact and for G.pallidipes the number of return contacts was increased. The results from direct observations were used to predict the number of repeat landings that would need to be made by flies in order to account for the catch of tsetse at intermittently electrified targets.

In this paper we report the observation of enhanced field emission properties from thiolated multi-wall carbon nanotubes (MWCNTs) produced by a simple and effective two-step chemical surface modification technique. This technique implements carboxylation and thiolation on the MWCNTs synthesized by microwave plasma chemical vapor deposition (MPCVD) on the flexible carbon cloth substrate. The resulting thiolated MWCNTs were found to have a very low threshold field value of 1.25 V µm(-1) and a rather high field enhancement factor of 1.93 × 10(4), which are crucial for applications in versatile vacuum microelectronics.

Glossina palpalis gambiensis and G. tachinoides are the main vectors of human and animal trypanosomoses in West Africa. In some parts of their distribution area, they co-exist in sympatry, but little is known about their interactions. This study aimed to explore their respective flight height and daily activity when co-existing or alone. Attractive targets were used, made of a black/blue/black cloth covered with adhesive film, so that all tsetse that landed were caught. The study was conducted in two areas in South Burkina Faso: Kartasso, upstream the Mouhoun river, where G. p. gambiensis is the only tsetse occurring; and Folonzo, on the Comoé river, where both species occur. Out of more than 3,800 tsetses caught in total, in Folonzo, G. tachinoides occurred at higher densities than G. p. gambiensis (84 vs 16% of the total densities). The mean height of capture was 55 cm for G. tachinoides, and 65 cm for G. p. gambiensis. As a comparison, in Kartasso where G. p. gambiensis is alone, the mean height of capture was 46 cm, these differences being statistically significant. In average, females were caught higher in altitude than males, and the two species showed a similar activity profile in the day. These results are discussed in the light of differences in the nature of the forest gallery, or possible interspecies competition behaviour in relation with their limited energy metabolism and flight capacities, or also with species differences in landing behavior, linked to host feeding detection. These observations have consequences on control tools releasing attractive odours, which may have contrasted efficacy depending of the flight height of the species.

BACKGROUND

Between June 1968 and March 1977, Starr-Edwards cloth-covered ball valves were exclusively implanted, in a total of 74 patients at our institution, on a routine basis.

METHODS

The retrospective postoperative follow-up rate was 84.5%, for up to 36 years in mitral valve patients (982.5 patient-years); and 81.3%, for up to 34 years in aortic valve patients (282.0 patient-years). Among 66 operative survivors, 20 patients required reoperation due to valve-related complications. Mortality and morbidity after valve replacement was reviewed, and excised valves were examined.

RESULTS

Survival rates after 10, 20, and 30 years were 74.6%, 64.1%, and 31.2%, respectively, after mitral valve replacement, and 62.5%, 50.0%, and 43.8%, respectively, after aortic valve replacement. Freedom from all valve-related complications, respectively after 10, 20, and 30 years, was 70.5%, 55.9%, and 46.4% after mitral valve replacement, and 56.2%, 37.5%, and 31.2% after aortic valve replacement. Cloth wear or pannus overgrowth was observed in all excised prostheses. Remarkable orifice tear was observed in mitral valves that were more than 20 years old. Pannus overgrowth on the studs contributed to prosthetic regurgitation in the older valves. Concomitant valve procedures were frequently required for valve-related complications or other aggravated valve lesions in the mitral position during the follow-up period.

CONCLUSIONS

Early diagnosis of valve dysfunction and the decision to reoperate are important to improve the long-term results for surviving patients who have received a cloth-covered Starr-Edwards valve, especially in the mitral position.

A cloth-base wearable triboelectric nanogenerator made of nylon and Dacron fabric was fabricated for harvesting body motion energy. Through the friction between forearm and human body, the generator can turn the mechanical energy of an arm swing into electric energy and power an electroluminescent tubelike lamp easily. The maximum output current and voltage of the generator reach up to 0.2 mA and 2 kV. Furthermore, this generator can be easily folded, kneaded, and cleaned like a common garment.

OBJECTIVE

To describe current practices of incontinence care in nursing homes (NHs) provided by certified nurse assistants (CNAs), and to evaluate the feasibility and acceptability of an integrated incontinence care product, the One Step Incontinence System (OSIS) in the NH setting. While the ultimate purpose of OSIS is to encourage more consistent skin cleansing and thus reduce perineal dermatitis and risk of pressure ulcers, this study reports an initial feasibility test of OSIS.

METHODS

Controlled trial at two NH sites, with one ward at each site assigned to intervention with OSIS and one ward at each site assigned to a control condition with a box of wipes placed at the bedside (BW).

METHODS

Two NHs (one community and one Veterans Administration) in the Los Angeles area.

METHODS

24 incontinent NH residents and 61 CNAs.

METHODS

OSIS integrates an adult brief and two cleansing/protective wipes into a single item by way of a waterproof pouch that is removed at the time of incontinence care. The OSIS briefs were placed on the intervention wards in the same location(s) and adjacent to regular adult briefs.

METHODS

Structured observations of incontinence care episodes were performed by trained research staff at baseline on all wards, and at follow-up with either the intervention (OSIS) or control condition (BW) in place. Observations included resident location, thoroughness and duration of incontinence care, and materials used. In addition, CNAs' opinions of their preferred incontinence care materials and their experience using OSIS were obtained by self-administered survey.

RESULTS

Use of OSIS resulted in significantly greater frequency of use of cleansing wipes (97% of episodes) compared to the baseline (77% of episodes) and BW conditions (41% of episodes). In 59% of the observed episodes in the BW condition, the box of wipes was actually missing from the bedside, or completely absent from the patient's room and had to be replaced. The two wipes that were incorporated with OSIS were used for perineal skin cleansing immediately when providing incontinence care. There was a significant reduction in the percentage use of and number of cloth towels used during incontinence care with OSIS (53% of episodes, 0.8 towels) compared to baseline (67%, 1.1 towels) and BW conditions (82%, 1.2 towels; p=.002 and p=.012, respectively). CNAs were significantly less often interrupted by the need to find supplies during OSIS condition (13%) compared to baseline (23%) and BW (36%; p= .005). There were no significant differences between conditions in the thoroughness of observed cleansing. The average observed time for incontinence care from putting on gloves to fastening the clean adult brief (T1) and between uncovering the resident to fastening a clean adult brief (T2) decreased significantly within both groups (OSIS and BW) at follow-up (all p-values <.05), but there were no significant differences in T1 and T2 between groups at follow-up. CNAs were more likely to report that they felt that OSIS facilitated skin cleansing compared to the BW.

CONCLUSIONS

We successfully implemented a trial of an innovative adult brief that encouraged skin cleansing during incontinence care. The system was easily and effectively incorporated into the nursing home, was used by CNAs whenever available (97% of the time), and was favored by CNAs. Patterns of incontinence care differed at follow-up with OSIS compared to BW, with fewer linens used, fewer wipes used, and less CNA interruption during care, which may result in greater privacy and comfort for residents.

Various environmental sites closely associated with spinally-injured patients were examined for contamination by organisms concurrently causing urinary infection. Of 30 episodes studied, the same organism was recovered from bedding on 20 occasions, from nine of 20 bath towels and less frequently from face cloths, clothing, wheelchairs and bedside units. The results indicate that contact with the immediate environment of spinal patients with urinary infection may lead to contamination of hands, and confirm and expand the need for handwashing by patients and staff.

We reported an adult case of transverse myelitis with erythema infectiosum. A 33-year-old female was admitted to Kyoto University Hospital because of a weakness in the lower extremities and "cloth-wearing" sensation of the trunk and legs. One month before admission, she became febrile and developed a symmetrical erythema on the extremities. At the same time she noticed a slight weakness of the legs and numbness in her fingers and toes, which disappeared next few days. A week later, she again developed a fever, severe weakness of the legs and "cloth-wearing" sensation on the trunk, and erythema appeared on the cheek. Physical examination on admission revealed a weakness and hyperreflexia in the extremities, in particular, knee and ankle jerk, and hypesthesia of the trunk and legs below the level of Th6. Cerebrospinal fluid (CSF) examination revealed 181/mm3 cells (mononuclear cell dominant) and 30 mg/dl protein. Magnetic resonance imaging, CT and electrophysiological studies indicated no abnormalities. IgM antibody against human parvovirus (B19) was detected in the serum and CSF. She was diagnosed as transverse myelitis with parvovirus infection and was medicated with prednisolone 40-60 mg/day, and improved gradually with the residua of a mild weakness of the legs and hypesthesia on the trunk between the level of Th6 and Th10.

OBJECTIVE

An in-vitro technique has been developed to assess the flow-induced thrombosis of artificial heart valves, using renneted milk as a blood analog. Previous studies have demonstrated similarities between the clotting of blood and milk on both microscopic and macroscopic scales. The study aim was to further validate the milk test by comparing the locations of milk clot to those of thrombus formation on a wide selection of mechanical heart valves.

METHODS

Nine different valves were tested in the aortic position of a model heart chamber in the Edinburgh milk rig. These included caged-ball valves (Starr-Edwards silastic ball with bare struts and metal ball with cloth-covered struts), tilting-disc valves (Björk-Shiley Standard, Björk-Shiley Monostrut, Medtronic-Hall, and Ultracor), and bileaflet valves (St. Jude Medical, Edwards-Duromedics, and CarboMedics). Renneted milk was pumped through the valves for 30 min at 2 l/min, 70 bpm pulsatile flow. After each run, valves were photographed for comparison with documented sites of thrombosis.

RESULTS

All valves developed milk clot in specific, reproducible locations when run in the aortic position. Milk clot was found on the struts of caged-ball valves and tilting-disc valves, and around the hinge mechanism of the bileaflet valves. This compared favorably to documented cases of thrombosis in vivo.

CONCLUSIONS

Renneted milk may be used to model flow-induced thrombus formation and to predict the thrombogenic sites of mechanical heart valves. Whilst it is not suggested that milk mimics the entire blood coagulation cascade, these results indicate that such behavior may not be necessary for predicting fluid mechanically induced clotting.

About three - quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital.

Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi - square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics.

Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08-7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22-8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12-0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10-1.75) were associated with newborn outcome at 1 h.

Mentorship and regular cost - effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR.