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Objectives In this work, we describe diabetes prevalence and birth outcomes in a primarily First Nations obstetrical population in northwest Ontario. Methods This retrospective, observational study of maternal and neonatal characteristics and birth outcomes was performed at the Sioux Lookout Meno Ya Win Health Centre between April 1, 2012 and March 31, 2017. Results The prevalence of pre-existing type 2 diabetes mellitus was 3.7% and gestational diabetes mellitus was 7.9%. Mothers with diabetes, compared to those without diabetes, were, on average, 5 years older and were of greater parity. Average prepregnancy weight was higher, with an increased incidence of hypertension, inductions and caesarean sections. Neonates had increased incidence of macrosomia, hypoglycemia and hyperbilirubinemia. All maternal cohorts had high rates of alcohol, tobacco and illicit opioid use. Conclusions We have identified a high prevalence of diabetes in this First Nations obstetrical population, with associated adverse maternal and neonatal outcomes.

Objective To examine rates of cesarean delivery (CD) and vaginal birth after cesarean delivery (VBAC) and the patient profile in a community-based obstetrical practice. Methods Retrospective data from 2012 to 2017 for the Sioux Lookout Meno Ya Win Health Centre (SLMHC) were compared to data from the 30 hospitals providing the same level of services (Maternity 1b: maternity care by family physicians/midwives with CD and VBAC capacity) and Ontario. SLMHC VBAC patients were then compared to the general SLMC obstetrical population. Data included maternal age, parity, comorbidities, CD, VBAC, neonatal birth weight, and Apgar scores. Results The SLMHC obstetrical population differed from comparable obstetrical programs, with significantly higher rates of alcohol, tobacco, and opioid use and a higher prevalence of diabetes. CD rates were significantly lower (25% vs. 28%), and women delivering at SLMHC chose a trial of labour after CD almost twice as often (46% vs. 27%), resulting in a significantly higher VBAC rate (31% vs. 16%). Patients in the VBAC population differed from the general SLMHC obstetrical population, being older (7 years) and of greater parity. The neonates of VBAC patients had equivalent Apgar scores but lower rates of macrosomia and lower birth weights, although the average VBAC birth weight at 3346 g was equivalent to the provincial average. Conclusion The SLMHC obstetrical program has lower CD and higher VBAC rates than expected, despite prevalent risk factors typically associated with CD. Our study demonstrates that VBAC can be safely performed in well-screened and monitored patients in a rural setting with emergency CD capacity.

We sought to determine the cost-effectiveness of noninvasive fetal RhD blood group genotyping in nonalloimmunized and alloimmunized pregnancies in Canada.We developed two probabilistic state-transition (Markov) microsimulation models to compare fetal genotyping followed by targeted management versus usual care (i.e., universal Rh immunoglobulin [RhIG] prophylaxis in nonalloimmunized RhD-negative pregnancies, or universal intensive monitoring in alloimmunized pregnancies). The reference case considered a healthcare payer perspective and a 10-year time horizon. Sensitivity analysis examined assumptions related to test cost, paternal screening, subsequent pregnancies, other alloantibodies (e.g., K, Rh c/C/E), societal perspective, and lifetime horizon.Fetal genotyping in nonalloimmunized pregnancies (at per-sample test cost of C$247/US$311) was associated with a slightly higher probability of maternal alloimmunization (22 vs. 21 per 10,000) and a reduced number of RhIG injections (1.427 vs. 1.795) than usual care. It was more expensive (C$154/US$194, 95% Credible Interval [CrI]: C$139/US$175-C$169/US$213) and had little impact on QALYs (0.0007, 95%CrI: -0.01-0.01). These results were sensitive to the test cost (threshold achieved at C$88/US$111), and inclusion of paternal screening. Fetal genotyping in alloimmunized pregnancies (at test cost of C$328/US$413) was less expensive (-C$6280/US$7903, 95% CrI: -C$6325/US$7959 to -C$6229/US$7838) and more effective (0.19 QALYs, 95% CrI 0.17-0.20) than usual care. These cost savings remained robust in sensitivity analyses.Noninvasive fetal RhD genotyping saves resources and represents good value for the management of alloimmunized pregnancies. If the cost of genotyping is substantially decreased, the targeted intervention can become a viable option for nonalloimmunized pregnancies.

Introduction: Diabetes in pregnancy confers increased risk. This study examines the prevalence and birth outcomes of diabetes in pregnancy at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) and other small Ontario hospitals. Methods: This was a retrospective study of maternal profile: age, parity, comorbidities, mode of delivery, neonatal birth weight, APGARS and complications. Data were compared to other Ontario hospitals offering an equivalent level of obstetrical services. Results: Type 2 diabetes mellitus in pregnancy is far more prevalent in mothers who deliver at SLMHC (relative risk [RR]: 20.9, 95% confidence interval [CI]: 16.0–27.2); the rates of gestational diabetes (GDM) are double (RR: 2.0, 95% CI: 1.7–2.3). SLMHC mothers with diabetes were on average 5 years younger and of greater parity with increased substance use. Neonates largely had equivalent outcomes except for increased macrosomia, neonatal hypoglycaemia and hyperbilirubinaemia in GDM pregnancies. Conclusion: Patients with diabetes in pregnancy at SLMHC differ substantially from mothers delivering at Ontario hospitals with a comparable level of service. Programming and resources must meet the service needs of these patients.

To conduct a randomized trial to test the primary hypothesis that once-daily tadalafil, administered orally for 48 weeks, lessens the decline in ambulatory ability in boys with Duchenne muscular dystrophy (DMD)., info:eu-repo/semantics/published

Many polymers are extruded through blown film dies to produce both monolayer and multilayer films. A common type of die in use today to produce blown films is the spiral mandrel die. This type of die can be used effectively for many polymers in structures containing up to approximately ten layers. This paper will discuss the development of new technology using a feedblock and layer multipliers in combination with encapsulation technology and a unique film die to produce microlayer blown film structures with significantly larger numbers of layers than can be produced using conventional blown film technology. POLYM. ENG. SCI., 56:598–604, 2016. © 2016 Society of Plastics Engineers

The aim of this study was to evaluate various optimization strategies to be used with computational fluid dynamics (CFD), in order to optimize the geometry for a polymer die to meet the dual objectives of uniform flow at the exit with minimal pressure drop. 3D finite element simulations using the numerically optimized geometry predict a more uniform flow than simulations using the baseline geometry. However, some of the initial optimized results yielded die geometries that would be impractical to fabricate. Additional constraints were placed on the allowable geometric parameters and solution space to push the optimization towards more feasible optimal solutions. Thus we have shown how CFD-based optimization methods, coupled with knowledge of die design technology and fabrication techniques can lead to the design of better performing polymer dies.

Confined crystallization of high-density polyethylene (HDPE) in multilayer films is studied in this paper. A new cyclic olefin copolymer (COC), HP030, is co-extruded with HDPE by a layer multiplying technique. The number of layers and layer compositions are changed to study the effect of layer thickness on the crystalline morphology of the HDPE layers under confinement. Atomic force microscopy (AFM) is used to investigate the crystalline morphology of the HDPE layers. MOCON (Minneapolis, MN, commercial instrument) units are employed to measure both oxygen permeability and water vapor transport rate (WVTR) of these co-extruded HDPE/HP030 multilayer films. We report that when the HDPE layer nominal thickness is about 290 nm in the HDPE/HP030 multilayer films, the HDPE layer effective gas barrier property is improved approximately 2 times for oxygen and 5 times for water vapor. This is the result of confined spherulite morphology of HDPE, which increases the tortuosity for gas to diffuse through the films. Similar phenomenon is found for polypropylene (PP), when PP is co-extruded against polycarbonate (PC). The same experiments as for HDPE are conducted to confirm that PP spherulites have been confined by PC in PP/PC multilayer films. We discover that the confined spherulites of PP improve its gas barrier properties as well.

High-density polyethylene (HDPE) was co-extruded against high glassy transition temperature (Tg) polycarbonate (PC) to fabricate multilayer films. Melt and recrystallization experiments were conducted on these extruded films to study the effects of isothermal recrystallization temperature and layer thickness on HDPE lamellae orientation. WAXS and AFM were used to demonstrate lamellar morphology of HDPE layers. We report that HDPE lamellae show twisted morphology in 30 nm thin layers after confined crystallization at a high temperature (128 °C). It may be the first time that anyone has created such twisted lamellar morphology with HDPE in such a thin layer. Similar twisted morphology of HDPE was also observed when HDPE was coextruded with another high Tg glassy polymer, polysulfone (PSF). Interestingly, the twisted HDPE lamellar morphology associated with an increased crystallinity improves both the oxygen and water vapor barrier properties of the multilayer films.

This study describes a process technology to maintain or improve the gas barrier property of ethylene vinyl alcohol (EVOH) barrier films after flexing. EVOH and polyethylene-grafted maleic anhydride (PE-g-MA) multi- and microlayer samples with 5, 19, and 35 layers were produced in a coextrusion line. Flexing was performed using a Gelbo flex tester (400 flexes). After flexing, pin hole tests were performed on the film and only those with fewer than two pin holes were re-tested for oxygen transmission rate (OTR). Pin holes decreased after 400 Gelbo flexes as the number of layers increased. The OTR on these films demonstrated that thin EVOH barrier layers can improve film flex crack resistance. This proves that for a given barrier resin total thickness the flex barrier property can be increased dramatically by microlayering.

Objectives To describe the effect of in utero exposure to the buprenorphine+naloxone combination product in a rural and remote population. Setting A district hospital that services rural and remote, fly-in communities in Northwestern Ontario, Canada. Participants A retrospective cohort study was conducted of 855 mother infant dyads between 1 July 2013 and 30 June 2015. Cases included all women who had exposure to buprenorphine+naloxone during pregnancy (n=62). 2 control groups were identified; the first included women with no opioid exposure in pregnancy (n=618) and the second included women with opioid exposure other than buprenorphine+naloxone (n=159). Women were excluded if they had multiple pregnancy or if they were part of a methadone programme (n=16). The majority of women came from Indigenous communities. Outcomes The primary outcomes were birth weight, preterm delivery, congenital anomalies and stillbirth. Secondary neonatal outcomes included gestational age at delivery, Apgar scores at 1 and 5 min, NAS Score >7 and treatment for neonatal abstinence syndrome (NAS). Secondary maternal outcomes included the number of caesarean sections, postpartum haemorrhages, out of hospital deliveries and transfer of care to tertiary centres. Results No difference was found in the primary outcomes or in the Apgar score and caesarean section rate between in utero buprenorphine+naloxone exposure versus no opioid exposure in pregnancy. Compared to women taking other opioids, women taking buprenorphine+naloxone had higher birthweight babies (p=0.001) and less exposure to marijuana (p

Coextrusion is a common method used for producing multilayer films and sheets. Coextrusion is a process in which two or more polymers are extruded and joined together in a feedblock or die to form a single structure with multiple layers. This technique allows the processor to combine the desirable properties of multiple polymers into one structure with enhanced performance characteristics. The coextrusion process can be used to produce multilayer sheet, blown film, cast film, blow molding parts, tubing, wire coating and profiles. It is important to understand the effects of material and equipment parameters on the final micro-/nanolayer structures. Layers normally should have uniform thicknesses throughout the structure for optimal performance. However, layer thickness non-uniformities have been observed in many coextruded structures. It is a very complex and challenging problem due to coupled material and processing variables. This paper will discuss experimental programs as well as numerical modeling of the coextrusion process. The topics that will be covered include rheological measurements of coextruded structures as well as flow of coextruded structures through layer multipliers and dies.

The second normal stress difference N2 experienced by non-Newtonian fluids flowing in a pipe may give rise to secondary flows in the transverse direction. As a result, one component tends to encapsulate the other in stratified flows. In multilayer coextrusion, such secondary flows tend to distort the interface and affect layer uniformity. This paper presents numerical simulations of the elastically driven encapsulation in two-component stratified viscoelastic fluids. The simulations are based on a phase-field theoretical model and use finite elements with adaptive meshing to resolve the moving interfaces. The results suggest two mechanisms for elastic encapsulation: One due to the mismatch of N2 between the components and the other due to noncircular geometry of the cross section. In circular pipes, the more elastic fluid tends to protrude into the other component in the center of the pipe and become encapsulated. This produces the curtate cycloid interface shape commonly seen in experiments. If the cross...

For two low-density polyethylenes and two polystyrenes, axisymmetric and planar elongational viscosities are estimated using entrance loss data from capillary and slit rheometers, respectively. The elongational viscosity is estimated by optimizing the values of various parameters in the Sarkar–Gupta elongational viscosity model such that the entrance loss predicted by a finite element simulation agrees with the corresponding experimental data. The predicted entrance loss is in good agreement with the experimental data at high flow rates. The difference in the experimental and predicted entrance loss at lower flow rates might have been caused by large error in the experimental data in this range. POLYM. ENG. SCI., 2008. © 2007 Society of Plastics Engineers

The effect of viscoelasticity on multilayer polymer extrusion is discussed. In these coextrusion processes predetermined patterns are created with a remarkable breadth of complexity even in geometrically simple dies via elastic rearrangements caused by the second-normal stress differences. A computational method is offered, based on the mapping method, which quantitatively describes the flow-induced patterns. Besides that the results are esthetically beautiful, they are also relevant for practice, since process and die design optimization is now possible. Not only to minimize interface distortion, but potentially also to deliberately create new processes and products based on this flow-induced patterning of polymers. Zusammenfassung: Der Einfluss der Viskoelastizitat auf die Mehrschichtextrusion bei Polymeren wird diskutiert. Bei diesen Koextrusionsprozessen werden vorher bestimmte Muster mit einer bemerkenswerten Komplexitatsvielfalt erzeugt, sogar in geometrisch einfachen Dusen mit Hilfe elastischer Umlagerungen, die durch die zweite Normalspannungsdifferenz erzeugt werden. Eine numerische Methode, die auf der Abbildungsmethode basiert, wird dargestellt, die die stromungsinduzierten Muster quantitativ beschreibt. Die Resultate sind nicht nur asthetisch schon, sondern auch fur die Praxis relevant, da die Optimierung des Prozess- und Dusendesigns nun moglich ist – nicht nur um die Verzerrung der Grenzflache zu minimieren, sondern um moglicherweise auch gezielt neue Prozesse und Produkte zu schaffen, die auf der stromungsinduzierten Musterbildung bei Polymeren basieren. Resume: L’effet de la viscoelasticite sur l’extrusion de polymeres multicouches est discute. Dans ces procedes de co-extrusion, des empreintes predeterminees sont creees qui possedent une gamme remarquablement etendue de complexite et ceci meme pour des filieres a geometrie simple. Ces empreintes sont associees a des rearrangements elastiques causes par la seconde difference de contraintes normales. Une methode de calcul numerique est proposee, basee sur la methode de cartographie qui decrit quantitativement les empreintes induites par l’ecoulement. En plus de l’obtention de resultats esthetiquement magnifiques, ceux-ci sont pertinents pour ce qui concerne la pratique, puisque l’optimisation des procedes ainsi que des conceptions des filieres est maintenant possible. Non seulement est-il possible de minimiser les distorsions d’interface, mais aussi de nouveaux procedes et produits peuvent etre potentiellement crees de maniere deliberee grâce a cette technique d’empreintes de polymeres induites par l’ecoulement.

Multilayer coextrusion is a process in which two or more polymers are extruded and joined together in a feed block or die to form a single structure with multiple layers. These layers should be uniform in thickness across the structure for best performance. However, layer thickness nonuniformities have been observed in many coextruded products. Previous work has shown that these layer thickness variations can occur due to viscosity differences between the polymers in the layers and/or elastic effects that introduce secondary flows. The objective of this work is to examine the effect of viscous and elastic forces present in polyethylene coextrusion processes.

The role of the anesthesiologist in the modulation of the coagulation cascade has grown greatly in the past few years. We no longer only give blood products and fluids during periods of massive blood loss. We have gained a leadership role at the forefront of basic science research into the intricate nature of coagulation. It is paramount that we give our residents and fellows a complete understanding of the physiology and pathology of bleeding. We must become experts on the pharmacodynamics of the many new agents that modulate coagulation. Who better to manage perioperative bleeding than the anesthesiologist? In this article, we discuss the action of several of the drugs in the forefront of hemostasis, starting with desmopressin, which has the longest track record, to the newer agents, aprotinin, tranexamic acid, and epsilon-aminocaproic acid (EACA). We also discuss the use of the technique of deliberate hypotension to decrease blood loss. We must work hand-in-hand with our surgical colleagues to decrease blood loss, and, if we have cases with marked blood loss, use agents that are appropriate to modulate the coagulation cascade.

The development of secondary motions due to the nonzero second normal stress difference is observed and analyzed by tracking the motion of the interface between two batches of the same low density polyethylene, each with a different pigmentation. in this article we focus on straight and tapered channels with a square cross section. Three-dimensional numerical simulations are also performed on the basis of a multimode differential viscoelastic fluid model. These calculations allow the investigation of the development of secondary motions in space. Predictions are compared with the experiments: good agreement is found between the experimental observations and their numerical counterparts. The magnitude and the relevance of secondary motions are also discussed. A numerical analysis is carried out on the sensitivity of secondary motions with respect to the nonlinear properties of the viscoelastic model. Finally, we make a brief attempt to explain the mechanism which drives the secondary motions. (C) 1999 The Society of Rheology. [S0148-6055(99)00406-X].

Paraneoplastic cerebellar degeneration (PCD) is a rare nonmetastatic neurological complication in cancer patients. Anti-Yo is one of the anti-onconeural antibodies found in PCD patients. It is believed that anti-Yo occurs almost always in women and is most likely associated with gynecologic or breast cancers, although exceptions exist. Here we report a PCD patient with ovarian cancer having high-titer anti-Yo. The acute onset of her PCD symptoms mimicked that of a stroke. Her ovarian cancer tissue contained abundant plasma cells and lymphocytes. After a thorough review of the literature, we propose a schematic hypothesis for the autoimmune pathogenesis of PCD. Despite anecdotal case reports of neurological improvement with different combinations of treatment, including IVIg, there is still no definitely effective treatment for PCD. Further research on the pathogenesis of PCD may lead to more effective therapies.

Previous work on the layer thickness uniformity of coextruded structures has centered primarily on the effects of differing polymer viscosities in the individual layers. These differences in viscosities result in a phenomenon known as “viscous encapsulation” in which the less viscous layer tends to encapsulate the more viscous layer producing nonuniform layer thicknesses. In this study, the effect of polymer viscoelasticity on the layer thickness uniformity of multilayer coextruded structures was investigated by coextruding multilayer structures through die channels of different cross-sectional shapes and observing the location of the interface. In order to minimize the viscosity effects, the coextrusion experiments were conducted with identical materials in each layer that were pigmented to allow observation of the layer interface. It was shown experimentally that coextruding identical polymers through channels of various geometries can cause the layers to rearrange. This layer rearrangement appears to be caused by secondary flows that occur in different channel geometries due to the viscoelastic characteristics of the polymer. Layer rearrangement of identical polymers implies that even resins with viscosities well matched for coextrusion may experience nonuniform layer thicknesses when coextruded through large dies.

The effect of second normal stress difference is analysed by observing the co-flow of two batches of the same viscoelastic fluid, each with a different pigmentation, in straight ducts. The development of secondary motions is observed by tracking the motion of the interface between both fluids. Numerical simulations are also performed on the basis of a multi-mode differential viscoelastic fluid model and are compared with the experiments. A good agreement is found between the experimental observations and their numerical counterparts. (C) 1997 Elsevier Science B.V.

Background:Patient registries represent an important method of organizing “real world” patient information for clinical and research purposes. Registries can facilitate clinical trial planning and recruitment and are particularly useful in this regard for uncommon and rare diseases. Neuromuscular diseases (NMDs) are individually rare but in aggregate have a significant prevalence. In Canada, information on NMDs is lacking. Barriers to performing Canadian multicentre NMD research exist which can be overcome by a comprehensive and collaborative NMD registry.Methods:We describe the objectives, design, feasibility and initial recruitment results for the Canadian Neuromuscular Disease Registry (CNDR).Results:The CNDR is a clinic-based registry which launched nationally in June 2011, incorporates paediatric and adult neuromuscular clinics in British Columbia, Alberta, Ontario, Quebec, New Brunswick and Nova Scotia and, as of December 2012, has recruited 1161 patients from 12 provinces and territories. Complete medical datasets have been captured on 460 “index disease” patients. Another 618 “non-index” patients have been recruited with capture of physician-confirmed diagnosis and contact information. We have demonstrated the feasibility of blended clinic and central office-based recruitment. “Index disease” patients recruited at the time of writing include 253 with Duchenne and Becker muscular dystrophy, 161 with myotonic dystrophy, and 71 with ALS.Conclusions:The CNDR is a new nationwide registry of patients with NMDs that represents an important advance in Canadian neuromuscular disease research capacity. It provides an innovative platform for organizing patient information to facilitate clinical research and to expedite translation of recent laboratory findings into human studies.

To determine the proportion and characteristics of children presenting with childhood absence epilepsy (CAE) who were not taking anti-epileptic drugs (AEDs) and were seizure-free over the last year of long-term follow-up.For case finding, centralized EEG records for the province of Nova Scotia allowed identification of all children with typical CAE diagnosed between 1977 and 1985. Follow-up was done in 1994 to 1995.Of 81 children with CAE, 72 (89%) were contacted for follow-up. Mean age at seizure onset was 5.7 years (range, 1 to 14 years) and at follow-up was 20.4 years (range, 12 to 31 years). Forty-seven (65%) were in remission. Twelve others (17%) were not taking AEDs but continued to have seizures. Thirteen (18%) were taking AEDs; five were seizure-free over the last year (in four of these a trial without AEDs had previously failed). Fifteen percent of the total cohort had progressed to juvenile myoclonic epilepsy (JME). Multiple clinical and EEG factors were examined as predictors of outcome. Factors predicting no remission (p0.05) included cognitive difficulties at diagnosis, absence status prior to or during AED treatment, development of generalized tonic clonic or myoclonic seizures after onset of AEDs, abnormal background on initial EEG, and family history of generalized seizures in first-degree relatives.Only 65% of children presenting with CAE had remission of their epilepsy. Forty-four percent of those without remission had developed JME. At the time of diagnosis, remission is difficult to predict accurately in most patients. However, development of generalized tonic-clonic seizures or myoclonic seizures during AED treatment is ominous, predicting both lack of remission of CAE and progression to JME.

This article examines the use of laboratory tests for managing mechanical ventilation. Blood gas analysis is a common test widely used for this purpose, and this is evaluated in detail. Other tests, however, provide valuable insight into the management of patients receiving mechanical ventilation. These include serum electrolytes, thyroid function tests, and adrenal function tests.

To the Editor.— A recent article in Pediatrics reported that methsuximide improved seizure control, without serious adverse effects, in 15 of 25 children with intractable epilepsy.1 We subsequently added methsuximide to the treatment regimen of a 17-year-old boy who was already taking valproate, clobazam, and intermittent lorazepam and paraldehyde for uncontrolled seizures. His seizures remained uncontrolled, but 24 days after the initiation of methsuximide he developed orofacial dyskinesia and akathesia, while receiving 450 mg per day (11.3 mg/kg/d).