Breast Milk and Glucose for Pain Relief in Preterm Infants: A Noninferiority Randomized Controlled Trial

OBJECTIVE: The study goal was to compare the efficacy of expressed breast milk (EBM) versus 25% glucose on pain responses of late preterm infants during heel lancing. METHODS: In a noninferiority randomized controlled trial, a total of 113 newborns were randomized to receive EBM (experimental group [EG]) or 25% glucose (control group [CG]) before undergoing heel lancing. The primary outcome was pain intensity (Premature Infant Pain Profile [PIPP]) and a 10% noninferiority margin was established. Secondary outcomes were incidence of cry and percentage of time spent crying and adverse events. Intention-to-treat (ITT) analysis was used. RESULTS: Groups were similar regarding demographics and clinical characteristics, except for birth weight and weight at data collection day. There were lower pain scores in the CG over 3 minutes after lancing (P<.001). A higher number of infants in the CG had PIPP scores indicative of minimal pain or absence of pain (P = .002 and P = .003 on ITT analysis) at 30 seconds after lancing, and the mean difference in PIPP scores was 3 (95% confidence interval: 1.507-4.483). Lower incidence of cry (P = .001) and shorter duration of crying (P = .014) were observed for CG. Adverse events were benign and self-limited, and there was no significant difference between groups (P = .736 and P = .637 on ITT analysis). CONCLUSIONS: Results based on PIPP scores and crying time indicate poorer effects of EBM compared with 25% glucose during heel lancing. Additional studies exploring the vol and administration of EBM and its combination with other strategies such as skin-to-skin contact and sucking are necessary. Pediatrics 2012;129:664-670

High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: A randomized, controlled trial

Aim: We evaluated the effectiveness of high-frequency transcutaneous electrical nerve stimulation (TENS) as a pain relief resource for primiparous puerpere who had experienced natural childbirth with an episiotomy. Methods: A controlled, randomized clinical study was conducted in a Brazilian maternity ward. Forty puerpere were randomly divided into two groups: TENS high frequency and a no treatment control group. Post-episiotomy pain was assessed in the resting and sitting positions and during ambulation. An 11-point numeric rating scale was performed in three separate evaluations (at the beginning of the study, after 60 min and after 120 min). The McGill pain questionnaire was employed at the beginning and 60 min later. TENS with 100 Hz frequency and 75 mu s pulse for 60 min was employed without causing any pain. Four electrodes ware placed in parallel near the episiotomy site, in the area of the pudendal and genitofemoral nerves. Results: An 11-point numeric rating scale and McGill pain questionnaire showed a significant statistical difference in pain reduction in the TENS group, while the control group showed no alteration in the level of discomfort. Hence, high-frequency TENS treatment significantly reduced pain intensity immediately after its use and 60 min later. Conclusion: TENS is a safe and viable non-pharmacological analgesic resource to be employed for pain relief post-episiotomy. The routine use of TENS post-episiotomy is recommended.

Low-level laser therapy for pain relief after episiotomy: a double-blind randomised clinical trial

Aims and objectives. To evaluate the effectiveness of a low-level laser therapy for pain relief in the perineum following episiotomy during childbirth. Background. Laser irradiation is a painless and non-invasive therapy for perineal pain treatment and its effects have been investigated in several studies, with no clear conclusion on its effectiveness. Design. A double-blind randomised controlled clinical trial. Method. One hundred and fourteen women who underwent right mediolateral episiotomies during vaginal birth in an in-hospital birthing centre in Sao Paulo, Brazil and reported pain =3 on a numeric scale (010) were randomised into three groups of 38 women each: two experimental groups (treated with red and infrared laser) and a control group. The experimental groups were treated with laser applied at three points directly on the episiotomy after suturing in a single session between 656 hours postpartum. We used a diode laser with wavelengths of 660 nm (red laser) and 780 nm (infrared laser). The control group participants underwent all laser procedures, excluding the emission of irradiation. The participants and the pain scores evaluator were blinded to the type of intervention. The perineal pain scores were assessed at three time points: before, immediately after and 30 minutes after low-level laser therapy. Results. The comparison of perineal pain between the three groups showed no significant differences in the three evaluations (p = 0.445), indicating that the results obtained in the groups treated with low-level laser therapy were equivalent to the control group. Conclusions. Low-level laser therapy did not decrease the intensity of perineal pain reported by women who underwent right mediolateral episiotomy. Relevance to clinical practice. The effect of laser in perineal pain relief was not demonstrated in this study. The dosage may not have been sufficient to provide relief from perineal pain after episiotomy during a vaginal birth.

A comparison for a multiscale study of structural lineaments in southern Brazil: LANDSAT-7 ETM+ and shaded relief images from SRTM3-DEM

This paper presents a comparison of descriptive statistics obtained for brittle structural lineaments extracted manually from LANDSAT images and shaded relief images from SRTM 3 DEM at 1:100, 000 and 1:500, 000 scales. The selected area is located in the southern of Brazil and comprises Precambrian rocks and stratigraphic units of the Paraná Basin. The application of this methodology shows that the visual interpretation depends on the kind of remote sensing image. The resulting descriptive statistics obtained for lineaments extracted from the images do not follow the same pattern according to the scale adopted. The main direction obtained for Proterozoic rocks using both image types at a 1:500, 000 scale are close to NS±10, whereas at a 1:100, 000 scale N45E was obtained for shaded relief images from SRTM 3 DEM and N10W for LANDSAT images. The Paleozoic sediments yielded the best results for the different images and scales (N50W). On the other hand, the Mesozoic igneous rocks showed greatest differences, the shaded relief images from SRTM 3 DEM images highlighting NE structures and the LANDSAT images highlighting NW structures. The accumulated frequency demonstrated high similarity between products for each image type no matter the scale, indicating that they can be used in multiscale studies. Conversely, major differences were found when comparing data obtained using shaded relief images from SRTM 3 DEM and Landsat images at a 1:100, 000 scale.

Effects of cryogenic and stress relief treatments on temper carbide precipitation in AISI D2 tool steel

The effects of cryogenic and stress relief treatments on temper carbide precipitation in the cold work tool steel AISI D2 were studied. For the cryogenic treatment the temperature was −196°C and the holding time was 2, 24 or 30 h. The stress relief heat treatment was carried at 130°C/90 min, when applied. All specimens were compared to a standard thermal cycle. Specimens were studied using metallographic characterisation, X-ray diffraction and thermoelectric power measurements. The metallographic characterisation used SEM (scanning electron microscopy) and SEM-FEG (SEM with field emission gun), besides OM (optical microscopy). No variation in the secondary carbides (micrometre sized) precipitation was found. The temper secondary carbides (nanosized) were found to be more finely dispersed in the matrix of the specimens with cryogenic treatment and without stress relief. The refinement of the temper secondary carbides was attributed to a possible in situ carbide precipitation during tempering.

Räumliche Verbreitung geogener Schwermetallgehalte in Böden des Taunus: Einfluss von periglazialer Deckschichtengenese

Während der Glazialphasen kam es in den europäischen Mittelgebirgen bedingt durch extensive solifluidale Massenbewegungen zur Bildung von Deckschichten. Diese Deckschichten repräsentieren eine Mischung verschiedener Substrate, wie anstehendes Ausgangsgestein, äolische Depositionen und lokale Erzgänge. Die räumliche Ausdehnung der Metallkontaminationen verursacht durch kleinräumige Erzgänge wird durch die periglaziale Solifluktion verstärkt. Das Ziel der vorliegenden Untersuchung war a) den Zusammenhang zwischen den Reliefeigenschaften und den Ausprägungen der solifluidalen Deckschichten und Böden aufzuklären, sowie b) mittels Spurenelementgehalte und Blei-Isotopen-Verhältnisse als Eingangsdaten für Mischungsmodelle die Beitrage der einzelnen Substrate zum Ausgangsmaterial der Bodenbildung zu identifizieren und quantifizieren und c) die räumliche Verteilung von Blei (Pb) in Deckschichten, die über Bleierzgänge gewandert sind, untersucht, die Transportweite des erzbürtigen Bleis berechnet und die kontrollierenden Faktoren der Transportweite bestimmt werden. Sechs Transekte im südöstlichen Rheinischen Schiefergebirge, einschließlich der durch periglaziale Solifluktion entwickelten Böden, wurden untersucht. Die bodenkundliche Geländeaufnahme erfolgte nach AG Boden (2005). O, A, B und C-Horizontproben wurden auf ihre Spurenelementgehalte und teilweise auf ihre 206Pb/207Pb-Isotopenverhältnisse analysiert. Die steuernden Faktoren der Verteilung und Eigenschaften periglazialer Deckschichten sind neben der Petrographie, Reliefeigenschaften wie Exposition, Hangneigung, Hangposition und Krümmung. Die Reliefanalyse zeigt geringmächtige Deckschichten in divergenten, konvexen Hangbereichen bei gleichzeitig hohem Skelettgehalt. In konvergent, konkaven Hangbereichen nimmt die Deckschichtenmächtigkeit deutlich zu, bei gleichzeitig zunehmendem Lösslehm- und abnehmendem Skelettgehalt. Abhängig von den Reliefeigenschaften und -positionen reichen die ausgeprägten Bodentypen von sauren Braunerden bis hin zu Pseudogley-Parabraunerden. Des Weiteren kommen holozäne Kolluvien in eher untypischen Reliefpositionen wie langgestreckten, kaum geneigten Hangbereichen oder Mittelhangbereichen vor. Außer für Pb bewegen sich die Spurenelementgehalte im Rahmen niedriger Hintergrundgehalte. Die Pb-Gehalte liegen zwischen 20-135 mg kg-1. Abnehmende Spurenelementgehalte und Isotopensignaturen (206Pb/207Pb-Isotopenverhältnisse) von Pb zeigen, dass nahezu kein Pb aus atmosphärischen Depositionen in die B-Horizonte verlagert wurde. Eine Hauptkomponentenanalyse (PCA) der Spurenelementgehalte hat vier Hauptsubstratquellen der untersuchten B-Horizonte identifiziert (Tonschiefer, Löss, Laacher-See-Tephra [LST] und lokale Pb-Erzgänge). Mittels 3-Komponenten-Mischungsmodell, das Tonschiefer, Löss und LST einschloss, konnten, bis auf 10 Ausreißer, die Spurenelementgehalte aller 120 B-Horizontproben erklärt werden. Der Massenbeitrag des Pb-Erzes zur Substratmischung liegt bei <0,1%. Die räumliche Pb-Verteilung zeigt Bereiche lokaler Pb-Gehaltsmaxima hangaufwärtiger Pb-Erzgänge. Mittels eines 206Pb/207Pb-Isotopenverhältnis-Mischungsmodells konnten 14 Bereiche erhöhter lokaler Pb-Gehaltsmaxima ausgewiesen werden, die 76-100% erzbürtigen Bleis enthalten. Mit Hilfe eines Geographischen Informationssystems wurden die Transportweiten des erzbürtigen Bleis mit 30 bis 110 m bestimmt. Die steuerenden Faktoren der Transportweite sind dabei die Schluffkonzentration und die Vertikalkrümmung. Diese Untersuchung zeigt, dass Reliefeigenschaften und Reliefposition einen entscheidenden Einfluss auf die Ausprägung der Deckschichten und Böden im europäischen Mittelgebirgsbereich haben. Mischungsmodelle in Kombination mit Spurenelementanalysen und Isotopenverhältnissen stellen ein wichtiges Werkzeug zur Bestimmung der Beiträge der einzelnen Glieder in Bodensubstratmischungen dar. Außerdem können lokale Bleierzgänge die natürlichen Pb-Gehalte in Böden, entwickelt in periglazialen Deckschichten der letzten Vereisungsphase (Würm), bis über 100 m Entfernung erhöhen.

Bodenuntersuchungen in Trockenmaaren der Eifel – Deckschichten in einer Vulkanreliefform und deren anthropogene Überprägung

Die im Rahmen des ELSA-Projekts des Geowissenschaftlichen Instituts der Johannes Gutenberg-Universität Mainz erbohrten Kerne im Oberwinkler Maar (OW1) und im Jungferweiher Maar (JW3) wurden auf das Vorkommen des periglazialen Deckschichtensystems und dessen anthropogenen Überprägung untersucht. Es gab bis dato noch keine Unternehmungen diese Formen der Bodenbildung und -entwicklung in einem Trockenmaar zu suchen, geschweige denn zu untersuchen. rnDie Ergebnisse zeigen auf, dass sich Deckschichten auch in der Vulkanreliefform eines Trockenmaars ausbilden können und dass die Überprägung je nach Kraterform und anthropogener Flächennutzung unterschiedlich im Bodenprofil in Erscheinung tritt (Mächtigkeit von kolluvialen/alluvialen Lagen oder Anzahl der Holzkohlefunde).rnZur Untersuchung der Deckschichten und deren anthropogenen Überprägung wurden sowohl bodenkundliche Analysen als auch Literatur- und Kartenauswertungen unternommen. Als eine neue Methode zur Identifizierung von den verschiedenen Bodenhorizonten wurde die mikroskopische Analyse eingeführt. Dabei kam es hauptsächlich darauf an, die Minerale der Laacher-See-Tephra (LST) ausfindig zu machen und so die Bodenbildung und -entwicklung nicht nur zeitlich einordnen zu können, sondern auch die verschiedenen Materialeinträge (u.a. Deckschichtenmaterial) an den Profilstandort unterscheiden zu können.rnAls grundlegendes Ergebnis liefert die vorliegende Arbeit den Beweis, dass sich die periglazialen Deckschichten und deren anthropogenen Überprägung nicht nur in den typischen Zonen der deutschen Mittelgebirge ausbilden, sondern auch in der vulkanischen Reliefform eines Trockenmaars. Hinzukommt die Tatsache, dass statt den typischen vielen Geländeaufschlüssen für einen Standort – Catena – jeweils ein einzelner Bohrkern ausgereicht hat, um zu dieser genauen Erkenntnisgewinnung – maßgeblich bedingt durch die mikroskopische Analyse – zu kommen.

Analisi di morfologie carsiche o crio-carsiche in relazione alla mobilizzazione di fluidi nella regione di Arabia Terra, Marte.

This thesis tries to interpret the origin and evolution of karst-like forms present in Arabia Terra, a region of Mars that develops in the equatorial zone of the planet. The work has been carried out specifically in the craters Crommelin (4o 91’ N-10o 51’ E), 12000088 (3o 48’ N-1o 30’ E), NE 12000088 (4° 20’ N-2° 50’ E), C "2" (3° 54’ N-1° W), and in their surrounding areas. These craters contain layered deposits characterized by a high albedo and on which erosion is very pronounced. The area containing the craters is a plateau that has the same characteristics of albedo and texture. The preliminary morphological study has made use of instrumentation such as the Mars Reconnaissance Orbiter (MRO), in particular HiRISE images (High Resolution Imaging Science Experiment), CTX (Context Camera) and CRISM (Compact Reconnaissance Imaging Spectrometers for Mars). A regional geomorphological map has been drawn up containing the main morphotypes, and detailed geomorphological maps were prepared for different karst-like morphologies. The analysis of spectral data collected from CRISM instrumentation has allowed to identify the footprint of sulphate minerals in the external area. Data were collected for morphometric negative forms (karst-like) and positive forms (mud volcanoes, dikes and pingos). For the analysis of the relief forms DTMs (Digital Terrain Models) produced by the union of stereographic CTX couples or HiRISE were used. From the analysis of high-resolution images morphological footprints similar to periglacial environments have been identified, including the presence of patterned ground and polygonal cracks found all over the area of investigation, and relief structures similar to pingos present in the crater C "2". These observations allow us to imagine a geological past with a cold climate at the equator able to freeze the few fluids present in the Martian arid terrain. The development of karst-like landforms, on the other hand, can be attributed to a subsequent improval of the weather conditions that led to a normal climate regime for the equatorial areas, resulting in the degradation of the permafrost. The melt waters have thus allowed the partial dissolution of the sulphate layers. The karst-like forms look rather fresh suggesting them to be not that old.

CROSS-SECTORAL COORDINATION OF DISASTER RELIEF

Coordinating organizational activity across different sectors is crucial in disaster management. We analysed the response of 291 aid workers to the Haiti earthquake in 2010 and found that common incentives and a high degree of equality among aid organizations positively affected perceived network coordination. Large and public organizations were more likely to take leadership roles and high numbers of public organizations involved in the disaster response network led to improved network coordination. These results indicate the need for mechanisms that enable smaller and non-profit organizations to participate in network coordination and leadership.

Oral sucrose and "facilitated tucking" for repeated pain relief in preterms: a randomized controlled trial

To test the comparative effectiveness of 2 nonpharmacologic pain-relieving interventions administered alone or in combination across time for repeated heel sticks in preterm infants.