Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.
Background: The present study intended to identify debris in the spine surgical field that frequently rises to the level of the surgeon's face during several different elective spine procedures. Unlike other areas of orthopedic surgery where infection risk is of high concern, in spine surgery the surgical team usually uses a nonsterile face mask instead of a protective space suit with a sterile face shield. It is possible that blood or bone burr particles striking the surgeon's face mask represent a potential source of infection if they ricochet back into the operative field. Methods: We reviewed 46 consecutive, elective spine surgeries between May 2015 and August 2015 from a singlesurgeon practice. For each surgery, every member of the surgical team wore sterile (space suit) personal protective equipment. After each procedure, the face shield was carefully inspected by 2 members of the surgical team to identify patient blood, tissue, or bone burr dust present on the face shield. Results: The rate of surgeon face shield debris inspected for each case overall was 38/46 (83%). The rate of first assistant face shield debris inspected per case was 16/46 (35%). The scrub technician had a 0% rate of face mask debris on inspection. The highest debris exposure rates occurred with transforaminal lumbar interbody fusions (100%), open laminectomy and fusions (100%), and anterior cervical discectomy and fusions 43/46 (93%). Conclusions: There is a high rate of blood and tissue debris contact that occurs during spine surgery, and it is procedure dependent. Spine surgeons may consider using sterile shields particularly in high-risk cases to protect themselves and their patients. Level of Evidence: 4.
This article examines the development of American policy in the Democratic Republic of the Congo. Why did the U.S. become involved? I argue that Washington's policy was based in how they framed the conflict. They chose to see it through the prism of Rwandan and Ugandan security needs. The Administration favored the narrative of genocide instead of contemplating a war of "partition and plunder." This may not be surprising because Washington often privileges a Westphalian approach to security and ignores the role of economic sub-state actors. However, by doing so they exhibited a "crushing neutrality" towards Laurent Kabila.
The Second Congo War in the Democratic Republic of the Congo (The Congo) has been the largest humanitarian crisis in the last decade. Over five million people have died, and millions more have been displaced. During the conflict, the ostensibly neutral United States subtly sided with Rwanda and Uganda at the expense of the Congolese President Laurent Kabila. I test whether the media indexed their coverage to Washington policy. However, I expand my analysis to compare coverage leading in British and French newspapers as well. After careful examination, I discover that there is no significant difference in reporting. However, the real question of bias and framing includes issues of neutrality, the prominence of linking the Second Congo War with the 1994 Rwandan genocide, and the persistent underreporting of economic exploitation that underpinned the violence.
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