The time is now: addressing the need for training in maternal critical care medicine.

Amongst many high-income countries, indirect medical conditions (e.g. cardiovascular disease, sepsis) now account for the majority of maternal deaths.

Risk Factors for Atonic Postpartum Hemorrhage: A Systematic Review and Meta-analysis.

Objective: To identify and quantify risk factors for atonic postpartum hemorrhage.

Data Sources: PubMed, CINAHL, EMBASE, Web of Science, and and ClinicalTrials.gov databases were searched for English language studies with no restrictions on date or location.

A qualitative analysis of parturients' experiences using nitrous oxide for labor analgesia: It is not just about pain relief.

Background: A vast majority of women who choose nitrous oxide for labor report high satisfaction despite variable analgesic effectiveness. We analyzed comments provided by women who used nitrous oxide for labor, to identify determinants of satisfaction in this population, and to better understand reasons for continuing with nitrous oxide despite variable analgesic effectiveness.

Methods: We conducted qualitative content analysis of comments in a quality improvement database of routine follow-up assessments of women who delivered vaginally, using nitrous oxide as the sole labor analgesic.

On the Road to Professionalism.

Many observers have concluded that we have a crisis of professionalism in the practice of medicine. In this essay, the author identifies and discusses personal attributes and commitments important in the development and maintenance of physician professionalism: humility, servant leadership, self-awareness, kindness, altruism, attention to personal well-being, responsibility and concern for patient safety, lifelong learning, self-regulation, and honesty and integrity. Professionalism requires character, but character alone is not enough.

Nitrous Oxide During Labor: Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness.

Background: Evidence on the analgesic effectiveness of nitrous oxide for labor pain is limited. Even fewer studies have looked at patient satisfaction. Although nitrous oxide appears less effective than neuraxial analgesia, it is unclear whether labor analgesic effectiveness is the most important factor in patient satisfaction.

Tracheobronchopathia osteochondroplastica and difficult intubation: case report and perioperative recommendations for anesthesiologists.

Tracheobronchopathia osteochondroplastica is a rare disorder characterized by cartilaginous or ossified submucosal nodules that project into the tracheobronchial lumen. It is typically discovered in the evaluation of chronic upper respiratory symptoms. A case of a completely asymptomatic man diagnosed with extensive disease throughout his upper airway after unanticipated difficult endotracheal intubation for elective surgery, is presented.

Acute hypotension associated with intraoperative cell salvage using a leukocyte depletion filter during management of obstetric hemorrhage due to amniotic fluid embolism.

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric complication that can lead to profound coagulopathy and hemorrhage. The role of cell salvage and recombinant human Factor VIIa (rFVIIa) administration in such cases remains unclear. We present a case of AFE and describe our experience with the use of cell salvage and rFVIIa administration during the resuscitation.

Assessment of animal impacts on bacterial water quality in a South Carolina, USA tidal creek system.

Fecal pollution may adversely impact water quality in coastal ecosystems. The goal of this study was to determine whether cattle were a source of fecal pollution in a South Carolina watershed. Surface water samples were collected in June 2002 and February through March 2003 in closed shellfish harvesting waters of Toogoodoo Creek in Charleston County, SC.

Local and paravertebral block anesthesia for outpatient elective breast cancer surgery.

Most breast cancer operations in the United States are performed with the patient given general anesthesia. We retrospectively reviewed our prospective breast cancer database to determine the percentage of patients who underwent breast cancer operations with either local or paravertebral block regional anesthesia from January 1 through June 30, 2008. Fifty-two of 70 patients (74%) were able to undergo breast cancer surgery with local or paravertebral block regional anesthesia.

Continuous-wave-pumped Raman-assisted fiber optical parametric amplifier and wavelength converter in conventional dispersion-shifted fiber.

We present a continuous-wave-pumped fiber optical parametric amplifier, operating near 1539 nm in conventional dispersion-shifted fiber, with maximum on-off gain and wavelength-conversion efficiency of 13.7 and 13.1 dB, respectively.

Copropagating and counterpropagating pumps in second-order- pumped discrete fiber Raman amplifiers.

The gains and noise figures of discrete second-order-pumped fiber Raman amplifiers utilizing copropagating and counterpropagating pump configurations were experimentally obtained, and the gain results were compared with computer simulations. It was found that the additional gain that is due to second-order Raman pumping is larger for the copropagating pumps than for the counterpropagating pumps, in agreement with simulations. In contrast to distributed second-order-pumped fiber Raman amplifiers, a slight increase in noise figure, by as much as ~1 dB was observed relative to the single-pump scheme.

4x repetition-rate multiplication and Raman compression of pulses in the same optical fiber.

A 21.7-km nonzero dispersion-shifted fiber was used to obtain 4x multiplication of the repetition rate of a 20-GHz train of 4.2-ps optical pulses through the temporal Talbot effect.

Low-threshold self-induced modulational instability ring laser in highly nonlinear fiber yielding a continuous-wave 262-GHz soliton train.

Modulational instability (MI) is employed in a self-induced ring cavity configuration based on highly nonlinear dispersion-shifted fiber (HNL DSF) and an erbium-doped fiber amplifier to generate a continuous-wave 262-GHz train of 365-fs optical solitons. The laser operates around 1540 nm, with an average output power of 15 mW. MI is achieved at a low threshold as a result of low average cavity dispersion and high fiber nonlinearity.

Estuarine habitat quality reflects urbanization at large spatial scales in South Carolina's coastal zone.

Land cover patterns were evaluated in 29 estuarine watersheds of South Carolina to determine relationships between urban/suburban development and estuarine habitat quality. Principal components analysis and Pearson product moment correlation analyses were used to examine the relationships between ten land cover categories and selected measures of nutrient or bacterial enrichment in the water column and contaminant enrichment in sediments. These analyses indicated strong relationships between land cover categories representing upland development and a composite measure of 24 inorganic and organic contaminants using the Effect Range Median-Quotient (ERM-Q).

F+ RNA coliphage typing for microbial source tracking in surface waters.

Aims: The utility of coliphages to detect and track faecal pollution was evaluated using South Carolina surface waters that exceeded State faecal coliform standards.

Methods And Results: Coliphages were isolated from 117 surface water samples by single agar layer (SAL) and enrichment presence/absence (EP/A) methods. Confirmed F+ RNA coliphages were typed for microbial source tracking using a library-independent approach.

Wavelength-versatile subpicosecond pulsed lasers using Raman gain in figure-of-eight fiber geometries.

A family of compact pulsed fiber lasers is described that employs broadband, wavelength-flexible Raman scattering in passively mode-locked figure-of-eight fiber laser geometries. Specifically, sources at 1.57, 1.

Red picosecond pulses generated by frequency doubling a Raman amplified widely tunable 1.3 microm fiber ring laser.

We generated 0.66 microm picosecond pulses by second-harmonic generation of the Raman amplified output of a 1.3 microm actively mode-locked fiber ring laser in a periodically poled potassium titanyl phosphate (PPKTP) waveguide.

Direct access testing: nuts and bolts of starting DAT in a hospital environment.

Direct Access Testing (DAT) is a consumer-driven phenomenon that is sweeping the country. It is a highly controversial subject, the implementation of which requires methodical planning and development to be successful. DAT's purpose is to allow the consumer to order a battery of laboratory tests previously available only with a physician's order.