Background: Pregnant patients with cardiac disease have significantly higher predicted maternal morbidity and mortality compared to the general obstetric population. Published guidelines on optimal management of these patients recommend multidisciplinary care provision. There are few published data on the incidence of haematological complications in pregnant women with cardiac disease, although the data that does exist suggests a relatively high rate of bleeding and thrombotic events.Aims: To determine the outcomes in terms of haematological morbidity occurring within a cohort of pregnant women with cardiac disease in the setting of multidisciplinary care provision.Methods: Patients were identified from a database compiled by the obstetric cardiology service listing all cardiac patients managed in the Rotunda maternity hospital during the period from 2004 to 2011. Data were obtained from the medical and obstetric case notes relating to details of perinatal care and the occurrence of antenatal and postnatal complications.Results: During the 8-year review period, 451 women with cardiac disease were assessed. Fifty-nine were determined to have moderate to high-risk disease. Each received consultant-delivered multidisciplinary care, where written management strategies were agreed by collaborating senior colleagues either preconceptually or in early pregnancy. No venous thromboembolic events occurred and a modest rate of post-partum haemorrhage (approximately 5%) was recorded. There were no maternal deaths.Conclusion: The relatively favourable outcomes observed within our institution highlight the importance of a multidisciplinary approach to the management of pregnant women with cardiac disease, particularly in scenarios where limited published evidence exists to guide management.

BACKGROUND:Surgical site infection (SSI) is an important complication of cesarean section (CS) delivery and a key quality indicator of patient care. METHODS:A baseline assessment was undertaken to determine SSI rates, and subsequently a quality improvement program was introduced, followed by repeat surveillance. Data were collected during in-hospital stays and for up to 30 days after CS during both periods. Interventions in the quality improvement program included the use of nonabsorbable sutures for skin closure, use of clippers instead of razors, and use of 2% ChloraPrep for skin disinfection before incision. RESULTS:A total of 710 patients were surveyed before the interventions, and 824 patients were surveyed after the interventions. Of these, 114 (16%) had an SSI before the interventions, and 40 (4.9%) had an SSI after the interventions (P < .001; odds ratio, 0.27), with 90% and 83%, respectively, detected after hospital discharge. In multivariate analysis, obesity (P = .002) and the use of absorbable suture materials for skin closure (P = .008) were significantly associated with a higher SSI rate before the interventions; however, only obesity was associated with a higher SSI rate after the quality program. CONCLUSION:Surveillance of SSI rates after CS followed by 3 interventions contributed to a significant reduction in SSI rate and improved patient care.

An exposure apparatus and method for irradiating a mask having a circuit pattern with light emitted from an intermittently emitting type light source so that the mask pattern is photolithographically transferred onto a semiconductor wafer, wherein the output of the intermittent-emission type light source is detected prior to the photolithographic transfer of the mask pattern onto the wafer and, in accordance with the result of such detection, the amount of exposure of the wafer to the light beam from the mask is controlled.

OBJECTIVEThe purpose of this study was to assess the effect of strenuous symptom-limited exercise on umbilical and uterine blood flow.STUDY DESIGNTwenty-two primiparous women between 30 and 34 weeks of gestation were recruited. At rest, umbilical and uterine artery waveforms were assessed by measuring the pulsatility index. This was followed by a symptom-limited incremental exercise test. Fetal umbilical and maternal uterine artery circulations were assessed after exercise.RESULTSStrenuous maternal exercise was demonstrated by the significant change in physiologic parameters, which was associated with an immediate increase in fetal heart rate, a significant increase in the right uterine artery pulsatility index, and a reduction in the umbilical artery pulsatility index.CONCLUSIONThe modest change in the uterine artery pulsatility index without an adverse change in the umbilical artery pulsatility index indicates that a single bout of maximum symptom-limited exercise does not have immediate adverse fetal or maternal cardiovascular effects.

OBJECTIVE:The purpose of this study was to analyze the effects of maternal exercise on fetal heart rate changes to determine prognostic factors for an abnormal trace in labor.STUDY DESIGN:Two hundred fifty-eight primiparous women who were 33 to 38 weeks of gestation with varying levels of activity were recruited. A symptom-limited incremental exercise test was preformed. Cardiotocography was carried out before and after exercise. Data were analyzed with specialized computer software.RESULTS:A strenuous level of exercise was achieved. The most common fetal heart rate response seen was tachycardia. The incidence did not vary with the level of fitness, maternal body mass index, or fetal weight. Male fetuses were more prone to fetal distress. A significantly higher proportion of distressed babies were born to older women (P <.0001). The percentage of abnormal traces was equal in the vaginal and caesarean delivery groups.CONCLUSION:The results showed no correlation among the incidence of fetal distress, the mode of delivery, and the fetal heart rate changes after exercise.

In this paper we attempt to relate Internet use to realistic MFL teaching practice. This is done both critically and practically, and in the light of a survey of teachers' attitudes. We define different Internet functions, identifying intrinsic pedagogical advantages and constraints. Internet use is placed within the frame of existing language learning methodology.

Insufficient scholarly attention has been accorded Canada's relationship with the Organization of American States (OAS), notwithstanding the fact that it has been a full-fledged member for almost ten years now. Not surprisingly, then, even less attention has focused on the nature and extent of the Canada-U.S. dynamic within the hemispheric bode.(1) Furthermore, this important and complex relationship, especially within a body long considered to be dominated by the United States (even more so than the United Nations), goes to the heart of much of the literature on Canadian foreign policy. And given the importance of this bilateral relationship for Canada, not to mention its often-controversial nature and its sensitivity to most Canadians, one would have expected otherwise. This is all the more striking in light of the fact that most of the opposition to Canada's decision to join the Organization was premised on a belief that it would unnecessarily harm and complicate Canada's overall relations with its superpower neighbor. There is no doubt that the issues on the OAS policy agenda create a number of potential opportunities for sharp disagreement--as well as cooperation and collaboration--between the two countries. In fact, with difficult and integral hemispheric questions about democracy, human rights, hemispheric free trade and the environment, there is certainly no shortage of possible policy areas in which to increase bilateral tension. The thorny question of Cuba (particularly in light of the Helms-Burton law) and the early 1990s constitutional crisis in Haiti stand out as two obvious examples, which clearly had (and continue to have) negative implications for the wider Canada-U.S. relationship.(2) Having said that, there also exist a number of issues areas in which both countries tend to share a common approach and similar objectives, while perhaps disagreeing over the appropriate mix of tactics and strategy to achieve these same inter-American goals. One needs to be careful, of course, about drawing too many firm conclusions about Canadian sovereignty or national independence from any evaluation of its behavior or record of performance within the OAS. In fact, how Canada has conducted itself within the body--including a tendency to take similar positions to that of the United States--may tell us very little about Canada's political independence, or lack thereof. Similarly, when Canada has adopted an opposite or different position from that of Washington, one should not automatically assume that this is a sure sign of autonomy or foreign policy independence. Still, few can question the fact that the United States plays a central role (an understandably so) in the formulation of Canada's overall foreign policy thrust--and this is no different in the case of Canada's conduct within the OAS. What is important to remember, however, is not the inescapable presence of the United States (and thus an important foreign policy or external determinant), but how and why Canadian officials--given the centrality of the U.S. factor--arrive at their policy decisions and positions within the hemispheric body. Accordingly, this article sets out to examine the Canada-U.S. dynamic within the context of the OAS--an area of Canadian foreign policy virtually ignored by the academic community. By doing so, it attempts to make a meaningful contribution to the extant literature on Canadian-American relations by grappling with two important questions. First, what exactly is the nature and extent of interaction between officials from both countries within the OAS? Secondly, and more important, has Canada's behavior or actions within the hemispheric body reflected policy independence or subservience vis-a-vis the United States? Thus, this article seeks to build upon previous ground-breaking research by Kal J. Holsti on diplomatic culture and adds a new and interesting layer of empirical analysis by focusing on the Canada-U. …

The platimun(II) alkyl-halide complexes cis[PtCl{CH2C(O)CH2Cl}(PPh3)2], cis- [PtCl{CH2C(O)CH3}(PPh3)2], trans-[PtI(Me)(PPh3)2], [Pt{EtSCH2C(O)CH2}Br(PPh3)] and [Pt{MeSCH2C(O)CH2}I(PPh3)] have been investigated by electrospray mass spectrometry (ESMS). For all complexes, loss of halide ion provides the initial ionization pathway and the resulting ions may contain coordinated ligands from the solvent (acetonitrile, ammonia and added pyridine). At high cone voltages, all complexes undergo cyclometallation of one of the triphenylphosphine ligands. However, for the chloroacetonyl complex cis-[PtCl{CH2C(O)CH2Cl}(PPh3)2], fragmentation to the ion [PtCl(PPh3)2]+ preceeds cyclometallation. It is proposed that this complex fragments via initial oxidative addition of the CCl bond, forming an unstable platina (IV)cyclobutan-3-one (oxodimethylenemethane) complex, which undergoes reductive elimination of cyclopropanone. The X-ray crystal structure of cis-[PtCl{CH2C(O)CH2Cl}(PPh3)2] is also reported.

Australian Journal of Politics & HistoryVolume 41, Issue 2 p. 253-270 Canada and the InterAmerican System, 1890–1968 Peter McKenna, Peter McKennaSearch for more papers by this author Peter McKenna, Peter McKennaSearch for more papers by this author First published: August 1995 https://doi.org/10.1111/j.1467-8497.1995.tb01261.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume41, Issue2August 1995Pages 253-270 RelatedInformation

There is little agreement about the methodology of clinical trials of antipsychotic drugs in patients with negative symptoms. A literature review revealed wide variation in experimental design, rating scales and study duration. This reflects differing views as to the definition and response to treatment of negative symptoms. Some degree of standardization would improve comparability of studies and aid the development of new compounds. Patients included in such studies should have displayed negative symptoms for at least 6 months. Depressive symptoms, positive schizophrenic symptoms and extrapyramidal signs may all influence or be confused with negative symptoms and may respond to treatment; they should be at a low level at baseline and should be measured during the study period. Studies should last at least 8 weeks. Several scales are available for measuring negative symptoms and are reviewed; a global impression score should be used additionally.

Treatment of [Pt(eta2-RCH=CHR)(PPh3)2] (R = H or Ph) with 1,3-dichloroacetone gave the chloroacetonyl complex cis-[PtCl{CH2C(O)CH2Cl}(PPh3)2] 1 which readily cyclised in high yield to the thiolate complex [Pt{SCH2C(O)CH2}(PPh3)2] 2 by treatment with sodium sulfide. Complexes 1 and 2 have been fully characterised by IR and NMR spectroscopies, and by elemental analysis. Ligand substitution reactions of complex 2 with an excess of isocyanide RNC (R = Bu(t), Bu(n) or 2,6-xylyl), an excess of tri-n-butylphosphine or 1 equivalent of trimethyl phosphite in dichloromethane afforded the monosubstituted complexes [Pt{SCH2C(O)CH2}(PPh3)(L)]). These complexes were typically isolated as a mixture of isomers, with the major isomer in each case having the PPh3 ligand trans to CH2. Treatment of complex 2 with an excess of trimethyl phosphite yielded the bis(phosphite) complex [Pt(SCH2C(O)CH2}{P(OMe)3}2]. Reaction of 2 with [Rh2(mu-Cl)2(CO)4] afforded a mixture of products from which the thiolate-bridged dimeric complex [{Pt[SCH2C(O)CH2](PPh3)}2] was isolated and characterised by a single-crystal X-ray diffraction study, which confirmed the formulation of these complexes as five-membered ring thiolates.

(1992). Hyperlanguage: to boldly go …? The Language Learning Journal: Vol. 6, No. 1, pp. 71-72.

The ligands L displace triphenylarsine from the complexes [[graphic omitted]H(CO2Me)}(AsPh3)2] to give good yields of the complexes [[graphic omitted]H(CO2Me)}L2](M = Pt, L = PPh3, PMePh2, PMe2Ph, L2= Ph2PCH2CH2PPh2(dppe); M = Pd, L = PPh3, L2= 2,2′-bipyridine). Treatment of the complexes [[graphic omitted]H(CO2Me)}L2] with one mole equivalent of t-butyl isocyanide gives the monosubstituted complexes [[graphic omitted]H(CO2Me)}(CNBut)L](M = Pt or Pd, L = AsPh3 or PPh3). The single-crystal X-ray structure of [[graphic omitted]H(CO2Me)}(CNBut)(AsPh3)] establishes the presence of a puckered platinacyclobutan-3-one ring [fold angle = 42(1)°] with the triphenylarsine ligand trans to the axial methoxycarbonyl group. The reactions of 1 mole equivalent of t-butyl isocyanide with [[graphic omitted]H(CO2Me)}(CNBut)(PPh3)] or 2 mole equivalents of CNBut with [[graphic omitted]H(CO2Me)}(PPh3)2] give the ring-expanded zwitterionic complex [[graphic omitted]NHBut}(CNBut)(PPh3)]. Similar complexes [[graphic omitted]NHBut}(CNBut)2] are formed upon treatment of [[graphic omitted]H(COR)L2](R = OMe, L = AsPh3 or PPh3; R = Me, L = PPh3) with three mole equivalents of CNBut. The structure of [[graphic omitted]NHBut}(CNBut)2] was established by a single-crystal X-ray diffraction study.

Heptane-2,4,6-trione reacts with the carbonate complexes [Pt(CO3)L2] in warm ethanol to afford high yields of the piatinacyclobutan-3-one complexes [P[graphic omitted]HR)L2](R = COMe, L = PPh3 or AsPh3). A single-crystal X-ray diffraction study has been carried out on the complex [[graphic omitted]H(COMe)}(PPh3)2]. The molecular structure can be considered to be based upon a highly puckered platinacyclobutan-3-one ring complex [fold angle 48.0(4)°] with a weak transannular Pt–C bond of 2.486(6)Å, the allylic structure [Pt{η3–CH(COMe)COCH(COMe)}(PPh3)2] making a significant contribution to the bonding. N.m.r. data (1H, 13C-{1H}) are reported and variable-temperature 1H n.m.r. data for the complexes [P[graphic omitted]H(COMe)}L2](L = PPh3 or AsPh3) are interpreted in terms of inversion of the platinacyclobutan-3-one ring through a planar transition state. In contrast, 1,5-diphenylpentane-1,3,5-trione reacts with [Pt(CO3)(PPh3)2] in warm ethanol to afford the dienediolate complex [[graphic omitted]}(PPh3)2] which was characterised by X-ray crystallography.

The reactions of the zerovalent palladium complex [Pd2(dba)3]·CHCl3(dba = dibenzylidene-acetone, PhCHCH–C(O)–CHCHPh), in the presence of a donor ligand L and dioxygen, with esters of 3-oxopentanedioic acid (RCH2COCH2R) in diethyl ether, afford, in high yield, the pallada-cyclobutan-3-one compounds [P[graphic omitted]HR)L2][R = CO2Me, L = PPh3, PMePh2, PMe2Ph, PEt3, or AsPh3, L2= 2,2′-bipyridyl (bipy); R = CO2Et, L = PPh3 or AsPh3, L2= bipy; R = CO2Prn, L2= bipy]. The compounds [P[graphic omitted]HR)L2](R = CO2Me or CO2Et, L = PPh3 or AsPh3) are also formed upon treatment of benzene solutions of [PdL4] with RCH2COCH2R in the presence of air. Treatment of the ketone MeO2CCH2COCH2CO2Me with either [Pd(O2)(PPh3)2] in benzene or [Pd(OCO3)(PPh3)2] in ethanol also affords [P[graphic omitted]H(CO2Me)}(PPh3)2]. Spectroscopic data (i.r. and n.m.r.) for the new compounds are reported, and discussed in relation to their structures, which were firmly established for [P[graphic omitted]H (CO2Me)}L2]·H2O [L = PPh3(3a), L = AsPh3(3e), and L2= bipy (3f)] by single-crystal X-ray diffraction studies. Crystals of (3a) are triclinic, space group P, Z= 2, in a unit cell with lattice parameters a= 11.995(5), b= 17.72(1), c= 10.30(1)Å, α= 94.7(1), β= 110.8(1), and γ= 102.84(2)°. The structure was refined to R 0.055 (R′ 0.060) for 5 093 reflections having 7 ⩽ 2θ⩽ 54°(Mo-KαX-radiation) collected at room temperature. Crystals of (3e) are triclinic, space group P, Z= 2, in a unit cell with lattice parameters a= 12.219(6), b= 17.56(1), c= 10.44(1)Å, α= 93.3(1), β= 110.8(1), and γ= 103.56(2)°. The structure was refined to R 0.043 (R′ 0.046) for 6 025 reflections having 7 ⩽ 2θ⩽ 54° collected at room temperature. Crystals of (3f) are monoclinic, space group P21/c, Z= 4, in a unit cell with lattice parameters a= 8.43(1), b= 14.594(6), c= 14.170(6)Å and β= 92.1(1)°. The structure was refined to R 0.043 (R′ 0.032) for 4 000 reflections having 7 ⩽ 2θ⩽ 60° collected at room temperature. The three molecules contain a highly puckered palladacyclobutan-3-one ring [fold angles 53.3(2) for (3a), 52.3(4) for (3e), and 51.3(3)° for (3f)] with a weak transannular Pd–C bond [Pd–C(2) 2.389(7) for (3a), 2.384(6) for (3e), and 2.374(3)Å for (3f)]. The molecules can be alternatively formulated with slipped η3-oxodimethylenemethane ligands. Variable-temperature 1H n.m.r. data for the compounds [P[graphic omitted]HR)L2](R = CO2Me, L = PPh3, PMePh2, PMe2Ph, PEt3, or AsPh3; L2= bipy) are interpreted in terms of inversion of the palladacyclobutan-3-one ring through a planar transition state.