Solutions to challenges facing a university digital library and press.

During the creation of a university digital library and press intended to serve as a medical reference and education tool for health care providers and their patients, six distinct and complex digital publishing challenges were encountered. Over nine years, through a multidisciplinary approach, solutions were devised to the challenges of digital content ownership, management, mirroring, translation, interactions with users, and archiving. The result is a unique, author-owned, internationally mirrored, university digital library and press that serves as an authoritative medical reference and education tool for users around the world. The purpose of this paper is to share the valuable digital publishing lessons learned and outline the challenges facing university digital libraries and presses.

Elimination of antithrombin III concentrate in healthy pregnant and preeclamptic women with an acquired antithrombin III deficiency.

The activity elimination half-life of heat-treated antithrombin III (AT III) concentrate was studied in 5 healthy pregnant and 5 preeclamptic women with a documented AT III deficiency. Healthy pregnant women received 1500 units over 20 minutes. Serial blood specimens were obtained over the next 12 hours. The mean (+/- SEM) activity elimination half-life of AT III was 29.4h +/- 3.4h. Preeclamptic subjects had a mean baseline AT III activity of 70.5 +/- 2% (range 61 to 75%). Their activity eliminator half-life after 3000 units of AT III concentrate was 8.5 +/- 1.2h. There was a direct relationship between the pre-concentrate AT III activity level and the AT III activity elimination half-life (r = 0.79, p = 0.01) for all subjects. Based upon parameters calculated from the first infusion, the AT III activity of preeclamptic subjects was maintained by a constant infusion at approximately 100% for 96h. At the conclusion of the infusion, the activity elimination half-life was again measured. A dramatic increase in the activity elimination half-life was demonstrated (433.6h). We conclude that the activity elimination half-life of AT III concentrate is increased during normal pregnancy and further increased in preeclamptic women with an acquired deficiency.

The effect of intravascular transfusion on umbilical venous pressure in anemic fetuses with and without hydrops.

Human fetal umbilical venous pressure was measured during 20 intravascular transfusions performed for treatment of hemolytic anemia. The mean (+/- 1 SEM) gestational age at the time of transfusion was 29.3 +/- 1 weeks and the mean beginning hematocrit was 27% +/- 2%. The mean volume of infused packed red blood cells (70% hematocrit) was 90.3 +/- 7 ml. The mean hematocrit at completion of the procedure was 48% +/- 1%. In nonhydropic fetuses umbilical venous pressure rose progressively from 6.7 +/- 1 mm Hg at the start of transfusion to 10.9 +/- 1 mm Hg at the completion of transfusion (p less than 0.002). However, most fetuses who began the infusion with a normal umbilical venous pressure ended the transfusion with a normal umbilical venous pressure (less than 10 mm Hg). Fetuses with immune hydrops (n = 2) had elevated umbilical venous pressure values before the initiation of transfusion therapy when compared with the first transfusion of nonhydropic fetuses (12.5 +/- 0.5 vs. 5.7 +/- 1 mm Hg, p = 0.01). However, the umbilical venous pressure measurements declined into the normal range within 24 hours of the first transfusion; this normalization was too rapid to be explained by the reversal of liver hypertrophy or portal hypertension. There was no demonstrable relationship between the rise in umbilical venous pressure and either the gestational age, the volume transfused, or the rise in hematocrit. This study demonstrated: (1) In terms of the umbilical venous pressure, direct intravenous infusion of the human anemic fetus is well tolerated; (2) the elevated umbilical venous pressure associated with immune hydrops can correct rapidly with red blood cell replacement.