Target Ranges of Oxygen Saturation in Extremely Preterm Infants

Previous studies have suggested that the incidence of retinopathy is lower in preterm infants with exposure to reduced levels of oxygenation than in those exposed to higher levels of oxygenation. However, it is unclear what range of oxygen saturation is appropriate to minimize retinopathy without increasing adverse outcomes.
Methods We performed a randomized trial with a 2-by-2 factorial design to compare target ranges of oxygen saturation of 85 to 89% or 91 to 95% among 1316 infants who were born between 24weeks 0 days and 27 weeks 6 days of gestation. The primary outcome was a composite of severe retinopathy of prematurity (defined as the presence of threshold retinopathy, the need for surgicalophthalmologic intervention, or the use of bevacizumab), death before discharge from the hospital, or both. All infants were also randomly assigned to continuous positive airway pressure or intubation and surfactant.
Results The rates of severe retinopathy or death did not differ significantly between the lower-oxygen-saturation group and the higher-oxygen-saturation group (28.3% and 32.1%, respectively; relative risk with lower oxygen saturation, 0.90; 95% confidence interval [CI], 0.76 to 1.06; P=0.21). Death before discharge occurred more frequently in the lower-oxygen-saturation group (in 19.9% of infants vs. 16.2%; relative risk, 1.27; 95% CI, 1.01 to 1.60; P=0.04), whereas severe retinopathy among survivors occurred less often in this group (8.6% vs. 17.9%; relative risk, 0.52; 95% CI, 0.37 to 0.73; P<0.001). There were no significant differences in the rates of other adverse events.
Conclusions A lower target range of oxygenation (85 to 89%), as compared with a higher range (91 to 95%), did not significantly decrease the composite outcome of severe retinopathy or death, but it resulted in an increase in mortality and a substantial decrease in severe retinopathy among survivors. The increase in mortality is a major concern, since a lower target range of oxygen saturation is increasingly being advocated to prevent retinopathy of prematurity.


                                                                        



                                   @NEJM
 SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network

Empowered

Yesterday i added 5 new books to my bookshelves;i can't express the deep joy i ' ve experienced with reading books in recent months;in these 2 months i added 8 books overall;
April :
1-The Inverted Forest ; J D Salinger

2-Blue Melody ; J D Salinger

3-The Will To Power ; F W Nietzsche
-------------------------------------------------------
Yesterday :
4-Cat's Cradle ; Kurt Vonnegut

5-L'homme Problematique ; Gabriel Marcel

6-A Perfect Night To Go To China ; David Gilmour

7-The Art Of Always Being Right ; Arthur Schopenhauer

8-The Time Of The Hero ; Mario Vargas Liosa


i'm currently reading Consolations Of Philosophy by Alain De Botton translated by Erfan Saabeti (which is an exceptional work) and A Happy Death by Albert Camus translated by Ehsan Lame'a ;
I'm also busy with the heavy philosophy of Hegel : 'Le Malheur De La Conscience Dans La Philosophie De Hegel' (written by Jean Wahl translated by Bagher Parham)

Refuse/Resist

It's been long years;Fighting for a cause;building up a systematic thinking;i've paid the price and always kept a fixed gaze to the future;
This has been always a tedious way for my age and i always tried to reduce and redfine my basic expectations;
There are plenty of hazards ;all the the time in a special genial clothing;
I believe intelligence and faith are two essential forces againts so-called fate.
All my life has been proving these auguries wrong;
Now i've faced the latest episode.





Title : Sepultura song 

Music On My Radar

I' ve been  closely following some new bands:also as always  i will give some variant genres a try;actually April was fully conquered by unique mournful sound of Shape Of Despair; i ' ve been listening to music as long as i can remember; but this kind of expression through a band's sound is something really rare.i had Angels of Distress since last September but i found the profund quality of it just lately.
Anyway May has been another revoking process ; i listened to Over The Rhine 's Trumpet Child again;and i have to say this couple are just fantastic;if you're interested in jazz music this album is a Must-Buy definitely.
But ...bands i 'm curious about them are these;

1-Source of Deep Shadows; Polish Doom Metal band and their 2007 album Source of Doom And Perpetual Night  specifically is in my Wish-List


2-The Stanley Brothers : Legendary Virginia-based Bluegrass band active between 1946 - 1966
 you better watch the lyrics of their song 'Your Worries and Troubles Are Mine " so mesmerizing sound belongs to this cult band


3-Abstract Spirit : Russian Funeral Doom Metal hail their 2009 Tragedy and Weeds is in my Wish-List


4-Shearwater  : Indie Rock band from Austin;their 2008 Rook is a highly praised album received an  average score of 85 indicating Universal Acclaim based on 20 reviews. Lyrics mostly focused on Nature and Fairy Tale


5-Lapsus Dei : Brutal Doom Metal band from Chile : after 2005 Beyond The Truth ;they haven't released a single EP; Highly lionized band for Doom Metal Fans

6-Flowing Tears : Outstanding Gothic Metal band from Germany;their album  "Thy Kingdom Gone" is in spotlight


7-Giant Squid : Progressive Metal act from Austin again ! i'm so curious about this 
american metal band .Overall their albums received a high score .


8-Circus Of Damnation : Italian Experimental Doom Metal band


9-Wormphlegm : Finnish Funeral Drone/Doom  Metal ; quite mysterious band


10-Depressed Mode : Finnish Ex- Funeral Doom/Death Metal act; i actually listened to their 2009 album "...For Death " actually it didn't turn to one of my favorites .

11-Comatose Vigil : Russian Funeral Doom Metal; my main target is their 2005 "Not A Gleam Of Hope"


12-Worm Ouroboros ; Exciting Post-Rock ,Post-Metal band with strong folk influence;This San Fransisco-based Trio seems something interesting  Interview here


13-Moonspell  : Gothic Metal giants ;Night Eternal...


14-Earthless : Pschedelic Rock band from San Diego


15-Riverside :"Anno Domini High Definition"2009 by Polish Progressive Rock/Meral bands;one of my favorite bands.

16-The Gathering : Werst Pole "2009


17-Karnivool : Five-piece Alternative/Progressive Rock band from Perth ;Their 2010 "Sound Awake " sounds enthralling


19-Canvas Solaris : Georgia based Progressive Metal band


20-Octopus : Progressive Rock/Metal band from Chile





21-Amorphis : Skyforger !


22-The Almost : American Alternative/Christian Rock band


23-Mogwai : Scottish Post-Rock band ;typically compose lenghty guitar-based instrumental pieces that feature dynamic contrast , melodic bass guitar lines,and heavy use of distortion and effects


24-My Vitriol : Alternative Rock from London


25-My Bloody Valentine ; Alternative Rock pioneers from Dublin

26-Brief Candles :They Live We Sleep A Review here


27-Ulver ;  Ambient-Avant-Garde-Industrial band from Norway


28- 31 Knots  : Math Rock / Indie Rock from Portland,Oregan 


29- Re123+ : Belorussian drone Metal act ; theomegaorder.com described their music as compelling mixture of drone,doom and post-metal atmospherics.

Nervy May

These days have been so uneasy to handle;waiting for my Internal Medicine Ward mark and there's a nervy waiting period of time;
Writing papers has been absolutely slow;so disappointing days;this crunching pressure is the new challenge of my life;
No way; i must overcome ; No to surmises.

Coming Back To Life

Where were you when i was burned and broken
While the days slipped by from my window watching
Where were you when i was hurt and i was helpless
Because the things you say and the things you do surround me
While you were hanging yourself on someone elses's words
Dying to believe in what you heard
I was staring straight into the shining sun


Lost in thought and lost in time
While the seeds of life and the seeds of change were planted
Outside the rain fell dark and slow
While i pondered on this dangerous but irresistible pastime
I took a heavenly ride through our silence
I knew moment had arrived
For killing the pas and coming back to life


I took a heavenly ride through our silence
I knew the waiting had begun
And headed straight...into the shining sun

در قیر شب

دیرگاهی است در این تنهایی

رنگ خاموشی در طرح لب است

بانگی از دور مرا می خواند

لیک پاهایم در قیر شب است.

رخنه ای نیست در این تاریکی :

درو دیوار به هم پیوسته.

سایه ای لغزد اگر روی زمین

نقش وهمی است ز بندی رسته.

نفس ادم ها

سربه سر افسرده است.

روزگاری است در این گوشه ی پژمرده هوا

هر نشاطی مرده است.

دست جادویی شب

در به روی من وغم می بندد.

می کنم هر چه تلاش

او به من میخندد.

نقش هایی که کشیدم در روز

شب زراه امد و با دود اندود.

طرح هایی که فکندم در شب

روز پیدا شد وبا پنبه زدود.

دیرگاهی است که چون من همه را

رنگ خاموشی در طرح لب است.

جنبشی نیست در این خاموشی:

دست ها پاها در قیرشب است.

                                                         سهراب سپهری

State Capitalism

this was basically Economist's article about global recess and newly defined roles of govenments;The return of Big Government and grappling again with some fundamental questios;


"15 years ago it seemed that the great debate about the proper size and role of the state had been resolved . In Britain and America alike ,Tony Blair and Bill Clinton pronounced the last rites of "the era of big government".
Privatising state-run companies was all the rage .The Washington consensus reigned supreme;persuade governments to put on "The golden straitjacket",in  Tom Friedman's phrase,and prosperity will follow.


Today government is back with a vengeance:not just as a brute fact but as a vigorous ideology.Britain's public spending is set to exceed 50% of GDP.
America 's  financial capital has shifted from New York to Washington DC and the government has been trying to extend its control over the health-care industry.Huge state-run  companies such as Gazprom and PetroChina are on the march .Nicolas Sarkozy,having run for office as a french Margaret Thatcher,now argues that the main feature of the credit crisis is "the return of the state,the end of the ideo;ogy of public powerlessness".



"The Return Of The State" is stirring up fiery opposition aswell as praise.In America the Republican Party's anti-government base is more agitated than it has been at any time since the days of the Gingrich revolution in 1994.
"Tea Party"protesters have been marching across the country with an amusing assortment of banners and buttons :"Born free,taxed to death "and "God only requires 10%(?)".On january 19th Scott Brown ,a Republican ,captured the Massachsetts senate seat long held by the late Ted Kennedy ,America's most prominent supporter of big -government liberalism.


Many European countries have devoted a high proportion of their GDP to public spendin for years.
And many governments cannot wait to get out of their new-found business of running banks and car companies.But the past decade has clearly produced changes which ,taken  cumulatively,have put the question of the state back at the centre of political debate.


The obvious reason for the change is the financial crisis .As global markets collapsed ,governmentsintervened on an unprecedented scale ,injecting liquidity into their econimiesand taking over ,or otherwise rescuing,banks and other companies that were judged "too big too fail".Afew months after Lehman Brothers had collapsed,the American government was in charge of General Motors and Chrysler,the British government was running high street banks and ,across the OCED,governments had pledged an amount equivalent to 2.5% of GDP.


The crisis upended conventional wisdom about the relative merits of governments and markets.Where government ,in Ronald Reagan's aphorism,was once the problem,today is the default villain is the market.Free-marketeers such as Alan Greenspan,the former head the Federal Reserve ,have apologised for their ideological zeal.A line from Rudyard Kipling sums it up best:"The gods  of market tumbled,and their smooth-tongued,Brown,Britain's chancellor and later its prime minister ,began his ministerial career as "Mr Prudent".During Labour's first 3 years in office public spending fell from 40.6%of GDP to 36.6%.But then he embarked on an Old Labour sprnding binge.He increased spending on the National Health Service by 6%a year in real terms and boosted spending on education .During Labour'13 years in  power two-thirds of all the new jobs created were driven by the public sector ,and pay has grown faster there than in the private sector .


In America ,George Bush did not even go through a prudent phase.He ran for office believing that "when somebody hurts ,has got to move".And he responded to the terrorist attacks with a broad-ranging war on terror .The result of his guns and butter strategy was the biggest expansion in the American state since Lyndon Johnson's in the mid-1960S. He added a huge new drug entitlement to medicine .He created the biggest new bureaucracy since WW II  ,the Department 's control over education and over the states.The gap between American public spending and Canada 's has tumbled from 15 percentage points in 1992 to just 2 percentage points today.





The Public Demands


The expansion of the state in both Britain and America met with widerspread approval .The opposition Conservative party applauded Mr Brown's increase  in NHS spending .Mr Bush met no significant opposition from his fellow Republicans to his spending binge .It was clear that ,when it came to their own benefits ,suburban Americans wanted government on their side .A banner at one of those tea-parties sums up the confused attitude of many of the so-called anti-government protesters :"Keep the government hands off my Medicare."


The demand for public services will soar in the coming decades ,thanks to the aging of the population .The UN points out that the proportion of the world's population that is over 60 will rise from 11% today to 22% in 2050.The situation is specially dire in the developed world :in 2050 one in three people in the rich world will be pensioners ,and one in ten will be over 80.In America more than 10.000 baby-boomers will become eligible for social security and Medicare every day for the next two decades.The Congressional Budget office  CBO calculates that entitlement spending will grow from 9% of GDP today to 20% in 2025.
If America keeps the distaste for taxes ,it will face fiscal Armageddon.


The level of public spending is only one indication of the state's power .America's federal government employs a quarter of a million bureaucrats whose job it is to write and apply federal regulations.They have cousins in national and supranational capitals all around the world .These regulators act as force multipliers:a regulation promulgated by a few can change the behaviour of entire industries .Periodic attempts to build "bonfires of regulations" have got nowher .Under Mr Bush the number of pages of federal regulations increased by 7.000 and eight of Britain's ten biggest regulatory bodies were set up under the current government.


The power of these regulators is growing all the time .Policy makers are drawing up new rules on everything from the amount of capital that banks have to set aside to what to do about them when they fail.Britain is imposing additional taxes on bankers' bonuses,America is imposing extra taxes on banks' liabilities,and central bankers are pondering ingenious ways to intervene in overheated markets.
Worries about climate change have already led to swathe of new regulations ,for example on carbon emissions from factories and power plants and on the energy efficiency of cars and light-bulbs.But since emissions are continuing to grow ,such regulations are likely to proliferate and ,at the same time ,get tighter .The Kerry-Boxer bill on carbon emissions ,which is now in the Senate ,runs to 821 pages.


Fear of Terrorism and worries about rising crime have also inflated the state .Governments have expanded their ability to police and supervise their populations .Britain has more than 4m CCTV cameras,one for every 14 people.
Chinese state-controlled companies have been buying up private companies during the financial crisis ,Russia 's state-controlled companies have a long record of snapping up private companies on the cheap.Sovereign wealth funds are increasingly important in the world's markets.


This is partly product of the oil boom.
Three-quarters of the world's crude-oil reserves are owned by national oil companies.By contrast ,conventional multinationals control just 3% of the world's reserves and produce 10% of its oil and gas)But it is also the result of something more fundamental ;the shift in the balance of economic power to countries with a very different view of the state from the one celebrated in the Washington consensus.The world is seeing the rise of a new econimic hybrid-what might be termed"stste capitalism".


Under state capitalism ,governments do not so much reject the market as use it as an instrument of state power .They encourage companies to take advantage of global capital markets and venture  abroad in search of opportunities.Malaysia's Petronas and China's National Petroleum Corporationrun business in some 30 countries .But they also use them to control the economy at home -to direct  resources to favoured industries or reward political clients,Politicians in China and elsewhere not only make decisions about the production of cars and mobile phones;they are also the hidden hands behind companies that are scouring the worlsd for the raw materials that go into them.


The revival of the state is creating a series of fierce debates that will shape policymaking over the coming decaded.Governments are beginning to cut public spending in an attempt to deal with surging deficits .But the inevitable quarrels over cuts will be paltry compared  with those about the growth of entitlements.America's deficit ,boosted by recession ,is already hovering at a post-war high of 12% of GDP ,and the American economy depends on the willingness of other countries to fund its debt.The CBO calculates that the deficit could rise to 23% of GDP in the next 40 years if it fails to tackle the yawning imbalance between revenue and expenditure.


Crises can be the midwives of serious thinking .The stagflation of the 1970s prepared the wa for the Reagan and Thatcher revolutions.More recently ,several countries have dealt with out of control spending by introducing dramatic cuts:New Zealan ,Canada and the Netherlands all reduced public spending by as much as 10% from 1992 onwards.


The rise of state capitalism is fraught with problems .It may be hard to argue with China's 30 years of hefty economic growth and $2.3 trillion in foreign-currency reserves.But subordinating econimic decisions to political ones can come with a price-tag in the long term:politicians are reluctant to let strategic companies fail,and companies become adjuncts of the state patronage machine.Giving the imprimatur of the state to global companies is also fraught with risks .America's Congress prevented Dubai from taking over American ports on grounds of national security.


Anatomising Failure


The most interesting arguments over the next few years will weigh government failure against market  failure .The market-failure school had been gaining strength even before the credit crunch struck .The rise of cowboy capitalism in Russia under Boris Yeltsin persuaded many people -not least the chinese-of the importanceof strong government.And the threat of global warming is an obvious example of how government intervention is needed to deter people fromm overheating the world .


The public sector is subjected to all sorts of perverse incentives.Politicians use public money to buy votes .America is littered with white elephants such as John Murtha airport in Jonestown ,Pennsylvania ,which cost hundreds of millions of dollars but serves only a handful of passengers ,including Mr Murtha ,who happens to be chairman of a powerful congressional committee.Interest groups spend hugely to try to affect political decisions :there are 1.800registered  lobbyists in the European Union ,5.000  in Canada and no fewer than 15.000 in America .Mr Bush 's energy bill was so influenced by lobbyists that John McCain dubbed it the "No Lobbyist Left Behind" act .


"The Question that we ask today ",said Barack Obama in his inaugural address ,"is not wether our government is too big or too small,but wether it works." This is clearly naive :with deficits soaring ,nobody can afford to ignore the size of government .Mr Obama 's appeal fpr pragmatism has some value :conservative attempts to roll back government regulations have led to disaster in the finance industry .But left-wing attempts to defend entitlements and public-sector privileges willy-nilly will condemn the state to collapse under its own weight .Policymakers will not be able to give a serious answer to Mr Obama's question of wether "government works"without first asking themselves some more fundamental questions about  what the state should be doing and what it should be leaving well alone.  

April-March-February movies

1-  Headless Woman ---------- Lucrecia Martel 2008                8/10
2-  Creation- ---------------- Jon Amiel 2009                            7/10
3-  Million Dollar Baby  ---------------- Clint Eastwood 2005    8/10
4-  Un Prophete'  ----------------- Jacques Audiard 2009         10/10
5-  Goodfellas  ----------------- Martin Scorsese 1990              9/10
6-  Eldorado  -------------------Bouli Lanners 2008                  6/10
7-  9  ---------------------Shane Acker 2009                            9/10
8-  Dead Ringers  ---------------- David Cranenberg 1988        6/10
9-NoOne knows about persian cats---- Bahman Ghobadi 2009 8/10
10-When We're all Asleep-----------Bahram Beizaee                6/10

11-Deep Breath --------------------Parviz Shahbazi   2003      10/10
12-We Don't Live Here Anymore-----John Curran 2004           6/10
13-20 Fingers ---------------Mania Akbari 2004                       6/10
14- A woman in Berlin ---------Max Faberbach 2008               6/10
15-Sisters-------Brian De Palma    1973                                    6/10
16-The invention of Lying ----Ricky Geravis/Matthew Robinson 9/10
17-Looking For Eric-----------Ken Loach 2008                        9/10
18-Kramer vs Kramer -------------- Robert Benton  1979         8/10
19-Mother and Son ------------Aleksandr Sokurov 1997          9/10
20-Nine Miles Down ----------Anthony Waller 2009                 3/10

21-The River Within -----------Zac Heath  2009                        5/10
22-Nine--------------------Rob Marshall  2009                         7/10
23-A Serious Man -----------Ethan and Joel Coen 2009                 7/10