Ketamine and the Obstetric Patient

Ketamine anaesthesia was administered to 135 mothers undergoing Caesarean section. The incidence of awareness, dream recall, and psychic disturbance in this group was compared with that occurring in 126 subjects anaesthetised with thiopentone and nitrous oxide. Factual recall was rare in both groups. Dreaming, although more frequent in the ketamine series, was usually pleasant in nature. Psychic phenomena occurred after ketamine anaesthesia, but were infrequent if ketamine dosage was limited, or anaesthesia supplemented with diazepam. It is concluded that ketamine may be used to advantage in obstetric anaesthesia, without significant dreaming or psychic disturbances.S. Afr. Med. J., 48, 734 (1974)

Magnetic coupling constants for MnO as calculated using hybrid density functional theory

The properties of MnO have been calculated using generalised gradient approximation (GGA-) and hybrid (h-) density functional theory (DFT), specifically variants of the popular PBE and PBESol exchange–correlation functionals. The GGA approaches are shown to be poor at reproducing experimental magnetic coupling constants and rhombohedral structural distortions, with the PBESol functional performing worse than PBE. In contrast, h-DFT results are in reasonable agreement with experiment. Calculation of the Néel temperatures using the mean-field approximation gives overestimates relative to experiment, but the discrepancies are as low as 15 K for the PBE0 approach and, generally, the h-DFT results are significant improvements over previous theoretical studies. For the Curie–Weiss temperature, larger disparities are observed between the theoretical results and previous experimental results

Learning associations between action and perception: effects of incompatible training on body part and spatial priming.

Observation of another person executing an action primes the same action in the observer's motor system. Recent evidence has shown that these priming effects are flexible, where training of new associations, such as making a foot response when viewing a moving hand, can reduce standard action priming effects (Gillmeister, Catmur, Liepelt, Brass, & Heyes, 2008). Previously, these effects were obtained after explicit learning tasks in which the trained action was cued by the content of a visual stimulus. Here we report similar learning processes in an implicit task in which the participant's action is self-selected, and subsequent visual effects are determined by the nature of that action. Importantly, we show that these learning processes are specific to associations between actions and viewed body parts, in that incompatible spatial training did not influence body part or spatial priming effects. Our results are consistent with models of visuomotor learning that place particular emphasis on the repeated experience of watching oneself perform an action

Hybrid-DFT Modeling of Lattice and Surface Vacancies in MnO

We have investigated the properties of defects in MnO bulk and at (100) surfaces, as used in catalytic applications, using hybrid-level density functional theory (i.e., inclusion of exact exchange within the exchange-correlation evaluation) in a hybrid QM/MM embedded-cluster approach. Initially, we calculate the formation energy for bulk Mn and O vacancies, comparing charged-defect compensation with charge carriers at the Fermi Level (ϵf) and through Schottky defect formation. Oxygen vacancies were also investigated at the (100) surface, where the vacancy formation energy is very similar to the bulk. Defect levels associated with the most stable vacancies are calculated using the ΔSCF method: all are positioned mid band gap, with surface environments failing to alter strongly the overall nature of the defect relative to bulk. Chemical activity of the (100) MnO surface was considered through the adsorption of a probe CO2 molecule, which is considered the initial step in the transformation of CO2 into hydrocarbons. CO2 adsorption was strongest over a neutral oxygen vacancy, where the associated trapped electrons of the defect transfer to the adsorbate and thus activate it. However, we have shown with our embedded-cluster approach that the neutral oxygen vacancy is not necessarily the dominant species, which has implications when interpreting results for future catalytic applications

Interventions to Promote Cancer Awareness and Early Presentation: Systematic Review

Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma

Health-related quality of life after treatment for bladder cancer in England

Background Little is known about quality of life after bladder cancer treatment. This common cancer is managed using treatments that can affect urinary, sexual and bowel function. Methods To understand quality of life and inform future care, the Department of Health (England) surveyed adults surviving bladder cancer 1–5 years after diagnosis. Questions related to disease status, co-existing conditions, generic health (EQ-5D), cancer-generic (Social Difficulties Inventory) and cancer-specific outcomes (Functional Assessment of Cancer Therapy—Bladder). Results In total, 673 (54%) patients responded; including 500 (74%) men and 539 (80%) with co-existing conditions. Most respondents received endoscopic treatment (60%), while 92 (14%) and 99 (15%) received radical cystectomy or radiotherapy, respectively. Questionnaire completion rates varied (51–97%). Treatment groups reported ≥1 problem using EQ-5D generic domains (59–74%). Usual activities was the most common concern. Urinary frequency was common after endoscopy (34–37%) and radiotherapy (44–50%). Certain populations were more likely to report generic, cancer-generic and cancer-specific problems; notably those with co-existing long-term conditions and those treated with radiotherapy. Conclusion The study demonstrates the importance of assessing patient-reported outcomes in this population. There is a need for larger, more in-depth studies to fully understand the challenges patients with bladder cancer face

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice.

BACKGROUND: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. SUMMARY: Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care