Cell Assembly-based Task Analysis (CAbTA)

Based on an Artificial Neural Network model, Cell Assembly-based Task Analysis is a new method that outputs a task performance model composed of integrated mind-brain Cell Assemblies, which are currently believed to be the most plausible, general organisation of the brain and how it supports mental operations. A simplified model of Cell Assemblies and their cognitive architecture is described and then used in the method. A brief sub-task is analysed. The method’s utility to research in Artificial Intelligence, neuroscience and cognitive psychology is discussed and the possibility of a General Theory suggested

Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery

Background. The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods. In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman’s two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. Results. During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25–75), decreased from 23 (20–30) %/min to 18 (12.5–19) %/min (p<0.001). Despite a generous crystalloid infusion rate (27 (22–35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p<0.001) and reversed to baseline values post HIPEC. Conclusion. Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP

Chemical simulation of greywater

Sustainable water resources management attracts considerable attention in today’s world. Recycling and reuse of both wastewater and greywater are becoming more attractive. The strategy is to protect ecosystem services by balancing the withdrawal of water and the disposal of wastewater. In the present study, a timely and novel synthetic greywater composition has been proposed with respect of the composition of heavy metals, nutrients and organic matter. The change in water quality of the synthetic greywater due to increasing storage time was monitored to evaluate the stability of the proposed chemical formula. The new greywater is prepared artificially using analytical grade chemicals to simulate either low (LC) or high (HC) pollutant concentrations. The characteristics of the synthetic greywater were tested (just before starting the experiment, after two days and a week of storage under real weather conditions) and compared to those reported for real greywater. Test results for both synthetic greywater types showed great similarities with the physiochemical properties of published findings concerning real greywater. Furthermore, the synthetic greywater is relatively stable in terms of its characteristics for different storage periods. However, there was a significant (p<0.05) reduction in 5-day biochemical oxygen demand (BOD5) for both low (LC) and high (HC) concentrations of greywater after two days of storage with reductions of 62% and 55%, respectively. A significant (p<0.05) change was also noted for the reduction (70%) of nitrate‒nitrogen (NO3‒N) concerning HC greywater after seven days of storage

Don't Let Primary Care Patients Slip through the Nets

Nearly 7 million patients might have been subject to a general practice error in the past year. With new models of care proposed, Sukhmeet Panesar and colleagues urge GPs to have a greater awareness of patient safet

Paramedic utility in screening patients who present to Emergency Medical Services and who may benefit from an Advance Care Plan: A mixed methods study with explanatory sequential design

We used a two phased mixed methods study with an explanatory sequential design to understand how frequently paramedics attend patients who, on paramedic assessment with the Gold Standards Framework Proactive Identification Guidance, are end-of-life and have advance care planning. We subsequently explored paramedic views on paramedic screening of patients to assess if they are end-of-life and onward referral to their General Practitioner for advance care planning.Paramedics screened and recorded 14.9% of patients as end-of-life and 44.3% of these patients were assessed to have no advance care plan in place. Where paramedics screened patients and they did have an advance care plan in place, 36.8% had only a Do Not Attempt Cardiopulmonary Resuscitation. Paramedics found using the Gold Standards Framework Proactive Identification Guidance to screen patients for end-of-life status useful and straightforward and considered themselves well placed to complete this task. Future research is required to address the practicalities of implementing a paramedic screening and referral tool for end of life care that results in the intended outcome of supporting effective advance care planning

A Televised, Web-Based Randomised Trial of an Herbal Remedy (Valerian) for Insomnia

BACKGROUND: This trial was conducted as part of a project that aims to enhance public understanding and use of research in decisions about healthcare by enabling viewers to participate in research and to follow the process, through television reports and on the web. Valerian is an herbal over-the-counter drug that is widely used for insomnia. Systematic reviews have found inconsistent and inconclusive results about its effects. METHODS: Participants were recruited through a weekly nationally televised health program in Norway. Enrolment and data collection were over the Internet. 405 participants who were 18 to 75 years old and had insomnia completed a two week diary-keeping run-in period without treatment and were randomised and mailed valerian or placebo tablets for two weeks. All participants and investigators were blind to treatment until after the analysis was completed. FINDINGS: For the primary outcome of a minimally important improvement in self-reported sleep quality (> or = 0.5 units on a 7 point scale), the difference between the valerian group (29%) and the placebo group (21%) was not statistically significant (difference 7.5%; 95% CI-0.9 to 15.9; p = 0.08). On the global self-assessment question at the end of the treatment period 5.5% (95% CI 0.2 to 10.8) more participants in the valerian group perceived their sleep as better or much better (p = 0.04). There were similar trends favouring the valerian group for night awakenings (difference = 6.0%, 95% CI-0.5 to 12.5) and sleep duration (difference = 7.5%, 95% CI-1.0 to 16.1). There were no serious adverse events and no important or statistically significant differences in minor adverse events. INTERPRETATION: Based on this and previous studies, valerian appears to be safe, but with modest beneficial effects at most on insomnia compared to placebo. The combined use of television and the Internet in randomised trials offers opportunities to answer questions about the effects of health care interventions and to improve public understanding and use of randomised trials. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN72748991