Haemodynamic consequences of Spinal Anaesthesia for non-emergency Caesarean section

Single shot spinal anaesthesia for caesarean section is currently accepted as the favoured method in the absence of contraindications, for reasons of safety and comfort. Firstly, there is an increased risk of failed intubation associated with general anaesthesia. Secondly, spinal anaesthesia, if practiced correctly, allows for a superior experience of the delivery and improved bonding with the infant. Maternal haemodynamic stability is desirable both for maternal and neonatal safety, and to diminish maternal side-effects such as nausea and vomiting. Therefore, after an extensive literature review, clinically relevant aspects of spinal anaesthesia were studied, with a view to contributing to knowledge which could improve safety and outcome. The central themes explored in this thesis were fluid management during spinal anaesthesia for caesarean section in healthy parturients, the haemodynamic effects of the vasoactive agents ephedrine, phenylephrine and oxytocin during spinal anaesthesia for caesarean section in healthy patients and in patients with preeclampsia, and short term neonatal outcome after spinal anaesthesia in patients with severe preeclampsia. Research methodology included non-invasive measures as well as the use of a pulse wave form analysis monitor to measure maternal cardiac output. A validation study was performed comparing this method with thermodilution in patients with postpartum complications of preeclampsia. Abstract viii The results of these studies showed that: The pulse wave form monitor employed showed acceptable limits of agreement with the thermodilution method. Crystalloid coload was associated with lower vasopressor requirements than conventional preload. Spinal anaesthesia was associated with afterload reduction, which was more pronounced in healthy patients than in preeclamptics. Ephedrine maintained or increased, and phenylephrine reduced maternal cardiac output in healthy patients. Oxytocin was associated with transient haemodynamic instability in healthy and preeclamptic patients, which was obtunded by phenylephrine in the healthy population. Spinal anaesthesia for caesarean section was associated with a greater umbilical arterial base deficit than general anaesthesia in patients with preeclampsia. Overall, these studies should contribute to improved knowledge of haemodynamic responses during spinal anaesthesia for caesarean section, and ultimately to improved maternal morbidity and mortality

Investigating the Relationship Between High School Technology Education and Test Scores for Algebra 1 and Geometry

The standards-based reform movement in education that began in the 1980s has evolved. In the 1990s, the focus was on producing subject-area content standards and modifying instruction. Today, the focus has shifted to assessment, and for technology education, demonstrating the impact on children and the efficacy of the discipline within general education. The purpose of this study was to compare the Standards of Learning (SOL) End-of-Course mathematics performance of high school students who completed courses in illustration and design technology to students who have not completed an illustration and design technology course. The following research questions were developed for this study: (1) Did students who had taken illustration and design technology courses perform better on their mathematics SOL tests than students who did not take illustration and design technology courses?; and (2) Did students who had not passed the mathematics SOL tests do better on their retake examinations after they took an illustration and design course? The population for this study was composed of 996 students in the 10th, 11th, and 12th grades who had taken the Algebra I and/or the Geometry end-of-course SOL examinations during the 2002-2003 school year. A t test was used to validate the first research question, and a Chi-square test was used to validate the second research question. The means and standard deviations were used to show the quality of testing between the Non-Illustration and Design Technology group and the Illustration and Design Technology group. The Illustration and Design Technology group had a 78% passing rate, while the Non-Illustration and Design Technology group had a passing rate of 73%. The Illustration and Design Technology group scored 14 points higher on average than the Non-Illustration and Design Technology group. The researchers recommend that this study be replicated with a larger sample in order to include more students. Technology educators must insure that planning at all levels implements contextual practice and includes meaningful assessment. The profession\u27s long tradition of contextual practice is meaningless if it cannot delineate the impact it is having on students

Exploring the utility of the Multidimensional State Boredom Scale.

Background: State boredom–the experience of boredom in the moment – is related to a number of psychosocial issues. Until the recent creation of the Multidimensional State Boredom Scale (MSBS), research was constrained by the lack of a comprehensive, validated measure. However, the MSBS could benefit from further evaluation. Aim: To more thoroughly validate the MSBS. Methods: In two studies, participants were induced into a state of either boredom or non-boredom, and then completed the MSBS. Results: Discriminant analysis showed that the full MSBS was able to correctly classify 68.1% (Study 2) – 84.1% (Study 1) of participants into their experimental condition. Based on 14 further DA analysis, a subset of eight items (a potential short form) is proposed. Differential item functioning (Study 1) found only one item to which responding differed by gender. Discussion: Use of the MSBS, including the full scale versus the short form, is discussed. Which experiential components of boredom may be particularly important for classifying bored individuals, and the issue of variability across boredom manipulations, are also considered

Implementation and performance of SIBYLS: a dual endstation small-angle X-ray scattering and macromolecular crystallography beamline at the Advanced Light Source.

The SIBYLS beamline (12.3.1) of the Advanced Light Source at Lawrence Berkeley National Laboratory, supported by the US Department of Energy and the National Institutes of Health, is optimized for both small-angle X-ray scattering (SAXS) and macromolecular crystallography (MX), making it unique among the world's mostly SAXS or MX dedicated beamlines. Since SIBYLS was commissioned, assessments of the limitations and advantages of a combined SAXS and MX beamline have suggested new strategies for integration and optimal data collection methods and have led to additional hardware and software enhancements. Features described include a dual mode monochromator [containing both Si(111) crystals and Mo/B(4)C multilayer elements], rapid beamline optics conversion between SAXS and MX modes, active beam stabilization, sample-loading robotics, and mail-in and remote data collection. These features allow users to gain valuable insights from both dynamic solution scattering and high-resolution atomic diffraction experiments performed at a single synchrotron beamline. Key practical issues considered for data collection and analysis include radiation damage, structural ensembles, alternative conformers and flexibility. SIBYLS develops and applies efficient combined MX and SAXS methods that deliver high-impact results by providing robust cost-effective routes to connect structures to biology and by performing experiments that aid beamline designs for next generation light sources

Cattle feedlot facilities and management study : a progress report on the first test at the University's Weldon Springs experimental feedlots

Caption title

Evaluation of drug information resources for drug-ethanol and drug-tobacco interactions

Objective: The research evaluated point-of-care drug interaction resources for scope, completeness, and consistency in drug-ethanol and drug-tobacco content. Methods: In a cross-sectional analysis, 2 independent reviewers extracted data for 108 clinically relevant interactions using 7 drug information resources (Clinical Pharmacology Drug Interaction Report, Facts & Comparisons eAnswers, Lexicomp Interactions, Micromedex Drug Interactions, Drug Interactions Analysis and Management, Drug Interaction Facts, and Stockley’s Drug Interactions). Scope (presence of an entry), completeness (content describing mechanism, clinical effects, severity, level of certainty, and course of action for each present interaction; up to 1 point per assessed item for a total possible score of 5 points), and consistency (similarity among resources) were evaluated. Results: Fifty-three drug-ethanol and 55 drug-tobacco interactions were analyzed. Drug-ethanol interaction entries were most commonly present in Lexicomp (84.9%), Clinical Pharmacology (83.0%), and Stockley’s Drug Interactions (73.6%), compared to other resources (p<0.05). Drug-tobacco interactions were more often covered in Micromedex (56.4%), Stockley’s Drug Interactions (56.4%), Drug Interaction Facts (43.6%), and Clinical Pharmacology (41.8%) (p<0.001). Overall completeness scores were higher for Lexicomp, Micromedex, Drug Interaction Facts, and Facts & Comparisons (median 5/5 points, interquartile range [IQR] 5 to 5, p<0.001) for drug-ethanol and for Micromedex (median 5/5 points, IQR 5 to 5, p<0.05) for drug-tobacco, compared to other resources. Drug Interaction Facts and Micromedex were among the highest scoring resources for both drug-ethanol (73.7%, 68.6%) and drug-tobacco (75.0%, 32.3%) consistency. Conclusions: Scope and completeness were high for drug-ethanol interactions, but low for drug-tobacco interactions. Consistency was highly variable across both interaction types

Recipes for obstetric spinal hypotension: The clinical context counts

Hypotension following obstetric spinal anaesthesia remains a common and important problem. While recent research advances have brought us closer to the perfect recipe for the obstetric spinal anaesthetic, these advances have not been translated into practical guidelines able to reduce the unacceptable number of fatalities that occur in environments where resources are limited. In South Africa, more than half of anaesthetic deaths are still related to spinal hypotension. A gap exists between the ‘perfect recipe’, developed from a clinical context rooted in resource-rich research environments, and its application and performance in real-world resource-poor environments – conditions experienced by more than 75% of the world’s population. This review attempts to define this knowledge gap and proposes a research agenda to address the deficiencies

Probing Multiple Sight Lines through the SN 1006 Remnant by UV Absorption Spectroscopy

Absorption-line spectroscopy is an effective probe for cold ejecta within an SNR, provided that suitable background UV sources can be identified. For the SN 1006 remnant we have identified four such sources, in addition to the much-studied Schweitzer-Middleditch (SM) star. We have used STIS on HST to obtain UV spectra of all four sources, to study "core samples" of the SN 1006 interior. The line of sight closest to the center of the SNR shell, passing only 2.0 arcmin away, is to a V = 19.5 QSO at z = 1.026. Its spectrum shows broad Fe II absorption lines, asymmetric with red wings broader than blue. The similarity of these profiles to those seen in the SM star, which is 2.8 arcmin from the center in the opposite direction, confirms the existence of a bulge on the far side of SN 1006. The Fe II equivalent widths in the QSO spectrum are ~ 50% greater than in the SM star, suggesting that somewhat more iron may be present within SN 1006 than studies of the SM star alone have indicated, but this is still far short of what most SNIa models require. The absorption spectrum against a brighter z = 0.337 QSO seen at 57% of the shell radius shows broad silicon absorption lines but no iron other than narrow, probably interstellar lines. The cold iron expanding in this direction must be confined within v <~ 5200 km/s, also consistent with a high-velocity bulge on the far side only. The broad silicon lines indicate that the silicon layer has expanded beyond this point, and that it has probably been heated by a reverse shock. Finally, the spectra of two ~ A0V stars near the southern shell rim show no broad or unusually strong absorption lines, suggesting that the low-ionization ejecta are confined within 83% of the shell radius, at least at the azimuths of these background sources.Comment: 26 pages, 8 postscript figure

Anaesthesia – what has the University of Cape Town contributed?

From humble beginnings, the University of Cape Town’s Department of Anaesthesia has played a major role in the development of anaesthesia as a speciality, in South Africa and internationally. We highlight these contributions in clinical service, teaching and research, with particular emphasis on the department’s leading role in the evolution of anaesthetic safety in adults and children: from the development of the treatment of malignant hyperthermia, to unique studies in mortality associated with anaesthesia, and modern contributions to improved drug safety. Innovations in anaesthetic techniques have contributed to significant surgical developments, including the first heart transplant. Furthermore, our research has contributed to major advances in obstetric and endocrine anaesthesia, and training in the department is recognised as being among the best in the world