The experience of patients undergoing knee surgery with local or regional anesthesia: an ethography

This ethnographic study is concerned with the surgical experience of patients within the social context in which it occurs: the operating theatre. Traditionally, the focus of the operating theatre has been on conducting safe, efficient surgery with unconscious patients. However, as the volume of surgery performed under local or regional anaesthesia increases, this focus is shifting. Care of awake patients in the operating theatre is now a prominent feature of modern perioperative practise, and support for the conscious patient has become a major responsibility for all perioperative staff. The aim of this thesis is to understand the experience of being a conscious patient during regional anaesthesia and knee surgery in the perioperative environment. Through such an understanding the nature of the relationship between the conscious patient and the rest of the perioperative team can be established and the most important factors that influence the perioperative experience of this patient group clarified. An ethnographic approach has been used to gather data which enables an understanding of the relationship between the conscious patient in an operating theatre and the rest of the perioperative team. Data was gathered through preoperative and postoperative interviews with seven adult patients scheduled for knee arthroplasty or knee arthroscopy under local or regional anaesthesia. One other patient was interviewed preoperatively but not postoperatively. In addition to the patients, three surgeons, one anaesthetist, one anaesthetic practitioner, one scrub practitioner and a recovery practitioner were also interviewed, making a total of 22 interviews. Participant observation was also conducted in four locations in the hospital; day surgery theatres and main theatres during surgery, the preoperative clinic referred to as ‘joint school’ (where seven consultations were observed) and the fracture clinic where a further seven consultations were observed. Collectively, these areas reflect those visited by patient participants during their surgical journey. The study generates an authentic ethnographic account of the patients’ experiences of knee surgery with local or regional anaesthesia. A thick description, drawn from the views of patients and perioperative staff, has been produced which supports theoretical interpretations of the behaviour and relationships enacted in the context of everyday life in an operating theatre setting. Data analysis was through a constant comparative approach which followed the six steps of grounded theory methodology (Glaser and Strauss, 1967). Perioperative staff caring for the patient during this time typically adopt a medical or scientific perspective towards the patient’s body, whereas patients view this experience from a lived perspective. Four themes identified as trust, capital, embodiment and the clinical gaze were identified through the data analysis. These themes relate to the strategies patients and staff utilise to bridge the gap between their different perspectives. An understanding of which can contribute to ways of interacting with and caring for surgical patients in the perioperative environment

‘I’ve just got to take that risk and have faith . . .’: The challenge of gaining and maintaining trust in patients undergoing knee surgery with a regional anaesthetic

Traditionally, the focus of the operating theatre has been on conducting safe, efficient surgery with unconscious patients. However, the care of awake patients is now a prominent feature of modern perioperative practise as the volume of surgery performed under regional anaesthesia increases. The aim of this novel study was to understand the experience of being a conscious patient during regional anaesthesia and knee surgery in the perioperative environment. Data were gathered through observation and ethnographic interview and analysis followed a constant comparative grounded theory approach. The concepts of Trust and Faith are identified as recurrent themes highlighted in the data. This article identifies the need to understand patients’ expectations regarding the clinical encounter and how subsequent treatment will develop, so that, reasons for any deviation can be discussed openly and an explanation provided. Each clinical encounter takes place within a relationship based upon an uneven distribution of power, enacted through the interaction itself, with the health care professional in a dominant role. It is the responsibility of health care staff to recognise and negate this power imbalance and reinforce trusting relationships so information and treatment options are not presented as a ‘fait accompli’ but negotiated through jargon free easy to understand language

Bosonic molecules in a lattice: unusual fluid phase from multichannel interactions

We show that multichannel interactions significantly alter the phase diagram of ultracold bosonic molecules in an optical lattice. Most prominently, an unusual fluid region intervenes between the conventional superfluid and the Mott insulator. In it, number fluctuations remain but phase coherence is suppressed by a significant factor. This factor can be made arbitrarily large, at least in a two-site configuration. We calculate the phase diagram using complementary methods, including Gutzwiller mean-field and density matrix renormalization group (DMRG) calculations. Although we focus on bosonic molecules without dipolar interactions, we expect multichannel interactions to remain important for dipolar interacting and fermionic molecules.Comment: 6 pages incl. refs, 4 figure

Defects in Thymocyte Differentiation and Thymocyte- Stromal Interactions in the Trisomy 16 Mouse

We have examined fetal thymic development in the trisomy 16 (Ts16) mouse, which is considered to be a model for human trisomy 21, or Down Syndrome. The Ts16 thymus contains 10 to 20% of the number of lymphocytes found in a normal thymus at a comparable stage. Expression of thymocyte differentiation markers (Thy-1, CD5, CD8, CD4, CD3, and HSA) is severely affected in Ts16 fetuses aged 14–18 gestational days. When thymuses from 14-day Ts16 mice were cultured in vitro, these markers eventually reached levels of expression comparable to those seen in normal thymuses in culture. On the other hand, expression of CD44 appears to be unaffected in Ts16 thymuses in vivo, but declines in vitro relative to normal thymuses. Reconstitution of depleted thymic stroma with thymocytes showed evidence of defects in both developmental compartments

Spectral line shape of resonant four-wave mixing induced by broad-bandwidth lasers

We present a theoretical and experimental study of the line shape of resonant four-wave mixing induced by broad-bandwidth laser radiation that revises the theory of Meacher, Smith, Ewart, and Cooper (MSEC) [Phys. Rev. A 46, 2718 (1992)]. We adopt the same method as MSEC but correct for an invalid integral used to average over the distribution of atomic velocities. The revised theory predicts a Voigt line shape composed of a homogeneous, Lorentzian component, defined by the collisional rate Γ, and an inhomogeneous, Doppler component, which is a squared Gaussian. The width of the inhomogeneous component is reduced by a factor of √2 compared to the simple Doppler width predicted by MSEC. In the limit of dominant Doppler broadening, the width of the homogeneous component is predicted to be 4Γ, whereas in the limit of dominant homogeneous broadening, the predicted width is 2Γ. An experimental measurement is reported of the line shape of the four-wave-mixing signal using a broad-bandwidth, "modeless", laser resonant with the Q1 (6) line of the A2 Σ - X2 Π(0,0) system of the hydroxyl radical. The measured widths of the Voigt components were found to be consistent with the predictions of the revised theory

Non-thermal particle acceleration and power-law tails via relaxation to universal Lynden-Bell equilibria

Collisionless and weakly collisional plasmas often exhibit non-thermal quasi-equilibria. Among these quasi-equilibria, distributions with power-law tails are ubiquitous. It is shown that the statistical-mechanical approach originally suggested by Lynden-Bell (1967) can easily recover such power-law tails. Moreover, we show that, despite the apparent diversity of Lynden-Bell equilibria, a generic form of the equilibrium distribution at high energies is a `hard' power-law tail $\propto \varepsilon^{-2}$, where $\varepsilon$ is the particle energy. The shape of the `core' of the distribution, located at low energies, retains some dependence on the initial condition but it is the tail (or `halo') that contains most of the energy. Thus, a degree of universality exists in collisionless plasmas.Comment: 33 pages, 5 figure

Diagnostic Problem

S u b je c t:C.S., married, female, aged 33. Housewife.Past History:1. Usual childhood illnesses.2. Pneumonia on three occasions between the ages of 3 and 5 years.3. Rheumatic fever, aged 9 years.4. Tonsillectomy, aged 10 years.5. Appendicectomy, aged 16 years.6. The patient had two normal pregnancies, aged 23 and 24 years.7. Perforation of duodenal ulcer, aged 25 years. — Gastroenterostomy.8. Gradually progressive exertional dyspnoea began, aged 27.9. Two miscarriages, aged 28, followed by tubal ligation on the grounds of rheumatic heart disease.10. Mitral valvulotomy successfully carried out, aged 29, with relief of symptoms.11. Recurrence of classical acute rheumatism, aged 30

The relationship between periphyton, flow and nutrients in foothill rivers of the south-western Cape, South Africa

Includes bibliographical references.This thesis examines spatial and temporal patterns in periphyton community composition and biomass and the environmental factors responsible for shaping these communities in south-western Cape rivers. The study focused on two prennial foothill rivers in the south-western Cape: the Berg River, which is oligotrophic but has a large dam (The Berg Dam) situated in its upper reaches; and the Molenaars River, which has a natural flow regime but is moderately enriched by trout farm effluent. Two site on the Berg River (one upstream and one downstream of the Berg Dam) and two on the Molenaars River (one upstream and one downstream of the Du Toit's Kloof trout farm) were used to study temporal dynamics in periphyton communities over a 21-month period between September 2007 and May 2009