Goal directed therapy: how long can we wait?

Intensive monitoring and aggressive management of perioperative haemodynamics (goal directed therapy) have repeatedly been reported to reduce the significant morbidity and mortality associated with high risk surgery. It may not matter what particular monitor is used to assess cardiac output but it is essential to ensure adequate oxygen delivery. If this management cannot begin preoperatively, it is still worth beginning goal directed therapy in the immediate postoperative period

(1+3) Covariant Dynamics of Scalar Perturbations in Braneworlds

We discuss the dynamics of linear, scalar perturbations in an almost Friedmann-Robertson-Walker braneworld cosmology of Randall-Sundrum type II using the 1+3 covariant approach. We derive a complete set of frame-independent equations for the total matter variables, and a partial set of equations for the non-local variables which arise from the projection of the Weyl tensor in the bulk. The latter equations are incomplete since there is no propagation equation for the non-local anisotropic stress. We supplement the equations for the total matter variables with equations for the independent constituents in a cold dark matter cosmology, and provide solutions in the high and low-energy radiation-dominated phase under the assumption that the non-local anisotropic stress vanishes. These solutions reveal the existence of new modes arising from the two additional non-local degrees of freedom. Our solutions should prove useful in setting up initial conditions for numerical codes aimed at exploring the effect of braneworld corrections on the cosmic microwave background (CMB) power spectrum. As a first step in this direction, we derive the covariant form of the line of sight solution for the CMB temperature anisotropies in braneworld cosmologies, and discuss possible mechanisms by which braneworld effects may remain in the low-energy universe.Comment: 22 pages replaced with additional references and minor corrections in Revtex4, and accepted for publication in Phys. Rev.

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

Science and Technology Progress at the Sydney University Stellar Interferometer

This paper presents an overview of recent progress at the Sydney University Stellar Interferometer (SUSI). Development of the third-generation PAVO beam combiner has continued. The MUSCA beam combiner for high-precision differential astrometry using visible light phase referencing is under active development and will be the subject of a separate paper. Because SUSI was one of the pioneering interferometric instruments, some of its original systems are old and have become difficult to maintain. We are undertaking a campaign of modernization of systems: (1) an upgrade of the Optical Path Length Compensator IR laser metrology counter electronics from a custom system which uses an obsolete single-board computer to a modern one based on an FPGA interfaced to a Linux computer - in addition to improving maintainability, this upgrade should allow smoother motion and higher carriage speeds; (2) the replacement of the aged single-board computer local controllers for the siderostats and the longitudinal dispersion compensator has been completed; (3) the large beam reducing telescope has been replaced with a pair of smaller units with separate accessible foci. Examples of scientific results are also included.Comment: 10 pages, 9 Figure

Braneworld Tensor Anisotropies in the CMB

Cosmic microwave background (CMB) observations provide in principle a high-precision test of models which are motivated by M theory. We set out the framework of a program to compute the tensor anisotropies in the CMB that are generated in braneworld models. In the simplest approximation, we show the braneworld imprint as a correction to the power spectra for standard temperature and polarization anisotropies.Comment: Minor corrections and references added. Accepted for publication in Phys. Rev.

Variants in the Mannose-binding Lectin Gene MBL2 do not Associate With Sepsis Susceptibility or Survival in a Large European Cohort

We use a large cohort of immune competent adults to analyze the influence of MBL2 genetic variants on sepsis susceptibility and survival. We find no significant associations with the 4 main functional single nucleotide polymorphisms in MBL2, or any combination of genotype

Vicious walkers, friendly walkers and Young tableaux II: With a wall

We derive new results for the number of star and watermelon configurations of vicious walkers in the presence of an impenetrable wall by showing that these follow from standard results in the theory of Young tableaux, and combinatorial descriptions of symmetric functions. For the problem of $n$-friendly walkers, we derive exact asymptotics for the number of stars and watermelons both in the absence of a wall and in the presence of a wall.Comment: 35 pages, AmS-LaTeX; Definitions of n-friendly walkers clarified; the statement of Theorem 4 and its proof were correcte

Association between tocilizumab, sarilumab and all-cause mortality at 28 days in hospitalised patients with COVID-19:A network meta-analysis

BACKGROUND: A recent prospective meta-analysis demonstrated that interleukin-6 antagonists are associated with lower all-cause mortality in hospitalised patients with COVID-19, compared with usual care or placebo. However, emerging evidence suggests that clinicians are favouring the use of tocilizumab over sarilumab. A new randomised comparison of these agents from the REMAP-CAP trial shows similar effects on in-hospital mortality. Therefore, we initiated a network meta-analysis, to estimate pairwise associations between tocilizumab, sarilumab and usual care or placebo with 28-day mortality, in COVID-19 patients receiving concomitant corticosteroids and ventilation, based on all available direct and indirect evidence. METHODS: Eligible trials randomised hospitalised patients with COVID-19 that compared tocilizumab or sarilumab with usual care or placebo in the prospective meta-analysis or that directly compared tocilizumab with sarilumab. Data were restricted to patients receiving corticosteroids and either non-invasive or invasive ventilation at randomisation. Pairwise associations between tocilizumab, sarilumab and usual care or placebo for all-cause mortality 28 days after randomisation were estimated using a frequentist contrast-based network meta-analysis of odds ratios (ORs), implementing multivariate fixed-effects models that assume consistency between the direct and indirect evidence. FINDINGS: One trial (REMAP-CAP) was identified that directly compared tocilizumab with sarilumab and supplied results on all-cause mortality at 28-days. This network meta-analysis was based on 898 eligible patients (278 deaths) from REMAP-CAP and 3710 eligible patients from 18 trials (1278 deaths) from the prospective meta-analysis. Summary ORs were similar for tocilizumab [0·82 [0·71–0·95, p = 0·008]] and sarilumab [0·80 [0·61–1·04, p = 0·09]] compared with usual care or placebo. The summary OR for 28-day mortality comparing tocilizumab with sarilumab was 1·03 [95%CI 0·81–1·32, p = 0·80]. The p-value for the global test of inconsistency was 0·28. CONCLUSIONS: Administration of either tocilizumab or sarilumab was associated with lower 28-day all-cause mortality compared with usual care or placebo. The association is not dependent on the choice of interleukin-6 receptor antagonist