Effect of intraoperative fluid optimisation on renal function in patients undergoing emergency abdominal surgery; a randomised controlled pilot study (ISRCTN 11799696) Fluid optimisation for emergency surgery

<b>Background:</b> Emergency abdominal surgery carries a high risk of postoperative morbidity and mortality. Goal directed therapy has been advocated to improve outcome in high-risk surgery. The aim of the present pilot study was to examine the effect of goal directed therapy using fluid alone on postoperative renal function and organ failure score in patients undergoing emergency abdominal surgery. <b>Methods:</b> This prospective randomised pilot study included patients over the age of 50 undergoing emergency abdominal surgery. In the intervention group pulse pressure variation measurements were used to guide fluid boluses of 6% Hydroxyethylstarch 130/0.4. The control group received standard care. Serum urea, creatinine and cystatin C levels were measured prior to and at the end of surgery and postoperatively on day 1, day 3 and day 5. <b>Results:</b> Thirty patients were recruited. One patient died prior to surgery and was excluded from the analysis. The intervention group received a median of 750ml of hydroxyethylstarch. The peak values of postoperative urea were 6.9 (2.7–31.8) vs. 6.4 (3.5–11.5)mmol/l (p=0.425), creatinine 100 (60–300) vs. 85 (65–150) μmol/l (p=0.085) and cystatin C 1.09 (0.66–4.94) vs. 1.01 (0.33–2.29)mg/dl (p=0.352) in the control and intervention group, respectively. <b>Conclusions:</b> In the present pilot study replacing the identified fluid deficit was not associated with a change in renal function. These results do not preclude that goal directed therapy using fluid alone may have an effect on renal function but they would suggest that the effect size of fluid optimisation alone on renal function is small

Reallocating resources to focused factories: a case study in chemotherapy

This study investigates the expected service performance associated with a proposal to reallocate resources from a centralized chemotherapy department to a breast cancer focused factory. Using a slotted queueing model we show that a decrease in performance is expected and calculate the amount of additional resources required to offset these losses. The model relies solely on typical outpatient scheduling system data, making the methodology easy to replicate in other outpatient clinic settings. Finally, the paper highlights important factors to consider when assigning capacity to focused factories. These considerations are generally relevant to other resource allocation decisions

On the Nonlinearity of Modern Shock-Capturing Schemes

The development is reviewed of shock capturing methods, paying special attention to the increasing nonlinearity in the design of numerical schemes. The nature is studies of this nonlinearity and its relation to upwind differencing is examined. This nonlinearity of the modern shock capturing methods is essential, in the sense that linear analysis is not justified and may lead to wrong conclusions. Examples to demonstrate this point are given

A search for H₂ emission in bipolar nebulae and regions of interstellar shock

We report a H2 emission survey of five bipolar outflow sources (NGC 1333, M2-9, As 353, S106, V645 Cyg), and one region of shock interaction between an H II region and molecular cloud (NGC 281). Two of the sources (M2-9, NGC 1333) were detected in the v = 1-0S(1), and Q-branch transitions of H2, and we provide a detailed analysis and modelling for these cases. The probable mass of shocked H2 is shown to range between 1.4 10-6 and 4.2 10-8 M⊙ for M2-9, and ≈ 2.5-4 and 1.9-10 M⊙ in the case of NGC 1333, although the latter values may require increasing by a factor of a few when due allowance is made for extinction. A detailed analysis for the core of M2-9 indicates that the ionized zone is extremely compact, and our Brackett line measures support other evidence in suggesting a high core extinction, large emission measure E~4 1010 cm-6 pc, and a projected angular radius θc~0.04. Similarly, it is apparent from the H2S(1) line strength that the core expansion velocity must be low and less than ~ 1 km s-1 (a constraint which is also required on dynamical grounds). Finally, CO J = 3-2 observations of the source failed to detect emission above a 2σ limit of T*R ~ 0.4 K, and this is shown to imply a probable expansion timescale of ≲2 103 yr

An open and parallel multiresolution framework using block-based adaptive grids

A numerical approach for solving evolutionary partial differential equations in two and three space dimensions on block-based adaptive grids is presented. The numerical discretization is based on high-order, central finite-differences and explicit time integration. Grid refinement and coarsening are triggered by multiresolution analysis, i.e. thresholding of wavelet coefficients, which allow controlling the precision of the adaptive approximation of the solution with respect to uniform grid computations. The implementation of the scheme is fully parallel using MPI with a hybrid data structure. Load balancing relies on space filling curves techniques. Validation tests for 2D advection equations allow to assess the precision and performance of the developed code. Computations of the compressible Navier-Stokes equations for a temporally developing 2D mixing layer illustrate the properties of the code for nonlinear multi-scale problems. The code is open source

Functional status and prosthesis use in amputees, measured with the Prosthetic Profile of the Amputee (PPA) and the short version of the Sickness Impact Profile (SIP68)

Amputation of (a part of) the lower extremity will cause loss or disturbance of locomotion. With prosthetic devices and rehabilitation many amputees are able to restore their locomotive function as well as their social function. Maintenance or restoration of function after discharge is even more important. In rehabilitating amputees, prosthetic devices can improve mobility. Little is known about whether these devices will still be used at home after discharge and if the improvement in functioning is stable. To verify whether the treatment strategy of amputees is sufficient or needs to be modified, it is important to check if the goals of rehabilitation are achieved. Outcome in amputees used to be related to mortality and cure, especially mobility, for example, by the Amputee Activity Score, a measure for activity, not related to age, sex or handicap (Day, 1981). Recently, ‘quality of life’ and ‘reintegration in normal life’ have been emphasized in measuring outcomes of rehabilitation programmes. Research on 42 amputees (Nissen and Newman, 1992) indicated that more attention should be paid to community, mobility, recreation and additional illnesses after amputation to improve reintegration to normal living. The purpose of this study is to evaluate (1) the status at discharge and (2) the maintenance of physical functioning (including mobility) and psycho-social functioning after a follow-up period of 2 months after discharge from a rehabilitation setting. Since mobility is related to prosthesis use, prosthesis use is also evaluated

CO J = 4 - 3 observations of molecular clouds

A survey of the CO J= 4-3 transition has been made towards a sample of seven galactic molecular clouds. These data have been combined with spectra for the lower CO transitions to examine how they vary in line shape with different transition. Such variations are examined using LVG modelling techniques to obtain estimates of the physical state of the emitting gas. The authors discuss the implications and importance that observations of these submillimetre wavelength transitions have in refining knowledge of the gas in molecular clouds

Reallocating resources to focused factories: a case study in chemotherapy

This study investigates the expected service performance associated with a proposal to reallocate resources from a centralized chemotherapy department to a breast cancer focused factory. Using a slotted queueing model we show that a decrease in performance is expected and calculate the amount of additional resources required to offset these losses. The model relies solely on typical outpatient scheduling system data, making the methodology easy to replicate in other outpatient clinic settings. Finally, the paper highlights important factors to consider when assigning capacity to focused factories. These considerations are generally relevant to other resource allocation decisions