Is the Air Handling Capability of the Quadrox D Pump Dependent within an ECMO Circuit? An In Vitro Study

The occurrence of gaseous microemboli (GME) within the extracorporeal membrane oxygenation circuit is largely overlooked, as are methods to ameliorate this occurrence. We aimed to determine if the air handling capability of the Quadrox D oxygenator was dependent upon whether it was used in conjunction with a centrifugal or roller pump; and if application of a Pall air eliminating filter (AEF) would prevent circuit air introduction from intravenous infusions. Using a blood primed circuit 1 mL of air was infused pre pump. GME were quantified post pump and post oxygenator using the EDAC® Quantifier. Trials were conducted at 1 and 2 L/min flow. To prevent GME recirculation a Capiox SX18 was used in circuit with negative pressure applied to its oxygenator; an EDAC® cuvette distal to this device quantified GME recirculation. Following air infusion, 3–5 minute data recordings were carried out for each trial. Separate trials were carried out for centrifugal and roller pumps, and for each flow rate. The process was then repeated following the application of the AEF to the air infusion line. More GME were detected post Quadrox D when the centrifugal pump was used in comparison to the roller pump at 1 L/min (p ≤ .05), and 2 L/min (p = .05). A greater volume of air was detected post Quadrox D when used in conjunction with the centrifugal device at 1 L/min (p ≤ .05), and 2 L/min (p ≤ .05). Application of the AEF resulted in zero GME detected at any circuit location. The results of this study confirm that a greater total count and volume of GME are detected distal to the Quadrox D when used in conjunction with a Rotaflow centrifugal pump. Application of a Pall AEF to infusion and drug lines can prevent air introduction from this source

\u3ci\u3eGeographers: Biobibliographical Studies, Volume 33\u3c/i\u3e

Editor: Hayden Lorimer and Charles W. J. Withers Chapter, Hull House Geography, by Christina E. Dando, UNO faculty member. Volume 33 of Geographers Biobibliographical Studies adds significantly to the corpus of scholarship on geography\u27s multiple histories and biographies with six essays on individuals who have made major contributions to the development of geography in the twentieth century. This volume focuses on European geographers, including essays on individuals from Britain, France and Hungary. These are individuals who have made important and distinctive contributions to a diverse range of fields, including cartography, physical geography, oceanography and urban theory. As with previous volumes, these biographical essays demonstrate the importance of geographers\u27 lives in terms of the lived experience of geography in practise.https://digitalcommons.unomaha.edu/facultybooks/1275/thumbnail.jp

Membrane Oxygenator Exhaust Capnography for Continuously Estimating Arterial Carbon Dioxide Tension During Cardiopulmonary Bypass

Typically, the standard practice for measuring the arterial blood carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CPB) is to take intermittent blood samples for analysis by a bench blood gas analyzer. Continuous inline blood gas monitors are available but are expensive. A potential solution is the capnograph, which was evaluated by determining how accurately the carbon dioxide tension in the oxygenator exhaust gases (PECO2) predicts PaCO2. A standard capnograph monitoring line was attached to the exhaust port of the membrane oxygenator. During CPB, the capnograph reading and arterial blood temperature were recorded at the same time as routine arterial blood gases were taken. One hundred fifty-seven blood samples were collected from 78 patients. A good correlation was found between the PECO2 and the temperature corrected PaCO2 (r2 = 0.833, P < .001). There was also a reasonable degree of agreement between the PECO2 and the temperature corrected PaCO2 during all phases of CPB: accuracy (bias or mean difference between PaCO2 and PECO2) of −1.2 mmHg; precision (95% limits of agreement) of ± 4.7 mmHg. These results suggest that oxygenator exhaust capnography may be a simple and inexpensive adjunct to the bench blood gas analyzer in continuously estimating PaCO2 of a clinically useful degree of accuracy during CPB

Coronary Artery Bypass Grafting: An Off-Pump versus On-Pump Review

There has been a proliferation in the number of coronary artery bypass grafts (CABG) being performed without the use of cardiopulmonary bypass (CPB). However, the benefits of off-pump coronary artery grafting (OPCAB) are still being determined. The aim of this retrospective review was to compare the perioperative outcomes of CPB patients with OPCAB patients and to identify the patients most likely to benefit from the off-pump procedure. We reviewed the perioperative data of all isolated CABG patients at two metropolitan hospitals for the period of August 2000 to September 2001. The two groups (OPCAB vs. CPB) were further divided into subgroups identifying patients by their predicted mortality (higher-risk and lower-risk) and the number of distal graft anastomoses received (1, 2, 3, 4, or 5). A p value less than .05 was considered significant. Out of the total of 882 patients, 46.2% were OPCAB cases. Both CPB and OPCAB groups were similar in terms of demographics and predicted risk of mortality. Intraoperatively, OPCAB patients had fewer distal graft anastomoses (2.4 ± 1.0 vs. 3.2 ± 1.0, p < .001). Postoperatively, patients in the OPCAB group had less chest drainage (889 ± 588 vs. 989 ± 662 mls, p < .001), sustained fewer strokes (0.2 vs. 1.9%, p < .05), were transfused less (15.4 vs. 32.5%, p < .001) and were discharged earlier (7.3 ± 5.6 vs. 8.5 ± 9.1 days, p < .05). For higher-risk patients, OPCAB was associated with fewer reoperations for bleeding (1.3 vs. 6.4%, p < .05), a lower stroke rate (0 vs. 3.2%, p < .05), and a trend toward lower mortality (7.1 vs. 15.1%, p = .08). However, lower-risk OPCAB patients’ stroke incidences (0.5% OPCAB group vs. 1.4% CPB group), and mortality rates (0.5 vs. 0.5%) were similar. Comparisons by number of grafts performed revealed that only the single-grafted OPCAB patients had statistically fewer postoperative complications, reduced chest drainage, and a shorter intensive care stay. Differences between either operation groups in transfusion rates were only statistically significant for the one to three grafted patients, while postoperative stays were similar for patients having four grafts. These results suggest that OPCAB is associated with a reduction in mortality and morbidity, particularly within the higher-risk patients. However, the benefits of OPCAB diminished with an increasing number of distal anastomoses performed

Police Attitudes in England to Return Interviews, in Repeat Missing Person Cases

Copyright © 2016 John Wiley & Sons, Ltd. The aim of this article is to examine the attitudes of English police officers to return interviews of people who are reported missing repeatedly (e.g. three times or more). In addition to a brief police ‘Safe & Well Check’ a return interview is also carried out by a police officer and seeks to find out where people went and why, in order to identify potential risks to their safety and whether they experienced harm whilst they were missing. A mixed-methods survey of 50 constables from one police force in England ran in March 2014, using quantitative and open qualitative questions. Key themes that emerged were individual frustration at repetition, negativity around usefulness of the interviews, a challenge to involve third sector partners, and development areas in training. Statistical significance was found in variables relating to officer experience and gender, against views on interviewing missing people. The article looks at the limited existing literature and makes recommendations about best practice with return interviews, advocating a multi-agency approach to improve interventions, and better training to improve positivity towards missing people. Copyright © 2016 John Wiley & Sons, Ltd

Antiviral Drugs for Viruses Other Than Human Immunodeficiency Virus

Most viral diseases, with the exception of those caused by human immunodeficiency virus, are self-limited illnesses that do not require specific antiviral therapy. The currently available antiviral drugs target 3 main groups of viruses: herpes, hepatitis, and influenza viruses. With the exception of the antisense molecule fomivirsen, all antiherpes drugs inhibit viral replication by serving as competitive substrates for viral DNA polymerase. Drugs for the treatment of influenza inhibit the ion channel M2 protein or the enzyme neuraminidase. Combination therapy with Interferon-α and ribavirin remains the backbone treatment for chronic hepatitis C; the addition of serine protease inhibitors improves the treatment outcome of patients infected with hepatitis C virus genotype 1. Chronic hepatitis B can be treated with interferon or a combination of nucleos(t)ide analogues. Notably, almost all the nucleos(t) ide analogues for the treatment of chronic hepatitis B possess anti–human immunodeficiency virus properties, and they inhibit replication of hepatitis B virus by serving as competitive substrates for its DNA polymerase. Some antiviral drugs possess multiple potential clinical applications, such as ribavirin for the treatment of chronic hepatitis C and respiratory syncytial virus and cidofovir for the treatment of cytomegalovirus and other DNA viruses. Drug resistance is an emerging threat to the clinical utility of antiviral drugs. The major mechanisms for drug resistance are mutations in the viral DNA polymerase gene or in genes that encode for the viral kinases required for the activation of certain drugs such as acyclovir and ganciclovir. Widespread antiviral resistance has limited the clinical utility of M2 inhibitors for the prevention and treatment of influenza infections. This article provides an overview of clinically available antiviral drugs for the primary care physician, with a special focus on pharmacology, clinical uses, and adverse effects