A comparison of soda lime (Intersurgical) with Amsorb® plus: the cost implications

This was a prospective study comparing the cost implications between two carbon dioxide (CO2) absorbers, soda lime (Intersurgical) and AMSORB® PLUS. The study was conducted over two 4-week periods in two dedicated operating theatres using Datex Ohmeda Aestiva/5 anaesthetic machines. AMSORB® PLUS was used during the first four weeks and soda lime (Intersurgical) the following four weeks. General anaesthesia was administered as routinely done but fresh gas flow (FGF) during the maintenance phase was limited to a maximum flow of 2 L/min. The CO2 absorber was only changed when there was evidence of exhaustion. Total duration of anaesthesia, sevoflurane (bottles) and CO2 absorber (kg) consumption, and amount of waste product (kg) was calculated at the end of each study period. The total cost of delivering general anaesthesia was lower in the AMSORB® PLUS group, RM82.40 (USD19.89)/hour versus the soda lime group, RM91.50 (USD 22.09)/hour (p=0.17), which translates to a 10% reduction in cost per hour. Reduction in sevoflurane consumption in the AMSORB® PLUS compared to the soda lime group was also not statistically significant (p=0.22). The only significant finding was the reduction in CO2 absorber consumption in the AMSORB® PLUS group as compared to soda lime group (p=0.001). In conclusion, AMSORB® PLUS consumption was significantly reduced compared to that of soda lime. However, the use of AMSORB® PLUS did not significantly reduce sevoflurane consumption nor the total cost of delivering general anaesthesia. Given the superior safety profile, AMSORB® PLUS may be a suitable, cost-effective alternative to soda lime in the daily practice of anaesthesia

Pengembangan Model Pembelajaran Klinik Experiential Terhadap Capaian Pembelajaran Pembelajaran Klinik Keperawatan Gawat Darurat Mahasiswa Ners

Keperawatan gawat darurat merupakan bagian kompetensi pendidikan profesi yang bertujuan agar mahasiswa mampu berpikir kritis untuk mengatasi masalah keperawatan klien yang mengancam kehidupan. Metode pembelajaran yang digunakan pada tahap ini adalah pembelajaran klinik experiential. Namun kenyataannya mahasiswa mengalami hambatan dalam mencapai tujuan pembelajaran, sehingga berdampak pada rendahnya capaian pembelajaran klinik. Penelitian ini menggunakan metode eksplanatif karena menjelaskan hubungan kausal antar variabel. Sampel penelitian adalah sebagian mahasiswa Ners Fakultas Keperawatan dan Kebidanan Unusa yang memenuhi kriteria penelitian sebesar 72 mahasiswa dengan tehnik simple random sampling. Variabel penelitian ini adalah karakteristik peserta didik, pengamatan, proses berpikir, perilaku belajar, Pembelajaran klinik experiential, dan capaian pembelajaran klinik keperawatan gawat darurat. Hasil uji PLS didapatkan semua indikator valid dan signifikan sedangkan variabel konstrak yang berpengaruh signifikan (T > 1,96) adalah variabel karakteristik peserta didik terhadap pengamatan, proses berpikir, dan pembelajaran klinik experiential, variabel pengamatan berpengaruh terhadap proses berpikir dan perilaku belajar, variabel proses berpikir berpengaruh terhadap perilaku belajar, variabel perilaku belajar berpengaruh terhadap pembelajaran klinik experiential, dan variabel pembelajaran klinik experiential berpengaruh terhadap capaian pembelajaran klinik keperawatan gawat darurat mahasiswa ners. Karakteristik peserta didik sebagai input sangat menentukan pada setiap tahapan pembelajaran klinik experiential, sehingga dengan karakteristik peserta didik yang baik akan mampu meningkatkan capaian pembelajaran klinik karena peserta didik mampu mengikuti proses pembelajaran klinik experiential. Hal ini sesuai dengan konsep sistem pendidikan, bahwa semua bagian komponen harus dilaksanakan dengan baik dan selaras dengan komponen lain, agar tujuan pembelajaran yang telah ditetapkan dapat dicapai secara optima

Cold gas accretion in galaxies

Evidence for the accretion of cold gas in galaxies has been rapidly accumulating in the past years. HI observations of galaxies and their environment have brought to light new facts and phenomena which are evidence of ongoing or recent accretion: 1) A large number of galaxies are accompanied by gas-rich dwarfs or are surrounded by HI cloud complexes, tails and filaments. It may be regarded as direct evidence of cold gas accretion in the local universe. It is probably the same kind of phenomenon of material infall as the stellar streams observed in the halos of our galaxy and M31. 2) Considerable amounts of extra-planar HI have been found in nearby spiral galaxies. While a large fraction of this gas is produced by galactic fountains, it is likely that a part of it is of extragalactic origin. 3) Spirals are known to have extended and warped outer layers of HI. It is not clear how these have formed, and how and for how long the warps can be sustained. Gas infall has been proposed as the origin. 4) The majority of galactic disks are lopsided in their morphology as well as in their kinematics. Also here recent accretion has been advocated as a possible cause. In our view, accretion takes place both through the arrival and merging of gas-rich satellites and through gas infall from the intergalactic medium (IGM). The infall may have observable effects on the disk such as bursts of star formation and lopsidedness. We infer a mean ``visible'' accretion rate of cold gas in galaxies of at least 0.2 Msol/yr. In order to reach the accretion rates needed to sustain the observed star formation (~1 Msol/yr), additional infall of large amounts of gas from the IGM seems to be required.Comment: To appear in Astronomy & Astrophysics Reviews. 34 pages. Full-resolution version available at http://www.astron.nl/~oosterlo/accretionRevie

Gaia Data Release 2. Kinematics of globular clusters and dwarf galaxies around the Milky Way

AIMS: The goal of this paper is to demonstrate the outstanding quality of the second data release of the Gaia mission and its power for constraining many different aspects of the dynamics of the satellites of the Milky Way. We focus here on determining the proper motions of 75 Galactic globular clusters, nine dwarf spheroidal galaxies, one ultra-faint system, and the Large and Small Magellanic Clouds. METHODS: Using data extracted from the Gaia archive, we derived the proper motions and parallaxes for these systems, as well as their uncertainties. We demonstrate that the errors, statistical and systematic, are relatively well understood. We integrated the orbits of these objects in three different Galactic potentials, and characterised their properties. We present the derived proper motions, space velocities, and characteristic orbital parameters in various tables to facilitate their use by the astronomical community. RESULTS: Our limited and straightforward analyses have allowed us for example to (i) determine absolute and very precise proper motions for globular clusters; (ii) detect clear rotation signatures in the proper motions of at least five globular clusters; (iii) show that the satellites of the Milky Way are all on high-inclination orbits, but that they do not share a single plane of motion; (iv) derive a lower limit for the mass of the Milky Way of 9.1{_₂.₆⁺⁶·²} x 10¹¹ M⊙ based on the assumption that the Leo I dwarf spheroidal is bound; (v) derive a rotation curve for the Large Magellanic Cloud based solely on proper motions that is competitive with line-of-sight velocity curves, now using many orders of magnitude more sources; and (vi) unveil the dynamical effect of the bar on the motions of stars in the Large Magellanic Cloud. CONCLUSIONS: All these results highlight the incredible power of the Gaia astrometric mission, and in particular of its second data release

Gaia Data Release 2 Variable stars in the colour-absolute magnitude diagram

Context. The ESA Gaia mission provides a unique time-domain survey for more than 1.6 billion sources with G ≲ 21 mag. Aims. We showcase stellar variability in the Galactic colour-absolute magnitude diagram (CaMD). We focus on pulsating, eruptive, and cataclysmic variables, as well as on stars that exhibit variability that is due to rotation and eclipses. Methods. We describe the locations of variable star classes, variable object fractions, and typical variability amplitudes throughout the CaMD and show how variability-related changes in colour and brightness induce “motions”. To do this, we use 22 months of calibrated photometric, spectro-photometric, and astrometric Gaia data of stars with a significant parallax. To ensure that a large variety of variable star classes populate the CaMD, we crossmatched Gaia sources with known variable stars. We also used the statistics and variability detection modules of the Gaia variability pipeline. Corrections for interstellar extinction are not implemented in this article. Results. Gaia enables the first investigation of Galactic variable star populations in the CaMD on a similar, if not larger, scale as was previously done in the Magellanic Clouds. Although the observed colours are not corrected for reddening, distinct regions are visible in which variable stars occur. We determine variable star fractions to within the current detection thresholds of Gaia. Finally, we report the most complete description of variability-induced motion within the CaMD to date. Conclusions. Gaia enables novel insights into variability phenomena for an unprecedented number of stars, which will benefit the understanding of stellar astrophysics. The CaMD of Galactic variable stars provides crucial information on physical origins of variability in a way that has previously only been accessible for Galactic star clusters or external galaxies. Future Gaia data releases will enable significant improvements over this preview by providing longer time series, more accurate astrometry, and additional data types (time series BP and RP spectra, RVS spectra, and radial velocities), all for much larger samples of stars

Pengembangan Model Pembelajaran Klinik Experiential Terhadap Capaian Pembelajaran Pembelajaran Klinik Keperawatan Gawat Darurat Mahasiswa Ners

Keperawatan gawat darurat merupakan bagian kompetensi pendidikan profesi yang bertujuan agar mahasiswa mampu berpikir kritis untuk mengatasi masalah keperawatan klien yang mengancam kehidupan. Metode pembelajaran yang digunakan pada tahap ini adalah pembelajaran klinik experiential. Namun kenyataannya mahasiswa mengalami hambatan dalam mencapai tujuan pembelajaran, sehingga berdampak pada rendahnya capaian pembelajaran klinik. Penelitian ini menggunakan metode eksplanatif karena menjelaskan hubungan kausal antar variabel. Sampel penelitian adalah sebagian mahasiswa Ners Fakultas Keperawatan dan Kebidanan Unusa yang memenuhi kriteria penelitian sebesar 72 mahasiswa dengan tehnik simple random sampling. Variabel penelitian ini adalah karakteristik peserta didik, pengamatan, proses berpikir, perilaku belajar, Pembelajaran klinik experiential, dan capaian pembelajaran klinik keperawatan gawat darurat. Hasil uji PLS didapatkan semua indikator valid dan signifikan sedangkan variabel konstrak yang berpengaruh signifikan (T > 1,96) adalah variabel karakteristik peserta didik terhadap pengamatan, proses berpikir, dan pembelajaran klinik experiential, variabel pengamatan berpengaruh terhadap proses berpikir dan perilaku belajar, variabel proses berpikir berpengaruh terhadap perilaku belajar, variabel perilaku belajar berpengaruh terhadap pembelajaran klinik experiential, dan variabel pembelajaran klinik experiential berpengaruh terhadap capaian pembelajaran klinik keperawatan gawat darurat mahasiswa ners. Karakteristik peserta didik sebagai input sangat menentukan pada setiap tahapan pembelajaran klinik experiential, sehingga dengan karakteristik peserta didik yang baik akan mampu meningkatkan capaian pembelajaran klinik karena peserta didik mampu mengikuti proses pembelajaran klinik experiential. Hal ini sesuai dengan konsep sistem pendidikan, bahwa semua bagian komponen harus dilaksanakan dengan baik dan selaras dengan komponen lain, agar tujuan pembelajaran yang telah ditetapkan dapat dicapai secara optima

Superior odontoid migration in the Klippel–Feil patient

Klippel–Feil syndrome (KFS) is an uncommon condition noted primarily as congenital fusion of two or more cervical vertebrae. Superior odontoid migration (SOM) has been noted in various skeletal deformities and entails an upward/vertical migration of the odontoid process into the foramen magnum with depression of the cranium. Excessive SOM could potentially threaten neurologic integrity. Risk factors associated with the amount of SOM in the KFS patient are based on conjecture and have not been addressed in the literature. Therefore, this study evaluated the presence and extent of SOM and the various risk factors and clinical manifestations associated therein in patients with KFS. Twenty-seven KFS patients with no prior history of surgical intervention of the cervical spine were included for a prospective radiographic and retrospective clinical review. Radiographically, McGregor’s line was utilized to evaluate the degree of SOM. Anterior and posterior atlantodens intervals (AADI/PADI), number of fused segments (C1–T1), presence of occipitalization, classification-type, and lateral and coronal cervical alignments were also evaluated. Clinically, patient demographics and presence of cervical symptoms were assessed. Radiographic and clinical evaluations were conducted by two independent blinded observers. There were 8 males and 19 females with a mean age of 13.5 years at the time of radiographic and clinical assessment. An overall mean SOM of 5.0 mm (range = −1.0 to 19.0 mm) was noted. C2–C3 (74.1%) was the most commonly fused segment. A statistically significant difference was not found between the amount of SOM to age, sex-type, classification-type, AADI, PADI, and lateral cervical alignment (P > 0.05). A statistically significant greater amount of SOM was found as the number of fused segments increased (r = 0.589; P = 0.001) and if such levels included occipitalization (r = 0.616; P = 0.001). A statistically significant greater amount of SOM was also found with an increase in coronal cervical alignment (r = 0.413; P = 0.036). Linear regression modeling further supported these findings as the strongest predictive variables contributing to an increase in SOM. A 7.20 crude relative risk (RR) ratio [95% confidence interval (CI) = 1.05–49.18; risk differences (RD) = 0.52] was noted in contributing to a SOM greater than 4.5 mm if four or more segments were fused. Adjusting for coronal cervical alignment greater than 10°, five or more fused segments were found to significantly increase the RR of a SOM greater than 4.5 mm (RR = 4.54; 95% CI = 1.07–19.50; RD = 0.48). The RR of a SOM greater than 4.5 mm was more pronounced in females (RR = 1.68; 95% CI = 0.45–6.25; RD = 0.17) than in males. Eight patients (29.6%) were symptomatic, of which symptoms in two of these patients stemmed from a traumatic event. However, a statistically significant difference was not found between the presence of symptoms to the amount of SOM and other exploratory variables (P > 0.05). A mean SOM of 5.0 mm was found in our series of KFS patients. In such patients, increases in the number of congenitally fused segments and in the degree of coronal cervical alignment were strongly associated risk factors contributing to an increase in SOM. Patients with four or greater congenitally fused segments had an approximately sevenfold increase in the RR in developing SOM greater than 4.5 mm. A higher RR of SOM more than 4.5 mm may be associated with sex-type. However, 4.5 mm or greater SOM is not synonymous with symptoms in this series. Furthermore, the presence of symptoms was not statistically correlated with the amount of SOM. The treating physician should be cognizant of such potential risk factors, which could also help to indicate the need for further advanced imaging studies in such patients. This study suggests that as motion segments diminish and coronal cervical alignment is altered, the odontoid orientation is located more superiorly, which may increase the risk of neurologic sequelae