Hocking's philosophy of the human self.

Thesis (Ph.D.)--Boston University

A retrospective study of the effects of a vasopressor bolus on systolic slope (dP/dt) and dynamic arterial elastance (Eadyn).

BACKGROUND: To enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn. METHODS: This was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively. RESULTS: 201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed. CONCLUSION: Bolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension. TRIAL REGISTRATION: Data was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225)

Anticoagulation for patients with heparin-induced thrombocytopenia using recombinant hirudin during cardiopulmonary bypass

Heparin-induced thrombocytopenia (HIT) is a common complication of heparin therapy. There are three types of HIT. In the majority of patients, thrombocytopenia is modest and resolves without sequelae (HIT I). In a smaller number of patients, the thrombocytopenia is severe (HIT II), and in still others, the thrombocytopenia is also associated with thrombosis (HITT). Administration of heparin to this latter group of patients causes platelet aggregation, thromboembolism, and thrombocytopenia. It is advisable that heparin not be administered in any form to patients with documented or suspected HIT II or HITT. This situation, of course, poses a problem for those patients requiring cardiopulmonary bypass (CPB) surgery. In this report, we summarize our experience with Lepirudin (Hoechst, Frankfurt Ammain, Germany), which is a recombinant hirudin (r-hirudin), as an alternative to heparin for systemic anticoagulation, as well as the use of the ecarine clotting time (ECT) for monitoring anticoagulation status during CPB

Sensing and Active Flow Control for Advanced BWB Propulsion-Airframe Integration Concepts

In order to realize the substantial performance benefits of serpentine boundary layer ingesting diffusers, this study investigated the use of enabling flow control methods to reduce engine-face flow distortion. Computational methods and novel flow control modeling techniques were utilized that allowed for rapid, accurate analysis of flow control geometries. Results were validated experimentally using the Techsburg Ejector-based wind tunnel facility; this facility is capable of simulating the high-altitude, high subsonic Mach number conditions representative of BWB cruise conditions

Anesthetic Preconditioning Combined with Postconditioning Offers No Additional Benefit Over Preconditioning or Postconditioning Alone

BackgroundRecent investigations demonstrate that anesthetic preconditioning and postconditioning reduce myocardial infarct size to a degree comparable to that achieved with ischemic preconditioning. We hypothesized that the combination of sevoflurane preconditioning and postconditioning would result in greater preservation of myocardium.MethodsLangendorff perfused rat hearts were divided into four groups: control, preconditioning, postconditioning, and preconditioning plus postconditioning. During reperfusion, left ventricular function (left ventricular developed pressure, left ventricular end diastolic pressure, and dp/dt) were measured. At the end of reperfusion, the infarct sizes were measured with 2,3,5 triphenyltetrazolium chloride staining. Nuclear magnetic resonance was used to measure intracellular pH, Na(+), and Ca(2+).ResultsLeft ventricular developed pressure, left ventricular end diastolic pressure, left ventricular dp/dt(max) and dp/dt(min) were significantly improved in the treatment groups when compared with those in the controls. Myocardial infarct size (24% +/- 7%, 16% +/- 8%, and 22% +/- 7% in preconditioning, postconditioning, and pre-plus postconditioning groups versus 44% +/- 8% in the control group, P < 0.05) and intracellular Na(+) and Ca(2+) were significantly decreased in all experimental groups at the end of reperfusion when compared with those in control. However, there were no differences between these variables in each treatment group.ConclusionSevoflurane postconditioning is as effective as preconditioning in protecting myocardial function after global ischemia. The combination of sevoflurane preconditioning and postconditioning offered no additional benefit over either intervention alone

Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery

BACKGROUND: Cardiac surgery is associated with a high risk of cardiovascular and other complications that translate into increased mortality and healthcare costs. This retrospective study was designed to determine whether the perioperative use of dexmedetomidine could reduce the incidence of complications and mortality following cardiac surgery. METHODS AND RESULTS: 1,134 patients who underwent CABG and CABG plus valvular and/or other procedures were included. 568 received intravenous dexmedetomidine infusion and 566 did not. Data were adjusted with propensity scores and multivariate logistic regression was used. The primary outcomes measured included mortality and postoperative major adverse cardiocerebral events (MACE: stroke, coma, perioperative myocardial infarction, heart block or cardiac arrest). Secondary outcomes included renal failure, sepsis, delirium, postoperative ventilation hours, length of hospital stay and 30-day readmission. Dexmedetomidine use significantly reduced postoperative in-hospital [1.23% vs. 4.59%; adjusted odds ratio (OR), 0.34; 95% confidence intervals (CI), 0.192 to 0.614; P < 0.0001], 30-day (1.76% vs. 5.12%; adjusted OR, 0.39; 95% CI, 0.226 to 0.655; P <0.0001) and 1-year (3.17% vs. 7.95%; adjusted OR, 0.47; 95% CI, 0.312 to 0.701; P = 0.0002) mortalities. Perioperative dexmedetomidine therapy also reduced the risk of overall complications (47.18 vs. 54.06%; adjusted OR, 0.80, 95% CI, 0.68 to 0.96; p= 0.0136) and delirium (5.46% vs. 7.42%; adjusted OR, 0.53; 95% CI, 0.37 to 0.75; p=0.0030). CONCLUSIONS: Perioperative dexmedetomidine use was associated with a decrease in postoperative mortality up to one year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery

On the dynamics of planetesimals embedded in turbulent protoplanetary discs with dead zones

(abridged) Accretion in protoplanetary discs is thought to be driven by [...] turbulence via the magnetorotational instability (MRI). Recent work has shown that a planetesimal swarm embedded in a fully turbulent disc is subject to strong excitation of the velocity dispersion, leading to collisional destruction of bodies with radii R_p < 100 km. Significant diffusion of planetesimal semimajor axes also arises, leading to large-scale spreading of the planetesimal population throughout the inner regions of the protoplanetary disc, in apparent contradiction of constraints provided by the distribution of asteroids within the asteroid belt. In this paper, we examine the dynamics of planetesimals embedded in vertically stratified turbulent discs, with and without dead zones. Our main aims are to examine the turbulent excitation of the velocity dispersion, and the radial diffusion, of planetesimals in these discs. We employ three dimensional MHD simulations [...], along with an equilibrium chemistry model [...] We find that planetesimals in fully turbulent discs develop large random velocities that will lead to collisional destruction/erosion for bodies with sizes below 100 km, and undergo radial diffusion on a scale \sim 2.5 au over a 5 Myr disc life time. But planetesimals in a dead zone experience a much reduced excitation of their random velocities, and equilibrium velocity dispersions lie between the disruption thresholds for weak and strong aggregates for sizes R_p < 100 km. We also find that radial diffusion occurs over a much reduced length scale \sim 0.25 au over the disc life time, this being consistent with solar system constraints. We conclude that planetesimal growth via mutual collisions between smaller bodies cannot occur in a fully turbulent disc. By contrast, a dead zone may provide a safe haven in which km-sized planetesimals can avoid mutual destruction through collisions.Comment: 18 pages, 13 figures, 3 tables, MNRAS in press, minor corrections to match the published versio

Historical trends in iodine and selenium in soil and herbage at the Park Grass experiment, Rothamsted Research, UK

Long term trends in iodine and selenium retention in soil, and uptake by herbage, were investigated in archived samples from the Park Grass Experiment, initiated in 1856 at Rothamsted, UK. Soil (0-23 cm) and herbage samples from plots receiving various mineral fertilisers and organic manures, with and without lime, were analysed for Se and iodine (I) to assess the effect of soil amendment, annual rainfall, crop yield and changes in soil chemistry from 1876 to 2008. Comparing soil from limed and un-limed control (unfertilized) plots, TMAH-extractable Se and I concentrations both diverged, with time, with greater retention in un-limed plots; differences in concentration amounted to 92 and 1660 µg kg-1 for Se and I respectively after 105 yr. These differences were broadly consistent with estimated additions from rainfall and dry deposition. Offtake of both elements in herbage was negligible compared to soil concentrations and annual inputs (<0.003% of total soil I and <0.006% of total soil Se). A positive correlation was observed between I and Se concentrations in herbage, suggesting some common factors controlling bioavailability. A growth-dilution effect for I and Se was suggested by the positive correlation between growing season rainfall (GSR) and herbage yield together with soil-to-plant transfer factors decreasing with yield. Phosphate and sulphate fertilizers reduced I and Se herbage concentrations, both through ion competition and increased herbage yield. Results suggest that in intensive agriculture with soil pH control, the I requirement of grazing animals is not likely to be met by herbage alone

Seasonal flows of international British Columbia-Alaska rivers: The nonlinear influence of ocean-atmosphere circulation patterns

The northern portion of the Pacific coastal temperate rainforest (PCTR) is one of the least anthropogenically modified regions on earth and remains in many respects a frontier area to science. Rivers crossing the northern PCTR, which is also an international boundary region between British Columbia, Canada and Alaska, USA, deliver large freshwater and biogeochemical fluxes to the Gulf of Alaska and establish linkages between coastal and continental ecosystems. We evaluate interannual flow variability in three transboundary PCTR watersheds in response to El Niño-Southern Oscillation (ENSO), Pacific Decadal Oscillation (PDO), Arctic Oscillation (AO), and North Pacific Gyre Oscillation (NPGO). Historical hydroclimatic datasets from both Canada and the USA are analyzed using an up-to-date methodological suite accommodating both seasonally transient and highly nonlinear teleconnections. We find that streamflow teleconnections occur over particular seasonal windows reflecting the intersection of specific atmospheric and terrestrial hydrologic processes. The strongest signal is a snowmelt-driven flow timing shift resulting from ENSO- and PDO-associated temperature anomalies. Autumn rainfall runoff is also modulated by these climate modes, and a glacier-mediated teleconnection contributes to a late-summer ENSO-flow association. Teleconnections between AO and freshet flows reflect corresponding temperature and precipitation anomalies. A coherent NPGO signal is not clearly evident in streamflow. Linear and monotonically nonlinear teleconnections were widely identified, with less evidence for the parabolic effects that can play an important role elsewhere. The streamflow teleconnections did not vary greatly between hydrometric stations, presumably reflecting broad similarities in watershed characteristics. These results establish a regional foundation for both transboundary water management and studies of long-term hydroclimatic and environmental change