Inhalational or total intravenous anaesthesia: is total intravenous anaesthesia useful and are there economic benefits?

PURPOSE OF REVIEW: The comparison of inhalational and intravenous anaesthesia has been the subject of many controlled trials and meta-analyses. These reported diverse endpoints typically including measures of the speed and quality of induction of anaesthesia, haemodynamic changes, operating conditions, various measures of awakening, postoperative nausea and vomiting and discharge from the recovery area and from hospital as well as recovery of psychomotor function. In a more patient-focused Health Service, measures with greater credibility are overall patient satisfaction, time to return to work and long-term morbidity and mortality. In practice, studies using easier to measure proxy endpoints dominate - even though the limitations of such research are well known. RECENT FINDINGS: Recent study endpoints are more ambitious and include impact on survival from cancer and the possibility of differential neurotoxic impact on the developing brain and implications for neuro-behavioural performance. SUMMARY: Economic analysis of anaesthesia is complex and most published studies are naive, focusing on drug acquisition costs and facility timings, real health economics are much more difficult. Preferred outcome measures would be whole institution costs or the ability to reliably add an extra case to an operating list, close an operating room and reduce the number of operating sessions offered or permanently decrease staffing. Alongside this, however, potential long-term patient outcomes should be considered

The response of a floating ice sheet to an accelerating line load

The two-dimensional response of a thin, floating sheet of ice to a line load that accelerates from rest at $t = 0$ to a uniform velocity V for $t \geq T$ is determined through an integral-transform solution of the linearized equations of motion. If $T = 0$ – i.e. if the load is impulsively started with velocity V – the solution exhibits singularities at $V = c_0$, the shallow-water-gravity-wave speed, and $V = c_{\min}$, the minimum speed for transverse motion of the ice, but these singularities are avoided by the acceleration of the load through the critical speeds

Instability of a plane conducting free surface submitted to an alternating magnetic field

This paper considers the stability of a horizontal liquid-metal free surface in the presence of a horizontal alternating magnetic field. A weak formulation is used to derive a generalized Mathieu–Hill equation for the evolution of surface perturbations. Previous studies which rely on time-averaging the electromagnetic force over one field cycle have predicted a generally weak instability, but we find much larger growth rates near the resonances, where the surface wave frequency is an integral multiple of the field frequency. The method can be extended to include viscous and ohmic damping; the former has little effect, while the latter damps all waves except those whose frequency is close to the field frequency. Growth rates can be closely approximated by simple algebraic formulae, as can the critical magnetic field strength for the onset of instability

Propofol and children--what we know and what we do not know.

The pharmacokinetics of propofol are relatively well described in the pediatric population. Recent work has confirmed the validity of allometric scaling for predicting propofol disposition across different species and for describing pediatric ontogenesis. In the first year of life, allometric models require adjustment to reflect ontogeny of maturation. Pharmacodynamic data for propofol in children are scarcer, because of practical difficulties in data collection and the limitations of currently available depth of anesthesia monitors for pediatric use. Hence, questions relating to the comparative sensitivity of children to propofol, and differences in time to peak effect relative to adults, remain unanswered. K(eo) half-lives have been determined for pediatric kinetic models using time to peak effect techniques but are not currently incorporated into commercially available target-controlled infusion pumps

The starfish experiment: a Lagrangian approach

The present paper analyses the free surface deformation of a liquid metal drop under the influence of an alternating magnetic field. The analysis is restricted to the first axi- symmetric mode oscillation. In the low frequency case, the electromagnetic forces are of gradient type and purely oscillatory. Without any viscous damping, it is then possible to build a Lagrangian function, which involves the kinetic energy, the gravitational energy, the surface energy and the electromagnetic energy. The time evolution of the pool height is easily obtained from the Lagrange equation. It is shown that the pool height behaves like a non-linear forced oscillator

Accommodating Students with Specific Learning Disabilities in Math: Developing Fact Fluency

Fact fluency is a crucial component for all students both with and without learning disabilities, as it lays the foundation for future success in all topics of math. For students who have a diagnosed Specific Learning Disability (SLD) in the area of math, fact fluency may be a difficult concept to grasp. To help students have a better understanding of fact fluency, there are multiple different tools that can be used. The purpose of this project is to research and outline some of the best ways to accommodate students who struggle with the concept of fact fluency in the area of mathematics. After creating a rubric based on the literature that outlines the criteria that teachers look for in online applications, the researcher rated each application. After conducting further analysis, the researcher discusses which applications should be highly recommended and why. Also, the researcher discusses different strategies that students can use to develop stronger skills with fact fluency, and then supports why these strategies are accurate. Lastly, the researcher discusses other engaging activities that help build a stronger background knowledge of fact fluency in the classroom based on the literature. By conducting this research, the investigator can justify the importance of fact fluency in mathematics