The effects of different weaning modes on the endocrine stress response

INTRODUCTION: The aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and T-piece modes. METHODS: Sixty patients were randomly divided into three groups (n = 20). The PS group received FiO(2 )≤ 0.4, PS ≤ 10 cmH(2)O, and positive end expiratory pressure ≤ 5 cmH(2)O for 2 hours. The CPAP group was given FiO(2 )≤ 0.4 and CPAP 5 ≤ cmH(2)O for 2 hours. The T-piece group (group T) received 4 l/min oxygen via a T-piece for 2 hours. After 1 hour and 2 hours in their respective weaning modes, blood and urine samples were taken for insulin, cortisol, glucose and vanilmandelic acid measurements. Forty-eight hours after extubation, blood and urine samples were again taken. RESULTS: Plasma insulin was greater in group T than in the PS and CPAP groups (P < 0.01 and P < 0.01). The plasma cortisol concentration was greater in group T than in group PS during weaning (P < 0.05) and after extubation (P < 0.05). Blood glucose concentrations were greater in group T than in the other groups (both P < 0.01) both during weaning and post extubation. Urine vanilmandelic acid was greater in group T than in the other groups during weaning and after extubation (both P < 0.001). CONCLUSION: Weaning via the T-piece caused a greater stress response than the PS and CPAP modes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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The purpose of this thesis is to model coherently detected BFSK, BPSK and QPSK, and noncoherently detected BFSK communications systems in the presence of additive white Gaussian Noise (AWGN) and different types of jamming signals by using MATLAB Communications Toolbox and Simulink. The theoretical results are available for the effect of AWGN on the performance of digital communication systems. To determine the performance of a system in the presence of AWGN and different types of jamming signals we need to use computer simulation. The results obtained by simulation are presented for bit-error rate (BER) as a function of signal-to-noise ratio (SNR) and signal-to-jamming ratio (SJR). As observed from the simulation results, different types of jamming affect each digital modulation technique differently.http://archive.org/details/digitalcommunica1094532961NAN

DIGITAL COMMUNICATIONS JAMMING

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Neuroleptic Malignant Syndrome Requires Intensive Care Monitoring: A Review with Three Cases

Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic and potentially fatal side effect of antipsychotics. The syndrome is characterised by hyperthermia (fever), muscle rigidity, autonomic disturbances and alterations of mental state. Psychotropic medications, such as typical and atypical antipsychotics, certain dopamine receptor-blocking drugs used in the treatment of nausea and gastroparesis (e.g. promethazine, metoclopramide and prochlorperazine) and antidepressants, such as amoxapine, have all been implicated in the aetiology of NMS. Herein, we report three cases of NMS and discuss their possible aetiology with reference to the existing literature

The nexus among perceived organizational support, organizational justice and cynicism

Purpose - A traditional view of an ideal workplace is an organization with a justice climate and a supportive atmosphere. Over the past years, justice and support practices in the workplace have received significant scholarly, practical and even political attention. Unfortunately, theoretical underpinnings and literature associated with these themes vary across multiple disciplines, cultural and contextual settings. To fill the void from the Turkish contextual perspective, the present study aims to examine the association among perceived organizational support (POS), organizational justice and cynicism. Design/methodology/approach - The sample was chosen from the public employees in the central organization of two ministries in Ankara Province. Data through questionnaires were collected by the conveniency method from a total of 326 public employees. The proposed model is analyzed withvariance-based structural equation modeling technique. Findings - Results suggest that POS and organizational justice exert a negative impact on cynicism. In particular, as employees-POS and organizational justice increases, the tendency for organizational cynicism decreases. Originality/value - In today’s dynamic environment, controlling and reducing the cynicism, which emerges as an important threat to the success of organizations, of employees has become essential in obtaining a sustainable competitive advantage. The originality of this research stems from its ability to put forward how to manage and control cynicism, with the help of organizational support and organizational justice and hence have a power that increases personal and organizational efficiency and performance from the Turkish contextual perspective. There is limited research examining the relationship among organizational POS, organizational justice and cynicism in the Turkish context.No sponso