Tuberculosis: the implications for anaesthesia

Tuberculosis is a common problem in South Africa, and provides a number of challenges for the anaesthetist. Patients may present in a variety of ways. Constitutional and pulmonary symptoms are the most common. These may impact on fitness for surgery and choice of anaesthesia. Tuberculosis treatment has the potential for a number of significant drug interactions. These are primarily mediated through induction of the cytochrome P450 enzyme system by rifampicin. Guidelines for the prevention of tuberculosis in the theatre environment need to be followed to avoid placing staff and other patients in danger.Keywords: tuberculosis, antitubercular agents, drug interactions, transmission, bacterial filte

Sertraline and Phenytoin Drug Interaction in a Geriatric Patient

This report presents the case of a 78-year-old man residing in a nursing home who presented with a 2-month history of increasing lethargy and confusion. These symptoms coincided with the initiation of sertraline in the patient. Among other medications, he was also taking phenytoin. The medical team concluded that the cause of the patient’s lethargy and confusion was a drug interaction between sertraline and phenytoin. Phenytoin was held, while the sertraline was slowly tapered to discontinuation. The patient’s symptoms resolved soon thereafter. Future research is needed to better guide clinicians in appropriate selection, dosing, and monitoring of selective serotonin reuptake inhibitors with concomitant phenytoin use.Key words: phenytoin, sertraline, SSRIs, drug interactio

The Perceived Business Benefit of Cloud Computing: An Exploratory Study

The objective of the research is to study the benefits of cloud computing perceived by adopters and examine the impact of moderating factors on the relationship between the type of cloud computing and the perceived benefit. The moderating factors include firm size and value-chain activities. A measurement instrument of a 5-point Likert scale was administered on businesses of different sizes in Taiwan. The benefit of cloud computing measured in the study were: cost reduction, improved capability and enhanced scalability. The results show that the perceived benefit of cloud computing varies depending on the type of cloud computing, the value chain activity where cloud computing is deployed, and the business size. Also, businesses benefit more in enhanced scalability than in cost reduction and increased business capability. After adopting cloud computing, businesses gain more capability in support activities than in primary activities. However, there is no significant difference in composite benefit among Software as a Service (SaaS), Platform as a Service (PaaS), and Infrastructure as a Service (IaaS). Furthermore, there is marginally significant interaction effect between the types of cloud computing and the business size

Results from a 1500 m deep, three-level downhole seismometer array: Site response, low Q values, and f_(max)

A three-level downhole array is being operated in a 1500-m-deep borehole within the seismically active Newport-Inglewood fault zone, Los Angeles basin. The array consists of three three-component 4.5 Hz seismometers deployed at the surface, and at 420 and 1500 m depth. An M = 2.8 earthquake that occurred 0.9 km away from the array at a depth of 5.3 km on 31 July 1986 generated rays traveling almost vertically up the downhole array. The P- and S-wave pulse shapes show increasing pulse rise time with decreasing depth, and the initial pulse slope is less steep at the surface than at 1500 m. The average value of t_s/t_p between 1500 and 420 m depth is 1.7 and between 420 and 0 m is 3.4. A near-surface site response results in amplification on the P wave by a factor of four and S waves by a factor of nine. These data indicate a near-surface Q_α of 44 ± 13 for rays traveling almost vertically. In the case of S waves, most of the high frequency content of the waveform beyond ∼ 10 Hz observed at 1500 m depth is lost through attenuation before the waveform reaches 420 m depth. The average Q_β is 25 ± 10 between 1500 and 420 m depth and 108 ± 36 between 420 and 0 m depth. The spectra of the S waves observed at 420 and 0 m of the downward reflected S phases may overestimate Q_β, because they are limited to a narrow band between 5 and 10 Hz and affected by the near-surface amplification. A Q_c of 160 ± 30 at 6 Hz was determined from the decay rate of the coda waves at all three depths. The corner frequency as determined from displacement spectra may be higher (f_c ∼ 10 Hz) at 1500 m depth than at (f_c ∼ 7 Hz) 420 and 0 m depth. Similarly, f_(max) significantly decreases as the waveforms travel toward the earth's surface, indicating that f_(max) is affected by near-surface attenuation. Beyond f_c, the average slopes of the spectra falloff of P-wave spectra is ∼f^(−2) at 1500 m depth and ∼ f^(−3) at the surface

Common bursting relationships underlie eukaryotic transcription dynamics

Transcription commonly occurs in bursts resulting from alternating productive (ON) and quiescent (OFF) periods. Yet how transcriptional bursts are regulated to determine spatiotemporal transcriptional activity remains unclear. Here we perform live transcription imaging of key developmental genes in the fly embryo, with single polymerase sensitivity. Quantification of single allele transcription rates and multi-polymerase bursts reveals shared bursting relationships among all genes, across time and space, as well as cis- and trans-perturbations. We identify the allele's ON-probability as the main determinant of the transcription rate, while changes in the transcription initiation rate are limited. Any given ON-probability determines a specific combination of mean ON and OFF times, preserving a constant characteristic bursting time scale. Our findings point to a convergence of various regulatory processes that predominantly affect the ON-probability, thereby controlling mRNA production rather than mechanism-specific modulation of ON and OFF times. Our results thus motivate and guide new investigations into the mechanisms implementing these bursting rules and governing transcriptional regulation

Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage among hospitalised patients with tuberculosis in rural KwaZulu-Natal

Background. There is little information regarding the presence and characteristics of methicillin-resistant Staphylococcus aureus (MRSA), an important nosocomial pathogen, in rural African hospitals. Objectives. To determine the prevalence of MRSA colonisation in patients admitted to a rural hospital with tuberculosis (TB) in an endemic HIV area and to describe transmission dynamics and resistance patterns among MRSA isolates. Methods. A prospective prevalence survey in the adult TB wards of the Church of Scotland Hospital, a provincial government district hospital in Tugela Ferry, KwaZulu-Natal. Patients were eligible if over the age of 15 and admitted to the TB wards between 15 November and 15 December 2008. Nasal swabs were cultured within 24 hours of admission and repeated at hospital-day 14 or upon discharge. Susceptibility testing was performed with standard disk diffusion. Demographic and clinical information was extracted from medical charts. Results. Of 52 patients with an admission nasal swab, 11 (21%) were positive for MRSA. An additional 4 (10%) of patients with negative admission swabs were positive for MRSA on repeat testing. MRSA carriage on admission was more common among patients with previous hospitalisation, and among HIV-infected patients was significantly associated with lower CD4 counts (p=0.03). All MRSA isolates were resistant to cotrimoxazole, and 74% were resistant to ≥5 classes of antibiotics; all retained susceptibility to vancomycin. Conclusions. A high prevalence of multidrug-resistant MRSA nasal carriage was found. Studies are needed to validate nosocomial acquisition and to evaluate the impact of MRSA on morbidity and mortality among TB patients in similar settings

'The last channel': vision at the temporal margin of the field.

The human visual field, on the temporal side, extends to at least 90° from the line of sight. Using a two-alternative forced-choice procedure in which observers are asked to report the direction of motion of a Gabor patch, and taking precautions to exclude unconscious eye movements in the direction of the stimulus, we show that the limiting eccentricity of image-forming vision can be established with precision. There are large, but reliable, individual differences in the limiting eccentricity. The limiting eccentricity exhibits a dependence on log contrast; but it is not reduced when the modulation visible to the rods is attenuated, a result compatible with the histological evidence that the outermost part of the retina exhibits a high density of cones. Our working hypothesis is that only one type of neural channel is present in the far periphery of the retina, a channel that responds to temporally modulated stimuli of low spatial frequency and that is directionally selective.Evelyn Trus

Baryon-Baryon Interactions

After a short survey of some topics of interest in the study of baryon-baryon scattering, the recent Nijmegen energy dependent partial wave analysis (PWA) of the nucleon-nucleon data is reviewed. In this PWA the energy range for both pp and np is now 0 < Tlab < 350 MeV and a chi^2_{d.o.f.}=1.08 was reached. The implications for the pion-nucleon coupling constants are discussed. Comments are made with respect to recent discussions around this coupling constant in the literature. In the second part, we briefly sketch the picture of the baryon in several, more or less QCD-based, quark-models that have been rather prominent in the literature. Inspired by these pictures we constructed a new soft-core model for the nucleon-nucleon interaction and present the first results of this model in a chi^2 -fit to the new multi-energy Nijmegen PWA. With this new model we succeeded in narrowing the gap between theory and experiment at low energies. For the energies Tlab = 25-320 MeV we reached a record low chi^2_{p.d.p.} = 1.16. We finish the paper with some conclusions and an outlook describing the extension of the new model to baryon-baryon scattering.Comment: 12 pages LaTeX and one postscript figure included. Invited talk presented at the XIVth European Conference of Few-Body Problems in Physics, Amsterdam, August 23-28, 199