The effects on arterial haemoglobin oxygen saturation and on shunt of increasing cardiac output with dopamine or dobutamine during one-lung ventilation

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsTheoretically, if the cardiac output were increased in the presence of a given intrapulmonary shunt, the arterial saturation should improve as the venous oxygen extraction per ml of blood decreases if the total oxygen consumption remains constant. Previous work demonstrated that this was not achieved with adrenaline or isoprenaline as increased shunting negated any benefit from improved cardiac output and mixed venous oxygen content. However, pharmacological stimulation of cardiac output and venous oxygen without any increase in shunt should achieve the goal of improved arterial oxygenation. To test this hypothesis, seven pigs were subjected to one-lung ventilation and infused on separate occasions, with dopamine and with dobutamine in random order to increase the cardiac output. The mixed venous oxygen content, shunt fraction, oxygen consumption and arterial oxygen saturation were measured. With both dopamine and dobutamine there was a consistent rise in venous oxygen content. However, with dopamine, the mean shunt rose from 28% to 42% and with dobutamine, the mean shunt rose from 45% to 59% (both changes P<0.01). With dopamine, the mean arterial oxygen saturation fell by 4.7%, and with dobutamine by 2.9%, but neither fall was statistically significant. It is concluded that any benefit to arterial saturation which might occur from a dopamine- or dobutamine-induced increase in mixed venous oxygen content during one-lung ventilation is offset by increased shunting. During one-lung anaesthesia, there would appear to be no benefit to arterial saturation in increasing cardiac output with an infusion of either dopamine or dobutamine.W. J. Russell, M. F. Jameshttp://www.aaic.net.au/Article.asp?D=200331

Intensified array camera imaging of solid surface combustion aboard the NASA Learjet

An intensified array camera was used to image weakly luminous flames spreading over thermally thin paper samples in a low gravity environment aboard the NASA-Lewis Learjet. The aircraft offers 10 to 20 sec of reduced gravity during execution of a Keplerian trajectory and allows the use of instrumentation that is delicate or requires higher electrical power than is available in drop towers. The intensified array camera is a charge intensified device type that responds to light between 400 and 900 nm and has a minimum sensitivity of 10(exp 6) footcandles. The paper sample, either ashless filter paper or a lab wiper, burns inside a sealed chamber which is filled with 21, 18, or 15 pct. oxygen in nitrogen at one atmosphere. The camera views the edge of the paper and its output is recorded on videotape. Flame positions are measured every 0.1 sec to calculate flame spread rates. Comparisons with drop tower data indicate that the flame shapes and spread rates are affected by the residual g level in the aircraft

An evaluation of the relative efficacy of an open airway, an oxygen reservoir and continuous positive airway pressure 5 cmH2O on the non-ventilated lung

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsThe aim of this study, during one-lung ventilation, was to evaluate if oxygenation could be improved by use of a simple oxygen reservoir or application of 5 cmH2O continuous positive airway pressure (CPAP) to the non-ventilated lung compared with an open airway. Twenty-three patients with lung malignancy, undergoing thoracotomy requiring at least 60 minutes of one-lung ventilation before lung lobe excision, were studied. After routine induction and establishment of one-lung ventilation, the three treatments were applied in turn to the same patient in a sequence selected randomly. The first treatment was repeated as a fourth treatment and these results of the repeated treatment averaged to minimize the effect of slow changes. Arterial oxygenation was measured by an arterial blood gas 15 minutes after the application of each treatment. Twenty patients completed the study. Mean PaO2 (in mmHg) was 210.3 (SD 105.5) in the 'OPEN' treatment, 186.0 (SD 109.2) in the 'RESERVOIR' treatment, and 240.5 (SD 116.0) in the 'CPAP' treatment. This overall difference was not quite significant (P=0.058, paired ANOVA), but comparison of the pairs showed that there was a significant better oxygenation only with the CPAP compared to the reservoir treatments (t=2.52, P=0.021). While the effect on the surgical field was not apparent in most patients, in one patient surgery was impeded during CPAP. Our results show that the use of a reservoir does not give oxygenation better than an open tube, and is less effective than the use of CPAP 5 cmH2O on the non-ventilated lung during one-lung ventilation.J. Slimani, W. J. Russell, C. Jurisevichttp://www.aaic.net.au/Article.asp?D=200404

Projected long-term outcomes in patients with type 1 diabetes treated with fast-acting insulin aspart versus conventional insulin aspart in the UK setting

Aims: Many patients with type 1 diabetes mellitus (T1DM) fail to achieve optimal glycemic control and mealtime insulins that more closely match physiological insulin secretion can help improve treatment. In the onset 1 trial, fast-acting insulin aspart (faster aspart) was shown to improve glycemic control in patients with T1DM compared with conventional insulin aspart (insulin aspart). In the UK, faster aspart and insulin aspart are associated with the same acquisition cost, and therefore the present analysis assessed the impact of faster aspart versus insulin aspart on long-term clinical outcomes and costs for patients with T1DM in the UK setting. Methods: The QuintilesIMS CORE Diabetes Model was used to project clinical outcomes and costs over patient lifetimes in a cohort with baseline characteristics from the onset 1 trial. Treatment effects were taken from the 26-week main phase of the onset 1 trial, with costs and utilities based on literature review. Future costs and clinical benefits were discounted at 3.5% annually. Results: Projections indicated that faster aspart was associated with improved discounted quality-adjusted life expectancy (by 0.13 quality-adjusted life years) versus insulin aspart). Improved clinical outcomes resulted from fewer diabetes-related complications and a delayed time to their onset with faster aspart. Faster aspart was found to be associated with reduced costs versus insulin aspart (cost savings of GBP 1,715), resulting from diabetes-related complications avoided and reduced treatment costs. Conclusions: Faster aspart was associated with improved clinical outcomes and cost savings versus insulin aspart for patients with T1DM in the UK setting

Width and size of regular resolution proofs

This paper discusses the topic of the minimum width of a regular resolution refutation of a set of clauses. The main result shows that there are examples having small regular resolution refutations, for which any regular refutation must contain a large clause. This forms a contrast with corresponding results for general resolution refutations.Comment: The article was reformatted using the style file for Logical Methods in Computer Scienc

What's wrong with the scrum laws in rugby union? - Judgment, truth and refereeing

Officiating and the role of officials in sport are crucial and often decisive factors in sports contests. Notable contributions in philosophy of sport include Collins (2012), Russell (1997; 1999), McFee (2011) & Mumford (2006) have brought a sharp philosophical focus to highlight that justice and desert of sport contests, in part, rely on officiating truths (performances) that arise from an appropriate admixture of epistemic (judgments) and metaphysical (actions) ingredients. This paper provides a rigorous and original philosophical analysis of the problems of obeying the rules and of applying the rules of sport. The paper focuses on a particular phase of play in rugby union, namely the scrum. It is fair to say that the scrum has become a focus of criticism and bewilderment. Elite televised rugby is damaged as a spectacle because too much time is wasted setting and re-setting scrums. Furthermore, our trust in the fairness of games is eroded because the scrum is a ‘lottery’ when it comes to officiating. In this paper, we identify two fundamental structural problems which contribute to the scrum controversy. First, drawing on Mumford (2006) and Collins (2012) we argue that officials cannot make reliable judgments about scrums because they cannot see what they need to see. Secondly, we argue that players cannot follow the laws of the scrum even if they have a strong desire to do so. Laws which can’t be followed are, according to Fuller (2000) defective. Consequently, the scrum is not only potentially dangerous but also flawed in terms of its capacity to actualize an intended part of the game

Study of Effect on Teeth of Intermittent Fluoridation of a Community Water Supply

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67913/2/10.1177_00220345530320011601.pd