Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis

<b>Objective</b>: To compare the cost and cost-effectiveness of a policy of pre-operative optimisation of oxygen delivery (using either adrenaline or dopexamine) to reduce the risk associated with major elective surgery, in high-risk patients. <b>Methods</b>: A cost-effectiveness analysis using data from a randomised controlled trial (RCT). In the RCT 138 patients undergoing major elective surgery were allocated to receive pre-operative optimisation employing either adrenaline or dopexamine (assigned randomly), or to receive routine peri-operative care. Differential health service costs were based on trial data on the number and cause of hospital in-patient days and the utilisation of health care resources. These were costed using unit costs from a UK hospital. The cost-effectiveness analysis related differential costs to differential life-years during a 2 year trial follow-up. <b>Results</b>: The mean number of in-patient days was 16 in the pre-optimised groups (19 adrenaline; 13 dopexamine) and 22 in the standard care group. The number (%) of deaths, over a 2 year follow-up, was 24 (26%) in the pre-optimised groups and 15 (33%) in the standard care group. The mean total costs were EUR 11,310 in the pre-optimised groups and EUR 16,965 in the standard care group. Life-years were 1.68 in the pre-optimised groups and 1.46 in the standard care group. The probability that pre-operative optimisation is less costly than standard care is 98%. The probability that it dominates standard care is 93%. Conclusions: Based on resource use and effectiveness data collected in the trial, pre-operative optimisation of high-risk surgical patients undergoing major elective surgery is cost-effective compared with standard treatment

Management of Phytophthora cinnamomi for biodiversity conservation in Australia: Part 2. National best practice guidelines

Disease in natural ecosystems of Australia, caused by the introduced plant pathogen Phytophthora cinnamomi, is listed as a key threatening process under the Environment Protection and Biodiversity Conservation Act 1999 (EPBC Act). The Act requires the Australian Government to prepare and implement a threat abatement plan for nationally coordinated action to mitigate the harm caused by P. cinnamomi to Australian species, particularly threatened flora, fauna and ecological communities. The .National Threat Abatement Plan for Dieback Caused by the Root-Rot Fungus Phytophthora cinnamomi. (NTAP) was released in 2001 (Environment Australia, 2001). The NTAP is designed to promote a common understanding of the national threat P. cinnamomi poses to biodiversity in Australia. This project, funded by the Australian Government Department of the Environment and Heritage (DEH), is one of the most significant actions to be implemented from the NTAP to date. The project has two major components: * to review current management approaches and identify benchmarks for best practice * the development of risk assessment criteria and a system for prioritising management of assets that are or could be threatened by P. cinnamomi. The project outputs are presented in a four-part document entitled Management of Phytophthora cinnamomi for Biodiversity Conservation in Australia: Part 1 - A Review of Current Management Part 2 - National Best Practice Guidelines Part 3 - Risk Assessment for Threats to Ecosystems, Species and Communities: A Review Part 4 - Risk Assessment Models for Species, Ecological Communities and Areas. A model of best practice was developed which encompasses all the components necessary for an informed and integrated approach to P. cinnamomi management, from strategic through to on-ground management. The current document (Part 1 . A Review of Current Management) thoroughly reviews the approaches to P. cinnamomi management in Australia within the context of the best practice model

Spectral absorption coefficients of carbon, nitrogen, and oxygen atoms

Spectral absorption coefficients of carbon, nitrogen, and oxygen atoms tabulated for use in radiant energy transfer calculation

Stable Isotope Analysis from a Burial at the Pipe Site (41AN67) in Anderson County, Texas

In this article, we present the findings of stable isotope analysis (carbon, nitrogen, and oxygen) from an analysis of human remains from a burial at the Pipe site (41AN67). The Pipe site is a late 15th-mid-16th century Caddo settlement and cemetery in the Lake Palestine area in the upper Neches River basin in East Texas that was investigated by Buddy Calvin Jones in 1968 and Southern Methodlst University in 1969

Effect of shock precursor heating on radiative flux to blunt bodies

Effect of shock precursor heating on radiative flux to blunt bodie

Universal scaling behavior at the upper critical dimension of non-equilibrium continuous phase transitions

In this work we analyze the universal scaling functions and the critical exponents at the upper critical dimension of a continuous phase transition. The consideration of the universal scaling behavior yields a decisive check of the value of the upper critical dimension. We apply our method to a non-equilibrium continuous phase transition. But focusing on the equation of state of the phase transition it is easy to extend our analysis to all equilibrium and non-equilibrium phase transitions observed numerically or experimentally.Comment: 4 pages, 3 figure

An Early Caddoan Period Cremation from the Boxed Springs Mound Site (41UR30) in Upshur County, Texas, and a Report on Previous Archaeological Investigations

The Boxed Springs Mound site (41UR30) is one of three major Early Caddoan (ca. A.D. 900- t 200) multiple mound centers in the Sabine River basin of northeastern Texas, the others including the Jamestown (41SM54) and Hudnall-Pirtle (41RK4) sites upstream and downstream, respectively, from Boxed Springs. It is situated on a large and prominent upland ridge projection that extends from a bluff on the Sabine River about 500 m north to where the landform merges with a broader stretch of uplands and Bienville alluvium. Sediments on the site are Trep loamy fine sand, a relatively fertile soil. The site is approximately 1.6 km west of the confluence of Big Sandy Creek and the Sabine River, but the old channels, sloughs, and oxbow lakes on both sides of the upland ridge and alluvial terrace suggest that previous channels of the Sabine River as well as Big Sandy Creek ran from north to south immediately adjacent to the site. When the Boxed Springs site was originally recorded by Sam Whiteside, an avocational archeologist from Tyler (see Walters and Haskins, this volume) in the early 1960s, it had four earthen mounds arranged around an open area or central plaza. The four mounds apparently included two low structural or house mounds with clay floors at the southeastern and southwestern ends of the plaza (Mounds #2 and #7 on a ca. 1962 sketch by Whiteside), one burial mound about 12 x 8 m in size and 1 m in height at the northwestern plaza edge (Mound #3), and a flat-topped mound of unknown function at the northeastern end of the plaza (Mound #6). There were borrow pits apparently visible to the east of Mound #3 and south of Mound #6, and occupation areas/midden deposits along the uplands at the southern edge of the site as well as north and northwest of Mound #3. Some years ago, while Dr. James E. Bruseth and Dr. Timothy K. Perttula were documenting a large collection of vessels and stone tools from the Boxed Springs site, they became aware of the fact that a cremation burial with associated vessels had been dug at the site. A few years later, the cremated remains from that burial were turned over to Dr. Perttula for study. In this paper, Diane E. Wilson summarizes for the first time the results of her bioarchaeological analyses of the cremated burial. With this information now available, it seemed appropriate to provide an archaeological context--as it was known--on the cremated burial, and also summarize in one place the available information on the archaeological record from the Boxed Springs site. Key to this effort was the fact that Mark Walters provided unpublished information and notes from the 1960s archaeological investigations by Sam Whiteside at the Boxed Springs site. Although it is a major Early Caddoan mound center, the archaeology of the Boxed Springs site is very poorly known. We hope that this paper on a cremated burial from the site, as well as a discussion of previous archaeological investigations at Boxed Springs, will rectify this situation to a certain extent, and also spur renewed professional archaeological interest in this very significant prehistoric Caddoan mound center

Magnetospheric influence on the Moon\u27s exosphere

[1] Atoms in the thin lunar exosphere are liberated from the Moon\u27s regolith by some combination of sunlight, plasma, and meteorite impact. We have observed exospheric sodium, a useful tracer species, on five nights of full Moon in order to test the effect of shielding the lunar surface from the solar wind plasma by the Earth\u27s magnetosphere. These observations, conducted under the dark sky conditions of lunar eclipses, have turned out to be tests of the differential effects of energetic particle populations that strike the Moon\u27s surface when it is in the magnetotail. We find that the brightness of the lunar sodium exosphere at full Moon is correlated with the Moon\u27s passage through the Earth\u27s magnetotail plasma sheet. This suggests that omnipresent exospheric sources (sunlight or micrometeors) are augmented by variable plasma impact sources in the solar wind and Earth\u27s magnetotail

The wall of the cave

In this article old and new relations between gauge fields and strings are discussed. We add new arguments that the Yang Mills theories must be described by the non-critical strings in the five dimensional curved space. The physical meaning of the fifth dimension is that of the renormalization scale represented by the Liouville field. We analyze the meaning of the zigzag symmetry and show that it is likely to be present if there is a minimal supersymmetry on the world sheet. We also present the new string backgrounds which may be relevant for the description of the ordinary bosonic Yang-Mills theories. The article is written on the occasion of the 40-th anniversary of the IHES.Comment: 18 pages, Late