Pulse contour analysis after normothermic cardiopulmonary bypass in cardiac surgery patients

INTRODUCTION: Monitoring of the cardiac output by continuous arterial pulse contour (CO(PiCCOpulse)) analysis is a clinically validated procedure proved to be an alternative to the pulmonary artery catheter thermodilution cardiac output (CO(PACtherm)) in cardiac surgical patients. There is ongoing debate, however, of whether the CO(PiCCOpulse )is accurate after profound hemodynamic changes. The aim of this study was therefore to compare the CO(PiCCOpulse )after cardiopulmonary bypass (CPB) with a simultaneous measurement of the CO(PACtherm). METHODS: After ethical approval and written informed consent, data of 45 patients were analyzed during this prospective study. During coronary artery bypass graft surgery, the aortic transpulmonary thermodilution cardiac output (CO(PiCCOtherm)) and the CO(PACtherm )were determined in all patients. Prior to surgery, the CO(PiCCOpulse )was calibrated by triple transpulmonary thermodilution measurement of the CO(PiCCOtherm). After termination of CPB, the CO(PiCCOpulse )was documented. Both CO(PACtherm )and CO(PiCCOtherm )were also simultaneously determined and documented. RESULTS: Regression analysis between CO(PACtherm )and CO(PiCCOtherm )prior to CPB showed a correlation coefficient of 0.95 (P < 0.001), and after CPB showed a correlation coefficient of 0.82 (P < 0.001). Bland-Altman analysis showed a mean bias and limits of agreement of 0.0 l/minute and -1.4 to +1.4 l/minute prior to CPB and of 0.3 l/minute and -1.9 to +2.5 l/minute after CPB, respectively. Regression analysis of CO(PiCCOpulse )versus CO(PiCCOtherm )and of CO(PiCCOpulse )versus CO(PACtherm )after CPB showed a correlation coefficient of 0.67 (P < 0.001) and 0.63 (P < 0.001), respectively. Bland-Altman analysis showed a mean bias and limits of agreement of -1.1 l/minute and -1.9 to +4.1 l/minute versus -1.4 l/minute and -4.8 to +2.0 l/minute, respectively. CONCLUSION: We observed an excellent correlation of CO(PiCCOtherm )and CO(PACtherm )measurement prior to CPB. Pulse contour analysis did not yield reliable results with acceptable accuracy and limits of agreement under difficult conditions after weaning from CPB in cardiac surgical patients. The pulse contour analysis thus should be re-calibrated as soon as possible, to prevent false therapeutic consequences

"It All Ended in an Unsporting Way": Serbian Football and the Disintegration of Yugoslavia, 1989-2006

Part of a wider examination into football during the collapse of Eastern European Communism between 1989 and 1991, this article studies the interplay between Serbian football and politics during the period of Yugoslavia's demise. Research utilizing interviews with individuals directly involved in the Serbian game, in conjunction with contemporary Yugoslav media sources, indicates that football played an important proactive role in the revival of Serbian nationalism. At the same time the Yugoslav conflict, twinned with a complex transition to a market economy, had disastrous consequences for football throughout the territories of the former Yugoslavia. In the years following the hostilities the Serbian game has suffered decline, major financial hardship and continuing terrace violence, resulting in widespread nostalgia for the pre-conflict era

The impact of an hematocrit of 20% during normothermic cardiopulmonary bypass for elective low risk coronary artery bypass graft surgery on oxygen delivery and clinical outcome – a randomized controlled study [ISRCTN35655335]

INTRODUCTION: Cardiopulmonary bypass (CPB) induces hemodilutional anemia, which frequently requires the transfusion of blood products. The objective of this study was to evaluate oxygen delivery and consumption and clinical outcome in low risk patients who were allocated to an hematocrit (Hct) of 20% versus 25% during normothermic CPB for elective coronary artery bypass graft (CABG) surgery. METHODS: This study was a prospective, randomized and controlled trial. Patients were subjected to normothermic CPB (35 to 36°C) and were observed until discharge from the intensive care unit (ICU). Outcome measures were calculated whole body oxygen delivery, oxygen consumption and clinical outcome. A nonparametric multivariate analysis of variance for repeated measurements and small sample sizes was performed. RESULTS: In a total of 54 patients (25% Hct, n = 28; 20% Hct, n = 26), calculated oxygen delivery (p = 0.11), oxygen consumption (p = 0.06) and blood lactate (p = 0.60) were not significantly different between groups. Clinical outcomes were not different between groups. CONCLUSION: These data indicate that an Hct of 20% during normothermic CPB maintained calculated whole body oxygen delivery above a critical level after elective CABG surgery in low risk patients. The question of whether a transfusion trigger in excess of 20% Hct during normothermic CPB is still supported requires a larger prospective and randomized trial

Flexitarianism (Flexible or Part-Time Vegetarianism): A User-Based Dietary Choice for Improved Wellbeing

Many think that eating meat is nutritionally necessary and beneficial. Industrialising livestock production provides meat that is often “cheaper” than fruit and vegetables. In reality, this has come at a cost for human, animal and ecological welfare. Western mainstream meat consumption is a leading cause of increasing ill-health, diabetes, cancers, non-communicable and chronic diseases, malnourishment, obesity, antibiotic resistance, spread of infectious diseases, hunger and possible global epidemics as well as climate change, biodiversity loss, water and land degradation. Rather than stop this, vested interests continue to promote meat consumption. If people are deliberately misinformed or have no access to reliable information, what chance do they have to make the right food choices? This paper outlines flexitarianism (flexible vegetarianism) as a personal user-driven opportunity to combat the geopolitical and industrial duplicity about meat. Consumers should have enough information about the implications of their nutritional choices. In addition to health benefits, flexitarianism can help mitigate climate change, environmental and social destruction and reduce animal suffering. The proposed information policy interventions are assessed against their impact on key stakeholders and overall value for public health and environmental wellbeing. They offer an opportunity to reclaim personal health and improve the health of the planet

Long-distance attachments and implications for tourism development: the case of the Western Ukrainian diaspora

This study analyzes the perspectives of roots tourism through the experiences of Western Ukrainian diaspora members. Their sense of attachment to the ancestral homeland and their visits to the places of origin are investigated, together with the views by tour operators specialized in roots tourism and public authorities dealing with tourism in the region, evaluating the actual or potential impact in terms of tourism development opportunities. The peculiar history of this territory makes it a distinct research target, with dynamics that are different from the rest of the country. The desire to turn Western Ukraine into a solid tourist destination and the aim of stimulating economic development in a region that is still struggling to re-emerge from its marginality are widespread and form a fertile basis for the growth of diaspora tourism as a solid asset. Lights and shadows emerge from the diaspora tourists’ experiences and perceptions. Specialized tour operators clearly see the enhancement of this form of tourism as an important business opportunity, while public authorities are not currently focusing on this segment, preferring general tourism promotion

Recovering critique in an age of datafication

This article starts out from the need for critical work on processes of datafication and their consequences for the constitution of social knowledge and the social world. Current social science work on datafication has been greatly shaped by the theoretical approach of Bruno Latour, as reflected in the work of Actor Network Theory and Science and Technology Studies (ANT/STS). The article asks whether this approach, given its philosophical underpinnings, provides sufficient resources for the critical work that is required in relation to datafication. Drawing on Latour’s own reflections about the flatness of the social, it concludes that it does not, since key questions, in particular about the nature of social order cannot be asked or answered within ANT. In the article’s final section, three approaches from earlier social theory are considered as possible supplements to ANT/STS for a social science serious about addressing the challenges that datafication poses for society

Seven HCI Grand Challenges

This article aims to investigate the Grand Challenges which arise in the current and emerging landscape of rapid technological evolution towards more intelligent interactive technologies, coupled with increased and widened societal needs, as well as individual and collective expectations that HCI, as a discipline, is called upon to address. A perspective oriented to humane and social values is adopted, formulating the challenges in terms of the impact of emerging intelligent interactive technologies on human life both at the individual and societal levels. Seven Grand Challenges are identified and presented in this article: Human-Technology Symbiosis; Human-Environment Interactions; Ethics, Privacy and Security; Well-being, Health and Eudaimonia; Accessibility and Universal Access; Learning and Creativity; and Social Organization and Democracy. Although not exhaustive, they summarize the views and research priorities of an international interdisciplinary group of experts, reflecting different scientific perspectives, methodological approaches and application domains. Each identified Grand Challenge is analyzed in terms of: concept and problem definition; main research issues involved and state of the art; and associated emerging requirements

Television device ecologies, prominence and datafication: the neglected importance of the set-top box

A key element of the infrastructure of television now consists of various Internet-connected devices, which play an increasingly important role in the distribution, selection and recommendation of content to users. The aim of this article is to locate the emergence of streaming devices within a longer timeframe of television hardware devices and infrastructures, by focusing on the evolution of one crucial category of such devices, television set-top boxes (STBs). STBs are a taken-for-granted part of many people’s homes across the world, and their global presence and importance are still growing. However, they (and television hardware devices more generally) have been very rarely analysed in television and media studies. To address this lacuna, we trace the development of STBs, delineate changing patterns of ownership and control in STB markets and outline the diverse forms and functions of STBs. We then show how analysis of STBs enriches understanding of two key recent developments in television: increasing battles over prominence and discoverability in a newly abundant video landscape and the collection, analysis and exchange of viewer data by businesses. In doing so, the article shows the importance of television hardware in shaping television as a social and cultural institution