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The man seated in the middle of this photo is Commodore Roger Boyce who we cared for several months ago following a motorcycle accident. He sustained closed head injuries, bi-lateral pneumothorax, 12 fractured ribs and a fractured clavicle. The helicopter crew slid him across onto our resuscitation bed like a large broken pizza. We put him back together. But we did not save his life. That happened much earlier. Every year hundreds of average people, mumbling along, minding their own business, find themselves suddenly thrust into a situation where they stand across the intersection of another persons life and their death. The ultimate challenge slapped across their cheeks. Quick. Do you know what needs to be done?. Clearing an airway, performing CPR, stopping bleeding. All simple things that anyone can easily learn. Simple things that may save a life. ShareThis ---------------------------------------------------------------------------------------------------
Amazon.com alone lists him as the author of 85,737 different titles on specialist topics such as childhood acute lymphoblastic leukemia, hemochromatosis and the import and export market for women's textile suits and costumes in the Middle East. But Parker doesn't describe himself as an "author", and he's far from the creative type. Rather, the US-based professor of management science at INSEAD business school has developed and patented algorithms enabling computers to write books for him. "The goal was to create original titles (book, videos, games, etc.) on topics that would not be economically viable if published using traditional methods, or covering topics that might be of interest to a limited audience that would nevertheless find the titles useful (what some call the 'long tail')," he said. The machines - up to 10 PCs for a single sub-sub-genre - then work on compiling thousands of individual titles around the topic, which take about an hour each to compile. "These genres create wholly original content or conclusions ... much the way consultants draw original conclusions from data they analyse," Parker said. "If data need to be collected online as on author would, then this process is fully automated - much the way bloggers 'read' things online and then create comments based on what they have read." Basic English errors in Parker's computer-compiled responses to interview questions highlight the fact that his processes aren't infallible. To be sure, Parker does not believe his technology will render all human authorship obsolete - only that which is "mundane" or uneconomical to otherwise produce. (Excerpted from) Asher Moses - Automaton Author Writes up a Storm, The Age, 21 April 2008. ---------------------------------------------------------------------------------------------------
ECG changes, similar to those seen during myocardial ischaemia, together with symptoms of chest pain, are common during Caesarean section (CS). We hypothesized that oxytocin administration has cardiovascular effects leading to these symptoms and ECG changes. MethodsForty women undergoing elective CS under spinal anaesthesia were given an i.v. bolus of either 10 IU of oxytocin (Group OXY-CS, n=20) or 0.2 mg of methylergometrine (Group MET-CS, n=20), in a double-blind, randomized fashion after delivery. Ten healthy, non-pregnant, non-anaesthetized women were used as normal controls (Group OXY-NC, n=10) and were given 10 IU of oxytocin i.v. Twelve-lead ECG, on-line, computerized vectorcardiography (VCG), and invasive arterial pressure were recorded. ResultsOxytocin produced a significant increase in heart rate, +28 (sd 4) and +52 (3) beats min–1 [mean (sem); P<0.001], decreases in mean arterial pressure, –33 (2) and –30 (3) mm Hg (P<0.001), and increases in the spatial ST-change vector magnitude (STC-VM), +77 (12) and +114 (8) µV (P<0.001), in CS patients and controls, respectively. Symptoms of chest pain and subjective discomfort were simultaneously present. Methylergometrine produced mild hypertension and no significant ECG changes. ConclusionsOxytocin administered as an i.v. bolus of 10 IU induces chest pain, transient profound tachycardia, hypotension, and concomitant signs of myocardial ischaemia according to marked ECG and STC-VM changes. The effects are related to oxytocin administration and not to pregnancy, surgical procedure, delivery, or sympathetic block from spinal anaesthesia. ---------------------------------------------------------------------------------------------------
The ionotropic glutamate receptor is a potential molecular site in the central nervous system that general anaesthetics may interact with to produce some of their biological actions. Protein phosphorylation has been well documented to occur in the intracellular C-terminal domain of -amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) subtype of glutamate receptors, which represents a pivotal mechanism for the post-translational modulation of AMPA receptor functions. In this study, we investigated a possible influence of an i.v. anaesthetic agent propofol on the phosphorylation of AMPA receptor GluR1 subunits in cultured neurons. MethodsThe effect of propofol on phosphorylation of GluR1 subunits at serine 831 and 845 was assayed in cultured rat striatal and cortical neurons by western blot with phospho- and site-specific antibodies. ResultsPropofol consistently elevated phosphorylation of GluR1 subunits at the C-terminal serine 845 site in both striatal and cortical neurons. The elevation in phosphorylation was concentration-dependent and started at a low concentration (3 µM). This increase in serine 845 phosphorylation was rapid and sustained during the entire course of propofol exposure. In contrast to serine 845, phosphorylation of GluR1 at serine 831 was not altered by propofol in striatal and cortical neurons. Total GluR1 abundance remained unchanged in response to propofol incubation. ConclusionsThese data indicate that propofol possesses the ability to upregulate AMPA receptor GluR1 subunit phosphorylation at a specific serine 845 site in neurons and provide evidence supporting the AMPA receptor as a molecular target for general anaesthetics. ---------------------------------------------------------------------------------------------------
The effects of xenon on regional cerebral blood flow (rCBF) are controversial. Moreover, the precise sites of action at which xenon exerts its effects in the human brain remain to be established. MethodsrCBF was sequentially assessed by H215O positron emission tomography in six volunteers. rCBF was determined at baseline and during general anaesthesia induced with propofol and maintained with one minimum alveolar concentration xenon. rCBF measurements were started after the calculated plasma concentration of propofol had decreased to subanaesthetic levels (<1.0 µg ml–1). Changes in rCBF were calculated for 13 cerebral volumes of interest by measurement of a semi-quantitative perfusion index (PI). In addition, voxel-wise changes in rCBF were analysed using statistical parametric mapping. ResultsXenon had only minor effects on PI in grey matter volumes of interest. In contrast, PI was increased in white matter [from 1.01 (0.11) to 1.24 (0.15) kcnt ml–1 MBq–1, P=0.05, mean (sd)]. Voxel-based analysis showed an increase of rCBF in white matter and a relative decrease of rCBF during xenon anaesthesia in distinct grey matter regions, particularly the orbito- and mesiofrontal cortex, cingulate gyrus, thalamus, hippocampus and bilateral cerebellum (P<0.05 corrected). When correlating PI with cerebral metabolic rate of glucose (previously obtained in another group of six volunteers using 18F-fluorodeoxyglucose as tracer), the flow–metabolism coupling was preserved during xenon anaesthesia. ConclusionsXenon exerted distinct regional effects on CBF: relative decreases in several cortical, subcortical, and cerebellar areas were accompanied by an increase in white matter. Flow–metabolism coupling was not impaired during xenon anaesthesia. ---------------------------------------------------------------------------------------------------
The role of routine chest radiography (CXR) after percutaneous dilatational tracheostomy (PDT) has been questioned. MethodsWe performed a prospective observational study, on a mixed medical/surgical critical care unit in a university teaching hospital. We studied all patients undergoing PDT as part of their critical care management from November 1, 2003 until July 31, 2007. All PDTs were performed under bronchoscopic guidance. After PDT, we reviewed the immediate post-procedural films to assess the utility of routine postoperative CXR. For the purposes of CXR review, we considered a procedure to be either uncomplicated or technically difficult. Clinically relevant CXR findings were new barotrauma (pneumothorax, pneumomediastinum) or a significant change in consolidation from the pre-procedure film. ResultsA total of 384 patients underwent PDT during the study period. Of these, 345 had immediate post-procedural CXRs available for review. There were 252 PDTs (73%) documented as uncomplicated. There were 93 (27%) technically difficult procedures, with 107 adverse events recorded. In 82 (24%) procedures, these difficulties were described as minor procedural complications [multiple attempts at needle insertion (≥3), minor bleeding or tracheal ring fracture]. Significant complications (mal-placement in the anterior mediastinum and major bleeding) were documented in 12 (3.5%) patients. New abnormalities were noted on 8 (2.3%) immediate post-procedural CXRs. In only one patient was there a new CXR change in an uncomplicated PDT. ConclusionsImmediate CXR after uncomplicated PDT performed under bronchoscopic guidance rarely reveals unexpected radiological abnormalities. The role of CXR after PDT appears to be restricted to those patients undergoing technically difficult and complicated procedures. A change in practice to this effect will lead to reductions in both medical costs and exposure of staff and patients to ionizing radiation. --------------------------------------------------------------------------------------------------- |
