bluuebunny/crossref_metadata_2025 huggingface dataset:
Stroke volume averaging for individualized goal‐directed fluid therapy with oesophageal Doppler
Authors: JØRGENSEN C. C. , BUNDGAARD‐NIELSEN M. , SKOVGAARD L. T. , SECHER N. H. , KEHLET H.
Published: December 2008

Background: An individualized fluid optimization strategy, based on maximization of cardiac stroke volume (SV) with colloid boluses (goal‐directed therapy), improves outcome after surgery. Oesophageal Doppler (OD) is used for SV maximization in most randomized studies, but evidence‐based guidelines for the SV maximization procedure are lacking and variation in SV may influence the indication for fluid administration. We measured beat‐to‐beat OD SV before and after fluid optimization in order to estimate the number of heartbeats for which SV needs to be averaged to provide an acceptable accuracy for goal‐directed therapy with this technology.

Methods: Twenty patients scheduled for surgery were anaesthetized, followed by OD SV assessment. Thirty seconds of beat‐to‐beat data were recorded before and after volume optimization performed by successive boluses of 200 ml colloid until SV did not increase ≥10%. SV variability was assessed before and after the volume optimization when SV was measured beat to beat and when it was averaged over 2–10 heartbeats.

Results: Nineteen (95%) and 17 (85%) patients demonstrated an SV variability ≥10% before and after volume optimization, respectively, when SV was measured beat to beat. However, when SV was averaged over 10 heartbeats, only two (10%) and one (5%) of the patients demonstrated an SV variability ≥10% before and after optimization, respectively (P<0.0001).

Conclusion: OD SV variability is significantly reduced and reaches an acceptable level when SV is averaged over 10 heartbeats. The use of a shorter averaging period for SV may lead to incorrect volume administration in goal‐directed fluid management.
Continuous intravenous lidocaine in the treatment of paralytic ileus due to severe spinal cord injury
Authors: BAUMANN A. , AUDIBERT G. , KLEIN O. , MERTES P. M.
Published: December 2008

Paralytic ileus is a major concern in the acute phase of spinal cord injury. Classical treatment with neostigmine is often ineffective. Continuous intravenous (i.v.) lidocaine infusion has been previously proposed intra and post‐operatively in order to decrease the duration of post‐operative ileus after abdominal surgery. We report the cases of seven patients suffering from complete paralytic spinal cord injury‐related ileus with colectasy resistant to neostigmine, who were treated by i.v. lidocaine infusion.
Paediatric airway management: basic aspects
Authors: HOLM‐KNUDSEN R. J. , RASMUSSEN L. S.
Published: December 2008

Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small children. This paper aims at providing the non‐paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children. Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described.
Severe hypoglycemia during intensive insulin therapy
Authors: KAUKONEN K.‐M. , RANTALA M. , PETTILÄ V. , HYNNINEN M.
Published: December 2008

Background: Tight glycemic control reduces mortality in surgical intensive care patients and in long‐term medical intensive care patients. A large study on intensive insulin therapy was prematurely discontinued due to safety issues. As the safety of intensive insulin therapy has been questioned, we screened all patients during a 17‐month period to reveal the incidence of hypoglycemia and its effects on the outcome of the patients.

Methods: All patients treated between February 2005 and June 2006 in two intensive care units (ICUs) of a tertiary care teaching hospital were included in the study. A nurse‐driven intensive insulin therapy with a target blood glucose level of 4–6 mmol/l had been introduced earlier. The patients were divided into two groups according to the presence of severe hypoglycemia (≤2.2 mmol/l).

Results: One thousand two hundred and twenty‐four patients (1124 treatment periods) were included. During the study period, 61,203 blood glucose measurements were performed, 2.6% of which were below and 52.6% above the target range. Severe hypoglycemia (glucose ≤2.2 mmol/l) occurred in 25 patients (36 measurements). The incidence was 0.06% of the measurements and 2.3% of the patients. The median age, sex, Acute Physiology And Chronic Health Evaluation II, Simplified Acute Physiology Score II, diagnosis category, ICU or hospital length of stay did not differ between the groups. The hospital mortalities were 25% and 15% in patients with or without severe hypoglycemia, respectively (P=0.16).

Conclusion: Severe hypoglycemia during intensive insulin therapy is rare in clinical practice compared with previous clinical trials.
Accuracy and reliability of continuous blood glucose monitor in post‐surgical patients
Authors: YAMASHITA K. , OKABAYASHI T. , YOKOYAMA T. , YATABE T. , MAEDA H. , MANABE M. , HANAZAKI K.
Published: December 2008

Background: The STG‐22™ is the only continuous blood glucose monitoring system currently available. The aim of this study is to determine the accuracy and reliability of the STG‐22™ for continuously monitoring blood glucose level in post‐surgical patients.

Methods: Fifty patients scheduled for routine surgery were studied in surgical intensive care unit (ICU) of a university hospital. After admission to the ICU, the STG‐22™ was connected to the patients. An attending physician obtained blood samples from a radial arterial catheter. Blood glucose level was measured using the ABL™800FLEX immediately after blood collection at 0, 4, 8, and 16 h post‐admission to the ICU (total of 200 blood glucose values).

Results: The correlation coefficient (R2) was 0.96. In the Clarke error grid, 100% of the paired measurements were in the clinically acceptable zone A and B. The Bland and Altman analysis showed that bias±limits of agreement (percent error) were 0.04(0.7)±0.35(6.3) mmol (mg/dl) (7%), −0.11(−2)±1.22(22) (15%) and −0.33(−6)±1.28(23) (10%) in hypoglycemia (<70(3.89) mmol (mg/dl), normoglycemia (3.89(70)–10(180) mmol (mg/dl), and hyperglycemia (>10(180) mmol (mg/dl), respectively.

Conclusions: The STG‐22™ can be used for measuring blood glucose level continuously and measurement results are consistent with intermittent measurement (percentage error within 15%). Therefore, the STG‐22™ is a useful device for monitoring in blood glucose level in the ICU for 16 h.
Different bispectral index values from both sides of the forehead in unilateral carotid artery stenosis
Authors: LEE E. H. , CHOI I. C. , SONG J. G. , JEONG Y. B. , HAHM K. D. , SON H. J.
Published: December 2008

Bispectral index (BIS) values derived from the left and right forehead are usually the same. We report on two patients with unilateral carotid artery stenosis in whom we observed differences between the BIS values obtained from sensors placed on each side of the forehead. During surgery, the BIS values of the diseased side decreased more than those of the opposite side when the mean arterial pressure decreased below 70 mmHg. BIS monitors should be used with caution in patients with unilateral carotid artery and cerebrovascular disease.
Midazolam dose for loss of response to verbal stimulation during the unilateral or bilateral spinal anesthesia
Authors: YUN M. J. , KIM Y. H. , OH A. Y. , JEON Y. T. , KIM Y. C.
Published: December 2008

Background: We have conducted this study to investigate whether unilateral or bilateral spinal anesthesia with bupivacaine induces different sensitivity to intravenous (i.v.) midazolam for sedation.

Methods: Forty‐two patients undergoing various elective unilateral lower extremity surgeries were allocated into two groups: (1) unilateral spinal anesthesia group (Group US, n=21; heavy bupivacaine 5 mg/ml, 9 mg) and (2) bilateral spinal anesthesia group (Group BS, n=21; heavy bupivacaine 5 mg/ml, 9 mg). One milligram of midazolam was injected i.v. at 30‐s intervals until the patients did not respond to the hand grasp test beginning 15 min after spinal anesthesia. The concentration of plasma bupivacaine was evaluated every 15 min for the first 75 min after the start of the spinal anesthesia, and the bispectral index was monitored continuously.

Results: The mean venous plasma concentration of bupivacaine was not significantly different between Group US and BS. The dose of midazolam required to abolish responses to verbal commands was significantly lower in Group BS (mean 5.9±1.2 mg) vs. Group US (mean 9.0±1.4 mg).

Conclusions: A higher dosage of midazolam is required for loss of response to verbal stimulation during unilateral spinal anesthesia than during bilateral spinal anesthesia.
Comparison of effects and plasma concentrations of opioids between elderly and middle‐aged patients after cardiac surgery
Authors: PESONEN A. , SUOJARANTA‐YLINEN R. , HAMMARÉN E. , TARKKILA P. , SEPPÄLÄ T. , ROSENBERG P. H.
Published: December 2008

Background:In elderly patients, opioids may cause prominent postoperative sedation and respiratory depression. We evaluated the influence of age on the effects of opioids and plasma concentrations of fentanyl and oxycodone in cardiac surgery patients.

Methods:Thirty (≥75 years, gender M9/F21) and 20 (≤60 years, gender M20/F0) patients scheduled to undergo cardiac surgery. A standard anesthesia with fentanyl as an opioid was used. Fentanyl plasma concentrations were measured at the end of surgery and 2 h later. After tracheal extubation, when the pain intensity was at least moderate, blood samples for fentanyl and oxycodone plasma concentration measurements were taken. Thereafter, oxycodone hydrochloride 0.05 mg/kg i.v. was administered. After 15 and 45 min, pain intensity, sedation and oxycodone plasma concentration were determined. This test protocol was repeated twice.

Results:The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients (5.7±2.2 vs. 3.8±1.2 ng/ml,P=0.001). The plasma concentrations of oxycodone were comparable between the groups. The interval between the second and the third oxycodone dose was longer in the elderly patients (P=0.036). Pain intensity on the verbal rating scale was lower at the 45‐min assessment point after all three oxycodone test doses (P=0.008) and sedation scores were significantly higher after the third dose in the elderly patients (P=0.035).

Conclusions:In elderly patients, the plasma concentration of fentanyl was higher but plasma levels of oxycodone were at a similar level compared with middle‐aged patients. However, the elderly patients had less pain and were more sedated after doses of oxycodone.
Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsiveness
Authors: SNYGG J. , BECH‐HANSSEN O. , LöNN L. , ANDERSSON B. , ÅNEMAN A.
Published: December 2008

Background: Static vascular filling pressures suffer from poor predictive power in identifying the volume‐responsive heart. The use of dynamic arterial pressure variables, including pulse pressure variation (PPV) has instead been suggested to guide volume therapy. The aim of the present study was to evaluate the performance of several clinically applicable haemodynamic parameters to predict volume responsiveness in a pig closed chest model of acute left ventricular myocardial infarction.

Methods: Fifteen anaesthetized, mechanically ventilated pigs were studied following acute left myocardial infarction by temporary coronary occlusion. Animals were instrumented to monitor central venous (CVP) and pulmonary artery occlusion (PAOP) pressures and arterial systolic variations (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery catheter and by using the PiCCO® monitor also giving stroke volume variation (SVV). Variations in the velocity time integral by pulsed‐wave Doppler echocardiography were determined in the left (ΔVTILV) and right (ΔVTIRV) ventricular outflow tracts. Consecutive boluses of 4 ml/kg hydroxyethyl starch were administered and volume responsiveness was defined as a 10% increase in CO.

Results: Receiver–operator characteristics (ROC) demonstrated the largest area under the curve for ΔVTIRV [0.81 (0.70–0.93)] followed by PPV [0.76 (0.64–0.88)] [mean (and 95% CI)]. SPV, ΔVTILV and SVV did not change significantly during volume loading. CVP and PAOP increased but did not demonstrate significant ROC.

Conclusion: PPV may be used to predict the response to volume administration in the setting of acute left ventricular myocardial infarction.
Isoflurane attenuates dynorphin‐induced cytotoxicity and downregulation of Bcl‐2 expression in differentiated neuroblastoma SH‐SY5Y cells
Authors: WU G.‐J. , CHEN W.‐F. , SUNG C.‐S. , JEAN Y.‐H. , HUNG C.‐H. , CHEN F.‐A. , HSIEH M.‐H. , WEN Z.‐H.
Published: December 2008

Background: It has been proposed that the volatile anesthetic isoflurane induces neuroprotection and that the endogenous opioid peptide dynorphin induces neurocytotoxicity in cells. The levels of dynorphin are often significantly elevated in neuropathophysiological conditions, and dynorphin can directly induce toxicity. However, the neuroprotective effects of isoflurane on dynorphin‐induced cytotoxicity are still unclear.

Methods: In order to determine the effect of isoflurane on dynorphin‐induced cytotoxicity in neuronal cells, we have designed a device wherein cultured human neuroblastoma SH‐SY5Y cells can be exposed to isoflurane. Fully differentiated SH‐SY5Y cells were obtained by treating the cells with retinoic acid for 6 days. We examined SH‐SY5Y cell survival, apoptosis, and antiapoptotic protein expression by cell viability, terminal deoxynucleotidyl transferase‐mediated dUTP nick end‐labeling stain, and Western blot analysis, respectively.

Results: After 16 h of dynorphin (10 μM) treatment, the SH‐SY5Y cells showed significant cytotoxicity, apoptosis, and downregulation of the antiapoptotic Bcl‐2 protein expression. These effects of dynorphin were significantly inhibited by isoflurane exposure for 32 h [pretreatment for 16 h and posttreatment (after dynorphin treatment) for 16 h].

Conclusion: Thus, our results suggest that isoflurane exerts neuroprotective effects in the case of dynorphin‐induced pathophysiological disruption.
Short‐ and long‐term consequences of early developmental conditions: a case study on wild and domesticated zebra finches
Authors: TSCHIRREN B. , RUTSTEIN A. N. , POSTMA E. , MARIETTE M. , GRIFFITH S. C.
Published: December 2008

Divergent selection pressures among populations can result not only in significant differentiation in morphology, physiology and behaviour, but also in how these traits are related to each other, thereby driving the processes of local adaptation and speciation. In the Australian zebra finch, we investigated whether domesticated stock, bred in captivity over tens of generations, differ in their response to a life‐history manipulation, compared to birds taken directly from the wild. In a ‘common aviary’ experiment, we thereto experimentally manipulated the environmental conditions experienced by nestlings early in life by means of a brood size manipulation, and subsequently assessed its short‐ and long‐term consequences on growth, ornamentation, immune function and reproduction. As expected, we found that early environmental conditions had a marked effect on both short‐ and long‐term morphological and life‐history traits in all birds. However, although there were pronounced differences between wild and domesticated birds with respect to the absolute expression of many of these traits, which are indicative of the different selection pressures wild and domesticated birds were exposed to in the recent past, manipulated rearing conditions affected morphology and ornamentation of wild and domesticated finches in a very similar way. This suggests that despite significant differentiation between wild and domesticated birds, selection has not altered the relationships among traits. Thus, life‐history strategies and investment trade‐offs may be relatively stable and not easily altered by selection. This is a reassuring finding in the light of the widespread use of domesticated birds in studies of life‐history evolution and sexual selection, and suggests that adaptive explanations may be legitimate when referring to captive bird studies.
Rapid changes in plasticity across generations within an expanding cedar forest
Authors: FALLOUR‐RUBIO D. , GUIBAL F. , KLEIN E. K. , BARITEAU M. , LEFÈVRE F.
Published: December 2008

We investigated the inter‐individual variation of phenotypic plasticity and its evolution across three generations within an expanding forest. Plasticity was assessed in situ from dendrochronological data as the response of radial growth to summer rainfall. A linear mixed model was used to account for spatial effects (environment and stand structure), temporal factors (stand dynamics) and the variation with age. Beyond these effects, our results reveal a significant inter‐individual variance of growth and plasticity within each generation. We also show that the mean values and variances of growth and plasticity changed significantly across generations, with different patterns for both traits. The possible environmental and genetic drivers of these changes are discussed. Contrasting with the trade‐off between stress tolerance and plasticity generally observed among populations, we detected a positive covariance at the individual level, which does not support the cost of plasticity hypothesis in this case.
Mating triggers dynamic immune regulations in wood ant queens
Authors: CASTELLA G. , CHRISTE P. , CHAPUISAT M.
Published: December 2008

Mating can affect female immunity in multiple ways. On the one hand, the immune system may be activated by pathogens transmitted during mating, sperm and seminal proteins, or wounds inflicted by males. On the other hand, immune defences may also be down‐regulated to reallocate resources to reproduction. Ants are interesting models to study post‐mating immune regulation because queens mate early in life, store sperm for many years, and use it until their death many years later, while males typically die after mating. This long‐term commitment between queens and their mates limits the opportunity for sexual conflict but raises the new constraint of long‐term sperm survival. In this study, we examine experimentally the effect of mating on immunity in wood ant queens. Specifically, we compared the phenoloxidase and antibacterial activities of mated and virgin Formica paralugubris queens. Queens had reduced levels of active phenoloxidase after mating, but elevated antibacterial activity 7 days after mating. These results indicate that the process of mating, dealation and ovary activation triggers dynamic patterns of immune regulation in ant queens that probably reflect functional responses to mating and pathogen exposure that are independent of sexual conflict.
Environmental Conditions and Intraspecific Interference: Unexpected Effects of Turbidity on Pike (Esox lucius) Foraging
Authors: Nilsson P. A. , Jacobsen Lene , Berg Søren , Skov Christian
Published: December 2008

Interference among predators decreases per capita foraging rates and has implications for both community dynamics and top‐down trophic processes. Interference originates from behavioural interactions among foragers, and these behaviours could be affected by environmental conditions. In experiments on pike foraging alone or among conspecifics in different levels of water turbidity, we expected high turbidity to decrease the perceived risk of intraspecific interactions among pike, and thereby decrease the strength of interference, as turbidity would decrease the visual contact between individuals and act as a refuge from behavioural interactions. The results show that this is not the case, but suggest that interference is induced instead of reduced in high turbidity. Per capita foraging rates do not differ between pike foraging alone or in groups in our clear and moderately turbid treatments, indicating no effect of interference. As high turbidity enhances prey consumption for pike individuals foraging alone, but does not have this effect for pike in groups, high turbidity induces the relative interference effect. We suggest that future evaluations of the stabilizing effects of interference on community dynamics and its reduction of predation impact on top‐down trophic cascades should consider potential unexpected effects of environmental conditions.
Parental Sex Differences in Food Allocation to Junior Brood Members as Mediated by Prey Size
Authors: Wiebe Karen L. , Slagsvold Tore
Published: December 2008

Individual offspring within a brood may receive different amounts of provisioning from the male and female parents. Some hypotheses suggest that this bias is the result of an active and adaptive choice by parents. An alternative hypothesis is that feeding biases arise as a result of a constraint of fitting large prey items into small gapes. In an experiment with pied flycatchers,Ficedula hypoleuca, we tested for sex‐biased allocation to junior nestlings in asynchronous broods and whether this could be explained by active parental choice or by passive allocation according to prey size and gape size. In both control broods and broods with experimentally increased degree of asynchrony, prey types did not differ between parents but females brought smaller prey than males at younger but not older nestling stages. At younger but not older nestling stages, the majority of feeds to junior nestlings were from females, and the smaller nestlings consumed smaller prey than older siblings. However, there was no evidence of active preference of small nestlings by females as parents did not differ in the tendency to bypass a begging senior nestling in order to feed a junior nestling. Provisioning rates by females were lower than those by males when nestlings were young and we suggest that foraging time constraints caused by the need to brood offspring result in females bringing smaller prey than males. In turn, the larger prey brought by males was more often transferred to larger offspring after the smaller ones failed to swallow it. In such cases, ‘preferential’ feeding of small nestlings by females may simply be a passive side effect of foraging constraints and gape‐size limitations.
Resources, not Kinship, Determine Social Patterning in the Territorial Gunnison’s prairie Dog (Cynomys gunnisoni)
Authors: Verdolin J. L. , Slobodchikoff C. N.
Published: December 2008

In this study, we describe patterns of relatedness in Gunnison’s prairie dog (Cynomys gunnisoni) social groups. Kin selection is often cited as a mechanism for the evolution and maintenance of social groups, and Gunnison’s prairie dog females are occasionally described as being strongly philopatric. Overall, randomization tests revealed that females within territorial groups were not more closely related to each other than expected at random. A similar pattern was found among males and between males and females, indicating that there was no sex‐biased dispersal occurring in these populations. Ecological variables measured in this study, such as food abundance and food dispersion, were not correlated with relatedness. In addition, territory size and density/m2did not correlate significantly with relatedness. Although there was variability in the spatial overlap among individuals within groups, there was no indication that relatedness explained this variation. These results suggest that kin selection is not maintaining social groups in these populations, but that competition for access to resources required by both males and females may explain dispersal and social group patterns in these populations.
To Compensate or Not? Caring Parents Respond Differentially to Mate Removal and Mate Handicapping in the Burying Beetle, Nicrophorus quadripunctatus
Authors: Suzuki Seizi , Nagano Masahiro
Published: December 2008

Game theoretical models predict that when one parent reduces its care, the mate should adjust its care facultatively to compensate partially. To test these models, mate‐removal and mate‐handicapping techniques have been used. However, there have been few experimental studies comparing results from mate removal and mate handicapping, and there has been no study on insects employing handicapping. Male and female burying beetles both maintain the nest and regurgitate to young. We examined how burying beetle parents adjust their level of care when their mates are removed or handicapped. Males increased their frequency of provisioning significantly after female removal, whereas females showed no response to male removal. However, neither sex showed a response to the handicapping of its partner, although handicapped mates decreased the frequency of their care. This result showed that burying beetle parents respond differentially to mate removal and handicapping, and suggests that parents do not respond to a change in the behavior of their mates.
Bioterrorism for the respiratory physician
Authors: WATERER Grant W. , ROBERTSON Hannah
Published: December 2008

Terrorist attacks by definition are designed to cause fear and panic. There is no question that a terrorist attack using biological agents would present a grave threat to stability of the society in which they were released. Early recognition of such a bioterrorist attack is crucial to containing the damage they could cause. As many of the most likely bioterrorism agents present with pulmonary disease, respiratory physicians may be crucial in the initial recognition and diagnosis phase, and certainly would be drawn into treatment of affected individuals. This review focuses on the biological agents thought most likely to be used by terrorists that have predominantly respiratory presentations. The primary focus of this review is on anthrax, plague, tularaemia, ricin, and Staphylococcal enterotoxin B. The pathogenesis, clinical manifestations and treatment of these agents will be discussed as well as historical examples of their use. Other potential bioterrorism agents with respiratory manifestations will also be discussed briefly.
Impact of oxidative stress on lung diseases
Authors: PARK Hee Sun , KIM So Ri , LEE Yong Chul
Published: December 2008

Reactive oxygen species (ROS) are products of normal cellular metabolism and are known to act as second messengers. Under physiological conditions, ROS participate in maintenance of cellular ‘redox homeostasis’ in order to protect cells against oxidative stress through various redox‐regulatory mechanisms. Overproduction of ROS, most frequently due to excessive stimulation of either reduced nicotinamide adenine dinucleotide phosphate by cytokines or the mitochondrial electron transport chain and xanthine oxidase, results in oxidative stress. Oxidative stress is a deleterious process that leads to lung damage and consequently to various disease states. Knowledge of the mechanisms of ROS regulation could lead to the pharmacological manipulation of antioxidants in lung inflammation and injury.
Quality of life and autonomy preferences in stable asthmatics: A developing country scenario
Authors: SIDANA Abhinav , SINGH Digvijay , MOHAN Anant , GULERIA Randeep
Published: December 2008

Background and objective:  The quality of life (QOL) and autonomy preferences of asthmatics in developing countries have been sparingly researched, with a resulting lack of management strategies. This study determined the asthma‐specific QOL and autonomy preferences of a population of asthmatics in a developing country and their association with relevant sociodemographic and clinical characteristics.

Methods:  A cross‐sectional study using the Asthma Quality of Life Questionnaire and the Asthma Autonomy Questionnaire was performed on a population of stable asthmatics recruited from a tertiary care centre in India. Severity of the disease was assessed by spirometry.

Results:  The study population comprised 80 asthmatics. The mean (SD) overall QOL score was 5.04 (0.97). This was significantly associated with history of hospitalization during the previous year for an asthma attack (P < 0.01) and with FEV1 (P < 0.05) on univariate analysis; on multivariate analysis, only history of hospitalization was significant. Autonomy preferences of the patients showed higher scores for information‐seeking (mean (SD) = 78.95 (16.35) ) than decision‐making (mean (SD) = 38.21 (14.6)). The information‐seeking preferences had a negative correlation with age (P < 0.01) and a positive correlation with education status (P < 0.01) and decision‐making correlated with education status (P < 0.05). A minority of patients (19%) indicated a preference for a greater say in decision‐making than their physicians. There was a lower tendency for decision‐making when given a ‘severe exacerbation’ scenario than in ‘mild exacerbation’ (P < 0.001) or ‘stable disease’ (P < 0.001).

Conclusions:  Hospitalization history and FEV1 values are the parameters having the most significant impact on the QOL of asthmatics. There is a clear desire to obtain more information about the disease but most patients do not endorse the idea of making independent disease‐related decisions.
Depth of sedation using Cerebral State Index in infants undergoing spinal anesthesia
Authors: DISMA NICOLA , TUO PIETRO , ASTUTO MARINELLA , DAVIDSON ANDREW J.
Published: December 2008

Background:  Infants are noted to frequently sleep during spinal anesthesia, with a concomitant fall in Bispectral Index. However, there are suggestions that EEG derived anesthesia depth monitors have inferior performance in infants. The aim of this study was to quantify the degree of sedation during spinal anesthesia in infants using another EEG derived measure of anesthesia effect – the Cerebral State Index (CSI).

Methods:  Twelve infants, <52 weeks postconceptual menstrual age, scheduled for bilateral inguinal hernia repair under spinal anesthesia were enrolled. Patients received a standard anesthetic protocol with a subarachnoid dose of 1 mg·kg−1 of levobupivacaine 0.5%. No premedication, sedatives, opioids or anticholinergics were administrated during the perioperative period and patients were left undisturbed during the surgical time, without tactile stimulation or loud auditory stimuli. CSI score (0–100) and bust suppression (BS) (0–100%) were continuously recorded during the surgical time and then statistically re‐evaluated.

Results:  In all patients the CSI fell during the procedure and there were significant levels of BS recorded by the CSI monitor. The BS occurred between 12 and 34 min after spinal anesthesia with the peak being at 30 min and mean onset time being 15 (2.6) min after spinal block. A statistical significant difference was found between the lowest mean CSI as well as the highest BS if compared with their baseline values. A negative correlation was found between CSI and BS.

Conclusions:  The degree of burst suppression detected by the CSI in our study supports the hypothesis that infants may have discontinuous patterns of EEG during spinal anesthesia similar to those seen during emergence from general anesthesia. Moreover, the limitations in the application of the adult algorithms to infant EEG may lead to an overestimation of the degree of sedation.
A national survey of the anesthetic management of tonsillectomy surgery in children
Authors: ALLFORD MARK , GURUSWAMY VELUPANDIAN
Published: December 2008

Background:  Tonsillectomy in children is a common procedure; however, there appears to be a significant degree of variability in anesthetic management. Thus far, there has been no large national survey looking at the perioperative care of these children.

Objectives:  We conducted a national survey with the aim of determining what represents common practice in the perioperative management of children undergoing tonsillectomy surgery. We compared the respondents’ management against evidence‐based practice.

Methods:  The survey took the form of a questionnaire, which was sent to members of The Association of Paediatric Anaesthetists (APAGBI) and to Royal College tutors. The questionnaire was sent in paper format to the College Tutors and in digital format to APAGBI members. Emphasis was placed upon preoperative preparation, induction technique, airway management, analgesia, postoperative nausea and vomiting strategy, fluid management and emergence from anesthesia.

Results:  Responses were obtained from 173 individuals representing a broad cross‐section of anesthetists from teaching and district general hospitals. Findings are as follows: the application of topical anesthetic cream is commonplace (93%), with Ametop® being the primary preparation used; the intravenous route was preferred to induce anesthesia; most practitioners intubate the trachea to maintain the airway during anesthesia (79%); a muscle relaxant was employed to assist intubation of the trachea in 47% of respondents and the routine use of suxamethonium was reported to be uncommon (9%); the administration of prophylactic ondansetron and dexamethasone was reported by 79% and 70% of respondents respectively; and nonsteroidal anti‐inflammatory drugs (NSAIDs) are used by 77% of individuals either pre‐emptively or during the intraoperative period.

Conclusions:  Whilst there is individual variability in the management of these cases, the majority of anesthetists prefer the intravenous route for induction of anesthesia, after application of topical anesthetic cream. It is routine practice to intubate the trachea, administer paracetamol, NSAIDs, strong opiates and antiemetics.
Changes in delivered tidal volume with the addition of carbon dioxide to mechanical ventilation
Authors: TOBIAS JOSEPH D. , MILTENBERG LAUREN
Published: December 2008

Objective:  To determine discrepancies in delivered tidal volumes induced by the addition of carbon dioxide (CO2) during mechanical ventilation.

Design:  Prospective, experimental, lung model study.

Setting:  Research laboratory at a University hospital.

Subjects:  Ventilator set‐up using a mechanical lung model.

Interventions:  Tidal volumes were measured during pressure and volume limited ventilation at various pressures and volumes with the addition of inspired CO2 concentrations of 0, 1, 2, and 4%. Three ventilator set‐ups were used including the addition of CO2 to the inspiratory limb (M1), the use of two external blenders to mix air, oxygen and CO2 prior to entry to the ventilator (M2), and the use of one external blender to mix air and CO2 prior to addition to the ventilator.

Measurements and main results:  Statistically significant increases in delivered tidal volume were noted with the addition of CO2 with all three of the ventilator set‐ups (M1, M2 and M3). However, the maximum increase was 2.4% above that of baseline (no CO2 added). With the M2 set‐up, there was also a significant discrepancy noted between the set and the delivered tidal volumes (16–17%) when using the volume limited mode even without the addition of CO2.

Conclusions:  Either the M1 or the M3 set‐up functioned efficiently without clinically significant alterations in ventilator performance. We prefer the M1 set‐up as it is the one that is used most commonly in clinical practice and does not require significant alterations in the working configuration of the ventilator.
Inhalation burn injury in children
Authors: FIDKOWSKI CHRISTINA W. , FUZAYLOV GENNADIY , SHERIDAN ROBERT L. , COTÉ CHARLES J.
Published: December 2008

With advances in burn care, many children are surviving severe burn injuries. Inhalation injury remains a predictor of morbidity and mortality in burn injury. Inhalation of smoke and toxic gases leads to pulmonary complications, including airway obstruction from bronchial casts, pulmonary edema, decreased pulmonary compliance, and ventilation–perfusion mismatch, as well as systemic toxicity from carbon monoxide poisoning and cyanide toxicity. The diagnosis of inhalation injury is suggested by the history and physical exam and can be confirmed by bronchoscopy. Management consists of supportive measures, pulmonary toilet, treatment of pulmonary infection and ventilatory support as needed. This review details the pathophysiology, diagnosis, and management options for inhalation injury.
Absorption pharmacokinetics of clonidine nasal drops in children
Authors: ALMENRADER NICOLE , LARSSON PETER , PASSARIELLO MAURIZIO , HAIBERGER ROBERTA , PIETROPAOLI PAOLO , LÖNNQVIST PER‐ARNE , EKSBORG STAFFAN
Published: December 2008

Background:  The α2 agonist clonidine has become a popular drug for premedication in children. Effects and pharmacokinetics after oral, rectal, and intravenous administration are well known. The aim of this study was to investigate the absorption pharmacokinetics of clonidine nasal drops in children.

Methods:  Thirteen ASA I pediatric patients received after induction of anesthesia 4 mcg·kg−1 of clonidine by the nasal route. Blood samples were taken during a 12‐h period and plasma levels of clonidine were analyzed by liquid chromatography–mass spectrometry. Data were calculated by a computer‐aided curve‐fitting program.

Results:  Plasma pharmacokinetics following administration of clonidine nasal drops showed a considerable interindividual variability and absorption was delayed and limited. A total of 95% confidence intervals for maximum plasma concentration and time to achieve maximum plasma concentration were 0.4–0.6 ng·ml−1 and 1.4–3.0 h, respectively.

Conclusions:  Clonidine nasal drops are erratically absorbed from the nasal mucosa and, thus, this mode of drug administration is not recommended for premedication purposes.
Informed dispersal, heterogeneity in animal dispersal syndromes and the dynamics of spatially structured populations
Authors: Clobert Jean , Le Galliard Jean‐François , Cote Julien , Meylan Sandrine , Massot Manuel
Published: December 2008

There is accumulating evidence that individuals leave their natal area and select a breeding habitat non‐randomly by relying upon information about their natal and future breeding environments. This variation in dispersal is not only based on external information (condition dependence) but also depends upon the internal state of individuals (phenotype dependence). As a consequence, not all dispersers are of the same quality or search for the same habitats. In addition, the individual’s state is characterized by morphological, physiological or behavioural attributes that might themselves serve as a cue altering the habitat choice of conspecifics. These combined effects of internal and external information have the potential to generate complex movement patterns and could influence population dynamics and colonization processes. Here, we highlight three particular processes that link condition‐dependent dispersal, phenotype‐dependent dispersal and habitat choice strategies: (1) the relationship between the cause of departure and the dispersers’ phenotype; (2) the relationship between the cause of departure and the settlement behaviour and (3) the concept of informed dispersal, where individuals gather and transfer information before and during their movements through the landscape. We review the empirical evidence for these processes with a special emphasis on vertebrate and arthropod model systems, and present case studies that have quantified the impacts of these processes on spatially structured population dynamics. We also discuss recent literature providing strong evidence that individual variation in dispersal has an important impact on both reinforcement and colonization success and therefore must be taken into account when predicting ecological responses to global warming and habitat fragmentation.
Timing and necessity of a flexible sigmoidoscopy in patients with symptoms suggestive of haemorrhoids
Authors: Vening W. , Willigendael E. M. , Tjeertes E. K. M. , Hulsewé K. W. E. , Hoofwijk A. G. M.
Published: December 2008

Objective  This study was performed to determine the probability of finding additional pathology, requiring treatment or follow‐up, in patients referred with symptoms suggestive of haemorrhoids. Secondly, to determine, at what age a flexible sigmoidoscopy should be performed in these patients.

Method  All patients referred for the treatment of haemorrhoids over a period of 5 years were prospectively included in a database. Data included patient characteristics, clinical information, histopathological analysis and the sigmoidoscopy results.

Results  Haemorrhoids were present in 961 (95.6%) of 1005 patients. Of these patients, 692 (72.0%) patients were free from any additional pathology, 161 (16%) patients had diverticulosis, in 15 (1.5%) patients the sigmoidoscopy showed signs of colitis, 116 (11.5%) patients had polyps and a malignancy was present in eight (0.8%) patients. In the age group between 30–40 and 40–50, the presence of additional pathology increased significantly (P < 0.05). No malignancies were found under the age of 40.

Conclusions  The vast majority of patients referred for the treatment and analysis of haemorrhoids were free from any additional pathology. But, over the age of 40, the incidence of additional pathology increased significantly. Therefore, we suggest that a flexible sigmoidoscopy should be performed in all patients over the age of 40, with clinical signs of haemorrhoids.
Constructing a ‘plausible narrative of progress’ for nursing: a neopragmatist suggestion
Authors: Mason Walter H.
Published: December 2008

Identity, difference, and the associated subject of cultural diversity pose challenges for nursing. As the demographics of the world change, demands are rising for nurses to provide sensitive, individualized care to people living in our ever‐changing global community. Issues concerning gender, sexuality, disability, age, language, economic and occupational status, multiculturalism, and ethnicity are made more complex because many of these topics strike a personal chord for individual nurses. In order for nursing to provide appropriate care to the world's people and to meet future challenges, nursing must define itself in new ways. Kikuchi and Simmons have stated that the best way for nursing to approach this task is through the development of a ‘sound’ philosophy of nursing that will ‘accommodate diversity in nursing thought’. They contend that before we can establish a philosophy of nursing, nurses will have to agree upon the nature of reality, human beings, truth, and knowledge. This paper will suggest that neopragmatism, as described by Richard Rorty, is a way to assure diversity of thought in nursing. However, I will argue against the requirement for this philosophy to be ‘sound’ in the sense that Kikuchi and Simmons use this term. In place of their call for ‘truth and unity in nursing thought’. I will attempt to demonstrate how neopragmatic ideas relate to the construction of what Rorty called a unifying ‘plausible narrative of progress’. This change will allow nursing to abandon the dead end debate over epistemologies and instead focus on more important issues related to improving nursing practice.
La différence: condition of exclusion or of reconnaissance?
Authors: Blondeau Danielle
Published: December 2008

From the Middle Ages onto the 19th century, following the trend set in leper hospitals, madness was to be hidden, secluded in dark places, far away from the mainstream of society. The emergence of the mad person, perceived as inevitably different, allows to make the boundaries between reason and folly, between human and inhuman, irrelevant. If leper hospitals have almost emptied out, if there are much fewer confinement facilities, the values and images related to the leper or the mad person, as well as the sense of exclusion, continue to persist. The purpose of this paper is to show clearly that this matter of exclusion is a serious legacy that could very well apply nowadays to other figures that, each in their own way, symbolize menace or mockery. It applies notably to the aged and the dying who both appear as the opposite of modern society and its values of efficiency, productivity and profitability. The multiplication of places where old people are left to die, and the elderly who are crowded in old folks homes, stand as proof of their exclusion from society. Nevertheless, youth and old age coexist, as well as life and death. If care of others is the trait of a humane civilization, must it be understood that barbarism consists in ignoring its own humanity as well as that of others? In view of such practices of exclusion, policy statements based on recognition of human dignity, where ethical obligation rests on recognition of others and humanism, are rather paradoxical. Is this a paradox or a deadlock; a condition of exclusion or of reconnaissance?
The Provision of Tax Services by Incumbent Auditors and Earnings Management: Evidence from Korea
Authors: Choi Won‐Wook , Lee Ho‐Young , Jun Byung Wook
Published: December 2008

This study examines the associations between the provision of tax services by incumbent auditors and earnings management. We investigate whether three different effects of tax service provision play different roles in accounting practices. The three effects include the audit independence effect, the knowledge spillover effect, and the tax avoidance effect. If the provision of tax services by incumbent auditors harms auditor independence, firms may exercise greater earnings management (audit independence effect). However, if incumbent auditors gain incremental knowledge by offering tax services, the quality of their audit services could be enhanced, and therefore, reported earnings could be more conservative (knowledge spillover effect). If tax service fee leads to low taxable income, it could depress book income when book‐tax conformity is high (tax avoidance effect). We find that the provision of tax services generally improves earnings quality by curtailing opportunistic accounting practices. The results also suggest that the negative association between the provision of tax services and discretionary accruals seems to be primarily driven by the knowledge spillover effect as opposed to the tax avoidance effect. Additional analysis is conducted in examining whether the tax avoidance effect exists in a sub‐sample.
International Differences in Wage Inequality: A New Glance with European Matched Employer–Employee Data
Authors: Simón Hipólito
Published: December 2008

Using international harmonized matched employer–employee micro data from the European Structure of Earnings Survey for nine European countries, this article examines the origin of international differences in wage inequality. Wage inequality is highly correlated with the magnitude of inter‐firm wage differentials. Workplace‐ and job‐related factors generally have a more significant impact on within‐country wage inequality than individual characteristics. European countries differ significantly not only in the extent of wage inequality but also in the relative influence of factors shaping wage inequality. Although cross‐country differences in labour force composition play a part in the explanation, differences in the distribution and in labour market prices attached to workplace and job characteristics are the primary factors contributing to international differences in wage inequality.
630. LATHYRUS ROSEUS
Authors: Kenicer Gregory , Norton Sylvia
Published: December 2008

Summary Lathyrus roseus Stev., a perennial from the Caucasus mountains and eastern Pontic region of Turkey, is described and illustrated.
632. LATHYRUS HETEROPHYLLUS
Authors: Kenicer Gregory , Norton Sylvia
Published: December 2008

Summary Lathyrus heterophyllus L., one of an interesting complex of perennial European peas is described and illustrated; its relations with these other members of the genus are discussed.