bluuebunny/crossref_metadata_2025 huggingface dataset:
Joint Enterprise Liability: Recent Developments and Judicial Responses
Authors: Grigg Edward
Published: January 2019

This article reconsiders the decision in R v Jogee [2016] UKSC 8 and the merits of joint enterprise liability. The article is structured in three sections. First, it outlines the background to the appeal in Jogee and argues that the Supreme Court’s decision is welcome on both normative and jurisprudential grounds. Second, it considers subsequent academic criticism and the approaches taken by the High Court of Australia and Hong Kong Court of Final Appeal. Third, it responds to these differing perspectives and suggests that Jogee has left the law in a more satisfactory state, but that accessorial liability as a whole remains in need of further clarification.
Religious memory on Facebook in times of refugee crisis
Authors: Guzek Damian
Published: January 2019

The aim of this article is to analyze the religious discourse on Polish Facebook in relation to the refugee crisis. The primary focus is on how religious memory is presented. A discourse analysis implemented by the author helps to identify and examine certain nodal points related to the religious debate about refugees, and then instruments used to recall religious memory are shown. In the course of the analysis, the author uses the theory of religion as a chain of memory. As a result, a complex attitude of Polish users toward the Pope, Islam, Christian martyrdom and religious buildings is shown. All of them refer to religious traces from the past.
The Tri-Faith Initiative
Authors: Alexander Chris
Published: January 2019

Countryside Community Church is the primary Christian presence of the Tri-Faith Initiative in Omaha NE. This initiative is an intentional co-location of a synagogue, mosque, and church on the same 35-acre Commons area, for the purpose of being intentional neighbors and investing in interfaith friendships. Our vision is to Work together to build an environment of acceptance, respect, and trust; to challenge stereotypes of each other; to learn from one another; and to counter the influence of extremists and agents of hate. This article is a story of how we came to be neighbors and what we hope to accomplish.
Interfaith friendship as incarnational mission practice: Presidential Address, ASM 2018
Authors: Lewis Bonnie Sue
Published: January 2019

Believing that the love of our triune God enables love of others and faithful witness to our lives in Christ, interfaith friendships are a testimony to the incarnational nature and power of God’s love. Such friendships not only provide the means for overcoming the growing fear, hostility, and distrust of the religious other among us, they also allow God to love us through the stranger. In so doing, we welcome the living Christ who dwells in our midst, relying on his Spirit to draw each of us closer to the compassionate heart of God.
Curiosity, responsibility, hospitality: Scenes of interreligious friendship
Authors: Houck Anita
Published: January 2019

Three themes in interreligious friendship are illustrated through stories from the author’s childhood and adulthood. Curiosity takes different forms across the life span but can continue to lead to relationships both personal and professional. Responsibility asks that one represent one’s own tradition accurately, including in recognizing that no single person can speak for a religion. Hospitality is understood both as interpersonal welcome and, drawing from Catherine Cornille, as recognizing and welcoming “actual truth” in other religions. Hospitality offers and sustains friendship despite societal obstacles and individual failures. Throughout the life cycle, the experience of envying others’ religiosity can both inspire friendship and refine how one understands and practices one’s own religious commitments.
Misinformation and Polarization in a High-Choice Media Environment: How Effective Are Political Fact-Checkers?
Authors: Hameleers Michael , van der Meer Toni G. L. A.
Published: January 2019

One of the most fundamental changes in today’s political information environment is an increasing lack of communicative truthfulness. To explore this worrisome phenomenon, this study aims to investigate the effects of political misinformation by integrating three theoretical approaches: (1) misinformation, (2) polarization, and (3) selective exposure. In this article, we examine the role of fact-checkers in discrediting polarized misinformation in a fragmented media environment. We rely on two experiments ( N = 1,117) in which we vary exposure to attitudinal-congruent or incongruent political news and a follow-up fact-check article debunking the information. Participants were either forced to see or free to select a fact-checker. Results show that fact-checkers can be successful as they (1) lower agreement with attitudinally congruent political misinformation and (2) can overcome political polarization. Moreover, dependent on the issue, fact-checkers are most likely to be selected when they confirm prior attitudes and avoided when they are incongruent, indicating a confirmation bias for selecting corrective information. The freedom to select or avoid fact-checkers does not have an impact on political beliefs.
Incorporation of a recycled rubber compound from the shoe industry in polystyrene: Effect of SBS compatibilizer content
Authors: Luna Carlos Bruno Barreto , Araújo Edcleide Maria , Siqueira Danilo Diniz , Morais Dayanne Diniz de Souza , Filho Edson Antônio dos Santos , Fook Marcus Vinícius Lia
Published: January 2019

This research aimed to evaluate the influence of styrene–butadiene–styrene (SBS) compatibilizer in the polystyrene blends properties with a recycled styrene–butadiene rubber compound. The SBS content was 5, 7.5, and 10%. Commercial high-impact polystyrene (HIPS) was used for comparison. The results indicated that the viscosity of the blends was higher than that of HIPS. The blends compatibilized with 5 and 7.5% had the same level of impact strength as HIPS, while the one with 10% obtained a gain of 80% in relation to HIPS. The flexural strength, hardness, heat deflection temperature, and Vicat softening temperature properties were similar to those of HIPS, which was attributed to the presence of inorganic fillers, minimizing losses in these properties. By atomic force microscopy, two distinct phases were observed, and in the morphology analyzed through scanning electron microscopy, a typical characteristic of immiscible blends was observed.
Imitation, Reference, and Exploration—Development Path to Urban Renewal in China (1985-2017)
Authors: Yao Zhou , Jiang Chang
Published: January 2019

In China, the field of urban renewal is one of the core concepts within the disciplines of urbanism and architecture. After decades of economic growth, many issues have been added to the field of urban development, which has diversified significantly. To comprehensively understand the developmental context of urban renewal in China, this paper starts from the urban and architectural disciplines, combined with the international background of urban regeneration, and systematically analyzes the progress of urban renewal in China from 1985 to 2017. Four major research themes are summarized and divided into three stages of development with the aim of chronologically sorting the contexts and trends of urban renewal in the thirty years since China’s “Open Door Policy.”
Transformational Leadership, High-Performance Work System Consensus, and Customer Satisfaction
Authors: Weller Ingo , Süß Julian , Evanschitzky Heiner , von Wangenheim Florian
Published: January 2019

We use human resources (HR) system strength theory to argue that transformational leadership leads to employee consensus on a unit’s high-performance work system (HPWS), that consensus helps align employee attitudes, and that a compression in attitudes facilitates strategy execution and unit-level outcomes. Empirical tests based on a 4-year linked employee–customer panel data set, involving 255 do-it-yourself stores, support our predictions. Transformational leadership is positively related to HPWS consensus. Consensus is negatively associated with unit-level job satisfaction dispersion, which in turn relates positively to unit-level customer satisfaction. Our study makes important contributions to the strategic HR and HR system strength literatures, highlighting the roles of leadership and employee consensus in strategy execution.
A Systematic Review of Human Resource Management Systems and Their Measurement
Authors: Boon Corine , Den Hartog Deanne N. , Lepak David P.
Published: January 2019

In the strategic human resource (HR) management literature, over the past three decades, a shared consensus has developed that the focus should be on HR systems rather than individual HR practices because the effects of HR practices are likely to depend on the other practices within the system. Despite this agreement, the extent to which the fundamental assumption in the field of interactions and synergy in the system holds true is unclear. We present a systematic review of 495 empirical studies on 516 HR systems in which we analyze the development of HR systems research over time and identify important trends, explicitly linking conceptualization and measurement of the HR system. Our findings suggest that the increasingly broad conceptualization and measurement of HR systems and the lack of clarity on the HR systems construct at different levels have hampered research progress. Much of the research to date does not align with the fundamental assumption of synergies between HR practices in a system, the measures have problems and increasingly confound HR systems with related concepts and outcomes, and insufficient attention is paid to the HR system construct at different levels. Overall, we thus still know little about the “systems” element and how synergies and interactions in an HR system operate. We offer actionable suggestions on how to advance HR systems research towards conceptual clarity and construct refinement, focusing both on how to conceptualize, measure, and combine practices in systems and on studying such systems at different levels of analysis.
The infrastructure of tolerance
Authors: Goldhill Simon
Published: January 2019

This article argues that integrated infrastructural planning is necessary for building cities that encourage tolerance as a civic behaviour. It argues in favour of open planning and insists that tolerance must be tolerance of risk and uncertainty in urban experience.
Toxicologic Pathology Forum: Current Status on the Use of Animal Models of Human Disease in the Pharmaceutical Industry in Japan in Nonclinical Safety Assessment–Opinion Paper
Authors: Tomohiro Masayuki , Okabe Takeshi , Kimura Yasushi , Kinoshita Kiyoshi , Maeda Mitsunori , Mitobe Yuko , Motoyama Keiko , Yonezawa Riichiro , Sasaki Shoji , Fujiwara Michio , Watanabe Kazuto
Published: January 2019

In nonclinical safety studies for new drug development, healthy animals have been commonly used. However, in some cases, the use of animal models of human disease is considered to be more favorable in evaluating risks in patients. To elucidate the current status of the use of animal models for nonclinical safety assessment, an internal questionnaire from the Japan Pharmaceutical Manufacturers Association and surveys (questionnaire period: August 27 to September 30, 2015) of both common technical documents and review reports of approved drugs (approval period: May 1999 to May 2017) disclosed by the Pharmaceutical and Medical Devices Agency were conducted. Although there were some concerns and limitations raised, the survey results revealed that animal models have been used in nonclinical safety assessment on a case-by-case basis and that nonclinical safety studies using animal models were included in the data packages of several approved drugs in Japan. The survey results also revealed that nonclinical safety studies using animal models have become more frequent in the past few years. In almost all cases, useful information, such as signs of toxicity under disease conditions and mechanisms of toxic change, was obtained from the results of nonclinical studies using animal models.

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Working Out Their Future: The NFL’s Play 60 Campaign and the Production of Adolescent Fans and Players
Authors: Rugg Adam
Published: January 2019

This article critically examines the National Football League’s (NFL) extensive “Play 60” campaign that operates in more than 73,000 schools in the United States. The year-round program—marketed as a campaign to end childhood obesity—now holds significance influence over school curriculums and operations, public constructions of health and diet, and governmental recommendations and policies on health and exercise. This article argues that the emergence of the Play 60 campaign as a major influence in these areas reflects the increasing privatization of physical education and wellness in U.S. schools. Furthermore, the program serves the commercial and political interests of the league by instilling familiarity with the labor and verbiage of football in program participants and advocating for the role of athletes (and the leagues they are a part of) in influencing youth ideas regarding nutrition and health. Most importantly, the program situates football as a safe and healthy practice for children amid increasing societal awareness and concern over the substantial health risks associated with playing youth football.
Quick atrial access by subxiphoid approach in extracorporeal cardiopulmonary resuscitation after bidirectional Glenn procedure
Authors: Yoneyama Fumiya , Okamura Toru
Published: January 2019

Bidirectional Glenn procedure outcomes are very good; therefore, extracorporeal membrane oxygenation use as extracorporeal cardiopulmonary resuscitation is uncommon. We describe a 13-month-old female who required extracorporeal cardiopulmonary resuscitation for ventricular tachycardia provoked by transient myocarditis 6 months post-bidirectional Glenn procedure. After extracorporeal membrane oxygenation induction with cannulation on the cervical vessels, small skin incision was created on the subxiphoid area without sternotomy and the atrium was cannulated. With adequate venous drainage and ventricular unloading, ventricular tachycardia eventually converted to sinus rhythm. The patient withdrew from extracorporeal membrane oxygenation and was discharged successfully. Our results suggest that for successful post-bidirectional Glenn extracorporeal cardiopulmonary resuscitation, quick atrial access and ventricular unloading are essential.
Assessing Quality of Stakeholder Engagement: From Bureaucracy to Democracy
Authors: Tomkiv Yevgeniya , Liland Astrid , Oughton Deborah H. , Wynne Brian
Published: January 2019

The idea of public or stakeholder engagement in governance of science and technology is widely accepted in many policy and academic research settings. However, this enthusiasm for stakeholder engagement has not necessarily resulted in changes of attitudes toward the role of stakeholders in the dialogue nor to the value of public knowledge, practical experience, and other inputs (like salient questions) vis-à-vis expert knowledge. The formal systems of evaluation of the stakeholder engagement activities are often focused on showing that the method is efficient and works. In this article, we argue that every stakeholder engagement process should be evaluated beyond a simple assessment of the methodology and that the wider context of the stakeholder engagement activity should also be addressed. We evaluate two different stakeholder engagement activities against the existing method evaluation criteria and demonstrate their limitations for assessing the quality of a stakeholder engagement. We argue that these criteria need to be extended so that engagement processes will have a chance to improve not only policies but also their democratic legitimacy.
Load frequency control enhancement of islanded micro-grid considering high wind power penetration using superconducting magnetic energy storage and optimal controller
Authors: Mohamed Emad A , Mitani Yasunori
Published: January 2019

This article proposes a robust load frequency control using a new optimal proportional–integral–derivative controller–based genetic moth swarm algorithm for islanded microgrids considering high wind power penetration. In such microgrids, the replacement of conventional generator units with a large number of renewable energy sources reduces the system inertia, which in turn causes undesirable influence on microgrid frequency stability, leading to weakening of the microgrid. Furthermore, sudden load shedding, load restoring, and short circuits caused large frequency fluctuations which threaten the system security and could lead to complete blackouts as well as damages to the system equipment. In order to solve this challenge, this study proposes a new coordinated optimal load frequency control plus modified control signal to superconducting magnetic energy storage for compensating the microgrid frequency deviation (∆ f). To prove the effectiveness of the proposed coordinated control strategy, an islanded microgrid was tested for the MATLAB/Simulink simulation. The physical constraints of the turbines such as generation rate constraints and speed governor dead band are considered in this study. The results confirmed the effectiveness and robustness of the proposed coordination performance against all scenarios of different load profiles, wind power fluctuation, and system uncertainties in microgrid integrated with high penetration of wind farms. Moreover, the results have been compared with both: the optimal load frequency control with/without the effect of conventional superconducting magnetic energy storage.
Can We Achieve Consensus on Central Venous Catheter-Related Infections?
Authors: Fraenkel D. J. , Rickard C. , Lipman J.
Published: January 2019

Central venous catheter-related bacteraemia is a substantial and preventable source of iatrogenic morbidity and mortality. A single episode of catheter-related bacteraemia has an estimated cost of A$50,000, with an attributable mortality between 10 and 35%. Catheter colonization is diagnosed with standard culture techniques. Diagnostic criteria for catheter-related bacteraemia include the results of cultures from the catheter tip, the peripheral blood and other possible sites of infection. The presence of clinical symptoms and subsequent defervescence may assist in making the diagnosis. This review explores the existing definitions of catheter-related infections and proposes a new and more rigorous classification with criteria for definite, probable and possible catheter-related bacteraemia. The authors hope that this classification will enhance the interpretation of the literature and the planning of new investigations.

Infection rates can be reduced by appropriate site selection, adequate skin preparation, sterile technique and appropriate dressings. Decreased manipulation of administration sets, with more careful technique and less frequent set replacement, may reduce hub contamination. Infection rates increase with the duration in situ of the catheter, however are not reduced by regular scheduled catheter replacement or guide-wire exchanges. A range of antimicrobial catheter materials and coatings are under investigation, some of which are effective in reducing the rate of catheter-related bacteraemia. Chorhexidine-silver sulphadiazine and rifampicin-minocycline are the best studied combinations to date. Further developments are expected, although none are likely to be as effective as not inserting or removing the central venous catheter when it is not required.
Does Adrenaline Improve Epidural Bupivacaine and Fentanyl Analgesia after Abdominal Surgery?
Authors: Sakaguchi Y. , Sakura S. , Shinzawa M. , Saito Y.
Published: January 2019

The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. Patients were randomly divided into two groups to receive a postoperative epidural infusion of fentanyl 5 μg/ml in bupivacaine 0.2%, with or without adrenaline 5 μg/ml, at a rate of 2 ml/h for more than 48 hours. Postoperative pain relief was assessed using visual analog scales (VAS), both at rest and during coughing, at 2, 24, and 48 hours after surgery. The number of rescue analgesics and side-effects such as nausea, vomiting, pruritus, respiratory depression, headache, muscle weakness, and hypotension were recorded.

Patients who received adrenaline (n=40) reported significantly lower mean VAS scores than those who received no adrenaline (n=37), both at rest at 24 hours postoperatively and during coughing at 24 and 48 hours. The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.
Timing of Midazolam and Propofol Administration for Co-Induction of Anaesthesia
Authors: Ong L. B. , Plummer J. L. , Waldow W. C. , Owen H.
Published: January 2019

We aimed to determine the optimum timing of midazolam administration prior to propofol to achieve the maximal reduction in the dose of propofol required to induce anaesthesia. Female (ASA 1–2) patients, aged 18 to 45 years, weighing 40 to 75 kg and scheduled for gynaecological surgery were eligible for the study. Consenting patients were randomly assigned to six groups. Group 1 received saline and Groups 2 to 6 received midazolam 3 mg at 1, 2, 4, 6 or 10 minutes respectively prior to propofol (n=20 to 22 per group) in a blinded manner. Propofol was administered IV over 10 seconds and flushed in with saline 5 ml. Two minutes later, the patient's response to pressure applied to the finger was determined as an index of loss of consciousness. The ED50 of propofol in each group was determined by the up-and-down method. Propofol ED50 was reduced to 34 to 67% (P<0.001) in the midazolam treated groups. There was no significant (P=0.14) difference in propofol ED50 among the five groups which received midazolam. Patients who received midazolam had less recollection of events surrounding induction (P<0.001) and recalled the induction experience as being more pleasant (P=0.03) than those who did not receive midazolam. These results indicate that midazolam may be given up to 10 minutes prior to propofol and still achieve a substantial dose reduction.
Sevoflurane Output from the Oxford Miniature Vaporizer in Drawover Mode
Authors: Liu E. H. C. , Dhara S. S.
Published: January 2019

The sevoflurane output from the Oxford Miniature Vaporizer (OMV) was measured in a series of bench tests in a drawover system. Using a range of settings on two OMVs in series, output ranged from 0.5 to 5.9% with a 600 ml tidal volume at a rate of 12 breaths/min produced by a Penlon Multivent. The OMVs’ output was steady over 40 minutes. In tests with tidal volumes ranging from 300 ml to 1200 ml, the OMVs’ output was lower at higher minute volumes. When continuous flow of carrier gas at 7.2 l/min was used, the output was lower than at the equivalent intermittent flow rate. Using two OMVs with a drawover system appears to be a feasible technique for the induction and maintenance of sevoflurane anaesthesia. Clinical tests of sevoflurane drawover anaesthesia are now required so that the advantages of sevoflurane can gain wider application in field and military anaesthesia.
Estimating the Diameter of the Left Main Bronchus
Authors: Hampton T. , Armstrong S. , Russell W. J.
Published: January 2019

Two hundred and six standard PA chest X-rays were measured. The mean diameter of the left main bronchus (LMB) was 12.6±1.9 mm. The mean diameter of the 92 male LMB was 13.0±2.6, and for females 11.8±1.6. These data correspond closely to that reported by others. The correlation between the diameter of the LMB and that of the trachea was 0.74 but was not precise enough to be useful as an estimate for clinical use. Similarly there was good correlation between the diameter of the right main bronchus and that of the left (r=0.75) but not precise enough to be clinically useful.

In contrast to previous claims, only direct measurement of the left main bronchus has sufficient precision to define the appropriate size of left double-lumen tube to be selected for lung separation.
Airway Management for Carinal Tumour Resection
Authors: Cokis C. , Strang T.
Published: January 2019

We describe the airway management during resection of a right main bronchial and carinal “pseudotumour” in a 16-year-old patient. Two 5 mm microlaryngoscopy tubes (Mallinckrodt) were inserted side by side in the trachea, with one positioned in the left main bronchus and the other just below the larynx. Independent ventilation of both lungs, with suctioning and fibreoptic inspection of the lower trachea, could easily be carried out. Current airway devices used to isolate lung ventilation are reviewed and their limitations considered.
Management of Postoperative Epidural Analgesia: A Survey of Australian Practice
Authors: Jastrzab G. , Fairbrother G. , Khor K. E.
Published: January 2019

A sample of Australian hospitals was surveyed about their practice preferences in relation to the management of epidural analgesia for postoperative pain. Results indicated substantial variation in practice preference across institutions with respect to observation protocols, epidural analgesia duration, catheter removal where anticoagulant therapy is concurrent and management of catheter problems. Further research appears necessary to develop optimal epidural analgesia management practice.
Severe Convulsant Hypomagnesaemia and Short Bowel Syndrome
Authors: Fagan C. , Phelan D.
Published: January 2019

Hypomagnesaemia as a primary cause of a generalized seizure is uncommon. A 60-year-old woman with Crohn's disease, who had had recent small bowel surgery and a total colectomy 10 years previously, was admitted complaining of severe nausea, vomiting, fatigue and thirst. Despite oral magnesium therapy she had a generalized seizure due to severe hypomagnesaemia of 0.09 mmol/l (normal range 0.65 to 1.05 mmol/l). Her serum calcium was 1.91 mmol/l (2.03 to 2.63 mmol/l).

Hypomagnesaemia can cause generalized convulsions but is usually associated with hypocalcaemia. This patient had an almost normal serum calcium level, and therefore hypomagnesaemia would seem to have been the direct cause of her seizure. Long-term intravenous magnesium was necessary to prevent further seizures.
Intraoperative Fibreoptic Bronchoscopy during Neonatal Tracheo-Oesophageal Fistula Ligation and Oesophageal Atresia Repair
Authors: De Gabriele L. C. , Cooper M. G. , Singh S. , Pitkin J.
Published: January 2019

Maintenance of adequate ventilation under anaesthesia can be difficult during identification and ligation of congenital tracheo-oesophageal fistula with repair of oesophageal atresia. Anaesthesia may also be complicated by problems associated with prematurity, pre-existing aspiration pneumonitis, and difficulty positioning the endotracheal tube to prevent inflation of the stomach with increased risk of aspiration and diaphragmatic splinting. Even intubation of the fistula and gastric rupture may occur. Two neonatal cases are presented where use of a 2.2 mm neonatal bronchoscope passed through a 3.0 mm ID tracheal tube facilitated surgical identification of the fistula, diagnosis of fistula intubation and other airway problems intraoperatively.
Laryngeal Mask vs Intubating Laryngeal Mask: Insertion and Ventilation by Inexperienced Resuscitators
Authors: Burgoyne L. , Cyna A.
Published: January 2019

The laryngeal mask airway (LMA) has been shown to be useful in airway maintenance during resuscitation. The intubating laryngeal mask (ILM) is a modified LMA permitting both ventilation and rapid endotracheal intubation. We aimed to compare the LMA and the ILM with regard to ease of insertion and successful ventilation by inexperienced personnel. We have used anaesthetized, apnoeic, non-paralysed patients as a model to simulate resuscitation. Following standardized training, non-anaesthetic medical staff with no previous experience in laryngeal mask airway insertion (novices) inserted either the LMA or ILM in 55 patients following induction of anaesthesia. There were no differences between the two patient groups included in our study with regard to mean age and body mass index (BMI). The success rate for inserting the airway device and achieving a significant end-tidal CO2 recording within two minutes was 23/28 for the LMA (82.1%) and 22/27 for the ILM (81.5%). Reasons for failure included inability to insert the ILM past the teeth and insertion of the LMA upside down. There were no clinically relevant differences in the mean time to airway insertion and successful ventilation (62.6 vs 62 seconds) or expired tidal volume (781 vs 767 ml) for the LMA and ILM respectively. We conclude that the ILM is as easily inserted and effectively used as an LMA by novices and, because it allows the option of facilitating endotracheal intubation, may be the preferred device for maintaining an airway during resuscitation.
Enteral Nutrition in the Critically Ill: A Prospective Survey in an Australian Intensive Care Unit
Authors: De Beaux I. , Chapman M. , Fraser R. , Finnis M. , De Keulenaer B. , Liberalli D. , Satanek M.
Published: January 2019

Nutritional support is routine practice in critically ill patients and enteral feeding is preferred to the parenteral route. However this direct delivery of nutrients to the gut is potentially ineffective for a variety of reasons. We performed a prospective audit of 40 consecutive intensive care patients to determine whether enteral feeding met the nutritional requirements of our patients. The ideal requirements for each patient were calculated using the Harris-Benedict equation with an adjustment determined by the patient's diagnosis. We compared the amount of feed delivered with the daily requirements over a seven-day period. Successful feeding was defined as the achievement of 90% of the ideal calorie requirement for two consecutive days. The mean calculated (±SD) energy requirement was 9566kJ (±2586). Patients received only 51% (SD 38) of their energy requirements throughout the study period. Only 10 patients (25%) were successfully fed for at least any two-day period in the seven days. Feeding was limited mainly by gastrointestinal dysfunction or by the need to fast the patient for medical, surgical and airway procedures. Success of feeding was not related to the use of sedative or paralysing agents and had no correlation with plasma albumin concentration. There was no difference in the volume of feed delivered to patients who survived or died. Prokinetic agents were used in 25 patients and in these patients there was a trend towards improved delivery of feed.
Current Usage of Dopamine in New Zealand Intensive Care Units
Authors: McHugh G. J.
Published: January 2019

A nation-wide evaluation of dopamine usage in New Zealand Intensive Care Units (ICUs) was undertaken. Twenty-six public hospital ICUs participated. Twenty-two ICUs (85%) use dopamine as an inotrope. Seventeen ICUs use dopamine for presumed selective renal effects at least occasionally, but with wide variation in what is considered to be “renal-dose”. Level 3 ICUs were less likely to use “renal-dose” dopamine than levels 1 and 2 (P=0.01). Nineteen units (83%) use weight-referenced (i.e., μg.kg-1.min-1) dopamine administration. Weight-referenced administration and “renal-dose” dopamine were likely to be in use together (P=0.02). Standard dopamine dilutions varied widely with a median of 2 mg.ml-1 (range 0.4 to 8 mg.ml-1). Given a demonstrated association between weight-referenced administration and “renal-dose” dopamine, along with particular pharmacokinetic and pharmacodynamic reservations, the value of weight-referenced administration of dopamine in adult patients is questioned.
Echocardiographic Diagnosis of Extrapericardial Tamponade Due to Dilated Gastric Roll following Oesophagectomy
Authors: Kariya N. , Shindoh M. , Nakatani K. , Asada A. , Nishi S. , Kurita S.
Published: January 2019

A complication of lower thoracic oesophagectomy for oesophageal carcinoma is reported. Extrapericardial tamponade was caused by a dilated retrosternal gastric roll. Echocardiography was useful for diagnosis. Diagnosis, investigation and management of this unusual but life-threatening complication are discussed. Transthoracic echocardiography is a useful and practical investigation for the evaluation of complications of oesophagectomy.
Increased B-type Natriuretic Peptide (BNP) Level is a Strong Predictor for Cardiac Dysfunction in Intensive Care Unit Patients
Authors: McLean A. S. , Tang B. , Nalos M. , Huang S. J. , Stewart D. E.
Published: January 2019

Patients admitted to an Intensive Care Unit (ICU) frequently have underlying cardiac dysfunction. Early interventions are sometimes difficult to initiate because of diagnostic uncertainty as to whether cardiac failure is present As B-type natriuretic peptide (BNP) has been shown to be increased in cardiac dysfunction, we sought to demonstrate whether BNP can be used as a screening tool for cardiac dysfunction in patients admitted to ICU.

All patients admitted to a combined medical and surgical ICU over a four-week period were included in the study. BNP was measured on the point of admission using a hand-held meter. Clinicians were blinded from the measurement when diagnoses were made as to whether or not the patients had clinically significant cardiac dysfunction.

Patients with cardiac dysfunction had a significantly higher level of BNP when compared to the non-cardiac dysfunction group: 516±385 pg/ml (n = 26) v 67±89 pg/ml (n=58) (P< 0.0001) A BNP cut-off value at 144 pg/ml exhibited a 92% sensitivity, 86% specificity and 96% negative predictive value. The sensitivity improved to 96% when the analysis was confined to patients ≥ 55 years. At this cut-off value, BNP is a strong predictor of cardiac dysfunction.

BNP measurement offers a rapid and affordable way to screen for cardiac dysfunction in patients admitted to ICU. An increased BNP level warrants further cardiac investigations so as to implement early interventions for cardiac decompensation in ICU patients.
Avoiding Inadvertent Epidural Injection of Drugs Intended for Non-epidural Use
Authors: Hew C. M. , Cyna A. M. , Simmons S. W.
Published: January 2019

Inadvertent administration of non-epidural medications into the epidural space has the potential for serious morbidity and mortality. The aim of this study was to collate reported incidents of this type, describe the potential mechanisms of occurrence and identify possible solutions. We searched medical databases and reviewed reference lists of papers retrieved, covering a period of 35 years, regarding this type of medication incident. The 31 reports of 37 cases found is likely to represent a gross underestimation of the actual number of incidents that occur. “Syringe swap”, “ampoule error”, and epidural/intravenous line confusion were the main sources of error in 36/37 cases (97%). Given that no effective treatment for such errors has been identified, prevention should be the main defence strategy. Despite all the precautions that are currently undertaken, accidents will inevitably occur. We have identified areas for system-wide change that may prevent these types of incidents from occurring in future.
Compensating for the Effect of Inlet Gas Temperature on Heated Humidifier Performance
Authors: Carter B. G. , Kemp T. , Mynard J. , Hochmann M. , Osborne A.
Published: January 2019

The humidity output of heated humidifiers may be compromised by inlet gas temperatures exceeding approximately 26°C, with humidity dropping below the recommended levels for intubated patients. A new version of the Fisher & Paykel MR850 humidifier claims to deal with this problem by offering a humidity compensation option. The present study tested this feature by measuring humidity output using the gravimetric method and a hygrometer at different inlet gas temperatures (16.6°C to 40.0°C) with compensation on and off. It was found that the compensation is effective in maintaining humidity levels despite high inlet gas temperatures.
Preparing a New Generation Anaesthetic Machine for Patients Susceptible to Malignant Hyperthermia
Authors: SchÖNell L. H. B. , Sims C. , Bulsara M.
Published: January 2019

Anaesthetic machines are prepared for use with patients who are susceptible to malignant hyperpyrexia (MH) by flushing with oxygen at 10 l/min for ten minutes to reduce the anaesthetic concentration to 1 part per million (ppm) or less. Anaesthetic workstations are now often used in place of traditional machines. Workstations have greater internal complexity, and it is not known if they can be made safe for susceptible patients by flushing with oxygen. We used a high sensitivity infrared gas analyser to measure the washout of isoflurane from five Datex-Ohmeda workstations. Measurements were then repeated with a patient breathing circuit. Isoflurane washout occurred in an exponential manner. The time to reach a concentration of 1ppm at the fresh gas outlet was 17±7 minutes, and all machines had reached less than 2 ppm by ten minutes. The washout of isoflurane from the machine and patient breathing circuit was much slower than from the machine alone, with a concentration less than 2 ppm reached only after 30 minutes. We conclude that the Datex-Ohmeda workstation can be prepared for use in MH susceptible patients by flushing with oxygen at 10 l/min for ten minutes. Flushing of the patient breathing system is not straightforward, and we recommend using a clean T-piece circuit. If the circle system and ventilator are required for anaesthesia, we suggest using new breathing hoses, rebreathing bag and soda lime cartridge, and ventilating an artificial lung for 30 minutes with a fresh gas flow rate of 10 l/min and tidal volume of 1 litre.
Patients’ Knowledge of and Attitudes towards Awareness and Depth of Anaesthesia Monitoring
Authors: Leslie K. , Lee L. , Myles P. S. , Lerch N. , Fiddes C.
Published: January 2019

Awareness during anaesthesia is uncommon (~0.1%), but causes significant anxiety, dissatisfaction and morbidity for patients. Several electroencephalographic monitors hold promise as monitors for awareness. We therefore conducted a survey to evaluate patients’ knowledge of and attitudes towards awareness and monitors of anaesthetic depth. Two hundred consenting, preoperative patients completed a seven-item questionnaire. The median number of previous operations was 2 (inter-quartile range, 1–5). Thirteen patients reported an experience which they thought might be awareness (2% of operations performed on the cohort). Only 56% of patients had heard about awareness before and many (35%) of these had heard about it in the media. Many (35%) were uncertain about what might cause awareness. Many (42.5%) were anxious about awareness: female sex and not having heard about awareness before were significant predictors of anxiety. Nevertheless only 34% were willing to pay for a proven awareness monitor if they were at low risk and only 50% if they were at high risk. Perceived risk and a previous awareness experience were significant predictors of willingness to pay for awareness monitoring.
Predictors of Preoperative Anxiety in Children
Authors: Wollin S. R. , Plummer J. L. , Owen H. , Hawkins R. M. F. , Materazzo F.
Published: January 2019

This study aimed to identify factors contributing to anxiety at induction of anaesthesia in children. One hundred and twenty children aged five to twelve years and scheduled for surgery requiring general anaesthesia were included. Children were interviewed and assessed prior to surgery. Parents completed anxiety measures prior to surgery and were interviewed after the induction of anaesthesia. The level of children's anxiety was determined at the time of induction of anaesthesia by the modified Yale Preoperative Anxiety Scale. Factors associated with increased levels of anxiety in the children included increased number of people in the room at induction of anaesthesia; longer waiting time between admission at the hospital and induction of anaesthesia; negative memories of previous hospital experiences; and having a mother who does not practise a religion. Suggestions for implementation of the findings and for future research are provided.
Consequences of Syringe Size Sensor Malfunction in a Modern Infusion Pump
Authors: Derrick J. L. , Ho A. M-H. , Cho A. M. W.
Published: January 2019

Prompted by an actual case of potentially life-threatening infusion pump malfunction, we investigated the effects of wire breakage(s) within the syringe size sensor circuit in a Graseby 3400 infusion pump.The circuit wires within the sensor were systematically broken.The syringe sizes recognised by the sabotaged circuit and the actual sizes of syringes inserted into the pump were compared.Thirty-eight per cent of the possible wire breakages resulted in a smaller syringe size being recognized, causing the infusion rate to be too fast, and 38% of the possible wire breakage resulted in a larger syringe size being recognized, causing the infusion rate to be too slow.The volume delivered for each different size of Terumo syringe as a function of distance travelled by the plunger was measured.The errors ranged from 0.4 to 2.6 times that of the expected rate.Only 1.3% of the possible wire breakage(s) were recognised as errors by the pump.The infusion rates were not affected in 22.5% of the cases.Wire breakage within the syringe size sensor in infusion pumps is yet another potential source of infusion error, with important safety implications.
Combined Spinal and Epidural Anaesthesia for Caesarean Section in a Parturient with Severe Primary Pulmonary Hypertension
Authors: Duggan A. B. , Katz S. G.
Published: January 2019

We describe the management of a parturient with severe primary pulmonary hypertension who underwent caesarean section. A multi-disciplinary approach was used. She was admitted to the intensive care unit perioperatively for invasive monitoring and trial of inhaled nitric oxide. Anaesthesia was provided by combined spinal-epidural block. We discuss controversies about the management of obstetric patients with this rare and serious condition.
The Bispectral Index and Induced Hypothermia— Electrocerebral Silence at an Unusually High Temperature
Authors: Puri G. D. , Bagchi A. , Anandamurthy B. , Dhaliwal R. S.
Published: January 2019

The optimal temperature for deep hypothermic circulatory arrest remains undefined. We present a case in which Bispectral Index monitoring during hypothermic cardiopulmonary bypass showed electrocerebral silence at a higher temperature than previously reported. Bispectral Index monitoring may be a potentially useful tool in surgery employing deep hypothermic circulatory arrest.
Orthodeoxia—An Uncommon Presentation following Bilateral Thoracic Sympathectomy
Authors: Van Heerden P. V. , Cameron P. D. , Karanovic A. , Goodman M. A.
Published: January 2019

We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy
Perioperative Intravenous Ketamine Infusion for the Prevention of Persistent Post-amputation Pain: A Randomized, Controlled Trial
Authors: Hayes C. , Armstrong-Brown A. , Burstal R.
Published: January 2019

We hypothesized that perioperative ketamine administration would modify acute central sensitization following amputation and hence reduce the incidence and severity of persistent post-amputation pain (both phantom limb and stump pain). In a randomized, controlled trial, 45 patients undergoing above- or below-knee amputation received ketamine 0.5 mg.kg–1 or placebo as a pre-induction bolus followed by an intravenous infusion of ketamine 0.15 mg.kg–1.h–1 or normal saline for 72 hours postoperatively. Both groups received standardized general anaesthesia followed by patient-controlled intravenous morphine. The surface area of allodynia over the stump was mapped at days 3 and 6. Postamputation pain was assessed at days 3 and 6 and at 6 months postoperatively.

We found no significant difference between groups in the surface area of stump allodynia or in morphine consumption. There was an unexplained, but significant, increase in the incidence of stump pain in the ketamine group at day 3. At six-month review, the incidence of phantom pain was 47% in the ketamine group and 71% in the control group. This did not reach statistical significance (P=0.28) as the power of the study was based on the search for a large treatment effect. The incidence of stump pain at six months was 47% in the ketamine group and 35% in the control group (P=0.72). There were no significant between-group differences in pain severity throughout the study period.

Ketamine at the dose administered did not significantly reduce acute central sensitization or the incidence and severity of post-amputation pain.
Post–suction Recruitment Manoeuvre Restores Lung Function in Healthy, Anaesthetized Pigs
Authors: Almgren B. , Wickerts C-J. , Hogman M.
Published: January 2019

Endotracheal suction can cause partial lung collapse and hypoxia and alter lung mechanics. We investigated the effects of adding a recruitment manoeuvre directly after endotracheal suction to restore lung volume in volume-controlled ventilation and pressure-controlled ventilation modes. Five anaesthetized pigs were investigated. The effects of endotracheal suction with or without a recruitment manoeuvre were compared in random order. In volume-controlled ventilation, compliance decreased after suction from 33±5 to 26±6 ml.cmH2O–1 (P<0.05), and 30 minutes later it remained decreased at 25±6 ml.cmH2O–1. Venous admixture increased after suction from 5±2 to 8±4% (P<0.05), but had recovered at 30 minutes. In pressure-controlled ventilation, compliance decreased after suction from 34±3 to 25±7 ml.cmH2O–1 (P<0.05), and 30 minutes later it remained decreased at 25±7 ml.cmH2O–1. Venous admixture increased after suction from 5±2 to 13±7% (P<0.05), and had not recovered after 30 minutes, 10±4%. When a recruitment manoeuvre was applied directly after suction, no negative side-effects were registered in volume-controlled ventilation or pressure-controlled ventilation. We conclude that the impairment of lung mechanics and gas exchange induced by endotracheal suction can be prevented by a simple post-suction recruitment manoeuvre. Further studies are needed to identify a suitable suction recruitment manoeuvre in patients with diseased lungs.