bluuebunny/crossref_metadata_2025 huggingface dataset:
Large Bilateral Internal Auditory Meatus Associated with Bilateral Superior Semicircular Canal Dehiscence
Authors: Manzari Leonardo , Scagnelli Paola
Published: January 2019

Superior semicircular canal dehiscence and an abnormally wide internal auditory meatus are clinical entities characterized by vestibular and cochlear symptoms. These symptoms are induced by hypersensitivity of labyrinthine receptors secondary to a bone defect of the otic capsule. We report the case of a 41-year-old man with congenital right-sided hearing loss who presented with bilateral superior semicircular canal dehiscence that was associated with wide, bulbous internal auditory meatus and a loss of the bony wall separating the lateral end of the meatus from the cochlea. The patient was experiencing vestibular and cochlear symptoms in the right ear and disabling tinnitus in the left ear. However, he refused all treatment and was lost to follow-up.
Ectopic Thymus Presenting as a Retropharyngeal Mass: Surgical Approach
Authors: Nolder Abby R. , Agarwal Amit , Howard Emily , Richter Gresham T.
Published: January 2019

Cervical ectopic thymus is a rare cause of solid neck masses in children. Most children are asymptomatic, but some may present with a palpable neck mass, with or without compressive symptoms. Cervical ectopic thymus is often discovered incidentally and mistaken for an infection or neoplasm. We present the case of an infant with retropharyngeal ectopic thymus and describe our intraoral surgical approach.
Malignant Melanoma Metastatic to the Larynx: A Case Report
Authors: Mianroodi Aliasghar Arabi , Mirshekari Tourajreza , Taheri Aliakbar
Published: January 2019

Malignant melanoma of the larynx is a rare cancer that can appear as a primary tumor or as a metastasis from a cutaneous head and neck primary. To the best of our knowledge, only 60 cases of primary laryngeal melanoma have been reported in the world literature. Melanomas metastatic to the larynx are even more rare, as only 24 cases have been previously reported. Survival is poor, and recurrence is uncommon. We describe a new case of a malignant melanoma metastatic to the larynx, which represents the first such case in Iran.
Restoration of the Efferent Phase of the Sneeze Reflex after Regression of an Arnold-Chiari Malformation with Compression of the Medulla Oblongata
Authors: Songu Murat , Can Nazan , Gelal Fazil
Published: January 2019

Te precise location of the sneeze center in the human brain has not been definitively identified. The aim of this report is to contribute to the effort to detect its location. We report the case of a 13-year-old boy who presented to our outpatient clinic for evaluation of an inability to sneeze. In an attempt to trigger the afferent (nasal) phase of the sneeze reflex, we first applied a cotton swab and later a silver nitrate stick to the patient's nasal mucosa. Once that was accomplished, we observed that the patient could not complete the efferent (expiratory) phase of the sneeze reflex, and thus he did not sneeze. Cranial magnetic resonance imaging (MRI) revealed that his cerebellar tonsils extended approximately 10 mm inferiorly through the foramen magnum, which represented a type I Arnold-Chiari malformation. The tonsils were noted to have compressed the posterolateral portion of the medulla oblongata. At follow-up 21 months later, we noted that the patient was able to sneeze spontaneously as well as with nasal stimulation. Repeat MRI revealed that the Arnold-Chiari malformation had undergone a spontaneous partial regression, which resulted in relief of the compression of the medulla oblongata. We believe that the patient's earlier inability to sneeze might have been attributable to the compression of the medulla oblongata by the cerebellar tonsils and that the site of the compression might represent the location of his sneeze center.
Huge Lipoma of the Right Parotid Gland: Case Report and Review of 42 Cases
Authors: Baykul Timuçin , Aydın M. Asım , Fındık Yavuz , Yıldırım Derya
Published: January 2019

Lipomas are rarely found in the parotid gland region. Because of their rarity at this site, they are not often considered in the differential diagnosis of parotid tumors. The parotid lipoma is a slowly growing, asymptomatic, freely movable, soft mass. Preoperative diagnosis is generally difficult. We present a case of a slowly enlarging mass of the parotid region in a 44-year-old man that proved to be a lipomatous tumor of the parotid gland. We also review 42 other cases from the literature. Our patient's huge tumor was located in the superficial lobe of the gland, and a parotidectomy with preservation of the facial nerve was performed. There was no complication or recurrence of the tumor after a follow-up of 1 year.
Ganglioneuromas Involving the Hypoglossal Nerve and the Vagus Nerve in a Child: Surgical Difficulties
Authors: Bakshi Jaimanti , Mohammed Abdul Wadood , Lele Saudamini , Nada Ritambra
Published: January 2019

Ganglioneuromas are benign tumors that arise from the Schwann cells of the autonomic nervous system. They are usually seen in the posterior mediastinum and the paraspinal retroperitoneum in relation to the sympathetic chain. In the head and neck, they are usually related to the cervical sympathetic ganglia or to the ganglion nodosum of the vagus nerve or the hypoglossal nerve. We describe what we believe is the first reported case of multiple ganglioneuromas of the parapharyngeal space in which two separate cranial nerves were involved. The patient was a 10-year-old girl who presented with a 2-year history of a painless and slowly progressive swelling on the left side of her neck and a 1-year history hoarseness. She had no history of relevant trauma or surgery. Intraoperatively, we found two tumors in the left parapharyngeal space—one that had arisen from the hypoglossal nerve and the other from the vagus nerve. Both ganglioneuromas were surgically removed, but the affected nerves had to be sacrificed. Postoperatively, the patient exhibited hypoglossal nerve and vocal fold palsy, but she was asymptomatic. In addition to the case description, we discuss the difficulties we faced during surgical excision.
Changes in the Nasalance of Vowels within the First Week following Uvulopalatopharyngoplasty
Authors: Yang Cheng-Chien , Wang Ying-Piao , Chang Chin-Wen
Published: January 2019

We conducted a retrospective study to evaluate the short-term effect of uvulopalatopharyngoplasty (UPPP) on changes in the nasalance of five vowels: /a/, /ε/, /i/, /Ɔ/, and /u/. Our study group was made up of 20 patients—15 males and 5 females, aged 16 to 57 years (mean: 37.3 ± 11.5)—who had undergone UPPP as a treatment for mild to moderate obstructive sleep apnea. Nasometry was used to obtain nasalance scores in all patients on the morning of the operation (day 1) and subsequently on day 4 or 5 (mean: 4.5 ± 0.5). Preoperatively, nasalance scores were highest for /i/ (mean: 29.8 ± 12.6) and /a/ (mean: 24.1 ± 10.3). After the operation, nasalance scores for all five studied vowels increased; they were highest for /i/ (mean: 40.7 ± +17.8) and /ε/ (mean: 30.0 ± 10.8). The increases in the nasalance of /i/, /ε/, and /u/ were statistically significant (p < 0.05). Our findings indicate that UPPP has a significant impact on nasalance immediately after surgery.
Methylenetetrahydrofolate reductase C677T polymorphism and diabetic retinopathy risk: a meta-analysis of the Chinese population
Authors: Xu Wei-hai , Zhuang Ying , Han Xiao , Yuan Zhi-lan
Published: January 2019

Objectives

This study evaluated associations between methylenetetrahydrofolate reductase ( MTHFR) C677T polymorphisms and diabetic retinopathy (DR) susceptibility within the Chinese population.

Methods

Five databases (PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure) were used for literature searches of open access articles from inception through April 2017.

Results

Eight publications were identified involving 600 DR cases, 363 healthy controls, and 646 nondiabetic retinopathy (NDR) controls. There was a positive association between MTHFR C677T polymorphisms and DR risk within the Chinese population (DR with NDR controls: T vs. C, odds ratio (OR): 2.14, 95% confidence interval (CI): 1.55–2.97; TT vs. CC, OR: 4.19, 95% CI: 2.09–8.41; TT + CT vs. CC, OR: 2.83, 95% CI: 1.86–4.40; TT vs. CC + CT, OR: 2.48, 95% CI: 1.52–4.05. DR with healthy controls: T vs. C, OR: 2.48, 95% CI: 1.99–3.09; TT vs. CC, OR: 4.92, 95% CI: 3.18–7.62; TT + CT vs. CC, OR: 3.22, 95% CI: 2.32–4.48; TT vs. CC + CT, OR: 3.11, 95% CI: 1.83–5.28). The association was similar in South China and North China, when stratifying by geographic areas.

Conclusion

MTHFR C677T polymorphisms increase DR risk within the Chinese population.
Precise differential diagnosis of acute bone marrow edema and hemorrhage and trabecular microfractures using naïve and gamma correction pinhole bone scans
Authors: Bahk Yong-Whee , Edmund Kim E. , Chung Yong-An , Park Jung Mee , Jeon Jeong Yong , Jeong Hyeonseok
Published: January 2019

Objective

To analyze the performance of sequential naïve pinhole bone scan (nPBS) and gamma correction pinhole bone scan (GCPBS), reinforced by ImageJ densitometry and pixelized microfracture measurement, for making specific diagnoses of bone marrow edema (BME), bone marrow hemorrhage (BMH), and trabecular microfractures (TMF).

Methods

We prospectively examined BME, BMH, TMF, and normal trabeculae in 10 patients using sequential nPBS and GCPBS. The intensity of 99mtechnetium-hydroxydiphosphonate (99mTc-HDP) uptake was measured using a pixelized method and calculated using ImageJ densitometry in terms of arbitrary units (AU). This overall method was termed a visuospatial-mathematic assay (VSMA). We analyzed the ability of the calculated AU values to discriminate between the four states using GraphPad Prism software, with reference to previous morphological data.

Results

The calculated values were categorized as ≤50 AU for normal trabecula, 51–100 AU for BME, 101–150 AU for BMH, and ≥151 AU for TMF. The difference in uptake between normal trabecula and BME was significant and the differences among BME, BMH, and TMF were highly significant.

Conclusion

VSMA is a useful technique for refining objective individual diagnoses and for differentiating and quantitating BME, BMH, and TMF.
Prevalence of Augmented Renal Clearance and Performance of Glomerular Filtration Estimates in Indigenous Australian Patients Requiring Intensive Care Admission
Authors: Tsai D. , Udy A. A. , Stewart P. C. , Gourley S. , Morick N. M. , Lipman J. , Roberts J. A.
Published: January 2019

Augmented renal clearance (ARC) refers to the enhanced renal excretion of circulating solute commonly demonstrated in numerous critically ill subgroups. This study aimed to describe the prevalence of ARC in critically ill Indigenous Australian patients and explore the accuracy of commonly employed mathematical estimates of glomerular filtration. We completed a single-centre, prospective, observational study in the intensive care unit (ICU), Alice Springs Hospital, Central Australia. Participants were critically ill adult Indigenous and non-Indigenous Australian patients with a urinary catheter in situ. Exclusion criteria were anuria, pregnancy or the requirement for renal replacement therapy. Daily eight-hour measured creatinine clearances (CrCLm) were collected throughout the ICU stay. ARC was defined by a CrCLm ≥130 ml/min/1.73 m2. The Cockcroft– Gault and Chronic Kidney Disease Epidemiology Collaboration equations were also used to calculate mathematical estimates for comparison. In total, 131 patients were recruited (97 Indigenous, 34 non-Indigenous) and 445 samples were collected. The median (range) CrCLm was 93.0 (5.14 to 205.2) and 90.4 (18.7 to 206.8) ml/min/1.73 m2 in Indigenous and non-Indigenous patients, respectively. Thirty-one of 97 (32%) Indigenous patients manifested ARC, compared to 7 of 34 (21%) non-Indigenous patients (P=0.21). Younger age, major surgery, higher baseline renal function and an absence of diabetes were all associated with ARC. Both mathematical estimates manifest limited accuracy. ARC was prevalent in critically ill Indigenous patients, which places them at significant risk of underdosing with renally excreted drugs. CrCLm should be obtained wherever possible to ensure accurate dosing.
The Establishment of An Anaesthetist-Managed Intraoperative Neurophysiological Monitoring Service and Initial Outcome Data
Authors: Olesnicky B. L. , D'Souza R. J. , Jayram D. , Kim O. M. O. , Rehak A.
Published: January 2019

Neurophysiological monitoring has been recommended to reduce the risk of neurological damage during a wide variety of surgeries. While the concept of an anaesthesia-led intraoperative neurophysiological monitoring (IONM) service is not new, the quality of this service provision has not been studied. In this article, we present our experience with the establishment of this service, and the results of our audit of 302 cases monitored over the initial four years. Our results identified that an anaesthesia-led IONM service was able to achieve a reliable signal in 95.4% of cases and capture significant alerts in 15.6% of these cases with sensitivity, specificity, false positive and negative rates consistent with published data. Our results indicate an anaesthesia-led IONM service is effective in identifying patients at an increased risk of an adverse outcome.
Predicting Medical Emergency Team Calls, Cardiac Arrest Calls and Re-Admission after Intensive Care Discharge: Creation of a Tool to Identify At-Risk Patients
Authors: Ng Y. H. , Pilcher D. V. , Bailey M. , Bain C. A. , MacManus C. , Bucknall T. K.
Published: January 2019

We aimed to develop a predictive model for intensive care unit (ICU)–discharged patients at risk of post-ICU deterioration. We performed a retrospective, single-centre cohort observational study by linking the hospital admission, patient pathology, ICU, and medical emergency team (MET) databases. All patients discharged from the Alfred Hospital ICU to wards between July 2012 and June 2014 were included. The primary outcome was a composite endpoint of any MET call, cardiac arrest call or ICU re-admission. Multivariable logistic regression analysis was used to identify predictors of outcome and develop a risk-stratification model. Four thousand, six hundred and thirty-two patients were included in the study. Of these, 878 (19%) patients had a MET call, 51 (1.1%) patients had cardiac arrest calls, 304 (6.5%) were re-admitted to ICU during the same hospital stay, and 964 (21%) had MET calls, cardiac arrest calls or ICU re-admission. A discriminatory predictive model was developed (area under the receiver operating characteristic curve 0.72 [95% confidence intervals {CI} 0.70 to 0.73]) which identified the following factors: increasing age (odds ratio [OR] 1.012 [95% CI 1.007 to 1.017] P <0.001), ICU admission with subarachnoid haemorrhage (OR 2.26 [95% CI 1.22 to 4.16] P=0.009), admission to ICU from a ward (OR 1.67 [95% CI 1.31 to 2.13] P <0.001), Acute Physiology and Chronic Health Evaluation (APACHE) III score without the age component (OR 1.005 [95% CI 1.001 to 1.010] P=0.025), tracheostomy on ICU discharge (OR 4.32 [95% CI 2.9 to 6.42] P <0.001) and discharge to cardiothoracic (OR 2.43 [95%CI 1.49 to 3.96] P <0.001) or oncology wards (OR 2.27 [95% CI 1.05 to 4.89] P=0.036). Over the two-year period, 361 patients were identified as having a greater than 50% chance of having post-ICU deterioration. Factors are identifiable to predict patients at risk of post-ICU deterioration. This knowledge could be used to guide patient follow-up after ICU discharge, optimise healthcare resources, and improve patient outcomes and service delivery.
Cannula Cricothyroidotomy and Rescue Oxygenation with the Rapid-O2™ Oxygen Insufflation Device in the Management of a Can't Intubate/Can't Oxygenate Scenario
Authors: Wexler S. , Hall K. , Chin R. Y. , Prineas S. N.
Published: January 2019

We describe the successful use of cannula cricothyroidotomy and the Rapid-O2™ oxygen insufflation device (Meditech Systems Ltd, Dorset, UK) for rescue of a can't intubate/can't oxygenate (CICO) scenario in a patient with severe airway haemorrhage post-debridement of laryngeal amyloidosis. This case highlights the practical utility of a cannula technique for CICO rescue when appropriate equipment is used and when institutional measures are taken to prepare for this rare anaesthetic crisis.
The Effect of a Multifaceted Postoperative Nausea and Vomiting Reduction Strategy on Prophylaxis Administration Amongst Higher-Risk Adult Surgical Patients
Authors: Pym A. , Ben-Menachem E.
Published: January 2019

Postoperative nausea and vomiting (PONV) is a common and distressing problem for patients and increases the burden of care in post-anaesthesia care units (PACU). As such it has been a recent focus for quality improvement. Evidence-based guidelines have demonstrated the benefit of PONV risk stratification and prophylaxis, but may be underutilised in clinical practice. This prospective pre-/post-intervention study was conducted at an adult tertiary hospital in non-cardiac adult surgical patients at higher risk of PONV. The intervention included promotion of an evidence-based PONV guideline, and provision of individualised prescribing and patient outcome data to anaesthetists. Six hundred and twenty-eight patients with ≥2 risk factors for PONV following general anaesthesia for non-cardiac surgery were included (333 pre-intervention and 295 post-intervention). Prior to the intervention, 9.0% (30/333) of moderate- and high-risk patients received antiemetic prophylaxis consistent with our guideline. Post-intervention, the rate of guideline adherence was 19.3% (57/295). In the high-risk PONV group, the time in PACU was significantly reduced post-intervention, 66 minutes versus 83 minutes (P=0.032). This institution-specific PONV reduction strategy had a modest but significant effect on improving prophylaxis administration. However, our findings indicate that further efforts would be required to ensure fuller compliance with the current extensive evidence base for PONV management in higher-risk patients.
Patients Retrieved to Intensive Care via a Dedicated Retrieval Service do not Have Increased Hospital Mortality Compared with Propensity-Matched Controls
Authors: Maclure P. T. , Gluck S. , Pearce A. , Finnis M. E.
Published: January 2019

This study was performed to estimate the effect of the retrieval process on mortality for patients admitted to a mixed adult intensive care unit (ICU) compared with propensity-matched, non-retrieved controls. Patients retrieved to the Royal Adelaide Hospital (RAH) ICU between 2011 and 2015 were propensity-score matched for age, gender, Aboriginal and Torres Strait Islander status, Acute Physiology and Chronic Health Evaluation (APACHE) III score and diagnostic group with non-retrieved ICU patients to estimate the average treatment effect of retrieval on hospital mortality. Factors associated with mortality in those retrieved were assessed by multiple logistic regression. Retrieved patients comprised 1,597 (14%) of 11,641 index ICU admissions; this group were younger, mean (standard deviation) 53 (18.5) versus 59 (17.7) years, had higher APACHE III scores, 61 (30.3) versus 56 (27.5), were more likely to be Indigenous (5.1% versus 3.7%) and to have sustained trauma (34% versus 9%). The average treatment effect for retrieval on hospital mortality, risk difference (95% confidence interval), was −0.7% (-2.8% to 1.3%), P=0.50. Variables independently associated with hospital mortality in those retrieved included age, APACHE III score and diagnostic category. Time from retrieval team activation to arrival with the patient, rural location, radial distance from the RAH and population size at the retrieval location were not significantly associated with mortality. The hospital mortality for retrieved patients was not significantly different when compared with propensity-matched controls. Mortality in those retrieved was associated with increasing age, APACHE III score and diagnostic category; however, was independent of time from team activation to arrival with the patient.
Effect on Neonatal Outcome of Pharmacological Interventions for Attenuation of the Maternal Haemodynamic Response to Tracheal Intubation: A Systematic Review
Authors: Aman A. , Salim B. , Munshi K. , Raza S. A. , Khan F. A.
Published: January 2019

The primary aim of this systematic review was to assess the effect on neonatal outcome of pharmacological interventions used for attenuation of the haemodynamic response to tracheal intubation in patients undergoing caesarean Section under general anaesthesia. A systematic search of randomised controlled trials from 1990 to 2015 was conducted. The primary outcome measure was the Apgar score at five minutes and secondary outcomes were umbilical arterial blood gas parameters and neurological adaptive capacity scores. Twenty-seven randomised controlled trials (1,689 patients) were included in the qualitative synthesis. Only five studies using opioids (383 patients) and five studies using non-opioid analgesics (358 patients) were subjected to meta-analysis. The Apgar score at five minutes was significantly lower in neonates of opioid-treated mothers (mean difference: −0.29, 95% confidence interval −0.56 to −0.02, P-value=0.03) compared to mothers in the control group; the umbilical arterial pH was lower and there was a higher requirement for tactile stimulation in neonates. No difference was seen in Apgar scores of neonates of mothers administered non-opioid analgesics compared to placebo. No difference was observed in other parameters between opioid- or non-opioid-treated mothers. This review suggests that opioid interventions for attenuation of the haemodynamic response to tracheal intubation in pregnant patients under general anaesthesia affect neonatal Apgar scores at five minutes in neonates but the difference did not appear to be clinically meaningful. We were unable to demonstrate any difference in safety.
Extended Duration Regional Analgesia for Total Knee Arthroplasty: A Randomised Controlled Trial Comparing Five Days to Three Days of Continuous Adductor Canal Ropivacaine Infusion
Authors: Sargant S. C. , Lennon M. J. , Khan R. J. , Fick D. , Robertson H. , Haebich S.
Published: January 2019

There is a growing body of evidence in favour of continuous adductor canal block (CACB) for total knee arthroplasty. However, there are no studies describing the optimal duration of the infusion. At our institution the usual practice was to stop the infusion on day three. Our hypothesis was that extending the infusion to five days would improve analgesia and quality of recovery. A prospective, non-blinded, randomised trial was undertaken. Patients received a continuous infusion of 0.2% ropivacaine via an adductor canal catheter for either three or five days. Primary outcome was pain while walking during the 24-hour period up to day five (numeric rating scale from 0 to 10). The minimum clinically important difference was set at 1.5 on the numeric rating scale. Secondary outcome measures included quality of recovery, mobility, pain while walking on postoperative day six, Oxford Knee Scores, and complications. Eighty-six patients were recruited with 43 randomised to each group. Seventy-eight were analysed. Median pain scores reported on day five were significantly better in the intervention group (1 versus 3, P=0.003). Furthermore, quality of recovery (QOR-15) scores were significantly better in the intervention group (133.6 versus 123.4, P=0.017). No statistically significant difference between groups was identified for other secondary outcome measures. CACB prolonged to five days provides superior analgesia and a higher quality of recovery on postoperative days four and five compared to a three-day infusion. This benefit did not extend beyond the period of infusion.
The Use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) for Pre-Oxygenation in Neurosurgical Patients: A Randomised Controlled Trial
Authors: Ng I. , Krieser R. , Mezzavia P. , Lee K. , Tseng C. , Douglas N. W. R. , Segal R.
Published: January 2019

This study explored the use of high-flow nasal oxygen (HFNO) in both pre-oxygenation and apnoeic oxygenation in adults who were intubated following a non–rapid sequence induction. Fifty patients were randomised to receive pre-oxygenation via a standard facemask or the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) device. After five minutes of pre-oxygenation, induction and muscle relaxant agents were given. While waiting for complete paralysis, patients in the standard facemask group received bag–mask ventilation (BMV), whereas patients in the HFNO group received apnoeic oxygenation via the THRIVE device. Serial blood samples for arterial blood gas analysis were taken. Baseline patient and airway characteristics were similar. The median PaO2 after pre-oxygenation was 357 (interquartile range [IQR] 324–450 [range 183– 550]) mmHg in the facemask group, compared to 471 (IQR 429–516 [range 185–550]) mmHg in the HFNO group (P=0.01). The median arterial partial pressure of oxygen (PaO2) in the HFNO group decreased after a period of apnoeic oxygenation, and was significantly lower when compared to patients who received BMV in facemask group. The arterial carbon dioxide partial pressure (PaCO2) level after complete paralysis was significantly higher in the HFNO group when compared to the facemask group (median 52 [IQR 48–55 {range 40–65}] versus median 43 [IQR 40–48 {range 35–63}] mmHg, P=0.0005 and P=0.004 respectively). There were no differences in the time to muscle paralysis and time to intubation. Seven patients required use of airway adjuncts during BMV in the facemask group, compared to none in the HFNO group (P=0.004). No complications were observed in either group. HFNO produces a higher PaO2 after pre-oxygenation and safe PaO2 during intubation. However, the subsequent fall in PaO2 and rise in PaCO2 indicates that it is not as effective as BMV in maintaining oxygenation and ventilation following neuromuscular blockade.
Optimised Dosing of Vancomycin in Critically Ill Indigenous Australian Patients with Severe Sepsis
Authors: Tsai D. , Stewart P. C. , Hewagama S. , Krishnaswamy S. , Wallis S. C. , Lipman J. , Roberts J. A.
Published: January 2019

Vancomycin is a commonly used antibiotic due to the high burden of methicillin-resistant Staphylococcus aureus infections. This study aimed to describe the pharmacokinetics (PK) of vancomycin in Australian Indigenous patients with severe sepsis, and advise an optimal dosing strategy. A population PK study was conducted in a remote Australian intensive care unit (ICU). Serial plasma samples were collected over one to two dosing intervals and assayed by validated chromatography. Concentration–time data collected were analysed using Pmetrics® software. The final population PK model was then used for Monte Carlo dosing simulations to determine optimal loading and intermittent maintenance doses. Fifteen Indigenous subjects were included for analysis with a median (interquartile range, IQR) age, weight and creatinine clearance (CrCL) of 43 (34–46) years, 73 (66–104) kg and 99 (56–139) ml/minute respectively. A two-compartment model described the data adequately. Vancomycin clearance (CL) and volume of distribution of the central compartment (Vc) were described by CrCL and patient weight respectively. Median (IQR) CL, Vc, distribution rate constants from central to peripheral, and from peripheral to central compartments were 4.6 (3.8–5.6) litres per hour, 25.4 (16.1–31.3) litres, 0.46 (0.28–0.52)/hour and 0.25 (0.12–0.37)/hour respectively. No significant interethnic PK differences were observed in comparison to published data. Therapeutic loading doses were significantly dependent on both weight and CrCL, whereas maintenance doses were dependent on CrCL. In the absence of severe renal impairment, initiation of maintenance dose eight hours post–loading dose achieved higher probability of target attainment at 24 hours. This is the first report of vancomycin PK in this patient group.
The Safety of Anaesthetising Biochemically Hyperthyroid Patients Undergoing Thyroidectomy—A Retrospective Cohort Study
Authors: Short H. L. , Tamatea J. A. U. , Conaglen H. M. , Furlonger A. J. , Meyer-Rochow G. Y. , Conaglen J. V. , Elston M. S.
Published: January 2019

Traditionally it is recommended that hyperthyroid patients should be made euthyroid prior to thyroidectomy. However, several small observational studies have reported no increase in adverse events when hyperthyroid patients undergo thyroidectomy. The aim of this study was to assess outcomes following total thyroidectomy in patients who were biochemically hyperthyroid at the time of surgery compared to those who were euthyroid. One hundred and fifty-one eligible patients undergoing thyroidectomy for hyperthyroidism between January 2012 and February 2016 were identified, of whom 57 were hyperthyroid on perioperative blood tests and 94 were euthyroid (comparison group). Primary outcomes were 30-day mortality, increased length of postoperative hospital stay and intraoperative signs consistent with thyrotoxicosis (e.g. heart rate >100 per minute, systolic blood pressure >180 or <60 mmHg, or temperature >38°C). Secondary outcomes were intraoperative beta-blocker use and level of care required postoperatively. Thirty-day mortality was zero. The only significant difference between the two groups was a higher use of intraoperative beta-blockers amongst hyperthyroid patients (28.1% versus 8.5%, P=0.002). Our findings suggest that thyroidectomy for mild to moderate biochemical hyperthyroidism performed by an experienced thyroid surgeon and anaesthetist, is associated with increased intraoperative beta-blocker use but no statistical difference in mortality, length of postoperative stay or intraoperative signs consistent with thyrotoxicosis. While we still recommend attempting to achieve a euthyroid state whenever possible prior to thyroid surgery, mild to moderate degrees of residual biochemical hyperthyroidism when appropriately managed may not be associated with an increase in adverse outcomes.
Audit of Ten Years of Donation after Circulatory Death Experience in Queensland: Observations of Agonal Physiology following Withdrawal of Cardiorespiratory Support
Authors: Cook D. A. , Widdicombe N.
Published: January 2019

An audit of ten years’ experience in all patients undergoing withdrawal of cardiorespiratory support (WCRS) in the context of donation after circulatory death (DCD) was conducted in Queensland, Australia (2008 to 2017). One hundred and seventy-one patients proceeded to donation after declaration of death by circulatory criteria with loss of pulsatile arterial blood pressure (circulatory arrest) for five minutes. The demographics, times and haemodynamic observations were abstracted, de-identified and collated. The average age of patients was 43 years (standard deviation 16.1 years) and 63% were male. The median and mean times to an agonal systolic blood pressure below 50 mmHg were 10 and 11 minutes and the median and mean times from WCRS to circulatory arrest were 14 and 16 minutes. After systolic blood pressure fell to 50 mmHg or lower, 33 patients (19.3%) had spontaneous return of systolic pressure to above 50 mmHg. Following periods of circulatory arrest, five patients were documented to have spontaneous return of pulsatile arterial pressure. Two patients had return of circulation after two minutes, but less than five minutes of circulatory arrest and three patients had return of circulation where circulatory arrest had been documented for less than two minutes. Following WCRS, transient restoration of circulation following circulatory arrest may occur, even following two minutes of circulatory asystole, albeit rarely.
A Survey of the Impact of Patient Adverse Events and near Misses on Anaesthetists in Australia and New Zealand
Authors: Harrison R. , Lee H. , Sharma A.
Published: January 2019

We conducted a cross-sectional online survey of members of the Australian and New Zealand College of Anaesthetists to investigate their experiences of adverse patient safety events and near misses, including their use of incident reporting systems and the organisational support available. There were 247 respondents. Of the 243 anaesthetists whose patients had an adverse event or near miss, 199 reported this had affected them personally or professionally; 177 reported stress, 153 anxiety, 109 sleep disturbance, and 127 lower professional confidence. Of 188 who had reported an adverse event using their local incident reporting systems, 68 were satisfied with this process, 136 received useful feedback, 114 saw local improvements, and 104 saw system changes. Two hundred and thirty-four reported feeling determined to improve, and 228 were anxious about the potential for future errors. Seventy-five anaesthetists admitted not reporting a safety incident that they knew they should have. Reasons for not reporting included an impression that nothing would improve from incident reporting, that reporting was onerous, or fears of punitive action. These findings should spur anaesthetists, anaesthetic departments and professional organisations across Australia and New Zealand to examine their support mechanisms in relation to adverse events and errors and their incident reporting mechanisms, and to attempt to improve these services where necessary.
Potential Consequences of High-Dose Infusion of Ketamine for Refractory Status Epilepticus: Case Reports and Systematic Literature Review
Authors: Golub D. , Yanai A. , Darzi K. , Papadopoulos J. , Kaufman B.
Published: January 2019

Our goal was to provide comprehensive data on the effectiveness of ketamine in refractory status epilepticus (RSE) and to describe the potential consequences of long-term ketamine infusion. Ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, blocks excitatory pathways contributing to ongoing seizure. While ketamine use is standard in anaesthetic induction, no definitive protocol exists for its use in RSE, and little is known about its adverse effects in long-term, high-dose administration. We present two cases of RSE that responded rapidly to ketamine infusion, both with fatal outcomes secondary to metabolic acidosis and cardiovascular collapse. We performed a systematic review of the application and consequences of ketamine use in RSE. PubMed, Ovid, MEDLINE and PMC were searched for articles describing ketamine treatment for RSE according to a predetermined search strategy and inclusion criteria. The systematic review revealed wide discrepancies in ketamine dosing (infusion maintenance dose range 0.0075–10.5 mg/kg/hour), but good outcomes in medically managed RSE (75% of studies reported moderate or complete seizure control in adults, 62.5% in paediatrics). Additionally, literature review elucidated a potentially causal relationship between prolonged ketamine infusion and both cardiovascular and metabolic dysregulation. Ketamine is effective in RSE by antagonising excitotoxic NMDA receptors. However, there is high variability in ketamine dosing and scarce data on its safety in long-term infusion. Metabolic acidosis and haemodynamic instability associated with the use of long-term, high-dose ketamine infusions must be of concern to clinicians administering ketamine to critically ill patients.
On Dr Dick Climie and Dr Jack Thomas, and the Genesis of Chemical-Clinical Pharmacology in Australian Anaesthesia Research
Authors: Mather L. E.
Published: January 2019

Pharmacokinetic and pharmacodynamic research is regularly reported in most contemporary anaesthesia-oriented journals. This sub-specialty area of pharmacology grew rapidly from the 1960s as various essential concepts and tools—laboratory analysis of drug/metabolite concentrations in biofluids, physiological signal collection, and methods for analysing/presenting relevant pharmacokinetic and pharmacodynamic data—started coming together. For Australia, such research began in Sydney in the mid-1960s with collaboration between anaesthetist Dr C.R. Climie (1923–2013) at the Royal Hospital for Women and medicinal chemist Dr J. Thomas OAM (1928–2017), and was achieved through a succession of postgraduate research student projects in the Department of Pharmacy of The University of Sydney, initially supervised by Dr Thomas. These consisted of studies concerned with the systemic absorption and placental transmission of drugs being used in parturients. By the late 1960s, Sydney anaesthetists Drs G.J. Long and C.A. Shanks (1936–1998) were also participating, and the projects were becoming more complex, including studies of the metabolism of local anaesthetics and other drugs by mothers and neonates. Between the mid-1970s and early-1980s, with additional anaesthetists, postgraduate research students and their academic supervisors participating, the projects focussed mainly on the pharmacokinetics and pharmacodynamics of neuromuscular blocking agents. This form of chemical-clinical-pharmacologically-based anaesthesia-oriented research that started in Sydney with the collaboration of Drs Climie and Thomas led to many challenging higher degree projects for pharmaceutical scientists, and access to unprecedented research capabilities for anaesthetists. Most significantly, it established a permanent place for multidisciplinary pharmacokinetic- and pharmacodynamic-based research within Australian academic departments of anaesthesia.
Professor Ross Holland: The Special Committee Investigating Deaths under Anaesthesia (Scidua) and His Other Contributions to Anaesthesia
Authors: Baker A. B.
Published: January 2019

As a young anaesthetic trainee in 1959 Ross Holland persuaded the Minister of Health in NSW, Australia, to establish SCIDUA, which by law required compulsory reporting for all deaths occurring during anaesthesia or up to 24 hours after cessation of the anaesthetic. The committee was multidisciplinary and, most importantly, had statutory privilege so that no discussions or findings were able to be subpoenaed for other legal investigations or case law. Holland was the foundation secretary of SCIDUA and later Chair. Apart from three years in the 1980s when there were political issues with legal privilege, the committee has met monthly and still meets. Holland was a major figure in antipodean anaesthesia, setting up in 1978 the clinical department at Westmead Hospital Sydney, then in 1987 becoming the foundation Professor to the Department of Anaesthesiology at the University of Hong Kong, and in 1990 foundation Professor and Chair, Department of Anaesthesia and Intensive Care at the University of Newcastle, NSW. Holland had strong historical interests and was responsible for founding the Society for the Preservation of Artefacts of Surgery and Medicine (SPASM) and its associated museum. He also served an important term as Dean of the Faculty of Anaesthetists, Royal Australasian College of Surgeons prior to that Faculty becoming independent as the Australian and New Zealand College of Anaesthetists (ANZCA). Professor Holland received many accolades for these activities during his life, which are noted. It is fitting to recognise his seminal contributions to patient safety over more than 50 years.
Security and Safety of Rail Transit Tunnels
Authors: Rakoczy Anna M. , Wilk Stephen T. , Jones MaryClara
Published: January 2019

Transportation Technology Center, Inc., with support from the Center for Urban Transportation Research at the University of South Florida, was tasked by the FTA to research areas of transit safety risk, identify existing specifications and guidelines for rail transit tunnel design, construction, maintenance, and rehabilitation, and perform a gap analysis to establish the need for additional standards, guidance, or recommended practices to support and further the safe operation of the United States’ public transportation industry. This paper presents industry needs with a focus on security and safety that were identified by reviewing past tunnel incidents and related literature. The compilation of past tunnel incidents includes available reports published by the National Transportation Safety Board and other U.S. and European agencies. These reports generally involve rare but high-risk events such as fires and flooding, and emphasize public safety. A summary of needs obtained through a literature review emphasizes the need for continually updated specifications and best practices. The industry needs findings include the need for working fire detection, ventilation, and emergency egress along with coordinated emergency response plans that can be utilized by trained personnel.
Convergence of Mortality Among African Americans
Authors: Naghshpour Shahdad , Sameem Sediq
Published: January 2019

The purpose of this study is to explore any possible convergence in African American mortality rates in the United States. Using county-level data of the United States over a period of nearly five decades (1968-2015), the findings indicate that β-convergence has occurred in mortality rates of African American population implying that their mortality rates are getting closer to their means. The results are particularly stronger for females and the elderly. The findings reflect lower cost of implementation and dissemination of strategies that would target the health of such population.

JEL Classifications: II0, I30, R10
Evaluating the thermal failure risk of large-format lithium-ion batteries using a cone calorimeter
Authors: Wang Zhi , Ning Xiaoyao , Zhu Kang , Hu Jianyao , Yang Han , Wang Jian
Published: January 2019

A series of experiments were conducted to study the thermal failure hazard of large-format commercial lithium-ion batteries with typical states of charge in a calorimeter apparatus. The results indicate that the thermal failure penetration of the lithium-ion battery with 70% state of charge is faster than the lithium-ion battery with 50% state of charge. Two typical thermal failure modes, “Gas-driven mode” and “Flame-driven mode,” were also observed, corresponding to lithium-ion battery with 70% state of charge and 50% state of charge, respectively. Significant heat release, accompanied by large amount of carbon dioxide (CO2) release, took place for lithium-ion battery with 50% state of charge. Inversely, lithium-ion battery with 70% state of charge presented a lower heat release while more carbon monoxide (CO) generation and obvious mass loss trend. This study may serve as a reference for safe storage, application, and transportation in lithium-ion batteries.
The Body: Discipleship of our Physicality
Authors: Steibel Sophia , Bergen Martha S.
Published: January 2019

Christian discipleship acknowledges the importance of the body for a holistic response to God’s redemption for all of life. The biblical view shows a Christian’s body and soul as a sacred unit that demands responsible stewardship. Often, however, the body is an arena where sin and righteousness struggle with habitual inclinations toward destructive rather than life-nurturing behaviors. Spiritual formation aimed at Christlikeness is crucial for the conquering of battles faced by Christians of all ages.
A Follow-Up Study on the Continuity and Spillover Effects of Intimate Partner Violence During Pregnancy on Postnatal Child Abuse
Authors: Kita Sachiko , Chan Ko Ling , Tobe Hiromi , Hayashi Mayu , Umeshita Kaori , Matsunaga Momoe , Uehara Nana , Kamibeppu Kiyoko
Published: January 2019

Previous studies have not focused on how intimate partner violence (IPV) during pregnancy predicts early postnatal child abuse. This study identifies the continuity and spillover effects of IPV during pregnancy on IPV and child abuse and neglect (CAN) at 1-month and 3-month postnatal periods. A total of 822 pregnant women were recruited at the third trimester of pregnancy at two obstetric hospitals in Tokyo, Japan, from June 2016 to September 2017. IPV during pregnancy and IPV and CAN at 1 month and 3 months postnatal were obtained through self-reported questionnaires. Results show that the rate of IPV was highest during pregnancy (16.4%), and there was significant continuance (69.4%) of this occurrence of IPV after childbirth (1 month: 13.9%; 3 months: 13.7%). In addition, the rate of CAN was 20.0% at 1 month postnatal and slightly increased at 3 months postnatal (21.8%). Furthermore, this study indicates that IPV during pregnancy was significantly associated with CAN at 1 month and 3 months postnatal (β = .16 and β = .14) and with IPV at 1 month (β = .68), and subsequently, IPV at 1 month was significantly associated with IPV at 3 months postnatal (β = .56). This study suggests the importance of conducting screenings for IPV during the perinatal period and providing intensive health interventions for abused women to support their parenting from pregnancy to 3 months postnatal to prevent or reduce CAN at 1 month and 3 months postnatal.
Are We Comparing Apples and Oranges? Exploring Trauma Experienced by Victims of Interpersonal Violence and Abuse and by Court-Involved Women Who Have Used Force in Relationships
Authors: Miller Susan L. , Becker Patricia
Published: January 2019

Due to the enactment of mandatory and proarrest policies, there has been a sharp increase in the number of women arrested for use of force against an intimate partner. Many of these arrested women are also victims of intimate partner violence (IPV) and experience high levels of trauma and post-traumatic stress disorder (PTSD). Our study explores experiences of two groups: 80 women who self-refer into survivor groups or individual counseling sessions facilitated by a trained counselor and 86 court-involved women who have been arrested on an IPV/abuse (IPV/A)-related charge and (in lieu of more substantial punishment) participate in an intervention/treatment program. The current research asks, “What do trauma measures tell us about women who voluntarily seek IPV/A victim support groups and about women court-mandated to a treatment program?” Using measures of adverse childhood experiences (ACEs), post-trauma distress, and danger assessments, we explore these two groups. Our findings demonstrate that within the three measures used, women who voluntarily sought victim counseling services had a higher mean compared with women arrested for use of force against an intimate partner. Yet, both groups are significantly different from the general population in terms of having experienced significant trauma. Both groups of women report significantly higher levels of ACEs, post-trauma distress, and danger assessments compared with the general population, indicating that women who experience IPV/A or women who use force in relationships may share more similarities than differences. In addition, we explore the ways in which different relationship characteristics and treatment trajectories might help explain the differences present between these two groups of women. We conclude with a discussion of policy and treatment implications.
Opto-electronic platform tracking control of multi-rotor unmanned aerial vehicles based on composite disturbance compensation
Authors: Wang Rijun , Bai Yue , Zeng Zhiqiang , Wang Junyuan , Du Wenhua , Duan Nengquan
Published: January 2019

Airborne opto-electronic platforms are very important in unmanned aerial vehicle systems. The stability and tracking performance of airborne opto-electronic platforms are easily affected by disturbance factors, making compensating for those disturbances a very prominent issue. In this paper, compared to the traditional disturbance observer, an improved velocity signal based disturbance observer (IVDOB) is particularly designed to compensate for the disturbance. Then its capability, robustness, and stability are discussed. For improving the stabilization accuracy and tracking performance of airborne opto-electronic platforms, the universal approximation property of fuzzy systems is used to compensate the disturbance further and an adaptive fuzzy control system based on IVDOBs is proposed. To validate the scheme, a series of experiments were carried out. The results show that the proposed control scheme can achieve reliable control precision and satisfy the requirements of airborne opto-electronic platform tasks.