bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Sea-Bed
Authors: Harders C. W. 
Published: January 2019

Nearly half a century has gone by since Sir Cecil Hurst invited readers of the British Year Book of International Law to consider with him the question—“Whose is the Bed of the Sea? ”Almost twenty-five years ago, President Truman initiated State action to assert authority over the natural resources of the sea-bed and sub-soil of the continental shelf beyond the limits of the territorial sea.In 1953, Australia contributed significantly to the body of State practice. On 11 September 1953, the Governor-General issued a proclamation declaring the existence under international law of Australia's sovereign rights over the sea-bed and subsoil of the continental shelf contiguous to the coasts of Australia and its Territories for the purpose of exploring and exploiting the natural resources of that sea-bed and subsoil. At about the same time, the Commonwealth Parliament enacted the Pearl Fisheries Act (No.2) 1953 (Cth) amending the Pearl Fisheries Act 1952-1953 (Cth), which made subject to Australian control foreign nationals and foreign vessels engaging in pearling on the continental shelf. In section 5 of the Principal Act, “pearling” was defined to include—
the work of searching for or obtaining pearl shell, trochus, bêchede-mer or green snails
Commonwealth Digest
Authors: Burmester H. C. , Pascoe J. H. 
Published: January 2019

This Digest is intended to provide lawyers with a key to those questions and Ministerial Statements in the Commonwealth Parliament in which they are most likely to be interested, and it is, of course, selective. It covers the period 12 March to 28 November 1968, and is compiled from the published debates of the Parliament of the Commonwealth of Australia.The page references to Parliamentary Debates (“S.Deb.” and “H.R. Deb.”) are to the published debates of the Senate and the House of Representatives, for the second Session of the Twenty-sixth Parliament, first and second periods.
Degree of Frontal Bone Exposure via Upper Blepharoplasty Incision: Considerations for Frontal Sinus Fracture
Authors: Kinzinger Michael , Steele Toby O. , Chin Oliver , Strong Edward B. 
Published: January 2019

ObjectiveThe upper eyelid blepharoplasty incision affords direct access to the frontal bone for skull base surgery and trauma reconstruction with a well‐hidden scar. The goal of this study is to quantify frontal bone exposure that can be achieved with an upper eyelid blepharoplasty incision.DesignAnatomic study with human cadaver heads.SettingUC Davis Medical Center.Subjects/MethodsFourteen human cadaver heads were used to perform 26 upper blepharoplasty approaches. Exposure was measured with virtual planning software to create virtual reference points at the midline of the superior orbital rim. Surgical navigation was used with a 3‐dimensionally printed drill model to measure the maximum exposure achievable relative to the virtual reference point at 5 standardized angles.ResultsMean ± SD exposures at medial 60°, medial 30°, 0°, lateral 30°, and lateral 60° were 16.1 ± 1.3 mm, 17.8 ± 1.3, 18.3 ± 1.4, 19.3 ± 1.9, and 20.9 ± 1.9, respectively. Significant differences were detected between exposures at 60° laterally and 60° medially and between exposures 60° laterally and 30° medially (P <. 05).ConclusionsThe upper eyelid blepharoplasty incision provides direct surgical access to the inferior frontal bone. Access was greatest with far lateral extension (mean, 20.9 mm) and most limited with far medial extension (mean, 16.1 mm). Treatment of injuries above this level could be achieved with additional percutaneous incisions for screw placement.
Relationship of Vitamin D Deficiency and Intraoperative Parathyroid Hormone Elevation in Completion and Total Thyroidectomy
Authors: Lawson Bradley R. , Hinson Andrew M. , Lucas Jacob C. , Bodenner Donald L. , Stack Brendan C. 
Published: January 2019

ObjectiveTo quantify how frequently intraoperative parathyroid hormone levels increase during thyroid surgery and to explore a possible relationship between secondary hyperparathyroidism due to vitamin D deficiency and elevation in intraoperative parathyroid hormone.Study DesignCase series with chart review.SettingTertiary academic center.Subjects and MethodsA total of 428 consecutive patients undergoing completion and total thyroidectomy by the senior author over a 7‐year period were included for analysis. All patients had baseline and postexcision intraoperative parathyroid hormone levels as well as vitamin D levels from the same laboratory. Institute of Medicine criteria were employed for vitamin D stratification (>30, normal; 20‐29.9, insufficient; <20, deficient). Other data analyzed include sex, age, neck dissection status, and parathyroid autotransplantation.ResultsA total of 118 patients (27.6%) had an intraoperative parathyroid hormone elevation above baseline. Patients with vitamin D deficiency were significantly more likely to experience hormone elevation (P =. 04). When parathyroid hormone rose, it did so by a mean 32.1 pg/mL. Patients with vitamin D deficiency demonstrated significantly larger hormone increases (P =. 03).ConclusionElevation in intraoperative parathyroid hormone levels above baseline after completion and total thyroidectomy occurs in over one‐fourth of cases and is significantly associated with vitamin D deficiency. This study is the first to report this observation. We hypothesize that vitamin D deficiency in these patients may create a subclinical secondary hyperparathyroidism that leads to intraoperative parathyroid hormone elevation when the glands are manipulated. Additional studies will be needed to explore this physiologic mechanism and its clinical significance.
Do Antisiphon Valves Reduce Flow Irregularities during Vertical Displacement of Infusion Pump Systems?
Authors: Weiss M. , Fischer J. , Neff T. , Schulz G. , Bänziger O. 
Published: January 2019

Vertical displacement of syringe pumps may cause irregular drug delivery due to hydrostatic pressure changes in the infusion line. The extent of flow fluctuations depends on the internal compliance of infusion lines, syringes and syringe pumps. We evaluated whether pressure regulation by antisiphon valves (ASV) reduces the flow variation during vertical displacement of 50 ml standard syringes and infusion pumps. An infusion assembly comprising a standard 50 ml BD Plastipak® or a 50 ml Fresenius syringe, with syringe pump and 2 m low compliance infusion line was used for in vitro measurement of fluid delivery. The assembly was tested without ASV, and with two ASVs of differing operating pressure (ASV:75: valve opening pressure=75 mmHg; ASV:155, 155 mmHg). Retrograde aspiration volume, zero-drug delivery time and valve opening bolus were determined after lowering the syringe pump by 50 cm. After elevating the syringe pump to its initial position the ensuing infusion bolus was recorded. Without an antisiphon valve the observed zero-drug delivery times after lowering the syringe pump were (mean±SD) 2.4±0.2 min using the BD Plastipak® syringe and 4.09±0.55 min using the Fresenius® syringe. Introduction of the antisiphon valve prolonged the zero drug delivery time 58% (ASV:75) and 88% (ASV:155) in the BD Plastipak® syringe assembly and 43% (ASV:75) and 81% (ASV:155) in the Fresenius® syringe assembly (P<0.001). Antisiphon valves worsen flow irregularities caused by vertical displacement of syringe pumps and when used with delivery of concentrated inotropic drugs at low infusion rates, they may aggravate haemodynamic consequences of inconstant drug delivery.
The Prevalence of Latex Allergy in Operating Theatre Staff
Authors: Hack M. E. 
Published: January 2019

Latex allergy has become increasingly common amongst health care workers. The prevalence of latex allergy in 102 theatre personnel at Princess Alexandra Hospital was determined by the results of a standardized questionnaire and a latex specific IgE radioallergosorbent test (RAST). Volunteers had their forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) measured at the beginning and end of their working shifts. Only one of 102 volunteers had a positive latex specific IgE RAST and he also experienced both local and systemic symptoms with latex exposure and a deterioration in daily FEV1/FVC. The 14 volunteers using asthma medications had significantly higher incidence of operating theatre symptoms (10/14), local reactions (8/14), and atopy (14/14). There was no clinically significant daily change in FEV1 in the total population or any specific group. The 1% (1/102) prevalence of latex allergy and sensitization in theatre staff demonstrates a much lower incidence than previously reported (12.5%1, 15.8%2 ).
Intrathecal Anaesthesia for the Elderly Patient: The Influence of the Induction Position on Perioperative Haemodynamic Stability and Patient Comfort
Authors: Fredman B. , Zohar E. , Rislick U. , Sheffer O. , Jedeikin R. 
Published: January 2019

Ninety elderly (>65 y) patients were studied to assess the influence of patient position during induction of spinal anaesthesia on the incidence of perioperative hypotension and haemodynamic stability. Prior to induction of anaesthesia, Lactated Ringer's solution (8–10 ml/kg) was administered. In the Sitting Group, intrathecal anaesthesia was performed with the patient in the sitting position. In the Lateral Group, patients assumed the lateral decubitus position. In all cases hyperbaric bupivacaine (10 mg) was administered using a 25 gauge Quincke spinal needle. Patients were placed in the supine (and thereafter lithotomy) position immediately after withdrawing the spinal needle. Incremental doses of ephedrine (5 mg, IV) were administered in response to hypotension (>20 % of baseline), nausea, vomiting, sweating, skin pallor or impaired consciousness. The mean arterial blood pressure, heart rate and the number of hypotensive episodes requiring ephedrine administration were unaffected by group affiliation. In the Sitting Group, nine patients received 24 doses of ephedrine 5 mg IV. In the Lateral Group, 21 incremental doses of ephedrine were administered to nine patients. The incidence of nausea, vomiting, sweating and pallor were similar between the groups. Patient comfort was similar. In summary, the incidence of hypotension and hypotension-related adverse effects was similar when intrathecal anaesthesia was induced in the sitting or lateral position. Furthermore, subjective perception of the induction process or anaesthetic experience was not affected by patient position.
The Frequency and Nature of Drug Administration Error during Anaesthesia
Authors: Webster C. S. , Merry A. F. , Larsson L. , McGrath K. A. , Weller J. 
Published: January 2019

We aimed to establish the frequency and nature of drug administration error in anaesthesia (a significant subset of error in medicine) at two hospitals. Anaesthetists were asked to return a study form anonymously for every anaesthetic, indicating whether or not a drug administration error or pre-error (defined as any incident with potential to become an error) had occurred. Further details were sought if the response was affirmative. From 10806 anaesthetics, 7794 study forms were returned, representing response rates of 80% from Hospital A and 57% from Hospital B (72% overall). The frequency (95% confidence intervals) of drug administration error, of any type, per anaesthetic was 0.0075 (0.006 to 0.009), of IV bolus errors was 0.005 (0.0035 to 0.006) and of pre-errors was 0.004 (0.003 to 0.005), with no significant difference between hospitals. Overall, one drug administration error was reported for every 133 anaesthetics. The two largest individual categories of error involved incorrect doses (20%) and substitutions (20%) with IV boluses of drug. Of the IV bolus substitutions, 69% occurred between different pharmacological classes. One patient was aware while under muscle relaxation, and two required prolonged ventilation. In addition, 47 transient physiological effects were reported, of which five required intervention. We conclude that drug administration error during anaesthesia is considerably more frequent than previously reported.
Simulation of Potassium Extraction by Continuous Haemodiafiltration
Authors: Amaya F. , Fukui M. , Tsuruta H. , Kooguchi K. , Shimosato G. 
Published: January 2019

Prediction of potassium extraction rates by continuous haemodiafiltration (CHDF) is useful for safe management of potassium levels in patients with hyperkalaemia. For this purpose, we developed a formula to predict the quantity of potassium extracted by CHDF. We hypothesized that potassium concentration in efflux dialysate was completely saturated by the influx blood, and potassium concentration in efflux blood was calculated based on this hypothesis. To check the accuracy of the calculation, potassium concentration was measured in efflux blood, and values were compared to predicted concentrations. Predicted potassium concentrations demonstrated good correlation to the measured values (95% confidence range, -0.32 to 0.58 mmol/l). These results confirmed that our hypothesis is applicable to clinical use of CHDF. Based on our observations, we created a formula to accurately predict the amount of potassium (dK) extracted by CHDF: dK=(Cb-Cd)xQd+CbxQf-CsxQs (Cb: plasma potassium concentration; Cd: potassium concentration in a dialysate; Cs: potassium concentration in the replacement fluid; Qd: dialysis rate; Qf: filtration rate and Qs: infusion rate of replacement fluid).
Closed-loop Control of Blood Glucose Levels in Critically Ill Patients
Authors: Chee F. , Fernando T. , Van Heerden P. V. 
Published: January 2019

A closed-loop control system was constructed for automatic intravenous infusion of insulin to control blood sugar levels (BSL) in critically ill patients. We describe the development of the system. A total of nine subjects were recruited to clinically test the control system. In the patients who underwent closed-loop control of BSL, the controller managed to control only one patient's glycaemia without any manual intervention. The average BSL attained during closed-loop control approached the target range of 6-10 mmol/l, and had less deviation than when BSL had been maintained manually. We conclude that closed-loop BSL control using a sliding scale algorithm is feasible. The main deficiency in the current system is unreliability of the subcutaneous glucose sensor when used in this setting. This deficiency mandates high vigilance during use of the system as it is being developed.
Variability in Infusion Pressure and Continuous Flow Rate Delivered from Pressurized Bag Pump Flush Systems
Authors: Hug M. I. , Buettiker V. , Cornelius A. , Weiss M. 
Published: January 2019

Using 10 different infusion bag pressure pumps, indicated manometer pressures were compared with measured infusion pressures proximal to the flow-regulating device in an in vitro experiment. Flow rates delivered through the flow-regulating device were gravimetrically measured at different monitored pressure levels. Significant differences were found between manometer and measured infusion pressures among the tested pressure bag pumps (e.g. 500 ml bag volume pressurized to 300mmHg manometer pressure: 219.6±7.8 to 407.2±2.7 mmHg). The infusion pressures were additionally affected by the vertical level of the infusion bag pump and by the volume of the infusion bag. Flow rates delivered through the flow-regulating device were directly correlated to the measured infusion pressure (r 2 =0.9926). Differences in flow rates can have a considerable impact on maintaining catheter patency and avoidance of fluid overload and retrograde flushing into the central arterial circulation in neonates and small children. A simple manoeuvre using the invasive pressure transducer allows monitoring and adjustment of the infusion pressure in the clinical setting.
Transient Lumbar Pain after 5% Hyperbaric Lignocaine Spinal Anaesthesia in Patients Having Minor Vascular Surgery
Authors: Davies M. J. , Cook R. J. , Quach K. 
Published: January 2019

Transient lumbar pain has been reported to occur frequently in patients having surgery using 5% hyperbaric lignocaine for spinal anaesthesia. The incidence of transient lumbar pain is highest with this agent in patients having surgery in the lithotomy position and in outpatients. The aim of this audit was to determine the incidence of transient lumbar pain in patients having minor surgery for the complications of peripheral vascular disease, a group of patients in whom short duration spinal anaesthesia is desirable. One hundred patients were audited prospectively. All patients had 5% hyperbaric lignocaine spinal anaesthesia and were followed up postoperatively utilizing a standardized questionnaire to determine the incidence of transient lumbar pain. The condition was found to occur in 4% of patients. This low incidence of transient lumbar pain justifies the continued use of 5% hyperbaric lignocaine for spinal anaesthesia in this group of patients.
Randomized Evaluation of the Single-use SoftSeal™ and the Re-useable LMA Classic™ Laryngeal Mask
Authors: Paech M. J. , Lain J. , Garrett W. R. , Gillespie G. , Stannard K. J. D. , Doherty D. A. 
Published: January 2019

A number of laryngeal masks are available, including both re-usable and single-use masks. Single-use laryngeal masks may decrease the risk of transmitting prion infections. We performed a single-blind randomized trial in 200 spontaneously breathing female patients under general anaesthesia with nitrous oxide, to compare a new single-use laryngeal mask, the SoftSeal™ (Portex Ltd, U.K.), with a re-usable laryngeal mask, the LMA Classic™ (Laryngeal Mask Company Ltd., Cyprus). The primary outcome was successful insertion at the first attempt. Size 4 single-use (n=99) or re-usable (n=100) laryngeal masks, inserted by experienced anaesthetists, were equivalent for successful placement at the first attempt (90% versus 91% respectively). The single-use mask was less easy to insert (47% difficult versus 9%, P<0.001). Clinical and anatomical tests of position and function were similar. The cuff pressure of the re-usable mask increased significantly compared with the single-use mask (median +10 cm versus –2 cm H 2 O, P<0.001). Forty per cent of patients allocated the single-use mask and 20% of those allocated the re-usable mask experienced sore throat at 24 hours postoperatively (P<0.05). An estimation of cost per patient use was greater for the re-usable mask. We conclude that the SoftSeal™ single-use laryngeal mask and the LMA Classic™ re-usable laryngeal mask airway are of similar clinical utility in terms of successful insertion and airway maintenance. The re-usable laryngeal mask was easier to insert and associated with less postoperative sore throat, but costs were higher.
Predictive Performance of a Model of Anaesthetic Uptake with Desflurane
Authors: Kennedy R. 
Published: January 2019

We have previously shown that a model of anaesthetic uptake and distribution, developed for use as a teaching tool, is able to predict end-tidal isoflurane and sevoflurane concentrations at least as well as commonly used propofol models predict blood levels of propofol. Models with good predictive performance may be useful as part of real-time prediction systems. The aim of this study was to assess the performance of this model with desflurane. Twenty adult patients undergoing routine anaesthesia were studied. The total fresh gas flow and vaporizor settings were collected at 10-second intervals from the anaesthetic machine. These data were used as inputs to the model, which had been initialized for patient weight and desflurane. Output of the model is a predicted end-tidal value at each point in time. These values were compared with measured end-tidal desflurane using a standard statistical technique of Varvel and colleagues. Data was analysed from 19 patients. Median performance error was 78% (95% CI 8-147), median absolute performance error 77% (6–149), divergence 10.6%/h (-80-101) and wobble 8.9% (-6-24). The predictive performance of this model with desflurane was poor, with considerable variability between patients. The reasons for the difference between desflurane and our previous results with isoflurane and sevoflurane are not obvious, but may provide important clues to the necessary components for such models. The data collected in this study may assist in the development and evaluation of improved models.
Association of Obesity with Increased Mortality in the Critically Ill Patient
Authors: Aldawood A. , Arabi Y. , Dabbagh O. 
Published: January 2019

The impact of obesity on critical care outcomes has been an issue for debate in the literature. Variable data and conflicting results have been reported. The purpose of our study is to examine the impact of obesity on the outcome of patients admitted to a tertiary closed Intensive Care Unit (ICU) in Saudi Arabia. Data was obtained from a prospectively collected database from September 2001 to May 2004. Patients younger than 18, those with burns, brain death and readmissions were excluded. The study population was stratified into six groups according to their Body Mass Index (BMI). Primary endpoints were ICU and hospital mortality, duration of mechanical ventilation and ICU length of stay. A total of 1835 patients were included in the analysis. Baseline characteristics were similar among the six groups including severity of illness scores, reflected by Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. The ICU mortality was not statistically different among the groups. Hospital mortality was lower in patients with BMI 35–39.9 kg/m2 and BMI >40 kg/m2 compared to those with BMI 18.5–24.9 kg/m2. Multivariate analysis showed that a BMI >40 kg/m2 was an independent predictor of lower hospital mortality (odds ratio 0.51, 95% confidence interval 0.28–0.92, P 0.025) after adjustment for other confounding factors. In conclusion, mortality of obese critically ill patients was not higher than patients with normal weight. In fact, the hospital mortality was lower for patients with BMI >40 kg/m2 compared to the normal BMI group despite similar severity of illness. Obesity might have a protective effect, although further studies are needed to substantiate this finding.
A Comparison of 5% Dextrose in 0.9% Normal Saline versus Non-Dextrose-Containing Crystalloids as the Initial Intravenous Replacement Fluid in Elective Surgery
Authors: Chin K. J. , Macachor J. , Ong K. C. , Ong B. C. 
Published: January 2019

Intravenous fluid replacement in adult elective surgery is often initiated with dextrose-containing fluids. We sought to determine if this practice resulted in significant hyperglycaemia and if there was a risk of hypoglycaemia if non-dextrose-containing crystalloids were used instead. We conducted a randomized controlled trial in 50 non-diabetic adult patients undergoing elective surgery which did not involve entry into major body cavities, large fluid shifts, or require administration of > 500 ml of intravenous fluid in the first two hours of peri-operative care. Patients received 500 ml of either 5% dextrose in 0.9% normal saline, lactated Ringer's solution, or 0.9% normal saline over 45 to 60 minutes. Plasma glucose, electrolytes and osmolality were measured prior to infusion, and at 15 minutes and one hour after completion of infusion. None of the patients had preoperative hypoglycaemia despite average fasting times of almost 13 hours. Patients receiving lactated Ringer's and normal saline remained normoglycaemic throughout the study period. Patients receiving dextrose saline had significantly elevated plasma glucose 15 minutes after completion of infusion (11.1 (9.9–12.2, 95% CI) mmol/l). Plasma glucose exceeded 10 mmol/l in 72% of patients receiving dextrose saline. There was no significant difference in plasma glucose between the groups at one hour after infusion, but 33% of patients receiving DS had plasma glucose ≥8 mmol/l. We conclude that initiation of intravenous fluid replacement with dextrose-containing solutions is not required to prevent hypoglycaemia in elective surgery. On the contrary, a relatively small volume of 500 ml causes significant, albeit transient, hyperglycaemia, even in non-diabetic patients.