bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Australian Constitution and the Australian Aborigine
Authors: Sawer Geoffrey 
Published: January 2019

The Australian Founding Fathers paid no attention at all to the position of the Australian aboriginal race, and the only two references to aborigines in the Constitution are highly negative in character.They are:s. 51. The Parliament shall, subject to this Constitution, have power to make laws for the peace, order, and good government of the Commonwealth with respect to:...(xxvi.) The people of any race, other than the aboriginal race in any State, for whom it is deemed necessary to make special laws.s. 127. In reckoning the numbers of the people of the Commonwealth, or of a State or other part of the Commonwealth, aboriginal natives shall not be counted.
The Privy Council, Natural Justice and Certiorari
Authors: Nettheim Garth 
Published: January 2019

‘Natural justice’ is one of the key concepts in our legal system. The concept has been employed to ensure fair adjudication, not only by courts in the strict sense, but also by a vast range of administrative tribunals, bodies and officials that have power to affect the rights of individuals.‘Natural justice’, to English and Australian lawyers, comprises two basic rules: the right to be heard (audi alterarn partern, the hearing rule) and the principle of fairness or impartiality (nerno debet esse judex in sua propria causa, the bias rule). These are ‘the essential characteristics of what is often called natural justice. They are the twin pillars supporting it’.
The social life of technicalities: ‘Terrorist’ lives in Delhi’s courts
Authors: Suresh Mayur 
Published: January 2019

How do we imagine the place of courtrooms in relation to society? There have been two dominant ways that ethnographers have viewed trials. The first treats trials as ways of understanding social structures and political power. In relation to terrorism trials, the courtroom becomes the arena in which nationalist politics can be re-enacted. There is the space of a pre-existing society—with all its hierarchies and conflicts—and the court case is then merely affixed to the social. The second way, which has a minor role in scholarship on India, has imagined courtrooms as theatrical spaces in which society is discursively constructed.  In this article, I argue that an ethnography of courtrooms can be a way of accessing the space of courtroom on its own terms. I argue that the technologies of law set in place their own relations and forms of sociality and that the courtroom is a world in and of itself. Based on an ethnography of terrorism trials in Delhi, I show how the terrorism trial is not only the arena in which bigger contestations over nationalism and religious identity may play out; it is also the space in which new forms of life specific to the courtroom emerge.
Cardiovascular and Pulmonary Effects of Epidural Anaesthesia
Authors: Veering B. T. , Cousins M. J. 
Published: January 2019

Epidural anaesthesia has been used since the early 1900s. Consequently the general characteristics of these procedures have been well defined. More studies have provided a better understanding of the cardiopulmonary changes produced by epidural anaesthesia. The cardiovascular effects observed with epidural anaesthesia are complex and variable, depending on a multitude of factors. The extent of sympathetic denervation, balance of sympathetic and parasympathetic activity, the pharmacological effect of systemically absorbed local anaesthetic agents, inclusion of adrenaline in the anaesthetic solution, the distribution of blood in relation to cardiac filling and cardiovascular function of the patient must be taken into account when considering the circulatory effects of epidural anaesthesia. Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block. Epidural anaesthesia that is restricted to the level of the low thoracic and lumbar region (T5-L4) results in a “peripheral” sympathetic blockade with vascular dilatation in the pelvis and lower limbs. High thoracic epidural anaesthesia, from the first to fifth thoracic, blocks the cardiac afferent and efferent sympathetic fibres with loss of chronotropic and inotropic drive to the myocardium. Thoracic epidural anaesthesia appears to at least partly reverse the diaphragmatic dysfunction that is a major determinant of the decrease in lung volumes observed after upper abdominal surgery. This article summarizes cardiovascular and pulmonary responses to epidural anaesthesia. Details of clinical management are not included in the review.
Can Insertion Length for a Double-Lumen Endobronchial Tube be Predicted?
Authors: Dyer R. A. , Heijke S. A. M. , Russell W. J. , Bloch M. B. , James M. F. M. 
Published: January 2019

It has been suggested that the appropriate length of insertion for double-lumen tubes can be estimated by external measurement. This study examined the accuracy of external measurement in estimating the actual length of insertion required in 130 patients. It also examined the relationship between the length inserted and the patient's height in 126 patients and their weight in 125 patients. Although there was a fair correlation between the measured external length and the final inserted length (r=0.61), the 95% confidence intervals of slope and intercept allowed a large variation and the prediction was too wide to be clinically useful. Height was reasonably well correlated with the final length (r=0.51) but an equally wide 95% confidence interval rendered it of little clinical value. There was no correlation between weight and final tube length. It is concluded that external measurement alone is not adequate to predict a clinically acceptable position of the double-lumen tube.
Patient Care Bridge—Mobile ICU for Transit Care of the Critically Ill
Authors: Nagappan R. , Riddell T. , Barker J. , Maiden N. J. , Lindsay S. 
Published: January 2019

We describe the development and introduction of a Patient Care Bridge—a mobile ICU for the transit care of the critically ill. This stretcher-mounted Patient Care Bridge is being used for intensive transit care of the critically ill in Northland, New Zealand. It carries all the basic intensive care monitoring accoutrements, is lightweight and is suited for pre-hospital, inter-hospital and intra-hospital transit care. It is ideal for patient evacuation from the scene of motor vehicle and sporting accidents, surface transportation of patients by surface ambulance and aeroevacuation of patients by the Helicopter Emergency Medical Service. This economic and space efficient unit has been used for transfer of more than one thousand critically ill patients.
Anaesthesia for Amiodarone-Induced Thyrotoxicosis: A Case Review
Authors: Sutherland J. , Robinson B. , Delbridge L. 
Published: January 2019

Amiodarone-induced thyrotoxicosis is a life-threatening problem that is very effectively managed by total thyroidectomy, although often many of these patients are considered “too unfit” for anaesthesia. The aim of this study was to review the safety of anaesthesia for total thyroidectomy in the acute management of amiodarone-induced thyrotoxicosis. Information was obtained retrospectively from a prospective endocrine surgical database and from hospital records. Data, including outcomes and morbidity, are presented from 12 patients who underwent anaesthesia for total thyroidectomy as an urgent procedure for amiodarone-induced thyrotoxicosis. Despite the fact that these patients had uncontrolled thyrotoxicosis and marked cardiac failure at the time of anaesthesia, no anaesthetic or surgical mortality was seen. We conclude that a challenging patient with amiodarone-induced thyrotoxicosis that has not responded to conservative measures may be considered for total thyroidectomy early in their management. Total thyroidectomy can be performed under general or local anaesthesia with apparent relative safety.
The Use of Thiopentone/Propofol Admixture for Laryngeal Mask Airway Insertion
Authors: Yeo K. S. J. , Kua S. W. J. , Teoh G. S. , Onsiong M. K. S. 
Published: January 2019

An admixture of thiopentone and propofol was evaluated against propofol for laryngeal mask airway (LMA) insertion. Eighty-one ASA 1 and 2 18- to 65-year-old patients, premedicated with 7.5 mg midazolam orally were assigned randomly to receive either propofol 1% or an admixture of thiopentone and propofol (1.25% and 0.5% respectively), both at a dose of 0.25 ml.kg–1. Satisfactory conditions for insertion were achieved with the admixture, which was comparable to propofol (73% vs 85%, P>0.05). There was no statistical difference in the incidence or severity of gagging, coughing, inadequate jaw relaxation and laryngospasm. The incidence of hypotension was lower in the admixture group (51% vs 78%, P=0.02). The duration of apnoea was not different between the admixture and propofol group (mean 103s vs 109 s respectively, P>0.05). We conclude that thiopentone/propofol admixture can be a suitable alternative to propofol for LMA insertion, producing less hypotension while allowing cost savings of up to 45%. An admixture of thiopentone and propofol (1.25% and 0.5% respectively) can produce suitable conditions compared to propofol 1%, for laryngeal mask insertion. In addition to cost containment, the admixture also produces less hypotension.
Do Anaesthetists Need to Wear Surgical Masks in the Operating Theatre? A Literature Review with Evidence-Based Recommendations
Authors: Skinner M. W. , Sutton B. A. 
Published: January 2019

Many operating theatre staff believe that the surgical face mask protects the healthcare worker from potentially hazardous biological infections. A questionnaire-based survey, undertaken by Leyland1 in 1993 to assess attitudes to the use of masks, showed that 20% of surgeons discarded surgical masks for endoscopic work. Less than 50% did not wear the mask as recommended by the Medical Research Council. Equal numbers of surgeons wore the mask in the belief they were protecting themselves and the patient, with 20% of these admitting that tradition was the only reason for wearing them. Policies relating to the wearing of surgical masks by operating theatre staff are varied. This indicates some confusion about the role of the surgical mask in modern surgical and anaesthetic practice. This review was undertaken to collate current evidence and make recommendations based on this evidence.
Vasopressin and Shock
Authors: Forrest P. 
Published: January 2019

Vasopressin (antidiuretic hormone) is emerging as a potentially major advance in the treatment of a variety of shock states. Increasing interest in the clinical use of vasopressin has resulted from the recognition of its importance in the endogenous response to shock and from advances in understanding of its mechanism of action. From animal models of shock, vasopressin has been shown to produce greater blood flow diversion from non-vital to vital organ beds (particularly the brain) than does adrenaline. Although vasopressin has similar direct actions to the catecholamines, it may uniquely also inhibit some of the pathologic vasodilator processes that occur in shock states. There is current interest in the use of vasopressin in the treatment of shock due to ventricular fibrillation, hypovolaemia, sepsis and cardiopulmonary bypass. This article reviews the physiology and pharmacology of vasopressin and all of the relevant animal and human clinical literature on its use in the treatment of shock following a MEDLINE (1966–2000) search.
Functional Iron Deficiency, Infection and Systemic Inflammatory Response Syndrome in Critical Illness
Authors: Patteril M. V. , Davey-Quinn A. P. , Gedney J. A. , Murdoch S. D. , Bellamy M. C. 
Published: January 2019

To investigate the prevalence and clinical relevance of functional iron deficiency in the critically ill, we performed a prospective observational study in a university hospital general intensive care unit. We collected patient demographics, severity of illness data, haematological and biochemical variables in 51 consecutive admissions. We recorded episodes of culture-positive infection. Functional iron deficiency (FID), measured by red cell hypochromasia on flow cytometry, was present in 35% of patients at admission to intensive care. FID patients were of similar age, diagnosis, APACHE score, sequential organ failure assessment (SOFA) score, haemoglobin, serum B12, folate and ferritin to patients without FID. However, patients with FID had a prolonged intensive care stay compared with non-FID patients (P<0.001) and increased time to hospital discharge (P=0.09). Duration of intensive care stay correlated with severity of FID (r=0.33, P<0.02). Systemic inflammatory response syndrome (SIRS) was present for longer in those with FID (P<0.02). Overall mortality did not differ between groups. No difference was seen in the incidence of positive cultures between those with FID (9/18 patients) and those without FID (15/33 patients). FID was independently associated only with abnormal white blood cell count (WBC <4 or >11x109.l-1) at admission to ICU, P=0.007, but not with positive cultures. There is a high prevalence of FID in intensive care, associated with an increased duration of stay and duration of SIRS. We have been unable to demonstrate a link with infection, either as a predisposing factor or as an acute response.
A Spoonful of Sugar—Improving the Sensitivity of the Glucose Oxidase Test Strip Method for Detecting Subclinical Pulmonary Aspiration of Enteral Feed
Authors: Young P. J. 
Published: January 2019

A 74-year-old woman was admitted to the intensive care unit (ICU) with respiratory failure. Following intubation and mechanical ventilation, nasogastric enteral feeding was begun. The sensitivity of the glucose oxidase strip method for detecting aspiration of enteral feed has been questioned because the glucose levels in commonly used feeds are similar to those of normal tracheal aspirates. In order to increase the glucose concentration of the feed, 10g of glucose was added to each 500 ml feed carton. Testing oral and tracheal secretions with standard glucose oxidase strips allowed the accurate detection of both pharyngeal regurgitation and tracheal aspiration. An episode of subclinical aspiration was detected and this was associated with a fall in the PaO2/FiO2 ratio. There were no further episodes of aspiration following the introduction of a gastric motility agent, maintaining the patient in the semi-recumbent position and an increase in the positive end expiratory pressure (PEEP).
Pharmacological Principles of Antibiotic Prescription in the Critically Ill
Authors: Pinder M. , Bellomo R. , Lipman J. 
Published: January 2019

The goal of antimicrobial prescription is to achieve effective drug concentrations. Standard antimicrobial dosing regimens are based on research performed often decades ago and for the most part with patients who were not critically ill. More recent insights into antibiotic activity (e.g. the importance of high peak/MIC ratios for aminoglycosides and time above MIC for β-lactam antibiotics), drug pharmacokinetics (e.g. increased volume of distribution and altered clearances) and the pathogenesis of sepsis (e.g. third space losses and altered creatinine clearances) have made re-evaluation of dosing regimens necessary for the critically ill. The inflammatory response associated with sepsis results in a rapid decrease in serum albumin levels, large fluid shifts and third space losses, initially with a high cardiac output. In turn these changes result in increased creatinine clearance and increased renal drug clearance. Unless these effects are offset by ensuing renal and/or hepatic impairment, with subsequent drug accumulation, antibiotic levels may be too low for optimal efficacy. The institution of continuous renal replacement therapy separately affects antibiotic clearances, and therefore dosing, even further. This article reviews relevant literature and offers principles for more effective and appropriate antibiotic dosing in the critically ill, based on the pharmacokinetic and pharmacodynamic principles of the main antibiotic groups (aminoglyosides, glycopeptides, β-lactams, carbapenems and quinolones) and knowledge of the pathophysiology of the inflammatory response syndrome. Finally it also provides some guidance on the basic principles of drug prescription for patients receiving continuous renal replacement therapy.
Procalcitonin and Proinflammatory Cytokine Clearance during Continuous Venovenous Haemofiltration in Septic Patients
Authors: Dahaba A. A. , Elawady G. A. , Rehak P. H. , List W. F. 
Published: January 2019

Procalcitonin (PCT), interleukin-6 (IL-6), tumour necrosis factor α (TNFα), and interleukin-1β (IL-1β) are important clinical prognostic markers in ICU septic patients. The goal of the study was to determine whether continuous venovenous haemofiltration (CVVH), using an AN69 haemofilter, leads to elimination of PCT, TNFα, IL-6 and IL-1βin 13 septic patients with multi-organ failure. At the start of haemofiltration (0), 6 and 12 hours the mean afferent plasma concentration ±SD of PCT (10.1±9.1, 7±6, 5.9±5.7 ng/ml), IL-6 (804.6±847.6, 611.7±528.4, 575.2±539.2 pg/ml), and that of TNFα (4.5±2.6, 4±3.1, 3.8±2.9 pg/ml) significantly declined during CVVH. The efferent plasma concentrations were significantly lower than the corresponding afferent concentrations. PCT, IL-6 and TNFαwere detectable in the ultra-filtrate of all patients. IL-1βwas only detectable in the plasma of eight patients and the ultrafiltrate of five patients. The plasma clearance of PCT, IL-6 and TNFαsignificantly decreased after 12 hours as a result of a decline in the adsorptive elimination of the mediators due to progressive membrane saturation. We demonstrated that if PCT, IL-6 and TNFα are used as clinical prognostic markers in septic patients who are treated with CVVH using an AN69 membrane, one should be aware that their plasma level could be modified by the therapy. In addition CVVH could represent an appropriate tool to remove a broad spectrum of proinflammatory mediators, if such removal is required in septic patients.
Remifentanil and Propofol Sedation for Retrobulbar Nerve Block
Authors: Rewari V. , Madan R. , Kaul H. L. , Kumar L. 
Published: January 2019

We studied remifentanil and propofol for analgesia and sedation during the placement of an ophthalmic block. Eighty ASA I or II patients undergoing elective cataract surgery under a retrobulbar block in a rural camp setting were included in the study. Patients were randomly divided into four groups and received different drug combinations as follows: Group I—remifentanil 1 μg/kg, Group II—remifentanil 0.5 μg/kg and propofol 0.5 mg/kg, Group III— remifentanil 1 μg/kg with propofol 0.5 mg/kg and Group IV—saline 0.1 ml/kg. Patients were observed for degree of movement, sedation, pain, recall and respiratory depression. No patient in the study groups reported pain or displayed movement whereas most of the patients in the control group had significant pain during the placement of the block. Also, seven (35%) patients in the control group showed significant movement which may have led to failure of block in two patients and retrobulbar haemorrhage in one patient. Incidence of significant respiratory depression was maximum in Group III patients (60%), followed by Group I (20%) and least in Group II (5%). All patients in the study groups remained cooperative and obeyed commands except four patients in group III (OAA/S-4). Postoperatively, other than the control group, recall was maximum in Group I (55%) and least in Group II (5%). Hence, a combination of remifentanil 0.5 μg/kg with propofol 0.5 mg/kg as a bolus was considered to provide excellent relief of pain and anxiety with least adverse effects for the placement of ophthalmic blocks.
Anaphylaxis to Haemaccel® and Cross Reactivity to Gelofusin®
Authors: Russell W. J. , Fenwick D. G. 
Published: January 2019

A recent change from Haemaccel® to Gelofusin® as the preferred colloid for resuscitation in our region caused us to review patients who were known to be allergic to Haemaccel. As Gelofusin and Haemaccel are both modified gelatine, it seemed likely that cross reactivity could occur. Two patients who had been diagnosed previously as having had anaphylactic reactions to Haemaccel were tested intradermally with dilutions of 1/100 of Haemaccel and Gelofusin. Both patients showed similar positive reactions to each agent. It appears that patients who are known to be allergic to Haemaccel are probably allergic also to Gelofusin. Both patients have been given new Medic Alert bracelets stating “Allergic to Haemaccel and Gelofusin”.
A New Model for the Oxyhaemoglobin Dissociation Curve
Authors: Anstey C. 
Published: January 2019

This paper describes a new model for the oxygen-haemoglobin dissociation curve in humans. The model is based on the known structural alterations that occur in the quaternary haemoglobin molecule during oxygenation and deoxygenation. The two alternative structures, tense and relaxed, are described using hyperbolic tangent curves and linked with a probability function to obtain the completed mathematical description of the oxygen-haemoglobin dissociation curve. Model accuracy is assessed by a bias/precision analysis of calculated logit (S) and P50 against gold standard data. A mechanism for the transition between the two structures involving the chloride ion as a major allosteric effector is proposed. Results were analysed against the Siggaard-Andersen model for bias, precision and calculated P50 in four saturation ranges—0.00<SO 2< 1.00, 0.20<SO 2< 0.80, 0.90<SO 2< 1.00 and 0.97<SO 2< 1.00. In each range except for 0.20<SO 2 <0.80, bias, precision and calculated P50 for the new model are significantly better (P<0.05). Analysis of calculated P50 across the entire saturation range revealed significant drift out of the acceptable range in the Siggaard-Andersen model for SO 2 >0.92. The new model remained within tolerance across the saturation range 0.00<SO 2 <1.00. The new model is significantly more accurate than the popular Siggaard-Andersen model, particularly in the range SO 2> 0.90.
Intubating Laryngeal Mask Airway
Authors: Caponas G. 
Published: January 2019

The Intubating Laryngeal Mask Airway (ILMA) was introduced into clinical practice in 1997 following numerous clinical trials involving 1110 patients. The success rate of blind intubation via the device after two attempts is 88% in “routine” cases. Successful intubation in a variety of difficult airway scenarios, including awake intubation, has been described, with the overall success rate in the 377 patients reported being approximately 98%. The use of the ILMA by the novice operator has also been investigated with conflicting reports as to its suitability for emergency intubation in this setting. Blind versus visualized intubation techniques have also been investigated. These techniques may provide some benefits in improved safety and success rates, although the evidence is not definitive. The use of a visualizing technique is recommended, especially whilst experience with intubation via the ILMA is being gained. The risk of oesophageal intubation is reported as 5% and one death has been described secondary to the complications of oesophageal perforation during blind intubation. Morbidity described with the use of the ILMA includes sore throat, hoarse voice and epiglottic oedema. Haemodynamic changes associated with intubation via the ILMA are of minimal clinical consequence. The ILMA is a valuable adjunct to the airway management armamentarium, especially in cases of difficult airway management. Success with the device is more likely if the head of the patient is maintained in the neutral position, when the operator has practised at least 20 previous insertions and when the accompanying lubricated armoured tube is used.