Anti-D in a D-positive renal transplant patient

PURPOSE: We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologically reversed with edrophonium after paralysis with rocuronium. CLINICAL FINDINGS: A 12-yr-old girl developed postoperative reparalysis following the intraoperative administration of rocuronium. A total of 0.92 mg.kg-1 rocuronium was administered. After surgery, pharmacological reversal was achieved with 20 mg edrophonium with 0.15 mg atropine sulfate iv 35 min after the last administration of rocuronium. Muscular relaxation was monitored using an ulnar peripheral nerve stimulator (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Hz were present. In the recovery room, following nebulized epinephrine, the patient became apneic. The patient was paralyzed and an ulnar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. CONCLUSION: Postoperative reparalysis following rocuronium may be a cause of postoperative respiratory distress. The definitive diagnosis is made using PNS and observing the response to pharmacological reversal. Nebulized epinephrine may have a previously undescribed role in the development of postoperative reparalysis.     

Designing Urban Pervasive Systems

A conceptual framework for designing and analyzing pervasive systems describes three aspects of these systems in the urban environment—architectural space, interaction space, and information sphere—and a spectrum of information "publicness."     

Memory and age differences in spatial manipulation ability.

Young and old adults were asked, in 3 experiments, to make decisions about the identity of line segment patterns after either adding or subtracting line segments from the original pattern. On some of the trials, the line segments from the initial display were presented again in the second display to minimize the necessity of remembering early information during the processing of later information. Although this manipulation presumably reduced the importance of memory in the tasks, it had little effect on the magnitude of the age differences in any of the experiments. Because the 2 groups were equivalent in accuracy of simple recognition judgments, but older adults were less accurate when the same types of decisions were required in the context of an ongoing task, the results suggested that older adults may be impaired in the ability to retain information while simultaneously processing the same or other information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deep brain stimulation for essential tremor

We examined the effects and safety of deep brain stimulation (DBS) as a treatment for essential tremor (ET). Ten ET patients with disabling medication-refractory tremor underwent stereotactic implantation of a DBS lead in the left Vim thalamic nucleus and completed a 6-month follow-up. The Clinical Tremor Rating Scale and disability assessments were performed at baseline, 1-, 3-, and 6-month follow-up. There were significant improvements in dressing, drinking, eating, bathing, and handwriting as reported by the subjects. Tremor severity, writing, pouring, and spiral and line drawing were significantly improved as rated by the examiner. Improvements persisted through the 6-month follow-up period. Although global disability significantly lessened in the group as a whole, one subject with hand-finger tremor accentuated by writing had no change in disability status. In this 6-month open-label study, DBS was effective and safe in reducing tremor and functional disability in ET.     

Creating a participant text: writing, multiple voices, narrative multiplicity

This article uses the ideas of social constructionism to explore how families change by investigating the way our perceptions of ourselves in relation to others are formed through language. The idea that language has the inherent potential to generate a reply has strongly influenced our thinking. We propose that the reply to others is shaped by our initial reply to ourselves in inner conversation. Interaction moves back and forth from inner conversation to conversation with others, from monologue to dialogue, becoming the "stuff" of new narratives. The particular focus on language in this article is on how adding writing to the session conversation produces a "participant text," a therapeutic narrative that is composed of the voices of the family and the therapists. These voices, often newly discovered or invented, allow our narrative discourse to expand and multiply. Using this approach with individuals, couples, and families from different socioeconomic levels, we have worked with mourning, divorcing couples, recovery from abuse, marital conflict, parenting dilemmas, and physical illness.     

Decision-theoretic planning with generalized first-order decision diagrams

Many tasks in AI require representation and manipulation of complex functions. First-Order Decision Diagrams (FODD) are a compact knowledge representation expressing functions over relational structures. They represent numerical functions that, when constrained to the Boolean range, use only existential quantification. Previous work has developed a set of operations for composition and for removing redundancies in FODDs, thus keeping them compact, and showed how to successfully employ FODDs for solving large-scale stochastic planning problems through the formalism of relational Markov decision processes (RMDP). In this paper, we introduce several new ideas enhancing the applicability of FODDs. More specifically, we first introduce Generalized FODDs (GFODD) and composition operations for them, generalizing FODDs to arbitrary quantification. Second, we develop a novel approach for reducing (G)FODDs using model checking. This yields – for the first time – a reduction that maximally reduces the diagram for the FODD case and provides a sound reduction procedure for GFODDs. Finally we show how GFODDs can be used in principle to solve RMDPs with arbitrary quantification, and develop a complete solution for the case where the reward function is specified using an arbitrary number of existential quantifiers followed by an arbitrary number of universal quantifiers.     

RESTORING SALMON HABITAT FOR A CHANGING CLIMATE

An important question for salmon restoration efforts in the western USA is ‘How should habitat restoration plans be altered to accommodate climate change effects on stream flow and temperature?’ We developed a decision support process for adapting salmon recovery plans that incorporates (1) local habitat factors limiting salmon recovery, (2) scenarios of climate change effects on stream flow and temperature, (3) the ability of restoration actions to ameliorate climate change effects, and (4) the ability of restoration actions to increase habitat diversity and salmon population resilience. To facilitate the use of this decision support framework, we mapped scenarios of future stream flow and temperature in the Pacific Northwest region and reviewed literature on habitat restoration actions to determine whether they ameliorate a climate change effect or increase life history diversity and salmon resilience. Under the climate change scenarios considered here, summer low flows decrease by 35–75% west of the Cascade Mountains, maximum monthly flows increase by 10–60% across most of the region, and stream temperatures increase between 2 and 6°C by 2070–2099. On the basis of our literature review, we found that restoring floodplain connectivity, restoring stream flow regimes, and re‐aggrading incised channels are most likely to ameliorate stream flow and temperature changes and increase habitat diversity and population resilience. By contrast, most restoration actions focused on in‐stream rehabilitation are unlikely to ameliorate climate change effects. Finally, we illustrate how the decision support process can be used to evaluate whether climate change should alter the types or priority of restoration actions in a salmon habitat restoration plan. Copyright © 2012 John Wiley & Sons, Ltd.