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Pulmonary function after one-lung ventilation in newborns: the basis for neonatal thoracoscopy

BACKGROUND: To maintain good exposure during major video-assisted thoracic surgery it is necessary to deflate completely the ipsilateral lung. However, little is known about the effects of one-lung ventilation (OLV) on pulmonary function in newborn patients. METHODS: Ten neonatal domestic pigs with a mean age of 6+/-0.6 days were intubated and ventilated in pressure-controlled mode (inspired oxygen fraction=1.0). One-lung ventilation was maintained for 120 minutes. Serial measurements of hemodynamics and gas exchange were done before, during, and until 90 minutes after OLV. Pulmonary function testing was performed before and after OLV for each lung separately. RESULTS: With the inspired oxygen fraction set at 1.0, arterial oxygen saturation remained stable at 100% during OLV. Venous admixture and alveolar-arterial oxygen tension gradient increased slightly from the baseline value of 2.6% +/-0.3% to 3.8%+/-0.3% during OLV (mean+/-standard error of the mean; p=0.02), and from 358+/-28 to 407+/-18 mm Hg (not significant), respectively. Both values returned to baseline during the subsequent ventilation of both lungs. Static compliance and resistance of the ventilated lung did not change. Compliance of the collapsed lung decreased after reexpansion from 0.42+/-0.07 to 0.29+/-0.06 mL x cm H2O(-1) x kg(-1), p=0.008). Resistance remained unchanged (0.22+/-0.02 versus 0.25+/-0.05 cm H2O x L(-1) x s(-1); not significant). CONCLUSIONS: There were only minor effects on pulmonary function during and after OLV in the neonatal piglet. Alterations in gas exchange during OLV were minimal. Prolonged collapse of the lung with subsequent reexpansion was associated with a slight decrease in compliance, indicating some mild lung injury.     

Managing information technology in the nineties

Business, not technology leaders should manage the change of Information Technology (IT) from a self-contained business support unit of the sixties to a distributed strategic business function of the nineties. Top management should recognize that a good business plan can only be developed and executed through the partnership between the business unit managers and the managers of the financial, the personnel, and the IT resource units. The technical problems associated with the management of IT may again be the easier part of the total management challenge.     

Symbolic parametrization of curves

If algebraic varieties like curves or surfaces are to be manipulated by computers, it is essential to be able to represent these geometric objects in an appropriate way. For some applications an implicit representation by algebraic equations is desirable, whereas for others an explicit or parametric representation is more suitable. Therefore, transformation algorithms from one representation to the other are of utmost importance.We investigate the transformation of an implicit representation of a plane algebraic curve into a parametric representation. Various methods for computing a rational parametrization, if one exists, are described. As a new idea we introduce the concept of working with classes of conjugate (singular or simple) points on curves. All the necessary operations, like determining the multiplicity and the character of the singular points or passing a linear system of curves through these points, can be applied to such classes of conjugate points. Using this idea one can parametrize a curve if one knows only one simple point on it. We do not propose any new method for finding such a simple point. By classical methods a rational point on a rational curve can be computed, if such a point exists. Otherwise, one can express the coordinates of such a point in an algebraic extension of degree 2 over the ground field.     

A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study

PURPOSE: To use a controlled, randomized design to assess the effect on patient satisfaction of an intensive psychosocial training program for residents. METHOD: Twenty-six first-year residents, in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine, were randomly assigned during 1991 and 1992 to a control group or a one-month intensive training program. Experiential teaching focused on many psychosocial skills required in primary care. A 29-item questionnaire administered before and after the residents' training evaluated their patients' satisfaction regarding patient disclosure, physician empathy, confidence in physician, general satisfaction, and comparison of the physician with other physicians. Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training. RESULTS: The patients of the trained residents expressed more confidence in their physicians (p = .01) and more general satisfaction (p = .02) than did the patients of controls. The effect of training on patient satisfaction with patient disclosure (p < .01) and physician empathy (p < .05) was greater for female than for male residents. CONCLUSION: The intensive psychosocial training program for residents improved their patients' satisfaction.