Continuous measurement of cardiac output by the Fick principle in infants and children: comparison with the thermodilution method

OBJECTIVE: To compare a system that continuously monitors cardiac output by the Fick principle with measurements by the thermodilution technique in pediatric patients. DESIGN: Prospective direct comparison of the above two techniques. SETTING: Pediatric intensive care unit of a university hospital. PATIENTS: 25 infants and children, aged 1 week to 17 years (median 10 months), who had undergone open heart surgery were studied. Only patients without an endotracheal tube leak and without a residual shunt were included. METHODS: The system based on the Fick principle uses measurements of oxygen consumption taken by a metabolic monitor and of arterial and mixed venous oxygen saturation taken by pulse- and fiberoptic oximetry to calculate cardiac output every 20s. INTERVENTIONS: In every patient one pair of measurements was taken. Continuous Fick and thermodilution cardiac output measurements were performed simultaneously, with the examiners remaining ignorant of the results of the other method. RESULTS: Cardiac output measurements ranged from 0.21 to 4.55 l/min. A good correlation coefficient was found: r2 = 0.98; P < 0.001; SEE = 0.41 l/min. The bias is absolute values and in percent of average cardiac output was - 0.05 l/min or - 4.4% with a precision of 0.32 l/min or 21.3% at 2 SD, respectively. The difference was most marked in a neonate with low cardiac output. CONCLUSION: Continuous measurement of cardiac output by the Fick principle offers a convenient method for the hemodynamic monitoring of unstable infants and children.     

X-ray electron spectroscopic investigation of the structure of double lead silicate glasses

The method of x-ray electron spectroscopy is used to investigate lead silicatexPbO(1 -x) · SiO₂ (x - 0.3, 0.4, 0.5, 0.55, 0.667) glasses. The concentration dependences of the spectra of inner Pb4f, Si2p, and Ols levels led to the conclusion that for low contents of PbO, lead is present in the glass in the form of modifying ions, whereas in high concentrations, it plays the role of glass former. Restructuring in the glass occurs for about 50% molar concentration of PbO. The Pb - O bond in the glass is more ionic than in PbO. With an increase in the PbO content in the glass, the Pb - O bond becomes closer to that of lead monoxide, i.e., is more covalent.     

Long-term follow-up of a randomized post-induction therapy trial in acute myelogenous leukemia (a Southeastern Cancer Study Group trial)

A phase III clinical trial was designed to determine if more intensive induction and consolidation therapy for acute myeloblastic leukemia increases the remission rate and prolongs survival. A minor objective was to determine if the use of non-cross resistant drugs was more effective than the same drugs used for induction. Patients with untreated leukemia between the ages of 15 and 50 were given daunorubicin 45 mg/m2 for the first 3 days of a 10-day continuous infusion of cytosine arabinoside, initially at a dose of 2000 mg/m2 but reduced to 100 mg/m2 because of toxicity. Those under 36 achieving a complete remission and with an histocompatible donor were assigned to a transplant arm. The rest were randomized to receive one of three consolidation arms: A, cytosine arabinoside, 200 mg/m2 daily for 7 days and daunorubicin 45 mg/m2 daily for 3 days for three courses; B, one course as in Arm A followed by amsacrine, 120 mg/m2 daily for 5 days followed by a 5-day continuous infusion of azacytidine, 150 mg/m2/day; C, thioguanine and cytosine arabinoside, 100 mg/m2 every 12 h and daunorubicin 10 mg/m2 daily for 5 days for three courses followed by four maintenance courses of cytosine arabinoside, 100 mg/m2 daily for 5 days and daunorubicin, 45 mg/m2 for 2 days every 13 weeks. From 1981 to 1986, 398 eligible patients were enrolled and 219 achieved a complete remission. The initial induction dose of cytosine arabinoside was reduced after five of 29 patients exhibited fatal gastrointestinal toxicity. Only 11 patients were assigned to the transplant arm. There were no significant differences in the consolidation arms. The 5 year disease-free survivals were 38, 31 and 27% in arms A, B, and C respectively. Intensive consolidation therapy with the same or different drugs used in induction was as effective as lower dose consolidation followed by maintenance therapy.     

The regularization ofNB-scheme in differential games

The optimality principles in non-zero sum differential games and multicriterial control problems taken from the corresponding static (simultaneous) game theory are usually dynamic unstable (time inconsistent), thus their use becomes questionable if special regularization attempts are not made. This important aspect was first considered in [1], but also in the earlier paper of Strotz [7] this was shown for a special control problem with discount payoff. We have shown in [2] that many of the known procedures (excluding those based on scalarization of the payoff vector), of selecting of a special Pareto-optimal solution from the set of all Pareto-optimal solutions are dynamic unstable (time-inconsistent) and therefore the regularization procedures leading to the dynamic stable optimality principles are purposed [3]. It turns out that also in the Nash [4] bargaining process the regularization attempt can be made by constructng a special equation for the conflict point. The idea of the method is closely connected with the paper [5]. The special attention to the time-consistency problem is given also in the recent publications [6,8].This paper is financially supported by Russian Fundamental Research Foundation (project N 93-011-1714).     

Closed-loop expressions of minimum energy control for single-inputlinear digital systems

Closed-loop expressions for the minimum energy control of a single-input linear digital system are described. They are obtained by two different methods. The optimal inputs are given by state feedback with the bounded variable gains. The gains are independent of the initial state of the system     

TQM implementation in hospitals

This paper discusses the essential elements for successful Total Quality Management (TQM) implementation in hospital, and the challenges that occur with such implementation. Guidelines for this implementation are provided to show how TQM tools can be used effectively in hospitals.