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.     

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.     

Sequence capture-PCR improves detection of mycobacterial DNA in clinical specimens

The rapid identification of mycobacterial DNA in clinical samples by PCR can be useful in the diagnosis of tuberculous infections, but several large studies have found that the sensitivity of this approach is not better than that of culture. In order to improve the sensitivity of detection of mycobacterial DNA in clinical specimens from patients with paucibacillary forms of tuberculosis, we have developed a procedure permitting the specific capture of mycobacterial DNA in crude samples prior to amplification, thereby concentrating the target sequences and removing irrelevant DNA and other potential inhibitors of the amplification reaction (sequence capture-PCR). By using this approach to capture and amplify two different sequences specific for organisms of the Mycobacterium tuberculosis complex (IS6110 and the direct repeat region), it was possible to detect as little as one genome of mycobacterial DNA in samples containing up to 750 micrograms of total DNA, representing a 10- to 100-fold increase in sensitivity compared with that obtained by purifying total DNA prior to amplification. Detection of the IS6110 sequence in pleural fluid samples from patients with tuberculous pleurisy by sequence capture-PCR gave positive results in 13 of 17 cases, including 3 of 3 culture-positive samples and 10 of 14 culture-negative samples. In contrast, when total DNA was purified from these samples by adsorption to a silica matrix prior to amplification, only the three culture-positive samples were positive by PCR. The sensitivity of detection of the direct repeat sequence in these samples by sequence capture-PCR was similar to that of IS6110 and, in addition, permitted immediate typing of the strains from some patients. We conclude that sequence capture-PCR improves the sensitivity of detection of mycobacterial DNA in paucibacillary samples. This approach should be useful in detecting rare target sequences from organisms implicated in other pathologic processes.     

Influence of interfacial microcracks on the elastic properties of composites

A model is established to quantify the influence of interfacial microcracks on the elastic properties of a particulate composite using a combination of theoretical and finite element analysis. A unique way to construct physical models which could accommodate both crack size and crack density is proposed. Based on energy principles, the influence of a dilute concentration of interfacial microcracks is first studied. The case of a finite concentration of microcracks is solved subsequently by combining the dilute concentration solutions and the differential scheme. Both cases agreed well with existing composite theories for the limiting condition of complete decohesion. The final model predicts the effective elastic properties as functions of both crack size and microcrack density.     

Diffusion bonding of ferritic oxide dispersion strengthened alloys to austenitic superalloys

The superior high temperature mechanical strength and oxidation resistance of ferritic oxide dispersion strengthened (ODS) tubular alloys are compromised by the difficulties encountered in joining. Conventional fusion welding techniques generate a weld fusion zone which is devoid of the mechanical strength exhibited by the base material. Therefore, more sophisticated solid state joining techniques, such as diffusion bonding, must be employed when joining ODS materials. This paper describes a series of solid state diffusion bonding experiments carried out between two tubular ferritic ODS alloys and two high temperature austenitic alloys. Careful control of bonding conditions produced pressure retaining joints between one of the tubular ODS alloys and both austenitic alloys. The successful joint design was incorporated into the manufacture of a tubular creep component, which enabled a series of internally pressurized creep tests to be carried out. The microstructure developed at the bond interface of each of the four separate material couples is described and the high temperature performance of the pressure retaining joints is discussed.     

Materials modelling: A bridge from atoms to bulk properties

The use of molecular-level materials modelling techniques in the development of advanced performance polymers is discussed, with particular emphasis upon bridging the large difference in the scales of dimensions between atomic structure and fabricated parts. The advantages and disadvantages of bulk quantitative structure-property relations and atomistic modelling are assessed, and the method of group interaction modelling is suggested as a means of bridging the dimensional scales.After a brief introduction to the concept of group interaction modelling, examples of modelling the engineering properties of polymers are presented which are difficult to model quantitatively by any other means. The important phase transitions from the crystal and glassy states of matter to those of rubber- and liquidlike states are shown quantitatively to be due to the same isoenergetic condition. The viscoelastic properties of a polymer are critical for many applications and expressions are derived for the loss and storage components of the complex modulus, with reference to failure initiation conditions. The effect of crosslinking in thermosets upon the glass transition temperature and viscoelastic properties is outlined. Finally, the scaling of time from atomic vibrations to the years involved in creep and ageing effects are discussed.     

Trends in low-cost, high-performance substrate technology

The trends in high density interconnection (HDI) multichip module (MCM) techniques that have the potential to reduce interconnection cost and production time are described. The implementation in laminated dielectric (MCM-L) technology of a workstation processor core illustrates current substrate technology capabilities. The design, routing, layout and thermal management of the processor core are described. Thin-film deposited dielectric (MCM-D) technology is discussed as a cost-effective method for future interconnection applications