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.     

ATMOSPHERIC DEPOSITION OF CHEMICAL SPECIES TO POLAR SNOW

Particles and gases can deposit from the atmosphere to polar snow by several mechanisms. Dry deposition can be considered to consist of three steps: aerodynamic transport from the free atmosphere to the viscous sublayer near the surface, boundary layer transport across the sublayer, and interactions with the surface. The particle dry deposition mass flux is dominated by the largest particles present in a size distribution. Wet deposition includes in-cloud and below-cloud scavenging, where the former refers to uptake of particles during nucleation of cloudwater as well as scavenging of particles and gases by existing droplets and ice crystals. Of all the wet deposition mechanisms, nucleation scavenging is often the most important mechanism for particles in the polar regions. Finally, incorporation of particles and gases into fog droplets and subsequent settling of the fog to the snow surface can be an important removal process in regions of frequent fog. For Summit, Greenland, the total deposition of MSA, SO₄^2-, Na⁺, K⁺, and Ca²⁺ during May 24-July 13, 1993 was dominated by wet deposition: this mechanism accounted for an average of 62% of the total deposition for these species. Fog and dry deposition accounted for 21% and 17% of the total, respectively. These results suggest that all three mechanisms may need to be considered when estimating total deposition of certain chemical species to polar snow.     

Investigating the thermal-plasma processing of advanced materials

Due to several inherent advantages, plasma processing technology may become a very useful tool in the production of new materials. An increasing research effort based on experimental as well as theoretical investigations has been invested in this area for the synthesis of advanced materials. In describing the thermal-plasma processing technique, this article employs examples from research at the Plasma Processing Laboratory at the University of Idaho.     

Minimum-phase filter design from linear-phase startpoint viabalanced model truncation

A new practical design approach for minimum-phase FIR or IIR filters, setting out from a high dimensionality FIR linear-phase prototype is described. The novelty of this technique lies in overcoming the inherent problem of finding the roots of a high order polynomial with repeated and/or very closely clustered roots     

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.