Correlation between late potentials duration and QTc dispersion: Is there a causal relationship?

This article is based on the current draft of a new AAMI equipment management standard (AAMI EQ56). Until now, no documentation has clearly specified the requirements for an equipment management program. At the time of the writing of this article, a February 1996 Committee Draft of the new standard was out for ballot and public review. Comments will be reviewed at a meeting of the AAMI Patient-Care Equipment Management Committee in June 1996, in conjunction with the AAMI Annual Meeting, and the standard could be formalized as early as October 1996. Readers should keep in mind that, while the final standard may differ somewhat from the material presented here, the author of this article and BI&T's staff felt that the interest of a very large portion of the AAMI membership warranted an advance article describing the content and general direction of the document.     

Intubation conditions: importance of the rate of repetition of the train-of-four

OBJECTIVES: To assess that neuromuscular relaxation onset of the adductor pollicis (AP) is related to neuromuscular stimulation rate. To assess that train-of-four (TOF) at 0.05 Hz is a more accurate indicator of optimal tracheal intubation time and conditions, than TOF at 0.08 Hz. STUDY DESIGN: Prospective, comparative, randomized double-blind study. PATIENTS: Forty adults, physical class ASA 1 or 2, undergoing general anaesthesia with tracheal intubation were allocated to two groups (n = 20) according to the sequence of stimulation of the AP: either TOF at 0.05 Hz (test group) or TOF at 0.08 Hz (control group). METHODS: Induction of anaesthesia was achieved with thiopentone, fentanyl and vecuronium (0.1 mg.kg-1). Neuromuscular monitoring was obtained with force displacement transducers attached to each AP. Tracheal intubation was performed once AP muscular response obtained with TOF at 0.05 Hz for test group and TOF at 0.08 Hz for control group was abolished. Results are expressed as mean +/- SEM. Fisher exact test was used for intubation conditions comparison. Curarization time between groups was compared with unpaired Student's t test (P < 0.05 accepted). RESULTS: TOF with 0.05 Hz stimulation significantly increased curarization time: 217 +/- 7 versus 162 +/- 6 s (P < 0.001). Intubation conditions were excellent in 95% and good in 5% of patients in the study group, compared to 15 and 40% in the control group, respectively (P < 0.01) in 45% of the control group patients coughing at intubation occurred. CONCLUSION: Low stimulation rate (TOF at 0.05 Hz) of AP is a reliable technique to determine the appropriate intubation time for patients paralyzed with vecuronium.     

Increased concentrations of octachlorodibenzo-p-dioxin in cases with breast cancer--results from a case-control study

Organochlorines are persistent and highly lipophilic environmental contaminants which bioaccumulate in the food chain. Some of these chemicals, 2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane (DDT) and polychlorinated biphenyls (PCBs), have been suggested to be of significance in the aetiology of breast cancer. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is an anti-oestrogen in animal studies and should be thus lower the risk of breast cancer. The other isomers of polychlorinated dibenzo-p-dioxins (PCDDs) or the chemically related polychlorinated dibenzofurans (PCDFs) have not been tested regarding carcinogenesis of the breast. The purpose of this study was to investigate whether PCDDs or PCDFs influence the risk for breast cancer. Consecutive patients who underwent surgery for a breast disease between 1993 and 1995 were recruited for the study. Cases were 22 patients with infiltrative breast cancer and controls were 19 patients operated for a benign breast disease during the same time period. Approximately 10 g of breast tissue free from tumour was taken from the specimen and frozen until analysis. Fat was extracted, cleaned and analysed with a high-resolution gas chromatograph coupled to a high-resolution mass spectrometer. Median concentrations of octachlorinated dibenzo-p-dioxin (OCDD) were 598 (170-14,880) and 396 (103-1,847) pg/g lipid in the cases and in the controls, respectively. In a multivariate logistic regression analysis controlling for other risk factors for breast cancer increased odds ratio (OR) was obtained for OCDD: 401-1000 pg/g lipid yielded OR 3.8, 95% confidence interval (CI) 0.4-39, > 1000 pg/g lipid gave OR 5.2, CI 0.4-72. When the lipid OCDD variable was examined as a continuous risk factor there was a 1.09 (9%), CI 0.95-1.25, increase in the adjusted OR for breast cancer per 100 unit (pg/g lipid) increase in OCDD. No differences were found between cases and controls for the other six tested PCDDs. Mean concentration of TCDD was in the cases 3.6 (1.0-7.9) and in the controls 3.3 (1.1-6.3) pg/g lipid. For PCDFs no significant differences were found between cases and controls. The results were not changed if oestrogen or progesterone receptor status, S-phase fraction and DNA ploidy were considered. Breast tissue concentration of OCDD was increased in cancer patients, whereas the concentrations of other PCDDs and PCDFs were equal in cases and controls.     

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).     

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.     

Deformation and fracture of glass bead/ CTBN-rubber/epoxy composites

Carboxyl-terminated butadiene-acrylonitrile-rubber decreases modulus and yield stress of the studied epoxy but increases fracture toughness. The addition of glass bead compensates for the loss in modulus but has little effect on yield stress. However, it significantly contributes to the fracture toughness by providing additional mechanisms for toughening of both the unmodified and rubber-modified epoxy. For the toughened epoxies studied, fracture surfaces gave only limited information on fracture mechanisms since significant energy absorption also occurs in the material below the fracture surface. Suggestions for suitable material compositions for fiber composite matrices are given.