Anti-D in a D-positive renal transplant patient

PURPOSE: We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologically reversed with edrophonium after paralysis with rocuronium. CLINICAL FINDINGS: A 12-yr-old girl developed postoperative reparalysis following the intraoperative administration of rocuronium. A total of 0.92 mg.kg-1 rocuronium was administered. After surgery, pharmacological reversal was achieved with 20 mg edrophonium with 0.15 mg atropine sulfate iv 35 min after the last administration of rocuronium. Muscular relaxation was monitored using an ulnar peripheral nerve stimulator (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Hz were present. In the recovery room, following nebulized epinephrine, the patient became apneic. The patient was paralyzed and an ulnar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. CONCLUSION: Postoperative reparalysis following rocuronium may be a cause of postoperative respiratory distress. The definitive diagnosis is made using PNS and observing the response to pharmacological reversal. Nebulized epinephrine may have a previously undescribed role in the development of postoperative reparalysis.     

APPLICATIONS MAINTENANCE OUTSOURCING An Alternative to Total Outsourcing

Appropriately structured arrangements for systems maintenance outsourcing can yield significant benefits to many organizations. This article reviews methods for assessing potential maintenance outsourcing suppliers, for defining service criteria, and for evaluating contract terms.     

Dexamethasone induces an increase in intracellular and membrane-associated lipocortin-1 (annexin-1) in rat astrocyte primary cultures

1. The antiinflammatory actions of glucocorticoid steroids are thought to occur through induction of the protein lipocortin-1 (LC-1; annexin-1). The purpose of the current study was to investigate whether astrocytic LC-1 content was increased in the presence of a synthetic glucocorticoid, dexamethasone. 2. Steroid-induced changes in cellular levels of LC-1 in astrocytes were determined by electrotransfer and immunoblotting techniques. Separate cell fractions were investigated to study the influence of dexamethasone on astroglial LC-1 content. The effect of culture state on LC-1 expression was also examined. 3. Intracellular LC-1 content was found to decrease after initiation of culture, with a substantial rise in both cell proliferation and LC-1 expression occurring after the replenishment of medium containing steroid-free serum. A further increase in intracellular LC-1 occurred upon incubation with dexamethasone. The glucocorticoid-induced change in intracellular LC-1 was a time-dependent event and coincided with an increase in membrane-associated LC-1. 4. The findings in this study indicate that astrocytic LC-1 content is influenced by cell culture conditions and, in the presence of glucocorticoid steroids, the cellular localization of LC-1 is altered. This may indicate that LC-1 has functions at more than one cellular locality.     

Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.     

Cynicism and Social Trust in the New Media Environment

This article, with minor modifications, was the author's presidential speech to the International Communication Association conference, May 2001. It summarizes trends in social trust, trust in government, media, and other social institutions and evaluates the news and entertainment media's roles in these trends. Alternatives to causal accounts are proposed, including variations on genetic or "memetic" forms of explanation for media influences on macrosocial trends.     

Opposed jet flames of lean or rich premixed propane-air reactants versus hot products

Several opposed jet flames, produced by a lean H₂-air jet opposing a rich or lean C₃H₈-air jet, are investigated. Spontaneous Raman spectroscopy is used for major species concentration and temperature measurements along the opposed jet centerline. The hot products of the H₂-air flame simulate the burnt gases of strong-burning near-stoichiometric reactants as they impinge upon a weak-burning lean or rich hydrocarbon-fueled reactant mix, a situation encountered in stratified charge operation of direct injection spark ignition engines. In addition the H₂-air flame hot products facilitate experimental data interpretation through the absence of carbon-bearing species. Good agreement between numerical and experimental data are obtained for a rich (equivalence ratio, φ = 1.25) C₃H₈-air jet versus a lean (φ = 0.4) H₂-air jet. Two lean C₃H₈-air jets (φ = 0.64 or 0.60), versus the φ = 0.4 H₂-air jet, are also investigated. For both of these flames, the amount of CO₂ production strongly depends upon φ, with the φ = 0.64 flame having a peak CO₂ mole fraction an order of magnitude higher than for the φ = 0.60 flame, and the C₃H₈ flames burning either as a normal flame (high CO₂) or as a “negative flame speed” flame producing little CO₂ and then only through diffusion of C₃H₈ into the hot products jet. The numerically predicted and experimental CO₂ profiles agree well for the positive flame speed flame, but the large discrepancy between predicted and measured peak CO₂ in the negative flame speed flame suggests modeling improvements are needed for this type of flame.     

Evaluation of ProKappa

ProKappa is an expert system tool kit developed by IntelliCorp in C using X-Windows for graphical interface. The SUN 3 or 4 version costs $9995/£7000 and $2595/£1800 for the interactive C environment.
This review covers ProKappa version 1.1, installed on a colour SUN SPARC Station 1 with the minimum recommended values of 12 Mb of memory and 30 Mb of swap space.
IntelliCorp can be contacted in the USA at 1975 El Camino Real West, Mountain View, CA 94040-2216 (+1 (415) 965-5500) and in the UK at 10 Jewry Street, Winchester, Hampshire SO23 8RZ (+44 (0)962 735348).     

Optimal algorithms for adjacent side routing

We consider the switchbox routing problem of two-terminal nets in the case when all thek nets lie on two adjacent sides of the rectangle. Our routing model is the standard two-layer model. We develop an optimal algorithm that routes all the nets whenever a routing exists. The routing obtained uses the fewest possible number of vias. A more general version of this problem (adjacent staircase) is also optimally solved.This research was supported in part by NSA Contract No. MDA-904-85H-0015, NSF Grant No. DCR-86-00378, and by NSF Engineering Research Centers Program NSFD CDR 88003012.