Phase analysis in high-frequency oscillation

This year, 1998, marks the 75th anniversary of the general availability of insulin in the United Kingdom. To mark the occasion, Diabetic Medicine publishes this account of the early days of insulin therapy in one of Britain's district general hospitals, Hereford General Hospital. The authors describe the first tentative use of insulin and draw some interesting parallels with the issues which still concern the introduction of novel therapies in endocrinology today.     

Interactive effects of betaine, crude protein, and net energy in finishing pigs

Two experiments were conducted to determine the effect of betaine on growth and carcass characteristics of finishing pigs. In Exp. 1, 32 gilts were fed one of two diets: 1) a corn-soybean meal basal (B) diet or 2) B + .125% betaine diet. In Exp. 2, 122 gilts were allotted to one of eight dietary treatments in a 2 x 2 x 2 factorial arrangement with two levels of betaine (0 or .125%), crude protein (adequate [ACP] or inadequate [ICP]), and net energy (NE; 0 or 6% added fat). In Exp. 1, betaine did not affect (P > .10) growth performance or carcass traits other than an increased (P < .05) dressing percentage. In Exp. 2, betaine tended to decrease ADFI during the overall experimental period (P = .11). In the late finishing period (LF), betaine increased ADG in inadequate CP low-NE diets and adequate CP high-NE diets, but decreased ADG in inadequate CP high-NE and adequate CP low-NE diets (betaine x CP x NE, P < .04). Betaine increased (P < .04) carcass length and decreased (P < .01) color score for pork quality. Other carcass measurements were unaffected (P > .10) by betaine. Betaine decreased (P < .02) serum urea N (SUN) in fed pigs during the LF period. Betaine decreased fasting SUN and albumin in pigs fed the ACP diets, but it increased fasting SUN and albumin in pigs fed the ICP diets during the LF period (betaine x CP, P = .10). Betaine increased serum total protein in the low-NE diets, but not in the high-NE diets (betaine x NE, P < .08). The serum metabolite data suggest that betaine may affect protein status of pigs, and these effects may depend on the crude protein and energy content of the diet.     

Intensive care unit bedside documentation systems. Realizing cost savings and quality improvements

Automating intensive care unit (ICU) documentation saves time and assists in interpreting data and planning care. The current economic climate makes the cost of ICU computer systems prohibitive for many institutions. Any expenditure without a measurable return on investment will be scrutinized carefully. The literature describing ICU computer system benefits often is difficult to interpret. No two implementations, hospitals, or benefit study designs have been the same. Each implementation has many unique variables. These variables make study comparison and replication potentially impossible. The authors have concluded that replicating previous studies may not be relevant if the goal is to justify system cost. The objective is met by designing a study that evaluates changes in data management activities as well as issues unique to the study unit or institution. The purpose of this article is to review the findings of previous benefits studies related to ICU documentation systems and to suggest other measures to support cost justification for expensive bedside documentation systems.     

Use of an extended monitoring strategy in patients with problematic syncope. Reveal Investigators

BACKGROUND: The conventional investigation of patients who present with syncope involves short-term ECG monitoring or provocative testing with head-up tilt and electrophysiological testing. A symptom-rhythm correlation is often difficult to obtain during spontaneous syncope because of its sporadic, infrequent, and unpredictable nature. METHODS AND RESULTS: We used a prolonged monitoring strategy to determine the cause of syncope in 85 patients (age, 59+/-18 years; 44 men) with recurrent undiagnosed syncope with an implantable loop recorder capable of cardiac monitoring for up to 18 months. During a mean of 10.5+/-4.0 months of follow-up, symptoms recurred in 58 patients (68%) 71+/-79 days (2.3+/-2.6 months) after implantable loop recorder insertion. An arrhythmia was detected in 42% of patients who recorded a rhythm during recurrent symptoms, with bradycardia present in 18 and tachycardia in 3. Five of the 18 bradycardic patients and 2 additional sinus rhythm patients received a clinical diagnosis of neurally mediated syncope. Patients who experienced presyncope were much less likely to record an arrhythmia during symptoms compared with recurrence of syncope (24% versus 70%, P=0.0005). There were no adverse events associated with recurrent symptoms, and there were no sudden deaths. Inability to freeze after an event occurred in 8 patients, and pocket infection occurred in 3. CONCLUSIONS: The strategy of prolonged monitoring is effective and safe in patients with problematic syncope.     

The role of spatial working memory in inhibition of return: evidence from divided attention tasks

Inhibition of return (IOR) refers to a bias against returning attention to a location that has been recently attended. In the present experiments, we examined the role of working memory in IOR by introducing secondary tasks (in the temporal interval between the cue and the target) that involved a working memory component. When the secondary task was nonspatial in nature (monitoring odd digits or adding digits), IOR was present, although overall reaction times were greater in the presence of the secondary task. When the task involved a spatial working memory load (remembering the directionality of arrows or the orientation of objects), IOR was eliminated. However, when the participants had incentive to process the directionality of an arrow but did not have to use any memory system, IOR persisted at peripheral locations. Overall, the results suggest that IOR is partially mediated by a spatial working memory system.