Channeling of three newly introduced antidepressants to patients not responding satisfactorily to previous treatment

OBJECTIVE: Trifluoromethane and CO are produced simultaneously during the breakdown of isoflurane and desflurane by dry CO2 absorbents. Trifluoromethane interferes with anesthetic agent monitoring, and the interference can be used as a marker to indicate anesthetic breakdown with CO production. This study tests representative types of gas monitors to determine their ability to provide a clinically useful warning of CO production in circle breathing systems. METHODS: Isoflurane and desflurane were reacted with dry Baralyme at 45 degrees C. Standardized samples of breakdown products were created from mixtures of reacted and unreacted gases to simulate the partial degrees of reaction which might result during clinical episodes of anesthetic breakdown using 1% or 2% isoflurane and 6% or 12% desflurane. These mixtures were measured by the monitors tested, and the indication of the wrong agent or a mixture of agents due to the presence of trifluoromethane was recorded and related to the CO concentration in the gas mixtures. RESULTS: When presented with trifluoromethane from anesthetic breakdown, monochromatic infrared monitors displayed inappropriately large amounts of isoflurane or desflurane. Agent identifying infrared and Raman scattering monitors varied in their sensitivity to trifluoromethane. Mass spectrometers measuring enflurane at mass to charge = 69 were most sensitive to trifluoromethane. CONCLUSION: Monochromatic infrared monitors were unable to indicate anesthetic breakdown via interference by trifluoromethane, but did indicate falsely elevated anesthetic concentrations. Agent identifying infrared and Raman monitors provided warning of desflurane breakdown via the interference of trifluoromethane by displaying the wrong agent or mixed agents, but may not be sensitive enough to warn of isoflurane breakdown Some mass spectrometers provided the most sensitive warnings to anesthetic breakdown via trifluoromethane, but additional data processing by some patients monitor units reduced their overall effectiveness.     

The effects of foveal load and visual context on peripheral letter recognition

Peripheral letter recognition was examined by presenting subjects with a letter triad centered 7.16 degrees to the right of fixation. At the same time, a single letter was presented at the point of fixation that was either the same as one of the letters in the triad or different from any of the triad letters. On other trials, no letter was presented at the point of fixation. Results supported and extended previous foveal load research. The disruptive effect of foveal load does not depend solely on the presence or absence of a foveal stimulus. Recognition of the first letter in non-words was disrupted when a foveal letter was presented that was different from the peripheral letter. Recognition of the middle letter for both words and non-words was disrupted when a foveal letter was presented that was the same as the middle letter. A significant interaction between foveal letter and triad type was also found. No evidence was found to suggest that recognition of a peripheral letter is significantly better when that same letter is also present at the point of fixation.     

Training in firearm safety counseling in family practice residency programs

We have studied the function of partial orthotopic liver transplantation in the rat by evaluating prothrombin time (PT), liver blood flow, basal and glucose-stimulated insulin secretion and glucose tolerance, and the reticuloendothelial function (RES) in hepatectomized rats subjected to partial liver transplantation. A graft corresponding to 68% of a normal liver was transplanted to totally hepatectomized rats. Comparison was made between control rats and rats subjected to 32% liver resection. PT was not significantly different in the transplanted group compared with liver-resected and control rats. Laser Doppler flowmetry showed that at 28 days after surgery, blood flow had increased in the transplanted livers. Furthermore, on the third day after transplantation, basal plasma insulin was increased and the plasma insulin response to glucose was exaggerated, suggesting reduced insulin action and impaired insulin degradation. Finally, uptake of radioactive-labeled E. coli bacteria, as a measure of RES function, was not compromised in transplanted animals. Based on these results, we conclude that reduced-size liver transplant in out-bred rats results in fast normalization of liver function after surgery although, immediately after surgery, glucose intolerance is seen.     

The Decline Of The Political Consensus For Urban Growth: Evidence from Los Angeles

This article explores growth politics in the United States by examining the case of Los Angeles. Recent observers of Los Angeles have noted that growth interests in the city increasingly lack the political coordination to effectively accomplish their projects. One writer has even announced the collapse of the growth machine in the region. Such an assertion is extraordinary, given the power most authors ascribe to growth coalitions and given Los Angeles' strong pro‐growth history. The article presents evidence that the machine has not collapsed, but the political consensus for growth has eroded severely over the past 15 years by a variety of factors. The article then argues that the same general processes that have caused the demise of the growth consensus in Los Angeles are in place in other cities and will likely have similar effects on growth politics there. The article ends by detailing some implications that the end of the growth consensus might have for local politics in the United States.