Adverse environmental conditions in the respiratory and medical ICU settings

Sleep deprivation and fragmentation occurring in the hospital setting may have a negative impact on the respiratory system by decreasing respiratory muscle function and ventilatory response to CO2. Sleep deprivation in a patient with respiratory failure may, therefore, impair recovery and weaning from mechanical ventilation. We postulate that light, sound, and interruption levels in a weaning unit are major factors resulting in sleep disorders and possibly circadian rhythm disruption. As an initial test of this hypothesis, we sampled interruption levels and continuously monitored light and sound levels for a minimum of seven consecutive days in a medical ICU, a multiple bed respiratory care unit (RCU) room, a single-bed RCU room, and a private room. Light levels in all areas maintained a day-night rhythm, with peak levels dependent on window orientation and shading. Peak sound levels were extremely high in all areas representing values significantly higher than those recommended by the Environmental Protection Agency as acceptable for a hospital environment. The number of sound peaks greater than 80 decibels, which may result in sleep arousals, was especially high in the intensive and respiratory care areas, but did show a day-night rhythm in all settings. Patient interruptions tended to be erratic, leaving little time for condensed sleep. We conclude that the potential for environmentally induced sleep disruption is high in all areas, but especially high in the intensive and respiratory care areas where the negative consequences may be the most severe.     

Hearing and Sj?gren's syndrome

Immune sensorineural hearing loss is manifested in several systemic immune diseases. Although hearing loss has been previously documented in patients with Sj?gren's syndrome (SS), the effect of SS on hearing is unclear. This prospective study was designed to assess the presence of hearing loss in 14 patients with SS and, if sensorineural hearing loss was present, to determine if the hearing loss was immune-mediated. Patients were evaluated with basic audiologic tests as well as for cellular immune inner ear reactivity as measured by the lymphocyte transformation test (LTT). Three patients had evidence of sensorineural hearing loss. Two patients had a positive LTT without evidence of sensorineural hearing loss. This preliminary study suggests that SS may not directly cause sensorineural hearing loss, immuno-mediated or otherwise.     

Clinically significant hearing loss in renal allograft recipients treated with intravenous erythromycin

BACKGROUND: Hearing loss is generally regarded as a rare side effect of erythromycin therapy. However, our own clinical experiences in erythromycin-treated patients led us to suspect that this complication may be more common among renal allograft recipients. The purpose of this study was to evaluate the incidence, predisposing factors, clinical characteristics, and outcomes of erythromycin-induced hearing loss among renal allograft recipients. METHODS: We reviewed medical records of renal transplant patients treated for pneumonia with intravenous erythromycin lactobionate. Patients were evaluated for the occurrence of clinically significant hearing loss (including onset, duration, and reversibility), other signs and symptoms of ototoxicity (vertigo and tinnitus), daily erythromycin dose and duration of treatment, concurrent ototoxic drug therapy, renal and hepatic function, and history of previous otic disease. RESULTS: Eleven (32%) of 34 courses of intravenous erythromycin therapy resulted in hearing loss. The incidence of hearing loss was 53% (eight of 15 courses) in patients treated with 4 g of erythromycin daily compared with 16% (three of 19 courses) among those receiving 2 g/d (P = .05). In addition, courses of erythromycin were longer in those suffering auditory toxicity (9.6 +/- 4.7 days) than in nontoxic patients (5.7 +/- 3.6 days) (P < .05). Hepatic and renal function did not differ between toxic and nontoxic patients. All episodes of erythromycin-induced hearing loss were reversible. CONCLUSIONS: We conclude that clinically significant hearing loss occurs in more than 30% of renal allograft recipients treated for pneumonia with intravenous erythromycin lactobionate. Patients who require prolonged courses of erythromycin and those treated with 4 g/d are at particular risk for the development of auditory toxicity. With prompt recognition and modification of therapy, erythromycin-induced hearing loss appears to be completely reversible.     

A 16-Mbit/s adapter chip for the IBM token-ring local area network

The authors describe a 9.02×9.02-mm chip built in 1-μm CMOS with two levels of metal and an additional mask level for fabricating capacitors. It contains both analog and digital circuits and has provisions for self-test. The function includes the transmitter, receiver, protocol handler, an microprocessor, as well as interfaces for RAM/ROM storage, IBM PC bus, IBM PS/2 bus, IBM 3174 bus, and Motorola 68000 bus. The physical design terrains are formed by 24K circuits of standard cell gates, a 10K-circuit equivalent hand-honed custom microprocessor, and an analog macro. The chip operates from a single 5-V supply, and the power consumption is 0.8 W nominal at 16 Mb/s. The chip can also be operated at 4 Mb/s     

A Low-Complexity Circuit for On-Sensor Concurrent A/D Conversion and Compression

A low-complexity circuit for on-sensor compression is presented. The proposed circuit achieves complexity savings by combining a single-slope analog-to-digital converter with a Golomb-Rice entropy encoder and by implementing a low-complexity adaptation rule. The adaptation rule monitors the output codewords and minimizes their length by incrementing or decrementing the value of the Golomb-Rice coding parameter k. Its hardware implementation is one order of magnitude lower than existing adaptive algorithms. The compression circuit has been fabricated using a 0.35 muM CMOS technology and occupies an area of 0.0918 . Test measurements confirm the validity of the design.     

Laser scattering instrument for real time in-vivo measurement of ciliary activity in human fallopian tubes

Based on a laser light scattering technique and fibre optic probe, we have developed and tested a simple and practical device for real time measurements of ciliary activity in human Fallopian tubes during laparoscopy and laparotomy. A further aim was to investigate the relationship between the ciliary beat frequency (CBF) and the morphology of the ciliary epithelium. The mean +/- SE of CBF in the fimbria and in the ampulla were 5.4 +/- 0.3 Hz and 5.0 +/- 0.1 Hz respectively. Small pieces of fimbria and ampulla epithelium were taken from the same sites at which the CBF was measured, and the percentage of ciliary cells was determined by scanning electron microscopy. A high positive correlation was found between CBF and the percentage of ciliary cells in the fimbria (r = 0.84) and in the ampulla (r = 0.88). The instrument presented in this study provided, for the first time, a quantitative examination of the CBF in intact human Fallopian tubes and may be used for the investigation of ciliary activity in patients with infertility.