Transjugular intrahepatic portosystemic shunts (TIPS) in children

The transjugular intrahepatic portosystemic shunt procedure is an accepted treatment for adults with complications of portal hypertension. We performed a retrospective review of all pediatric TIPS placements performed at the University of California, San Francisco between 1990 and 1996. Twelve procedures were attempted in nine children, with a mean age (+/- SD) of 9.4 +/- 3.9 years (range, 5 to 15 years) and a mean weight of 31 +/- 18 kg (range, 16 to 70 kg). The indications for TIPS placement were portal hypertension complicated by chronic variceal hemorrhage not controlled with sclerotherapy (n = 7) and hypersplenism with thrombocytopenia (n = 2). TIPS placement was successfully completed initially in seven of nine (78%) patients. Unfavorable vascular anatomy was the cause of failure in two cases. The seven patients who underwent successful TIPS placement were followed up for an average of 136 days (range, 1 to 800 days); two still have patent shunts, three underwent liver transplantation, one had a splenorenal shunt after stenosis, and one died of underlying liver disease. Variceal bleeding was controlled in four of five patients who successfully underwent TIPS placement. Shunt occlusion occurred in four patients; patency was restored by transjugular shunt revision in three, and a splenorenal shunt was performed in one.     

Surface tension as a controlled variable in mechanical dishwashing

Using a continuous, in-line, nondestructive technique based on the maximum bubble pressure method, the surface tension of the wash water in a mechanical dishwashing machine has been monitored. This technique has enabled surface tension to be used as a controlled variable, providing feedback to regulate the amount of surfactant added. Assuming the mechanical force of the water spray is adequate to remove bound soil from the dish surface, the food soil may be titrated against surfactant, providing an indirect indication as to when the dishes are clean. This technique also could be applied to a recirculated wash solution for in-place cleaning.     

Patients requiring sedation

Recent advances in the pharmacology of sedative drugs have expanded their use in the intensive care unit. Indications and endpoints for sedation, however, often are defined poorly and are difficult to assess. Nevertheless, the complications of sedative drug administration are real. New indications for sedation have been proposed in recent years, including enforcing sleep/wake cycles, manipulating cellular metabolism, and preventing myocardial ischemia. The evidence supporting the efficacy of these new indications is not yet complete.     

Teachers' brief nonverbal behaviors in defined instructional situations can predict students' evaluations.

Can a few seconds of high school teachers' nonverbal (NV) behavior predict students' ratings of these teachers (SRT)? Yes, but NV-SRT relations varied among various instructional situations. NV behaviors while administering the class and using the board were unrelated to SRT. Positive judgments of NV behavior while disciplining the class and interacting with students were positively related to SRT. NV behaviors in frontal teaching were negatively related to SRT. The most negative NV-SRT relations were found for teachers' differential NV behavior toward high- versus low-achieving students. Teacher differentiality and SRT have rarely been investigated in high school. The structure of SRT seems to differ between high school and college, and students' anger about teachers' differentiality strongly predicted their evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanical behaviour of SiC fibre-reinforced titanium/titanium aluminide hybrid composites

The viability of developing an SiC fibre-reinforced titanium/titanium aluminide hybrid matrix composite was explored. The hybrid composites are expected to be used at temperatures beyond those attainable in conventional titanium matrix composites while improving the damage tolerance of the titanium aluminide matrix composites. The room-temperature mechanical characteristics studied were tensile strength, fracture toughness, low-cycle fatigue life and fatigue crack growth rate. The mechanisms of damage initiation and propagation under various loading conditions were also characterized. The directions for developing a satisfactory composite with hybrid titanium/titanium aluminide matrix are also addressed.     

On the variation with flux and frequency of the core loss coefficients in electrical machines

A model of core losses, in which the hysteresis coefficients are variable with the frequency and induction (flux density) and the eddy-current and excess loss coefficients are variable only with the induction, is proposed. A procedure for identifying the model coefficients from multifrequency Epstein tests is described, and examples are provided for three typical grades of non-grain-oriented laminated steel suitable for electric motor manufacturing. Over a wide range of frequencies between 20-400 Hz and inductions from 0.05 to 2 T, the new model yielded much lower errors for the specific core losses than conventional models. The applicability of the model for electric machine analysis is also discussed, and examples from an interior permanent-magnet and an induction motor are included.     

The feasibility of smoking bans on psychiatric units

Cryptococcal meningitis has a high mortality rate of central nervous infection. The patients usually die of the disease itself, or complications from increased intracranial pressure. Early diagnosis and treatment, including surgical drainage, will improve the results. In this series, twenty-one patients with high intracranial pressure (ICP > 300 mmH2 O) are presented. Fourteen received implantation of Ommaya reservoir to aspirate cerebrospinal fluid (CSF) for relief of symptoms of ICP. Meanwhile 4 of these 14 patients also received intraventricular injection of amphotericin B because of poor response to systemic drugs. Another seven patient received systemic drug therapy only. Survival during therapy occurred in 11 of 14 patients in the surgical group, compared with only 1 of 7 patients treated by drug therapy alone (P = 0.019). In the 14 patients who received implantation of an Ommaya reservoir, there was one complication of CSF leakage when the reservoir ruptured because of repeated aspiration. For patients with cryptococcal meningitis with high ICP, early implantation of an Ommaya reservoir will improve the survival rate.     

Successful long-term ventricular pacing via the coronary sinus after the Fontan operation

A man with double inlet left ventricle and severe subpulmonary stenosis underwent a Fontan operation at the age of 29 years. Eight years later he developed atrial flutter with complete heart block. To avoid a further thoracotomy, a unipolar carbon tipped electrode was placed into the posterior cardiac vein via the coronary sinus. More than 8 years after implantation of the original lead, and after two generator changes, telemetric thresholds remain between 1.8-2.1 volts. Percutaneous transvenous ventricular pacing via the coronary sinus can produce an excellent long-term result and should be the initial approach of choice after a Fontan-type operation.