Temperature monitoring

Central temperature is usually tightly regulated in human beings. Anesthesia alters the normal thermoregulatory controls of the body. Intraoperatively, mild degrees of hypothermia may provide some cerebral protection. However, the risk of organ dysfunction and shivering require that the anesthesiologist be prepared to treat severe hypothermia. Appropriate measures such as warning the operating room and using forced air blankets can prevent both intraoperative hypothermia and postoperative shivering. The use of temperature measurement is not limited to the operative and immediate recovery periods. Anesthesiologists practicing in intensive care units and in pain clinics use temperature monitoring as a diagnostic tool in a variety of situations.     

Elimination of False-Locking in Long Loop Phase-Locked Receivers

Although long-loop phase-locked techniques are finding increasing application in the fields of mobile radio and satellite communications, their use has several drawbacks. Time delay associated with filtering processes within the loop gives rise to a degradation in acquisition capability, and information components entering the control loop cause a reduction in adjacent channel performance. In this paper, a split-loop technique is described, which eliminates false-locking, substantially improves the acquisition characteristics to that associated with a loop with zero time delay, and "cleans up" the first local oscillator spectrum. Furthermore, the technique is simple to implement.     

Correction factors for the determination of optical-fibre refractive-index profiles by the near-field scanning technique

Numerical calculations are presented of the correction factor for use with the near-field scanning method of index profile determination. It is shown that a single curve can be applied to a range of possible profiles, and a numerically obtained average curve is given.     

Review of A family like yours: Breaking the patterns of drug abuse.

Reviews the book, A family like yours: Breaking the patterns of drug abuse by James L. Sorensen and Guillermo Bernal (1987). A family like yours is a self-help guide aimed at families with a drug-abusing member. It attempts to fill a gap in the self-help literature on substance abuse and families. The problem readers may encounter is one of integrating without outside help the overwhelming amount of material presented. The chapters cover many basic concepts in family systems and life cycle theory without sufficient space devoted to particular concepts or points. Points are made with little elaboration, and the reader may not be able to integrate much of the material. However, for the family that is involved in treatment, the book may prove helpful in promoting insights into the functioning of the family and may serve as a valuable adjunct to treatment by provoking questions and insights that can move a family toward change. The authors' emphasis on providing the family support and optimism tempered by realistic limits may also serve to make this book a useful adjunct to treatment. This book serves as a valuable addition to the self-help literature on drug abuse in families and partially fills a gap currently existing in that marketplace. It covers a great deal of material that is not easily available to the lay reader at this time. This book is more likely to be insight provoking, practical, and motivating, however, to the drug abusing family that is in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of race and socioeconomic status on the perception of process variables in counseling.

Analyzed the effects of race and socioeconomic status (SES) on the perception of process variables in counseling, including judged counselor empathy, judged counselor–client cognitive similarity, and attraction. The study used a 2?×?12?×?2?×?6 design (race of S, tape order, SES of client, race of counselor and client) with repeated measures on the SES of client variable and the race of counselor and client variable. Following empathy training, 12 Black and 12 White undergraduate middle-class males listened to 12 specially prepared counselor–client taped dialogs and rated the counselor and client on each tape on the process variables being researched. All hypotheses were confirmed. Both Black and White Ss gave highest counselor empathy ratings, client–counselor attraction and cognitive similarity ratings, and client improvement ratings to matchings in which the counselor and client were similar over race and social class, and they gave lowest ratings when the counselor and client were dissimilar over race and social class. Effects of client accent were generally not significant. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of epsilon-aminocaproic acid on fibrinolysis and thrombin generation during cardiac surgery

Despite the efficacy of antifibrinolytic drugs in reducing bleeding after cardiac surgery, concerns remain regarding their potential to promote thrombosis. We examined the effect of the antifibrinolytic drug, epsilon-aminocaproic acid (EACA) on fibrinolysis and thrombin generation during cardiac surgery. Forty-one adults undergoing primary coronary artery bypass graft surgery requiring cardiopulmonary bypass (CPB) were prospectively randomized in a double-blind trial to receive either saline or EACA. A loading dose of 150 mg/kg EACA was given before anesthetic induction, followed by a 15 mg x kg(-1) x h(-1) infusion, which continued until 3 h after CPB. Plasma samples for the measurement of D-dimer, thrombin-antithrombin III, and soluble fibrin were obtained before surgery, 1 h on CPB, and 3 and 20 h after CPB. In the EACA group, fibrinolytic activity, as measured by D-dimer, was significantly decreased 3 h after CPB, (0.51 +/- 0.15 mg/L vs 1.13 +/- 0.14 mg/L, P < 0.005). Decreased fibrinolytic activity was accompanied by decreased bleeding in the EACA group (660 +/- 127 mL vs 931 +/- 113 mL, P < 0.05). No differences in the generation of thrombin or soluble fibrin were apparent between the two groups. Suppression of fibrinolytic activity in the absence of concomitant reductions in thrombin generation suggests that EACA could potentiate a hypercoagulable prethrombotic state in the perioperative setting. Implications: In a randomized, prospective trial of primary cardiac surgery, we demonstrated that the synthetic antifibrinolytic drug epsilon-aminocaproic acid suppresses fibrinolysis with no effects on thrombin generation. These results suggest the potential for synthetic antifibrinolytic drugs to induce a hypercoagulable prethrombotic state in the perioperative setting.     

The arterial to end-tidal carbon dioxide gradient increases with uncorrected but not with temperature-corrected PaCO2 determination during mild to moderate hypothermia

End-tidal carbon dioxide (PETCO2) monitoring is recommended as a basic standard of care and is helpful in adjusting mechanical ventilation. Gas solubility changes with temperature, which might affect the PaCO2 and thereby the gradient between PaCO2 and PETCO2 (PA-ETCO2) under hypothermic conditions. We investigated whether the PA-ETCO2 changes during mild to moderate hypothermia (36 degrees C-32 degrees C) using PaCO2 measured at 37 degrees C (uncorrected PaCO2) and PaCO2 corrected to actual body temperature. We preoperatively investigated 19 patients. After anesthesia had been induced, controlled ventilation was established to maintain normocarbia using constant uncorrected PaCO2 to adjust ventilation (alpha-stat acid-base regimen). Body core temperature was reduced without surgical intervention to 32 degrees C by surface cooling. Continuous PETCO2 was monitored with a mainstream PETCO2 module. The PA-ETCO2 was calculated using the uncorrected and corrected PaCO2 values. During body temperature reduction from 36 degrees C to 32 degrees C, the gradient between PETCO2 and uncorrected PaCO2 increased 2.5-fold, from 4.1 +/- 3.7 to 10.4 +/- 3.8 mm Hg (P < 0.002). The PA-ETCO2 remained unchanged when the corrected PaCO2 was used for the calculation. We conclude that when the alpha-stat acid-base regimen is used to adjust ventilation, the PA-ETCO2 calculated with the uncorrected PaCO2 increases and should be added to the differential diagnosis of widened PA-ETCO2. In contrast, when the corrected PaCO2 is used for the calculation of the PA-ETCO2, the PA-ETCO2 remains unaltered during hypothermia. Implications: We investigated the impact of induced hypothermia (36 degrees C-32 degrees C) on the gradient between PaCO2 and PETCO2 (PA-ETCO2). The PA-ETCO2 increased 2.5-fold when CO2 determinations were not temperature-corrected. Hypothermia should be added to the differential diagnosis of an increased PA-ETCO2 when the alpha-stat acid-base regimen is used.     

Small intestinal transit in diabetics

Small intestinal transit was assessed in diabetic patients and healthy controls by measuring the breath hydrogen appearance time after the ingestion of lactulose. Transit in diabetics with autonomic neuropathy was significantly slower than in diabetics without neuropathy and controls. Delayed transit is probably due to vagal denervation. These slower transit times would allow bacteria to proliferate, which might explain why some diabetics have diarrhoea. The test cannot be used in patients with bacteria in the small bowel because these may metabolise lactulose and release hydrogen prematurely.     

Gastric emptying of solid meals in diabetics

The gastric emptying rate of an isotopically labelled solid meal was compared in 29 insulin-dependent well-controlled diabetics and 18 normal controls. The diabetics were assessed for evidence of autonomic neuropathy. No significant difference in gastric emptying rate was found between controls and diabetics with or without autonomic neuropathy. Only three diabetics had greatly delayed gastric emptying, but in one of these the test had given a normal result on an earlier occasion.