Mixed venous oxygen saturation monitoring revisited : thoughts for critical care nursing practice

Background Less invasive methods of determining cardiac output are now readily available. Using indicator dilution technique, for example has made it easier to continuously measure cardiac output because it uses the existing intra-arterial line. Therefore gone is the need for a pulmonary artery floatation catheter and with it the ability to measure left atrial and left ventricular work indices as well the ability to monitor and measure a mixed venous saturation (SvO2). Purpose The aim of this paper is to put forward the notion that SvO2 provides valuable information about oxygen consumption and venous reserve; important measures in the critically ill to ensure oxygen supply meets cellular demand. In an attempt to portray this, a simplified example of the septic patient is offered to highlight the changing pathophysiological sequelae of the inflammatory process and its importance for monitoring SvO2. Relevance to clinical practice SvO2 monitoring, it could be argued, provides the gold standard for assessing arterial and venous oxygen indices in the critically ill. For the bedside ICU nurse the plethora of information inherent in SvO2 monitoring could provide them with important data that will assist in averting potential problems with oxygen delivery and consumption. However, it has been suggested that central venous saturation (ScvO2) might be an attractive alternative to SvO2 because of its less invasiveness and ease of obtaining a sample for analysis. There are problems with this approach and these are to do with where the catheter tip is sited and the nature of the venous admixture at this site. Studies have shown that ScvO2 is less accurate than SvO2 and should not be used as a sole guiding variable for decision-making. These studies have demonstrated that there is an unacceptably wide range in variance between ScvO2 and SvO2 and this is dependent on the presenting disease, in some cases SvO2 will be significantly lower than ScvO2. Conclusion Whilst newer technologies have been developed to continuously measure cardiac output, SvO2 monitoring is still an important adjunct to clinical decision-making in the ICU. Given the information that it provides, seeking alternatives such as ScvO2 or blood samples obtained from femorally placed central venous lines, can unnecessarily lead to inappropriate treatment being given or withheld. Instead when using ScvO2, trending of this variable should provide clinical determinates that are useable for the bedside ICU nurse, remembering that in most conditions SvO2 will be approximately 16% lower.

Resection-intersection bundle adjustment revisited

Bundle adjustment is one of the essential components of the computer vision toolbox. This paper revisits the resection-intersection approach, which has previously been shown to have inferior convergence properties. Modifications are proposed that greatly improve the performance of this method, resulting in a fast and accurate approach. Firstly, a linear triangulation step is added to the intersection stage, yielding higher accuracy and improved convergence rate. Secondly, the effect of parameter updates is tracked in order to reduce wasteful computation; only variables coupled to significantly changing variables are updated. This leads to significant improvements in computation time, at the cost of a small, controllable increase in error. Loop closures are handled effectively without the need for additional network modelling. The proposed approach is shown experimentally to yield comparable accuracy to a full sparse bundle adjustment (20% error increase) while computation time scales much better with the number of variables. Experiments on a progressive reconstruction system show the proposed method to be more efficient by a factor of 65 to 177, and 4.5 times more accurate (increasing over time) than a localised sparse bundle adjustment approach.

miRNAs in head and neck cancer revisited

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cause of cancer mortality in the world and the 5th most commonly occurring cancer. Tobacco smoking, alcohol consumption and human papilloma virus (HPV) infections have been associated with the occurrence of HNSCC. Despite advances that have been made in HNSCC treatment, smoking-associated HNSCC patients still exhibit a poor 5 year survival rate (30-50 %) and a concomitant poor quality of life. The major clinical challenge to date lies in the early detection of dysplastic lesions,which can progress to malignancy. In addition, there are currently no tools available to monitor HNSCC patients for early stages of local recurrences or distant metastases. In the recent past, micro-RNAs (miRNA) have been assessed for their role in cancer initiation and progression, including HNSCC. It is now well-established that deregulation of these single stranded, small non-coding, 19-25 nt RNAs can e.g. enhance the expression of oncogenes or subdue the expression of tumor suppressor genes. The aims of this review are three-fold: first to retrieve from the literature miRNAs that have specifically been associated with HNSCC, second to group these miRNAs into those regulating tumor initiation, progression and metastasis, and third to discern miRNAs related to smoking-associated HNSCC versus HPV-associated HNSCC development. This review gives an overview on the miRNAs regulating the development of head and neck cancers. The ultimate establishment of miRNA expression profiles that are HNSCC specific, and miRNAs that orchestrate altered gene and protein expression levels in HNSCC, could pave the way for a better understanding of the mechanism underlying its pathogenesis and the development of novel, targeted therapies.

Valuers, liability and insurance obligations revisited

- Overview of negligence from the valuer’s perspective - Consideration of defences - Impact of lender conduct - Insurance obligations and impact for the valuer

First hyperpolarizability of bacteriorhodopsin, retinal and related molecules revisited

The previously reported beta values of BR and retinal based chromophores were very high but subsequent measurements found them to be much less. We have found that the beta values of these compounds do not vary so much with experimental conditions as with the method of analysis. Hyper-Rayleigh scattering measurements at 1543 and 1907 nm produce more realistic beta values close to the intrinsic (static) hyperpolarizability, beta(0) which for BR is still very high (275 x 10 (30) esu). The optical nonlinearity of BR arises entirely due to the protonated retinal Schiff Base (PRSB) which in its isolated form has the same intrinsic hyperpolarizability as that of the rotein.

Diffusion Parameters in the Nb-Mo System: Revisited

The variation of the interdiffusion coefficient with the change in composition in the Nb-Mo system is determined in the temperature range of 1800 °C to 1900 °C. It was found that the activation energy has a minimum at around 45 at. pct Nb. The values of the pre-exponential factor and the activation energy for diffusion are compared with the data available in the literature. Further, the impurity diffusion coefficients of Nb in Mo and Mo in Nb are calculated.

Agenda-Setting Revisited: Social Media and Sourcing in Mainstream Journalism

In political journalism, the battle over agenda-setting between journalists and their sources has been described using many metaphors and concepts. Herbert Gans saw it as a dance where the two parties competed for leadership, arguing that sources usually got the lead. We address the question of how social media, in particular Twitter, contribute to media agenda-building and agenda-setting by looking at how tweets are sourced in election campaign coverage in Australia, Norway and Sweden. Our findings show that the popularity of elite political sources is a common characteristic across all countries and media. Sourcing from Twitter reinforces the power of the political elites to set the agenda of the news media – they are indeed “still leading the dance”. Twitter content travels to the news media as opinions, comments, announcements, factual statements, and photos. Still, there are variations that must be explained both by reference to different political and cultural characteristics of the three countries, as well as by the available resources and journalistic profiles of each media outlet.

Functional programming systems revisited

Functional Programming (FP) systems are modified and extended to form Nondeterministic Functional Programming (NFP) systems in which nondeterministic programs can be specified and both deterministic and nondeterministic programs can be verified essentially within the system. It is shown that the algebra of NFP programs has simpler laws in comparison with the algebra of FP programs. "Regular" forms are introduced to put forward a disciplined way of reasoning about programs. Finally, an alternative definition of "linear" forms is proposed for reasoning about recursively defined programs. This definition, when used to test the linearity of forms, results in simpler verification conditions than those generated by the original definition of linear forms.

Hanukkah lamp from Babylon Coin

Silver 5 Lirot coin. Obverse: Number 5. Reverse: Hanukkah lamp from Babylon.

The Hamilton-Jacobi equation revisited

A new analysis of the nature of the solutions of the Hamilton-Jacobi equation of classical dynamics is presented based on Caratheodory’s theorem concerning canonical transformations. The special role of a principal set of solutions is stressed, and the existence of analogous results in quantum mechanics is outlined.

Fournier polarography revisited

A theory for Fournier polarography and higher order harmonics is presented. This is valid for reversible systems under semi-infinite diffusion to stationary and expanding plane electrodes. The algorithm is simple, accurate and exploits the identities holding for the interfacial concentrations. The computations — minimal in nature — can be carried out easily and the results given here were evaluated taking into account the presence of harmonics to, at least, the twenty-fifth order.

Can an Ecdysiast Fag speak the voice of transgender? Phoenix (un)rising and the assumptions in Re Kevin revisited

"Each night the men look so surprised I change my sex before their eyes Tell me if you can What makes a man a man" - Charles Aznavour, ‘What makes a man a man (Comme ils disent)’. In (the few) Western jurisdictions in which marriage remains a forensic artefact constructed on the basis of a man|woman binary, the anatomical and heteronormative assumptions which underlie the construction of marriage remain as artificial constructs which do not map well (if indeed at all) to current social, or even medical, approaches to gender. In Re Kevin (Validity of Marriage of Transsexual) [2001] FamCA 1074, Justice Chisolm sought to recast the forensic ascription of sex against a broader set of criteria, expanding the range of sexually dimorphic anatomy used to determine sex for the purposes of marriage in Australia and incorporating observations of psycho-social gender-differentiation as factors relevant to the ultimate question for the Court — ‘What makes a man a man?’ Yet neither expansion is unproblematic. This article explores this fundamental forensic question against the background of Aznavour’s ‘Comme ils dissent’, in which the persona of un(e) stripteaseuse travesti struggles to answer precisely the same question. It concludes that Re Kevin might offer no more sophisticated an analysis of the lived reality of trans than Aznavour’s ecdysiast fag — not trans, but un travesti: "I shop and cook and sew a bit Though mum does too, I must admit I do it better."