An evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.

INTRODUCTION: We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non-steady-state conditions, accounting for the lag time between sevoflurane effect-site concentration (Ce) and end-tidal (ET) concentration would improve predictions. METHODS: Twenty patients received a sevoflurane, remifentanil, and fentanyl anesthetic. Two model predictions of responsiveness were recorded at emergence: an ET-based and a Ce-based prediction. Similarly, 2 predictions of a response to noxious stimuli were recorded when patients first required analgesics in the recovery room. Model predictions were compared with observations with graphical and temporal analyses. RESULTS: While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (> or = 99%). However, after termination of the anesthetic, models exhibited a wide range of predictions at emergence (1%-97%). Although wide, the Ce-based predictions of responsiveness were better distributed over a percentage ranking of observations than the ET-based predictions. For the ET-based model, 45% of the patients awoke within 2 min of the 50% model predicted probability of unresponsiveness and 65% awoke within 4 min. For the Ce-based model, 45% of the patients awoke within 1 min of the 50% model predicted probability of unresponsiveness and 85% awoke within 3.2 min. Predictions of a response to a painful stimulus in the recovery room were similar for the Ce- and ET-based models. DISCUSSION: Results confirmed, in part, our study hypothesis; accounting for the lag time between Ce and ET sevoflurane concentrations improved model predictions of responsiveness but had no effect on predicting a response to a noxious stimulus in the recovery room. These models may be useful in predicting events of clinical interest but large-scale evaluations with numerous patients are needed to better characterize model performance.

Be rich or don’t be sick: Estimating Vietnamese patients’ risk of falling into destitution

This paper represents the first research attempt to estimate the probabilities for Vietnamese patients to fall into destitution facing financial burdens occurring during their curative stay in hospital. The study models the risk against such factors as level of insurance coverage, location of patient, costliness of treatment, among others. The results show that very high probabilities of destitution, approximately 70%, apply to a large group of patients, who are nonresident, poor and ineligible for significant insurance coverage. There is also a probability of 58% that low-income patients who are seriously ill and face higher health care costs would quit their treatment. These facts will put Vietnamese government’s ambitious plan of increasing both universal coverage (UC) to 100% of expenditure and rate of UC beneficiaries to 100% at a serious test. The study also raises issues of asymmetric information and alternative financing options for the poor, who are most exposed to risk of destitution, following market-based health care reforms.

Optimizing the reliability of power electronics module isolation substrates

Optimal design of a power electronics module isolation substrate is assessed using a combination of finite element structural mechanics analysis and response surface optimisation technique. Primary failure modes in power electronics modules include the loss of structural integrity in the ceramic substrate materials due to stresses induced through thermal cycling. Analysis of the influence of ceramic substrate design parameters is undertaken using a design of experiments approach. Finite element analysis is used to determine the stress distribution for each design, and the results are used to construct a quadratic response surface function. A particle swarm optimisation algorithm is then used to determine the optimal substrate design. Analysis of response surface function gradients is used to perform sensitivity analysis and develop isolation substrate design rules. The influence of design uncertainties introduced through manufacturing tolerances is assessed using a Monte-Carlo algorithm, resulting in a stress distribution histogram. The probability of failure caused by the violation of design constraints has been analyzed. Six geometric design parameters are considered in this work and the most important design parameters have been identified. Overall analysis results can be used to enhance the design and reliability of the component.

Risikowahrnehmung und psychologische Reaktionen in öffentlichen Krisensituationen am Beispiel von Terrorattentaten / Risk perception and psychological reactions in public crisis situations using the example of terror attacks

The reactions to the 9/11 terror attacks were immense in the western population. In the current review, the impact of terror attacks is presented with surveys, clinical interviews, and scientific polls, which were identified in a comprehensive literature search. Results show that the fear of further terror attacks is comparatively overestimated in the population and is associated with numerous psychological consequences and reactions. The overestimation of the probability of further terror attacks is related among other reasons to its unique features and its strong representation in the media. Several independent studies proved that the number of stress symptoms and psychiatric diagnoses is associated with a high risk perception in relation to terror attacks. This was not only the case for victims of terror attacks, but also for people indirectly exposed to the terror attacks. In addition, there is evidence that the number of the stress symptoms correlate with the duration of TV consumption of new findings about terror attempts. Methodologically, there is a critical lack of more in-depth analyses to explain the development of risk perceptions and its influence on mental and physical health. Because of the international importance and cross-cultural differences, an international standardization of research is desirable. [In German] Die Reaktionen auf die Terrorattentate vom 9. September 2001 in New York waren in der westlichen Bevölkerung immens. In der vorliegenden Übersichtsarbeit werden die Auswirkungen von Terrorattentaten durch Einbeziehung bevölkerungsrepräsentativer Untersuchungen, Surveys, klinischer Interviews und Einstellungsbefragungen dargestellt, die über eine deskriptive Literaturrecherche ermittelt wurden. Als Ergebnis des Reviews zeigt sich, dass die Angst vor weiteren Terrorattentaten in der Bevölkerung vergleichsweise hoch und mit zahlreichen psychologischen Folgen und Reaktionen assoziiert ist. Die Einschätzung der Auftretenswahrscheinlichkeit eines Terrorattentats hängt unter anderem mit den besonderen Charakteristika und der hohen medialen Präsenz des Themas zusammen. Die Anzahl der Stresssymptome bis hin zu psychiatrischen Diagnosen erwies sich in mehreren unabhängigen Untersuchungen mit einer hohen Risikowahrnehmung assoziiert. Dies ließ sich nicht nur bei den Opfern von Terrorattentaten, sondern auch bei indirekt Betroffenen zeigen. Darüber hinaus gibt es mehrfache Belege dafür, dass die Anzahl der Stresssymptome mit der Dauer des TV-Konsums über Neuigkeiten zu Terrorattentaten zusammenhing. Als methodische Kritik ist an den gegenwärtigen Untersuchungsszenarien einzuwenden, dass es derzeit keine tiefer gehenden Analysen zur Entwicklung der Risikowahrnehmung und zu ihrem Einfluss auf die Gesundheit gibt. Aufgrund der internationalen Bedeutung des Themas und der interkulturellen Unterschiede im Umgang mit Krisensituationen ist eine internationale Standardisierung von Untersuchungszugängen wünschenswert.

Analysis of classification accuracy for pre-filtered multichannel remote sensing data

Noise is one of the main factors degrading the quality of original multichannel remote sensing data and its presence influences classification efficiency, object detection, etc. Thus, pre-filtering is often used to remove noise and improve the solving of final tasks of multichannel remote sensing. Recent studies indicate that a classical model of additive noise is not adequate enough for images formed by modern multichannel sensors operating in visible and infrared bands. However, this fact is often ignored by researchers designing noise removal methods and algorithms. Because of this, we focus on the classification of multichannel remote sensing images in the case of signal-dependent noise present in component images. Three approaches to filtering of multichannel images for the considered noise model are analysed, all based on discrete cosine transform in blocks. The study is carried out not only in terms of conventional efficiency metrics used in filtering (MSE) but also in terms of multichannel data classification accuracy (probability of correct classification, confusion matrix). The proposed classification system combines the pre-processing stage where a DCT-based filter processes the blocks of the multichannel remote sensing image and the classification stage. Two modern classifiers are employed, radial basis function neural network and support vector machines. Simulations are carried out for three-channel image of Landsat TM sensor. Different cases of learning are considered: using noise-free samples of the test multichannel image, the noisy multichannel image and the pre-filtered one. It is shown that the use of the pre-filtered image for training produces better classification in comparison to the case of learning for the noisy image. It is demonstrated that the best results for both groups of quantitative criteria are provided if a proposed 3D discrete cosine transform filter equipped by variance stabilizing transform is applied. The classification results obtained for data pre-filtered in different ways are in agreement for both considered classifiers. Comparison of classifier performance is carried out as well. The radial basis neural network classifier is less sensitive to noise in original images, but after pre-filtering the performance of both classifiers is approximately the same.

Joint distributions of waves and rain

The transfer of gases between the atmosphere and ocean is affected by a number of processes, of which wave action and rainfall are two of potential significance. Efforts have been made to quantify separately their contributions; however such assessments neglect the interaction of these phenomena. Here we look at the correlation statistics of waves and rain to note which regions display a strong association between rainfall and the local sea state. The conditional probability of rain varies from ~0.5% to ~15%, with most of the equatorial belt (which contains the ITCZ) showing a greater likelihood of rain at the lowest sea states. In contrast the occurrence of rain is independent of wave height in the Southern Ocean. The 1997/98 El Niño enhances the frequency of rain in some Pacific regions, with this change showing some association with wave conditions.

Economic modelling of antenatal screening and ultrasound scanning programmes for identification of fetal abnormalities

Objective Within the framework of a health technology assessment and using an economic model, to determine the most clinically and cost effective policy of scanning and screening for fetal abnormalities in early pregnancy. Design A discrete event simulation model of 50,000 singleton pregnancies. Setting Maternity services in Scotland. Population Women during the first 24 weeks of their pregnancy. Methods The mathematical model was populated with data on uptake of screening, prevalence, detection and false positive rates for eight fetal abnormalities and with costs for ultrasound scanning and serum screening. Inclusion of abnormalities was based on the relative prevalence and clinical importance of conditions and the availability of data. Six strategies for the identification of abnormalities prenatally including combinations of first and second trimester ultrasound scanning and first and second trimester screening for chromosomal abnormalities were compared. Main outcome measures The number of abnormalities detected and missed, the number of iatrogenic losses resulting from invasive tests, the total cost of strategies and the cost per abnormality detected were compared between strategies. Results First trimester screening for chromosomal abnormalities costs more than second trimester screening but results in fewer iatrogenic losses. Strategies which include a second trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected. Conclusions The preferred strategy includes both first and second trimester ultrasound scans and a first trimester screening test for chromosomal abnormalities. It has been recommended that this policy is offered to all women in Scotland.

Enhancement of Ca2+-dependent outward current in sheep bladder myocytes by evans blue dye.

Whole-cell and inside-out patch-clamp techniques were used to assess the action of a well-known dye, Evans blue, on membrane currents in bladder isolated smooth muscle cells from sheep. In whole cells Evans blue dose-dependently increased the outward current by up to fivefold. In contrast, Evans blue had no effect on inward Ca2+ current. The effect on outward current was abolished or reduced if the cells were bathed in Ca2+-free solution, iberiotoxin (5 x 10(-8) M), or charybdotoxin (5 x 10(-8) M), but was unaffected by externally applied caffeine (5 mM) or in cells exposed to heparin (1 mg/ml) via the patch pipette. In inside-out patches bathed in a Ca2+ concentration of 5 x 10(-7) M, Evans blue (10(-4) M) increased the open probability of large-conductance (298-pS) Ca2+-dependent K+ channels (BK channels), shifting the half maximal-activation voltage by -70 mV. We conclude that Evans blue dye acts as an opener of BK channels.

Effect of purinergic blockers on outward current in isolated smooth muscle cells of the sheep bladder

Freshly dispersed cells from sheep urinary bladder were voltage clamped using the whole cell and inside-out patch-clamp technique. Cibacron and Basilen blue increased outward current in a dose-dependent manner with a half-maximal response at 10(-5) M. Suramin, in concentrations to 10(-3) M, had no such effect. The Cibacron blue response was abolished in Ca2+-free physiological salt solution, suggesting that it was acting on a Ca2+-dependent current. Similarly, the Cibacron blue-sensitive current was significantly attenuated by charybdotoxin. Cibacron blue did not modulate inward current nor were its effects modified by caffeine or heparin, suggesting that its effect on outward current was not secondary to an increase in intracellular Ca2+. Application of 10(-4) M Cibacron blue to the inside membrane of excised patches caused a rapid increase in open probability of a large-conductance (300 pS) K+ channel. These results suggest that Cibacron blue is a potent activator of a Ca2+-dependent outward current in bladder smooth muscle cells in addition to its action as a purinergic blocker.

Impact of Government Intervention on Employment Change and Plant Closure in Northern Ireland, 1983-97

Harris R. and Trainor M. (2007) Impact of government intervention on employment change and plant closure in Northern Ireland, 1983-97, Regional Studies 41, 51-63. Financial assistance to manufacturing industry is an important element of the industrial development policy in Northern Ireland. This paper uses the individual plant-level records of the Annual Respondents Database (ARD) for the Northern Ireland manufacturing sector (1983-97) matched to the plant-level details of financial support provided by the Industrial Development Board to examine the effect of selective financial assistance (SFA) on employment change and plant closure. It is found that SFA concentrated on protecting existing, rather than new, enterprises in terms of employment change. Using a hazard model, it is found that the receipt of SFA significantly reduced the probability of plant closure by, on average, between 15 and 24%.

Current-induced embrittlement of atomic wires

Recent experiments suggest that gold single-atom contacts and atomic chains break at applied voltages of 1 to 2 V. In order to understand why current flow affects these defect-free conductors, we have calculated the current-induced forces on atoms in a Au chain between two Au electrodes. These forces are not by themselves sufficient to rupture the chain. However, the current reduces the work to break the chain, which results in a dramatic increase in the probability of thermally activated spontaneous fracture of the chain. This current-induced embrittlement poses a fundamental limit to the current-carrying capacity of atomic wires.

On the recollision-free excitation of krypton during ultrafast multi-electron tunnel ionization

The probability of multiple ionization of krypton by 50 femtosecond circularly polarized laser pulses, independent of the optical focal geometry, has been obtained for the first time. The excellent agreement over the intensity range 100 TW cm-2 to 100 PW cm-2 with the recent predictions of Kornev et al (2003 Phys. Rev. A 68 043414) provides the first experimental confirmation that non-recollisional electronic excitation can occur in strong-field ionization. This is particularly true for higher stages of ionization, when the laser intensity exceeds 10 PW cm-2 as the energetic departure of the ionized electron(s) diabatically distorts the wavefunctions of the bound electrons. By scaling the probability of ionization by the focal volume, we discuss why this mechanism was not apparent in previous studies.

Temporal patterns of territory settlement and detectability in mated and unmated Nightingales Luscinia megarhynchos

In many bird species the sex ratio of adults is male-biased, which is likely to have consequences for the ecology as well as for the conservation of a species. For example, when some males remain unpaired in a population, there should be strong selection on behavioural traits that enhance pairing success. A surplus of males is also likely to have important implications for the interpretation of breeding bird survey data. In our study population of Nightingales Luscinia megarhynchos, about half of the males stayed unpaired, suggesting that the number of males encountered singing was greater than the number of breeding pairs. Furthermore, the detectability (the probability of encountering a male singing) of mated males was only two-thirds that of unmated males when censused in the morning or late in the breeding season. The relative detectability was more similar early in the season and during the twilight periods before sunrise and after sunset. Males that arrived earlier on the breeding grounds were more successful in attracting a mate than males arriving later. Some of the unmated males deserted their territories and prospected areas up to 4000 m distant, whereas others settled on the study site only late in the season and may actually have changed territories. We suggest that adult sex ratios and the time of the census should be taken into account when interpreting the results of breeding bird surveys.

Analysis procedure for calculation of electron energy distribution functions from incoherent Thomson scattering spectra

Incoherent Thomson scattering (ITS) provides a nonintrusive diagnostic for the determination of one-dimensional (1D) electron velocity distribution in plasmas. When the ITS spectrum is Gaussian its interpretation as a three-dimensional (3D) Maxwellian velocity distribution is straightforward. For more complex ITS line shapes derivation of the corresponding 3D velocity distribution and electron energy probability distribution function is more difficult. This article reviews current techniques and proposes an approach to making the transformation between a 1D velocity distribution and the corresponding 3D energy distribution. Previous approaches have either transformed the ITS spectra directly from a 1D distribution to a 3D or fitted two Gaussians assuming a Maxwellian or bi-Maxwellian distribution. Here, the measured ITS spectrum transformed into a 1D velocity distribution and the probability of finding a particle with speed within 0 and given value v is calculated. The differentiation of this probability function is shown to be the normalized electron velocity distribution function. (C) 2003 American Institute of Physics.

Ultrafast Probing of Collective Electron Dynamics Driven by Dielectronic Repulsion

We use the time-dependent R-matrix approach to investigate an ultrashort pump-probe scheme to observe collective electron dynamics in C(+). The ionization probability of a coherent superposition of the 2s2p(2) (2)D and (2)S states shows rapid modulation due to collective dynamics of the two equivalent 2p electrons, with the modulation frequency linked to the dielectronic repulsion. The best insight into this collective dynamics is achieved by a transformation from LS symmetry to the uncoupled basis. Such dynamics may be important in high-harmonic generation using open-shell atoms and ions.