Two Cases of Late Shone Syndrome With Pulmonary Hypertension: Heart-Lung Transplant or Valve Surgery?

Two cases of Shone syndrome with severe mitral and aortic valve problems and pulmonary hypertension were referred for heart-lung transplantation. Severely elevated pulmonary vascular resistance (PVR) was confirmed as was severe periprosthetic mitral and aortic regurgitation. Based on the severity of the valve lesions in both patients, surgery was decided upon and undertaken. Both experienced early pulmonary hypertensive crises, one more than the other, that gradually subsided, followed by excellent recovery and reversal of pulmonary hypertension and PVR. These cases illustrate Braunwald's concept that pulmonary hypertension secondary to left-sided valve disease is reversible.

Guidelines on artificial nutrition versus hydration in terminal cancer patients

Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step I: define the eight key elements necessary to reach a decision: Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e. improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.

Culture-bound technological solutions: An artificial theoretic insight

Sometimes, technological solutions to practical problems are devised that conspicuously take into account the constraints to which a given culture is subjecting the particular task or the manner in which it is carried out. The culture may be a professional culture (e.g., the practice of law), or an ethnic-cum-professional culture (e.g., dance in given ethnic cultures from South-East Asia), or, again, a denominational culture prescribing an orthopraxy impinging on everyday life through, for example, prescribed abstinence from given categories of workday activities, or dietary laws. Massimo Negrotti's Theory of the artificial is a convenient framework for discussing some of these techniques. We discuss a few examples, but focus on the contrast of two that are taken from the same cultural background, namely, technological applications in compliance with Jewish Law orthopraxy. •Soya-, mycoprotein- or otherwise derived meat surrogates are an example ofnaturoid; they emulate the flavours and olfactory properties, as well as the texture and the outer and inner appearance, of the meat product (its kind, cut, form) they set out to emulate (including amenability to cooking in the usual manner for the model), while satisfying cultural dietary prohibitions. •In contrast, the Sabbath Notebook, a writing surrogate we describe in this paper, is atechnoid: it emulates a technique (writing to store alphanumeric information), while satisfying the prohibition of writing at particular times of the liturgical calendar (the Sabbath and the major holidays).

Guest editorial. [Computers and Artificial Intelligence. 1998. Vol. 17, No. 2-3]

Editorial

Multicomponent gas-mixture measurements using an array of gas sensors and an artificial neural-network

An Electronic Nose is being jointly developed between the University of Greenwich and the Institute of Intelligent Machines to detect the gases given off from an oil filled transformer when it begins to break down. The gas sensors being used are very simple, consisting of a layer of Tin Oxide (SnO2) which is heated to approximately 640 K and the conductivity varies with the gas concentrations. Some of the shortcomings introduced by the commercial gas sensors available are being overcome by the use of an integrated array of gas sensors and the use of artificial neural networks which can be 'taught' to recognize when the gas contains several components. At present simulated results have achieved up to a 94% success rate of recognizing two component gases and future work will investigate alternative neural network configurations to maintain this success rate with practical measurements.

Reducing the incidence of coronary heart disease

The incidence of coronary heart disease (CHD) has been significantly reduced by the introduction of the National Service Framework in 2000 but has not yet reached set targets. This article analyses the adverse effects of specific CHD risk factors to the cardiovascular system and proposes local and national strategies for further reduction in the incidence, morbidity and mortality of CHD. It provides an example of how nurses can use a health promotion programme to support patients in giving up smoking, a major contributing factor in CHD. The programme uses cognitive behaviour therapy to improve patients' uptake and adherence.

Art always at heart

The Art Workers Guild, brother body to the SPAB and once presided over by William Morris and his followers, is 125 years old this year. Alan Powers looks back over its history, and sheds light on the characters and common bonds between the two bodies – while present Brothers of the Guild are pictured at work by photographer Lara Platman for new book to mark the event.

'Bowing from the heart': an investigation into discourses of professionalism and the work of caring for students in further education

Since their incorporation in 1993, further education (FE) colleges in England have been responsible for their own staffing and, faced with funding constraints as well as recruitment and retention targets, some have introduced a new category of staff referred to here as 'learning support workers' (LSWs). Though their employment conditions and specific duties vary considerably, LSWs' work often includes providing individual care for students. In this small-scale study, using semi-structured interviews, the perceptions of some teachers and LSWs about the nature of their relationships with each other and with students are investigated. The study is set broadly in the context of debates about the impact of public sector reform on FE colleges and teachers. A discourse analysis approach is adopted in discussion of the data. The authors conclude that although they are differently positioned in relation to traditional discourses of professionalism, both teachers and LSWs are perceived to be carrying out what Hochschild termed 'emotional labour'. The contradictory nature of emotional labour is also highlighted. Some of the implications of employing a new group of workers in FE are discussed.

Artificial neural networks in modelling osmotic dehydration of foods

Artificial neural network (ANN) models for water loss (WL) and solid gain (SG) were evaluated as potential alternative to multiple linear regression (MLR) for osmotic dehydration of apple, banana and potato. The radial basis function (RBF) network with a Gaussian function was used in this study. The RBF employed the orthogonal least square learning method. When predictions of experimental data from MLR and ANN were compared, an agreement was found for ANN models than MLR models for SG than WL. The regression coefficient for determination (R2) for SG in MLR models was 0.31, and for ANN was 0.91. The R2 in MLR for WL was 0.89, whereas ANN was 0.84.Osmotic dehydration experiments found that the amount of WL and SG occurred in the following descending order: Golden Delicious apple > Cox apple > potato > banana. The effect of temperature and concentration of osmotic solution on WL and SG of the plant materials followed a descending order as: 55 > 40 > 32.2C and 70 > 60 > 50 > 40%, respectively.