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Sample records for care mac sedation

  1. Monitored anesthesia care (MAC sedation: clinical utility of fospropofol

    Directory of Open Access Journals (Sweden)

    Eric A Harris

    2009-12-01

    Full Text Available Eric A Harris, David A Lubarsky, Keith A CandiottiDepartment of Anesthesiology, Perioperative Management, and Pain Medicine, University of Miami/Miller School of MedicineAbstract: Fospropofol, a phosphorylated prodrug version of the popular induction agent propofol, is hydrolyzed in vivo to release active propofol, formaldehyde, and phosphate. Pharmacodynamic studies show fospropofol provides clinically useful sedation and EEG/bispectral index suppression while causing significantly less respiratory depression than propofol. Pain at the injection site, a common complaint with propofol, was not reported with fospropofol; the major patient complaint was transitory perianal itching during the drug’s administration. Although many clinicians believe fospropofol can safely be given by a registered nurse, the FDA mandated that fospropofol, like propofol, must be used only in the presence of a trained anesthesia provider.Keywords: fospropofol, propofol, monitored anesthesia care

  2. [Monitoring Required for Monitored Anesthesia Care (MAC) and Specific MAC Methodologies].

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    Suzuki, Toshiyasu

    2015-03-01

    Many physicians responsible for monitored anesthesia care (MAC) are not anesthesiologists and are not acquainted with treatment in response to sudden changes in patient condition. In particular, rapid response and early detection are essential for respiratory depression. Physicians engaged in MAC require pharmacological knowledge regarding sedative and analgesic medications, need to be able to accurately evaluate physiological responses to sedative and anesthetic levels, and need to be acquainted with emergency procedures such as basic life support (BLS) and advanced cardiovascular life support (ACLS). Patient management focusing on both ventilation and oxygenation, through the use of capnography and continuous respiratory monitoring, in addition to oxygenation monitoring using a pulse oximeter, and measuring ECGs and blood pressure in the management of sedated patients, is also important. PMID:26121782

  3. Sedation in neurological intensive care unit

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    Birinder S Paul

    2013-01-01

    Full Text Available Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives.

  4. Analgesia and sedation for children undergoing burn wound care.

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    Bayat, Ahmad; Ramaiah, Ramesh; Bhananker, Sanjay M

    2010-11-01

    Standard care of burn wounds consists of cleaning and debridement (removing devitalized tissue), followed by daily dressing changes. Children with burns undergo multiple, painful and anxiety-provoking procedures during wound care and rehabilitation. The goal of procedural sedation is safe and efficacious management of pain and emotional distress, requiring a careful and systematic approach. Achieving the best results needs understanding of the mechanisms of pain and the physiologic changes in burn patients, frequent evaluation and assessment of pain and anxiety, and administration of suitable pharmacological and nonpharmacological therapies. Pharmacological therapies provide the backbone of analgesia and sedation for procedural pain management. Opioids provide excellent pain control, but they must be administered judiciously due to their side effects. Sedative drugs, such as benzodiazepines and propofol, provide excellent sedation, but they must not be used as a substitute for analgesic drugs. Ketamine is increasingly used for analgesia and sedation in children as a single agent or an adjuvant. Nonpharmacological therapies such as virtual reality, relaxation, cartoon viewing, music, massage and hypnosis are necessary components of procedural sedation and analgesia for children. These can be combined with pharmacological techniques and are used to limit the use of drugs (and hence side effects), as well as to improve patient participation and satisfaction. In this article, we review the pathophysiologic changes associated with major thermal injury in children, the options available for sedation and analgesia for wound care procedures in these children and our institutional guidelines for procedural sedation. PMID:20977331

  5. The use of dexmedetomidine in intensive care sedation

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    Massimo Antonelli

    2013-05-01

    Full Text Available The goals and recommendations for ICU (Intensive Care Unit patients’ sedation and analgesia should be to have adequately sedated patients who are calm and arousal, so that they can guarantee a proper evaluation and an adequate control of pain. This way, it is also possible to perform their neurological evaluation, preserving intellectual faculties and helping them in actively participating to their care. Dexmedetomidine is a selective alpha-2 receptor agonist, member of theraputical cathegory: “other hypnotics and sedatives” (ATC: N05CM18. Dexmedetomidine is recommended for the sedation of adult ICU patients who need a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale 0 to -3. After the EMA approval, some European government authorities have elaborated HTA on dexmedetomidine, based on clinical evidence derived from Prodex and Midex trials. Dexmedetomidine resulted to be as effective as propofol and midazolam in maintaining the target depth of sedation in ICU patients. The mean duration of mechanical ventilation with dexmedetomidine was numerically shorter than with propofol and significantly shorter than with midazolam. The resulting favourable economic profile of dexmedetomidine supported the clinical use in ICU. Dexmedetomidine seems to provide clinical benefits due to the reduction of mechanical ventilation and ventilator weaning duration. Within the present review, an economic analysis of costs associated to the use of dexmedetomidine was therefore performed also in the Italian care setting. Thus, four different analyses were carried out based on the quantification of the total number of days in ICU, the time spent on mechanical ventilation, the weighted average number of days with mechanical ventilation or not and TISS points (Therapeutic Intervention Scoring System. Despite the incremental cost for drug therapy associated with dexmedetomidine, a reduction of

  6. Comfort and patient-centred care without excessive sedation

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    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S;

    2016-01-01

    Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical...... contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of...... an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified....

  7. Evaluating and monitoring analgesia and sedation in the intensive care unit

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    Sessler, Curtis N; Jo Grap, Mary; Ramsay, Michael AE

    2008-01-01

    Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly ...

  8. Comfort and patient-centred care without excessive sedation:the eCASH concept

    OpenAIRE

    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S; Pandharipande, Pratik P; Ball, Jonathan A.; Spronk, Peter; Longrois, Dan; Strom, Thomas; Conti, Giorgio; Funk, Georg-Christian; Badenes, Rafael; Mantz, Jean; Spies, Claudia; Takala, Jukka

    2016-01-01

    We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as th...

  9. Comfort and patient-centred care without excessive sedation: the eCASH concept

    OpenAIRE

    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S; Pandharipande, Pratik P.; Ball, Jonathan A.; Spronk, Peter; Longrois, Dan; Strøm, Thomas; Conti, Giorgio; Funk, Georg-Christian; Badenes, Rafael; Mantz, Jean; Spies, Claudia; Takala, Jukka

    2016-01-01

    We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH—early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as th...

  10. Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit

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    Jaquilene Barreto da Costa; Sonia Silva Marcon; Claudia Rejane Lima de Macedo; Amaury Cesar Jorge; Péricles Almeida Delfino Duarte

    2014-01-01

    Objective To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the partici...

  11. Comfort and patient-centred care without excessive sedation: the eCASH concept.

    Science.gov (United States)

    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S; Pandharipande, Pratik P; Ball, Jonathan A; Spronk, Peter; Longrois, Dan; Strøm, Thomas; Conti, Giorgio; Funk, Georg-Christian; Badenes, Rafael; Mantz, Jean; Spies, Claudia; Takala, Jukka

    2016-06-01

    We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified target level that is subject to regular review and adjustment; routine use of benzodiazepines should be minimised. From the outset, the objective of sedation strategy is to eliminate the use of sedatives at the earliest medically justifiable opportunity. Effective analgesia and minimal sedation contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified. PMID:27075762

  12. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

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    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  13. European Association for Palliative Care (EAPC framework for palliative sedation: an ethical discussion

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    Juth Niklas

    2010-09-01

    Full Text Available Abstract Background The aim of this paper is to critically discuss some of the ethically controversial issues regarding continuous deep palliative sedation at the end of life that are addressed in the EAPC recommended framework for the use of sedation in palliative care. Discussion We argue that the EAPC framework would have benefited from taking a clearer stand on the ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. It is unclear what constitutes refractory symptoms and what the relationship is between refractory symptoms and intolerable suffering, which in turn makes it difficult to determine what are necessary and sufficient criteria for palliative sedation at the end of life, and why. As regards the difference between palliative sedation at the end of life and so-called slow euthanasia, the rationale behind stressing the difference is insufficiently demonstrated, e.g. due to an overlooked ambiguity in the concept of intention. It is therefore unclear when palliative sedation at the end of life amounts to abuse and why. Conclusions The EAPC framework would have benefited from taking a clearer stand on some ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. In this text, we identify and discuss these issues in the hope that an ensuing discussion will clarify the EAPC's standpoint.

  14. Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit

    DEFF Research Database (Denmark)

    Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug

    2015-01-01

    closeness. CONCLUSION: Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation was......OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where a...... protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description. FINDINGS: An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake...

  15. Closed-loop control for cardiopulmonary management and intensive care unit sedation using digital imaging

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    Gholami, Behnood

    This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. Patients in the intensive care unit who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the intensive care unit, and also due to pain or other variants of noxious stimuli. In this dissertation, we develop a rule-based expert system for cardiopulmonary management and intensive care unit sedation. Furthermore, we use probability theory to quantify uncertainty and to extend the proposed rule-based expert system to deal with more realistic situations. Pain assessment in patients who are unable to verbally communicate is a challenging problem. The fundamental limitations in pain assessment stem from subjective assessment criteria, rather than quantifiable, measurable data. The relevance vector machine (RVM) classification technique is a Bayesian extension of the support vector machine (SVM) algorithm which achieves comparable performance to SVM while providing posterior probabilities for class memberships and a sparser model. In this dissertation, we use the RVM classification technique to distinguish pain from non-pain as well as assess pain intensity levels. We also correlate our results with the pain intensity

  16. Tracheotomy does not affect reducing sedation requirements of patients in intensive care – a retrospective study

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    Veelo, Denise P; Dongelmans, Dave A; Binnekade, Jan M; Korevaar, Johanna C; Vroom, Margreeth B; Schultz, Marcus J

    2006-01-01

    Introduction Translaryngeal intubated and ventilated patients often need sedation to treat anxiety, agitation and/or pain. Current opinion is that tracheotomy reduces sedation requirements. We determined sedation needs before and after tracheotomy of intubated and mechanically ventilated patients. Methods We performed a retrospective analysis of the use of morphine, midazolam and propofol in patients before and after tracheotomy. Results Of 1,788 patients admitted to our intensive care unit during the study period, 129 (7%) were tracheotomized. After the exclusion of patients who received a tracheotomy before or at the day of admittance, 117 patients were left for analysis. The daily dose (DD; the amount of sedatives for each day) divided by the mean daily dose (MDD; the mean amount of sedatives per day for the study period) in the week before and the week after tracheotomy was 1.07 ± 0.93 DD/MDD versus 0.30 ± 0.65 for morphine, 0.84 ± 1.03 versus 0.11 ± 0.46 for midazolam, and 0.62 ± 1.05 versus 0.15 ± 0.45 for propofol (p < 0.01). However, when we focused on a shorter time interval (two days before and after tracheotomy), there were no differences in prescribed doses of morphine and midazolam. Studying the course in DD/MDD from seven days before the placement of tracheotomy, we found a significant decline in dosage. From day -7 to day -1, morphine dosage (DD/MDD) declined by 3.34 (95% confidence interval -1.61 to -6.24), midazolam dosage by 2.95 (-1.49 to -5.29) and propofol dosage by 1.05 (-0.41 to -2.01). After tracheotomy, no further decrease in DD/MDD was observed and the dosage remained stable for all sedatives. Patients in the non-surgical and acute surgical groups received higher dosages of midazolam than patients in the elective surgical group. Time until tracheotomy did not influence sedation requirements. In addition, there was no significant difference in sedation between different patient groups. Conclusion In our intensive care unit, sedation

  17. The effects of sedative agents used in intensive care unit on haemodynaemia and oxygen transport

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    Kunt, N.

    2004-01-01

    Full Text Available Purpose: Sedation is a part of the therapy which is applied in intensive care units. We investigated the effects of propofol, midazolam and remifentanil on haemodynaemia and oxygen transport Material-Methods: Forty-five patients dependent on ventilators in the intensive care unit were included in our study and were separated randomly into 3 groups. Sedation levels were adjusted to 3 to 4 according to Ramsey sedation score, with the continual administration of an infusion of remifentanil 0.05 μg/kg/min (±0.01, propofol 35 μg/kg/min (±7 and midazolam 1 μg/kg/min (±0.2. Following the ECG and intraarterial monitoring, a pulmonary artery catheter was inserted. CVP, PAP, PCWP, CO, SvO2, PaO2, SaO2 and Hb levels were measured, and CI, SVR, PVR, DO2, VO2 and O2ER were calculated by the thermodilution method(1st measurement. When the doses reached expected sedation levels, measurements were repeated (2nd measurement. Results: It was found that following sedation, MAP, HR, PAP, DO2 and VO2 parameters decreased in all 3 groups compared to the control values (p0.05. CO and CI values were significantly decreased in the remifentanil and propofol groups compared to control values (p0.05. Conclusion: The heamodynamic effects of remifentanil, propofol and midazolam are not

  18. The language of sedation in end-of-life care: The ethical reasoning of care providers in three countries.

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    Seale, Clive; Raus, Kasper; Bruinsma, Sophie; van der Heide, Agnes; Sterckx, Sigrid; Mortier, Freddy; Payne, Sheila; Mathers, Nigel; Rietjens, Judith

    2015-07-01

    The application of ethically controversial medical procedures may differ from one place to another. Drawing on a keyword and text-mining analysis of 156 interviews with doctors and nurses involved in end-of-life care ('care providers'), differences between countries in care providers' ethical rationales for the use of sedation are reported. In the United Kingdom, an emphasis on titrating doses proportionately against symptoms is more likely, maintaining consciousness where possible. The potential harms of sedation are perceived to be the potential hastening of social as well as biological death. In Belgium and the Netherlands, although there is concern to distinguish the practice from euthanasia, rapid inducement of deep unconsciousness is more acceptable to care providers. This is often perceived to be a proportionate response to unbearable suffering in a context where there is also greater pressure to hasten dying from relatives and others. This means that sedation is more likely to be organised like euthanasia, as the end 'moment' is reached, and family farewells are organised before the patient is made unconscious for ever. Medical and nursing practices are partly responses to factors outside the place of care, such as legislation and public sentiment. Dutch guidelines for sedation largely tally with the practices prevalent in the Netherlands and Belgium, in contrast with those produced by the more international European Association for Palliative Care whose authors describe an ethical framework closer to that reportedly used by UK care providers. PMID:25389235

  19. The language of sedation in end-of-life care: The ethical reasoning of care providers in three countries

    OpenAIRE

    Seale, C; Raus, K; Bruinsma, S.; van der Heide, A.; Sterckx, S.; Mortier, F.; Payne, S; Mathers, N.; Rietjens, J; On behalf of the UNBIASED consortium

    2014-01-01

    The application of ethically controversial medical procedures may differ from one place to another. Drawing on a keyword and text-mining analysis of 156 interviews with doctors and nurses involved in end-of-life care ('care providers'), differences between countries in care providers' ethical rationales for the use of sedation are reported. In the United Kingdom, an emphasis on titrating doses proportionately against symptoms is more likely, maintaining consciousness where possible. The poten...

  20. The effect of interruption to propofol sedation on auditory event-related potentials and electroencephalogram in intensive care patients

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    Yppärilä, Heidi; Nunes, Silvia; Korhonen, Ilkka; Partanen, Juhani; Ruokonen, Esko

    2004-01-01

    Introduction In this observational pilot study we evaluated the electroencephalogram (EEG) and auditory event-related potentials (ERPs) before and after discontinuation of propofol sedation in neurologically intact intensive care patients. Methods Nineteen intensive care unit patients received a propofol infusion in accordance with a sedation protocol. The EEG signal and the ERPs were measured at the frontal region (Fz) and central region (Cz), both during propofol sedation and after cessation of infusion when the sedative effects had subsided. The EEG signal was subjected to power spectral estimation, and the total root mean squared power and spectral edge frequency 95% were computed. For ERPs, we used an oddball paradigm to obtain the N100 and the mismatch negativity components. Results Despite considerable individual variability, the root mean squared power at Cz and Fz (P = 0.004 and P = 0.005, respectively) and the amplitude of the N100 component in response to the standard stimulus at Fz (P = 0.022) increased significantly after interruption to sedation. The amplitude of the N100 component (at Cz and Fz) was the only parameter that differed between sedation levels during propofol sedation (deep versus moderate versus light sedation: P = 0.016 and P = 0.008 for Cz and Fz, respectively). None of the computed parameters correlated with duration of propofol infusion. Conclusion Our findings suggest that use of ERPs, especially the N100 potential, may help to differentiate between levels of sedation. Thus, they may represent a useful complement to clinical sedation scales in the monitoring of sedation status over time in a heterogeneous group of neurologically intact intensive care patients. PMID:15566595

  1. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

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    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

  2. Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit.

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    Sacco, Tara L; LaRiccia, Brenton

    2016-01-01

    Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful. PMID:27163223

  3. Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach.

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    Krishna, Lalit Kumar Radha

    2015-09-01

    The application of continuous deep sedation (CDS) in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia (PAS/E), which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient's situation and the engagement of a multidisciplinary team (MDT) guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process. PMID:26173777

  4. Narratives of 'terminal sedation', and the importance of the intention-foresight distinction in palliative care practice.

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    Douglas, Charles D; Kerridge, Ian H; Ankeny, Rachel A

    2013-01-01

    The moral importance of the 'intention-foresight' distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating 'slow euthanasia'. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. The majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some 'mental gymnastics,' the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of 'terminal' sedation--cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles. PMID:21726263

  5. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

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    Alawi Luetz

    Full Text Available Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1 and 868 patients (part 2 were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%. In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524 and approved by the ethical committee.

  6. Intensive care unit-acquired infection as a side effect of sedation

    OpenAIRE

    Nseir, Saad; Makris, Demosthenes; Mathieu, Daniel; Durocher, Alain; Marquette, Charles-Hugo

    2010-01-01

    Introduction Sedative and analgesic medications are routinely used in mechanically ventilated patients. The aim of this review is to discus epidemiologic data that suggest a relationship between infection and sedation, to review available data for the potential causes and pathophysiology of this relationship, and to identify potential preventive measures. Methods Data for this review were identified through searches of PubMed, and from bibliographies of relevant articles. Results Several epid...

  7. Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

    Directory of Open Access Journals (Sweden)

    Patrick Hoek

    Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

  8. Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine

    Directory of Open Access Journals (Sweden)

    Rajesh Chawla

    2014-01-01

    Full Text Available Background and Aim: Use of sedation, analgesia and neuromuscular blocking agents is widely practiced in Intensive Care Units (ICUs. Our aim is to study the current practice patterns related to mobilization, analgesia, relaxants and sedation (MARS to help in standardizing best practices in these areas in the ICU. Materials and Methods: A web-based nationwide survey involving physicians of the Indian Society of Critical Care Medicine (ISCCM and the Indian Society of Anesthesiologists (ISA was carried out. A questionnaire included questions on demographics, assessment scales for delirium, sedation and pain, as also the pharmacological agents and the practice methods. Results: Most ICUs function in a semi-closed model. Midazolam (94.99% and Fentanyl (47.04% were the most common sedative and analgesic agents used, respectively. Vecuronium was the preferred neuromuscular agent. Monitoring of sedation, analgesia and delirium in the ICU. Ramsay′s Sedation Scale (56.1% and Visual Analogue Scale (48.07% were the preferred sedation and pain scales, respectively. CAM (Confusion Assessment Method-ICU was the most preferred method of delirium assessment. Haloperidol was the most commonly used agent for delirium. Majority of the respondents were aware of the benefit of early mobilization, but lack of support staff and safety concerns were the main obstacles to its implementation. Conclusion: The results of the survey suggest that compliance with existing guidelines is low. Benzodiazepines still remain the predominant ICU sedative. The recommended practice of giving analgesia before sedation is almost non-existent. Delirium remains an underrecognized entity. Monitoring of sedation levels, analgesia and delirium is low and validated and recommended scales for the same are rarely used. Although awareness of the benefits of early mobilization are high, the implementation is low.

  9. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

    Directory of Open Access Journals (Sweden)

    Mohanad Shukry

    2010-03-01

    Full Text Available Mohanad Shukry, Jeffrey A MillerUniversity of Oklahoma Health Sciences Center, Department of Anesthesiology, Children’s Hospital of Oklahoma, Oklahoma City, OK, USAAbstract: Dexmedetomidine was introduced two decades ago as a sedative and supplement to sedation in the intensive care unit for patients whose trachea was intubated. However, since that time dexmedetomidine has been commonly used as a sedative and hypnotic for patients undergoing procedures without the need for tracheal intubation. This review focuses on the application of dexmedetomidine as a sedative and/or total anesthetic in patients undergoing procedures without the need for tracheal intubation. Dexmedetomidine was used for sedation in monitored anesthesia care (MAC, airway procedures including fiberoptic bronchoscopy, dental procedures, ophthalmological procedures, head and neck procedures, neurosurgery, and vascular surgery. Additionally, dexmedetomidine was used for the sedation of pediatric patients undergoing different type of procedures such as cardiac catheterization and magnetic resonance imaging. Dexmedetomidine loading dose ranged from 0.5 to 5 μg kg-1, and infusion dose ranged from 0.2 to 10 μg kg-1 h-1. Dexmedetomidine was administered in conjunction with local anesthesia and/or other sedatives. Ketamine was administered with dexmedetomidine and opposed its bradycardiac effects. Dexmedetomidine may by useful in patients needing sedation without tracheal intubation. The literature suggests potential use of dexmedetomidine solely or as an adjunctive agent to other sedation agents. Dexmedetomidine was especially useful when spontaneous breathing was essential such as in procedures on the airway, or when sudden awakening from sedation was required such as for cooperative clinical examination during craniotomies.Keywords: dexmedetomidine, sedation, nonintubated patients

  10. Sedation in the ICU

    DEFF Research Database (Denmark)

    Strøm, Thomas

    2012-01-01

    Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. This standard treatment to all patients has been greatly challenged over the last decade. At the general intensive care department at Odense University hospital the standard treatment has been ...... were: a no sedation strategy would reduce secondary organ failure such as kidney injury and would not increase the risk of post-traumatic stress disorder after hospital discharge....

  11. Effect of Magnesium Level to the Development of Delirium in Patients Under Sedation in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Zümrüt Ela Aslan

    2015-04-01

    Full Text Available Objective: Delirium is a state not to be neglected which can cause severe consequences that is related to critical illness in intensive care unit with acute cerebral dysfunction. Magnesium (Mg plays an important role in many physiological events affecting the brain. In this study, we retrospectively investigated the incidence of delirium development and its relationship with the serum Mg levels. Material and Method: Patients who admitted to intensive care unit (ICU were divided in to two groups according to their serum Mg levels (0.7 normomagnesemia. Delirium was assessed using Richmond Agitation Sedation Scale and Confusion Assessment Method for ICU. We identified the duration of mechanical ventilation, applied sedation, age, gender, sepsis, shock, malignancy, ICU requirement after operation, admission SOFA score, admission APACHE II score, admission of Mg and mean Mg levels as secondary outcome measures whether they affected delirium incidence. Results: A total of 178 patients were assessed, 72 of them were found delirium positive. The incidence of delirium was found 45% in patients with hypomagnesaemia; this was found 25% in patients with normomagnesaemia. Duration of mechanical ventilation, ICU stay, and mortality rate were found higher in patients with delirium than those in individuals without delirium. Conclusion: We retrospectively investigated delirium incidence in critically ill patients and the percentage was found remarkably high. Our findings were parallel with the other studies that, delirium has a negative impact on morbidity and mortality rates.

  12. Sedation practice in Nordic and non-Nordic ICUs

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Albarran, John W.; Ring, Mette;

    2013-01-01

    A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries.......A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries....

  13. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version

    OpenAIRE

    Baron, R.; Binder, A.; Biniek, R; Braune, S; Buerkle, H; Dall, P.; Demirakca, S; Eckardt, R; Eggers, V; Eichler, I; Fietze, I.; Freys, S; Fründ, A; Garten, L; Gohrbandt, B

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  14. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    OpenAIRE

    DAS-Taskforce 2015; Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  15. Monitoring and delivery of sedation.

    Science.gov (United States)

    Sheahan, C G; Mathews, D M

    2014-12-01

    Sedation for medical procedures is provided in a variety of clinical settings by medical personnel with differing levels of education and training. Although generally a safe practice, there is a degree of morbidity and mortality associated with sedation practice. Monitoring standards continue to be refined by professional societies with the goal of improving care. The depth of sedation should be monitored with clinical criteria. Processed electroencephalographic monitors currently do not contribute significantly to sedation care. Monitoring ventilation using pulse oximetry should be abandoned for more direct methods, such as capnography-transcutaneous carbon dioxide, respiratory acoustical and thoracic impedance monitoring could also play a role. Propofol has become widely utilized for sedation, although there are concerns about its margin of safety and synergistic interactions with other agents. Dexmedetomidine and propofol/ketamine also have utility. Patient-controlled sedation pumps and target-controlled infusion devices have been developed to improve patient care and satisfaction. A computer-assisted propofol sedation device to be used by non-anaesthesiologists has been approved in the USA by the Food and Drug Administration. More computer-assisted sedation delivery devices are likely to be developed, but their clinical utility is unclear. PMID:25498581

  16. The perspectives of clinical staff and bereaved informal care-givers on the use of continuous sedation until death for cancer patients: The study protocol of the UNBIASED study

    Directory of Open Access Journals (Sweden)

    van der Heide Agnes

    2011-03-01

    Full Text Available Abstract Background A significant minority of dying people experience refractory symptoms or extreme distress unresponsive to conventional therapies. In such circumstances, sedation may be used to decrease or remove consciousness until death occurs. This practice is described in a variety of ways, including: 'palliative sedation', 'terminal sedation', 'continuous deep sedation until death', 'proportionate sedation' or 'palliative sedation to unconsciousness'. Surveys show large unexplained variation in incidence of sedation at the end of life across countries and care settings and there are ethical concerns about the use, intentions, risks and significance of the practice in palliative care. There are also questions about how to explain international variation in the use of the practice. This protocol relates to the UNBIASED study (UK Netherlands Belgium International Sedation Study, which comprises three linked studies with separate funding sources in the UK, Belgium and the Netherlands. The aims of the study are to explore decision-making surrounding the application of continuous sedation until death in contemporary clinical practice, and to understand the experiences of clinical staff and decedents' informal care-givers of the use of continuous sedation until death and their perceptions of its contribution to the dying process. The UNBIASED study is part of the European Association for Palliative Care Research Network. Methods/Design To realize the study aims, a two-phase study has been designed. The study settings include: the domestic home, hospital and expert palliative care sites. Phase 1 consists of: a focus groups with health care staff and bereaved informal care-givers; and b a preliminary case notes review to study the range of sedation therapy provided at the end of life to cancer patients who died within a 12 week period. Phase 2 employs qualitative methods to develop 30 patient-centred case studies in each country. These involve

  17. Initial experience with intravenous pentobarbital sedation for children undergoing MRI at a tertiary care pediatric hospital: the learning curve

    International Nuclear Information System (INIS)

    Objective. Our purpose is to describe the initial experience with intravenous pentobarbital sedation in children undergoing MRI at a tertiary pediatric hospital to identify errors associated with inexperience. Subjects and methods. The study included the first 100 children sedated with intravenous pentobarbital prior to magnetic resonance examination at a tertiary pediatric hospital. The protocol included a maximum dose of 6 mg/kg administered in three divided doses with the total dose not to exceed 200 mg. Flow sheets documenting vital signs, administered drug doses, and adverse reactions were maintained contemporaneous to sedation. Results. Sedation was successful in 92 children. Of the eight children who failed sedation, three were at least 12 years old and three weighed more than 50 kg. χ2 tests identified significantly greater failure rates in children older than 11 years or weight greater than 50 kg. Two children had prolonged sedation after the maximum suggested dose was exceeded. Conclusions. The success rate was good, but could have been improved by restricting the use of pentobarbital to children less than 12 years of age and weighing less than 50 kg. Radiologists inexperienced with intravenous sedation should strictly observe the maximum suggested dose of pentobarbital to prevent prolonged sedation. (orig.)

  18. Mac Bible

    CERN Document Server

    Spivey, Dwight

    2009-01-01

    This essential guide answers all your questions on using a Macintosh computer, whether you?re unpacking your very first Mac after switching from a PC or upgrading from an older Mac. You?ll walk through all pre-installed Mac applications, including using Mac OS X, browsing the Web using Safari, downloading music from the iTunes store, troubleshooting Mac-specific problems, organizing photos in iPhoto, organizing calendars in iCal, editing digital video in iMovie, and more.

  19. Retrospective Outcomes Evaluation of 100 Parenteral Moderate and Deep Sedations Conducted in a General Practice Dental Residency

    OpenAIRE

    Messieha, Zakaria; Cruz-Gonzalez, Wanda; Hakim, Michel I

    2008-01-01

    An abstract of this study was presented at the American Association for Dental Research (AADR) Dental Anesthesiology Research Group in Honolulu, Hawaii, in March of 2004. This study was conducted to correlate the intraoperative and postoperative morbidity associated with moderate and deep sedation, also known as monitored anesthesia care (MAC), provided in a General Practice Residency (GPR) clinic under the supervision of a dentist anesthesiologist. After internal review board approval was ob...

  20. Effect of an analgo-sedation protocol for neurointensive patients

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Jensen, Malene Brorson; Herling, Suzanne Forsyth; Welling, Karen-Lise

    2010-01-01

    Sedation protocols are needed for neurointensive patients. The aim of this pilot study was to describe sedation practice at a neurointensive care unit and to assess the feasibility and efficacy of a new sedation protocol. The primary outcomes were a shift from sedation-based to analgesia...

  1. Under a watchful eye...: New Medication and Monitoring of Sedation and Analgesia in Pediatric Intensive Care

    NARCIS (Netherlands)

    S.A. Prins (Sandra)

    2005-01-01

    textabstractErnstig zieke kinderen op een kinder-intensive care (IC) afdeling, krijgen regelmatig kalmerende middelen (sedativa) en pijnstillers (analgetica) toegediend om discomfort, onrust en pijn te voorkomen. Om bijwerkingen van deze middelen te voorkomen en om er voor te zorgen dat ze goed hun

  2. Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

    Directory of Open Access Journals (Sweden)

    Kerckhove Wannes

    2010-01-01

    Full Text Available Abstract Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA. Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows

  3. Association of nausea and vomiting in between anaesthetic or patients factors in Monitored Anaesthesia Care (MAC after gastrointestinal endoscopies in tertiary care hospital: An Audit

    Directory of Open Access Journals (Sweden)

    Khalid Maudood Siddiqui

    2012-09-01

    Full Text Available Introduction: Esophagogastroduodenoscopy (EGD is used for both diagnostic and therapeutic procedures. EGD under Monitored Anesthesia Care (MAC is gaining wide acceptance, but nausea and vomiting remains one of the most common and distressing complications, which require additional resources and may delay in the discharge of patient from hospital. The aim of this audit was to determine the association of nausea and vomiting in between anaesthetic technique or patients factors after gastrointestinal endoscopic procedures under MAC. Methods: After finishing 3 hours of endoscopic procedure one of the investigators evaluated and collects the patient’s data in the ward and filled the predesigned assessment form and ticked the different variables which may have effect on nausea and vomiting. Results: 130 patients were enrolled over the period of 1 year. During the all procedure we observed mild to severe nausea vomiting in those patients who have diabetes mellitus and 10 patients were need antiemetic to control vomiting. Conclusion: Incidence of PONV (Postoperative nausea and vomiting is high after endoscopy under MAC especially in those patients who has high risk factors for PONV as well as in known diabetic patients. So prophylactic antiemetic therapy should be commenced in those patients and further randomized controlled trial should be recommended to establish this relationship.

  4. MacBook for dummies

    CERN Document Server

    Chambers , Mark L

    2014-01-01

    Make friends with your MacBook the fun and easy way! Ultra-light, ultra-fast, and ultra-powerful, the MacBook is the coolest laptop in town, and longtime Mac guru Mark L. Chambers is just the guy to help you get to know your MacBook in no time. Take a closer look at the latest features, get the lowdown on OS X, unleash your creative forces with iLife, take care of business with the iWork applications, and sync it all with iCloud with the expert advice in this bestselling MacBook guide. Whether this is your first MacBook or your first laptop, period, you''ll learn to navigate the Mac desktop, c

  5. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015 – short version

    Directory of Open Access Journals (Sweden)

    DAS-Taskforce 2015

    2015-11-01

    Full Text Available In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine, twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM in conjunction with Society of Critical Care Medicine (SCCM and American Society of Health-System Pharmacists (ASHP from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation, Grade “B” (recommendation and Grade “0” (open recommendation. The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

  6. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    Science.gov (United States)

    Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang; Heppner, Hans-Jürgen; Horter, Johannes; Huth, Ralf; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, Stefan; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, Maritta; Putensen, Christian; Roth, Bernd; Schaefer, Michael; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter; Trieschmann, Uwe; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weisshaar, Guido

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine. PMID:26609286

  7. Terminal sedation: ethical implications in different situations.

    Science.gov (United States)

    Hallenbeck, J L

    2000-01-01

    Terminal sedation (TS) is a recently coined term that may apply to a variety of practices with differing ethical implications. Two hypothetical cases are presented and contrasted. The first presents the more common scenario in which sedation is used for severe distress in a patient very close to death, who has stopped eating and drinking. The second case is more problematic: a nonterminally ill spinal cord injury patient requests sedation because of psychic distress. Sedation is supported in the former, but not the latter case. Suggested principles guiding the ethical use of sedation are: (1) While respect for autonomy is important, we are not obliged under all circumstances to provide sedation. (2) Physician intent matters. In providing sedation the physician's primary intent should be to alleviate suffering. (3) Reasonable inferences of intent can be made from physician actions, providing safeguards to ensure proper care. Sedatives should be titrated to observable signs of distress. (4) Proximity to death is a more useful concept than terminality in weighing benefits and burdens of sedation. (5) The nature of physician action should depend upon the nature of the suffering. Not all suffering is appropriately treated with sedation. (6) In patients close to death who have already stopped eating and drinking, sedation cannot be said to hasten death through dehydration or starvation. (7) Where TS is otherwise appropriate and where dehydration may in fact hasten death, ethical concerns may be addressed through informed consent. If hydration is refused, TS cannot be considered synonymous with euthanasia. PMID:15859672

  8. Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety.

    Directory of Open Access Journals (Sweden)

    Valérie Collado

    Full Text Available The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID compared to dentally anxious patients (DA. Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale, and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS. 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test. Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test. Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test. Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions and were less often relaxed after induction (58.9% ID vs. 90.3% DA and during dental treatment (39.5% ID vs. 59.7% DA (p<0.001, Fisher exact test than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂, were shown to be safe and effective in patients with intellectual disability when administered by dentists.

  9. No-sedation during mechanical ventilation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2016-01-01

    care unit (ICU), patients were Richmond Agitation and Sedation Scale (RASS) scored, nursing workload was measured with the Nursing Care Recording System (NCR11) and nurse's self-assessment of workload was reported on a Numeric Rating Scale from 1 (low) to 10 (high). RESULTS: Patients from the no...... use of a 1:1 nurse-patient ratio and no-sedation compared with sedation and a 1:2 nurse-patient ratio.......BACKGROUND: Evidence is growing that less or no-sedation is possible and beneficial for patients during mechanical ventilation. AIM: To investigate if there was a difference in patient consciousness and nursing workload comparing a group of patients receiving no-sedation with a group of sedated...

  10. Pediatric dental sedation: challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Nelson TM

    2015-08-01

    Full Text Available Travis M Nelson, Zheng Xu Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA Abstract: High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a

  11. Sedation and Analgesia in Mechanical Ventilation

    DEFF Research Database (Denmark)

    Strøm, Thomas; Toft, Palle

    2014-01-01

    Traditionally, critically ill patients undergoing mechanical ventilation (MV) have received sedation. Over the last decade, randomized controlled trials have questioned continued use of deep sedation. Evidence shows that a nurse-driven sedation protocol reduces length of MV compared with standard...... strategy with sedation. Furthermore, daily interruption of sedation reduces length of MV, intensive care unit (ICU), and hospital length of stay (LOS). A larger scale trial with daily interruption of sedation has confirmed these findings and furthermore showed a reduction in 1-year mortality with the use...... psychological morbidity. Moreover, delirium has gained increased focus in recent years with development of validated tools to detect both hyperactive and hypoactive forms of delirium. Using validated tools for detecting delirium is important in monitoring and detecting acute brain dysfunction in critically ill...

  12. 重症加强治疗病房成人患者浅镇静治疗进展%The progress of light sedation for critically ill adult patients in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    李双玲; 王东信; 杨拔贤

    2016-01-01

    The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.%对重症加强治疗病房(ICU)成人患者镇静方面的最新进展进行综述,强调浅镇静策略是目前ICU危重患者镇静的主要治疗原则,其主要内容包括:①目标导向的浅镇静应常规化,尽可能在镇静早期即达标;②应摒弃常规使用苯二氮类药物,尤其对有谵妄风险或已经有谵妄的患者;③联合药物或非药物的有效方法预防和治疗躁动;④制定纳入疼痛、躁动和谵

  13. Mycobacterium Avium Complex (MAC)

    Science.gov (United States)

    ... Select a Language: Fact Sheet 514 Mycobacterium Avium Complex (MAC) WHAT IS MAC? HOW DO I KNOW ... THE BOTTOM LINE WHAT IS MAC? Mycobacterium Avium Complex (MAC) is a serious illness caused by common ...

  14. The Practice of Continuous Palliative Sedation in Long-Term Care for Frail Patients with Existential Suffering.

    Science.gov (United States)

    van Deijck, Rogier H P D; Hasselaar, Jeroen G J; Krijnsen, Petrus J Cc; Gloudemans, Amadea J M; Verhagen, Stans C A H H V M; Vissers, Kris C P; Koopmans, Raymond T C M

    2015-01-01

    Some guidelines and recommendations identify existential suffering as a potential refractory symptom for which continuous palliative sedation (CPS) can be administered under certain conditions. However, there has been little research on the characteristics of patients with existential suffering treated with CPS and the degree to which the preconditions are fulfilled. The aim of this study was to provide insight into this specific indication for CPS. Questionnaires were sent to nursing home physicians in The Netherlands, who described 314 patients. Existential suffering was a refractory symptom in 83 of the patients. For most of the patients with refractory existential suffering, other refractory symptoms were also reported, and life expectancy was seven days or less; informed consent for initiating CPS had been obtained in all cases. Consultation and intermittent sedation before the start of CPS were far less frequently reported than one would expect based on the guidelines. Multivariate analysis showed that being male, having previously requested euthanasia, having a nervous system disease, or having an other diagnosis were positively correlated with the administration of CPS for existential suffering. We conclude that more attention should be paid to the suggested preconditions and to the presence of existential suffering in male patients or patients with a nervous system disease. PMID:26514019

  15. Sedação e analgesia em terapia intensiva Sedación y analgesia en terapia intensiva Sedation and analgesia in intensive care

    Directory of Open Access Journals (Sweden)

    Fábio Ely Martins Benseñor

    2003-09-01

    características principales bien como sus efectos colaterales más importantes. Adicionamos algunos protocolos utilizados en nuestra UTI para analgesia y sedación, como también las Conclusiones del último consenso del Colegio Americano de Medicina Intensiva y de la Sociedad Americana de Terapia Intensiva. CONCLUSIONES: A pesar del grande arsenal terapéutico disponible en la práctica clínica, se nota un gran desconocimiento de las principales características de los fármacos utilizados para sedación y analgesia en la terapia intensiva. Los consensos realizados intentan difundir las calidades y efectos colaterales de los fármacos más utilizados, normalizando su uso, haciendo con que la analgesia y sedación realizadas en las UTI, sean procedimientos que beneficien y recuperen más rápidamente los pacientes.BACKGROUND AND OBJECTIVES: Pain and anxiety may cause major discomfort, increase the risk for postoperative complications in surgical patients and may even prolong their hospital stay. This study aimed at reviewing concepts of sedation and analgesia in intensive care, updating knowledge and reviewing information available in the literature as well as already published consensus. CONTENTS: Sedation and analgesia are presented in separate, reviewing each group of available drugs, their major characteristics and side-effects. We have included some protocols used in our ICU for analgesia and sedation as well as the conclusions of the latest consensus of the American College of Critical Care Medicine and the Society of Critical Care Medicine. CONCLUSIONS: In spite of the therapeutic armamentarium available, there is a lack of understanding about major characteristics of drugs used for sedation and analgesia in Intensive Care. Developed consensus try to explain qualities and side-effects of most popular drugs, normalizing their use for ICU analgesia and sedation to benefit and faster recover patients.

  16. Macs portable genius

    CERN Document Server

    McFedries, Paul

    2008-01-01

    You're one of the legions of fans who enjoy the ease and simplicity of the Mac. But some functions still elude you. How do you synch your Mac with other devices? What are the best ways to organize your life and files with your Mac? Can you get more from your Mac hardware or upgrade it? The Portable Genius is here to help. With expert advice and a Mac-savvy attitude, the Macs Portable Genius guides you through getting the most out of your Mac. From the Introduction: ""Welcome to Macs Portable Genius. This book is like a mini Genius Bar all wrapped up in an easy to use, easy

  17. Benzodiazepines: Sedation and Agitation.

    Science.gov (United States)

    Gallagher, Catherine

    2016-01-01

    Dental anxiety is common and frequently poses a barrier to necessary dental treatment. The increasing availability of conscious sedation in dental practice has made treatment much more accessible for anxious patients. At present, benzodiazepines are the most commonly used drugs in sedation practice and provide a pleasant experience for most, but not all, patients. An understanding of the mechanism of action of benzodiazepines should inform our practice and deepen our understanding of why and how sedation may fail. CPD/CLINICAL RELEVANCE: As an increasing number of dentists provide sedation for their patients an update on benzodiazepines is timely. PMID:27024905

  18. Sedative drug interactions of clinical importance.

    Science.gov (United States)

    Cushman, P

    1986-01-01

    In an age of widespread availability of psychoactive drugs, use of multiple sedatives is very common. Why such multiple drug use prevails is poorly understood. Sequential drug use may leave sequential problems. Concomitant use of several drugs can produce a host of interactions. Increasingly, the metabolic basis of sedative interactions are becoming known. Cross-tolerance between sedatives permit substitution of one for another and reduced sedation when combined. Metabolic interactions at the hepatic oxidation enzyme level may greatly affect drug disposal rates. Recognition of polysubstance abuse can assist in management. Treatment ranges from urgent life support to abrupt or slow withdrawal, to substitution long-term treatment usually requiring specialized care, with abstinence the preferred goal. However, polysubstance abusers seem to have low probabilities of achieving lasting abstinence. PMID:2871595

  19. Strategies to optimize analgesia and sedation.

    Science.gov (United States)

    Schweickert, William D; Kress, John P

    2008-01-01

    Achieving adequate but not excessive sedation in critically ill, mechanically ventilated patients is a complex process. Analgesics and sedatives employed in this context are extremely potent, and drug requirements and metabolism are unpredictable. Clinicians must have heightened awareness of the potential for enduring effects and are encouraged to employ strategies that maximize benefit while minimizing risk. Successful sedation protocols have three basic components: frequent assessments for pain, anxiety, and agitation using a reproducible scale; combination therapy coupling opioids and sedatives; and, most importantly, careful communication between team members, with a particular recognition that the bedside nurse must be empowered to pair assessments with drug manipulation. In recent years, two broad categories of sedation protocols have achieved clinical success in terms of decreasing duration of mechanical ventilation and intensive care unit length of stay by minimizing drug accumulation. Patient-targeted sedation protocols (the first category) rely on structured assessments to guide a careful schema of titrated drug escalation and withdrawal. Variation exists in the assessment tool utilized, but the optimal goal in all strategies is a patient who is awake and can be readily examined. Alternatively, daily interruption of continuous sedative infusions (the second category) may be employed to focus care providers on the goal of achieving a period of awakening in the earliest phases of critical illness possible. Newer literature has focused on the safety of this strategy and its comparison with intermittent drug administration. Ongoing investigations are evaluating the broad applicability of these types of protocols, and currently one may only speculate on whether one strategy is superior to another. PMID:18495057

  20. Sedation levels during propofol administration for outpatient colonoscopies

    OpenAIRE

    Ramsay, Michael A.E.; Newman, Kate B.; Jacobson, Robert M.; Richardson, Charles T; Rogers, Lindsay; Brown, Bertrand J.; Hein, H. A. Tillmann; De Vol, Edward B.; DaouD, Yahya A.

    2014-01-01

    The levels of sedation required for patients to comfortably undergo colonoscopy with propofol were examined. One hundred patients undergoing colonoscopy with propofol were enrolled. In addition to standard-of-care monitoring, sedation level was monitored with the Patient State Index (PSI) obtained from a brain function monitor, transcutaneous carbon dioxide (tcpCO2) was monitored with the TCM TOSCA monitor, and end-tidal carbon dioxide was monitored via nasal cannula. The Ramsay Sedation Scor...

  1. McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol

    Science.gov (United States)

    Bailly, Arthur; Le Thuaut, Aurelie; Boisrame-Helms, Julie; Kamel, Toufik; Mercier, Emmanuelle; Ricard, Jean Damien; Lemiale, Virginie; Champigneulle, Benoit; Reignier, Jean

    2015-01-01

    Introduction Critically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation and anaesthesia such as hypotension and hypoxaemia. The complication rate increases with the number of intubation attempts. Videolaryngoscopy improves elective endotracheal intubation. McGRATH MAC is the lightest videolaryngoscope and the most similar to the Macintosh laryngoscope. The primary goal of this trial was to determine whether videolaryngoscopy increased the frequency of successful first-pass intubation in critically ill patients, compared to direct view Macintosh laryngoscopy. Methods and analysis MACMAN is a multicentre, open-label, randomised controlled superiority trial. Consecutive patients requiring intubation are randomly allocated to either the McGRATH MAC videolaryngoscope or the Macintosh laryngoscope, with stratification by centre and operator experience. The expected frequency of successful first-pass intubation is 65% in the Macintosh group and 80% in the videolaryngoscope group. With α set at 5%, to achieve 90% power for detecting this difference, 185 patients are needed in each group (370 in all). The primary outcome is the proportion of patients with successful first-pass orotracheal intubation, compared between the two groups using a generalised mixed model to take the stratification factors into account. Ethics and dissemination The study project has been approved by the appropriate ethics committee (CPP Ouest 2, # 2014-A00674-43). Informed consent is not required, as both laryngoscopy methods are considered standard care in France; information is provided before study inclusion. If videolaryngoscopy proves superior to Macintosh laryngoscopy, its use will become standard practice, thereby decreasing first-pass intubation failure rates and, potentially, the frequency of intubation

  2. Determination of total and unbound propofol in patients during intensive care sedation by ultrafiltration and LC-MS/MS.

    Science.gov (United States)

    Eisenried, Andreas; Wehrfritz, Andreas; Ihmsen, Harald; Schüttler, Jürgen; Jeleazcov, Christian

    2016-07-15

    For the quantification of propofol total and unbound drug concentrations a sensitive and specific liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated. To separate unbound propofol an ultrafiltration step before sample preparation was performed. Both the ultrafiltrate and plasma samples were extracted with solid-phase extraction and substituted with deuterated propofol as an internal standard. Separation was performed by gradient elution using UPLC-like system and analyzed by MS/MS consisting of an electrospray ionization source. To detect low and high concentration levels of propofol two calibration curves were identified and showed linearity within the range of 1-50ng/ml and 50-20000ng/ml. The lower limit of quantification was 1ng/ml. Intra- and interassay precision and accuracy did not exceed ±15%. The method was applied to a clinical study during intensive care treatment of patients after coronary artery bypass grafting. PMID:27214058

  3. Macs for dummies

    CERN Document Server

    Baig, Edward C

    2014-01-01

    Get the most out of your Mac with this comprehensive guide Macs For Dummies, 13th Edition is the ultimate guide to your Mac, fully updated to include information about the latest updates. The book walks you through troubleshooting, syncing mobile devices, integrating Windows, and more, so you can take advantage of everything Macs have to offer. Whether you're a new user, a recent convert, or you just want to get the most out of your Mac, this book puts all the information you need in one place. Discover what makes Macs superior computing machines. Learn the basics, from mastering the Dock and

  4. Windows for Intel Macs

    CERN Document Server

    Ogasawara, Todd

    2008-01-01

    Even the most devoted Mac OS X user may need to use Windows XP, or may just be curious about XP and its applications. This Short Cut is a concise guide for OS X users who need to quickly get comfortable and become productive with Windows XP basics on their Macs. It covers: Security Networking ApplicationsMac users can easily install and use Windows thanks to Boot Camp and Parallels Desktop for Mac. Boot Camp lets an Intel-based Mac install and boot Windows XP on its own hard drive partition. Parallels Desktop for Mac uses virtualization technology to run Windows XP (or other operating systems

  5. European Palliative Care Research collaborative pain guidelines. Central side-effects management: what is the evidence to support best practice in the management of sedation, cognitive impairment and myoclonus?

    Science.gov (United States)

    Stone, Patrick; Minton, Ollie

    2011-07-01

    This is a systematic review examining the management of opioid-induced central side effects. It has been conducted as part of a larger European Palliative Care Research collaborative review into the use and role of opioids in cancer pain. The review process identified 26 studies that met the inclusion criteria. The overall quality of the data was low and the few recommendations that can be made are weak and require confirmatory studies. The main central side effects examined were sedation, cognitive failure, sleep disturbance and myoclonus. Overall there is limited evidence for the use of methylphenidate in counteracting opioid-induced sedation and cognitive disturbance. No clear recommendations can be made concerning other individual drugs for the management of any of the central side effects examined. Given the lack of available data from this review there need to be further prospective controlled trials to confirm or refute these findings. PMID:20870687

  6. Intention, procedure, outcome and personhood in palliative sedation and euthanasia.

    Science.gov (United States)

    Materstvedt, Lars Johan

    2012-03-01

    Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect. PMID:24653491

  7. Mac OS X Forensics

    Science.gov (United States)

    Craiger, Philip; Burke, Paul

    This paper describes procedures for conducting forensic examinations of Apple Macs running Mac OS X. The target disk mode is used to create a forensic duplicate of a Mac hard drive and preview it. Procedures are discussed for recovering evidence from allocated space, unallocated space, slack space and virtual memory. Furthermore, procedures are described for recovering trace evidence from Mac OS X default email, web browser and instant messaging applications, as well as evidence pertaining to commands executed from a terminal.

  8. Enterprise Mac administrators guide

    CERN Document Server

    Smith, William

    2015-01-01

    IT departments everywhere will be integrating Macs and Mac OS X into their IT infrastructure and this book will tell them how to do it. It will serve as an authoritative, useful and frequently referenced book on Mac OS X administration.

  9. Rectal Sedation with Thiopental in Children

    International Nuclear Information System (INIS)

    Objective: to determine the effectiveness of a rectal sedation protocol with sodium thiopental in children undergoing diagnostic imaging studies in a level-four-complexity health care facility. Materials and Methods: this case series observational study was developed between the months of January and March 2004 in the Fundacion clinica Valle del Lili. All pediatric patients between the ages of three months and eight years of age who underwent an imaging study were included. A dose of 25-40 mg/kg of sodium thiopental was administered rectally. Successful sedation was defined as one that allowed the successful completion of the study with the least number of motion artifacts. The features of the sedation and the adverse effects were evaluated. Results: the study population included 103 children with a median age of two years. The imaging studies were successfully concluded in 97% of the patients. The average total time until complete awakening was 2.9 hours. With respect to the interruption of sedation, we found statistically significant differences between the children who were kept awake the night before the procedure and those who were not. The most common adverse effect was diarrhea, which was recorded in 13 patients. Five of the patients required a supplemental dose of the sedative. There were two cases of increased salivation and one of vomiting, yet they resolved spontaneously. Conclusions: this rectal sodium thiopental protocol is a safe and effective procedure for the completion of diagnostic imaging studies in the pediatric population at our health care center.

  10. A protocol of no sedation for critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Strøm, Thomas; Martinussen, Torben; Toft, Palle

    2010-01-01

    BACKGROUND: Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general intesive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation....

  11. Enterprise Mac Administrator's Guide

    CERN Document Server

    Edge, Charles; Hunter, Beau

    2009-01-01

    Charles Edge, Zack Smith, and Beau Hunter provide detailed explanations of the technology required for large-scale Mac OS X deployments and show you how to integrate it with other operating systems and applications. Enterprise Mac Administrator's Guide addresses the growing size and spread of Mac OS X deployments in corporations and institutions worldwide. In some cases, this is due to the growth of traditional Mac environments, but for the most part it has to do with "switcher" campaigns, where Windows and/or Linux environments are migrating to Mac OS X. However, there is a steep cu

  12. A study of patient attitudes towards fasting prior to intravenous sedation for dental treatment in a dental hospital department.

    LENUS (Irish Health Repository)

    McKenna, Gerald

    2010-01-01

    Intravenous sedation is the most commonly used method of sedation for the provision of adult dental care. However, disparity exists in pre-operative fasting times in use for patients throughout the United Kingdom.

  13. Mac at Work

    CERN Document Server

    Sparks, David

    2011-01-01

    Bridge the gap between using a Mac at home and at the office. Now that you love your Mac at home, you want to use one at the office without missing a beat of productivity or professionalism. This unique guide shows you how.  You'll find best Mac business practices for handling word processing, spreadsheet and presentation creation, task and project management, and graphics. The book also explores topics such as hardware maintenance, how to synchronize with multiple computers, data backup, and communication with Windows networks.: Covers the nuts and bolts of using a Mac at work, including sync

  14. Macs portable genius

    CERN Document Server

    McFedries, Paul

    2010-01-01

    Facts, tips, and secrets for using the powerful-but less obvious-features of a Mac Packed with tricks, tools, and shortcuts that you may not discover by simply working with a program or software on your Mac, Macs Portable Genius, 2nd Edition reveals smart and innovative ways to execute various tasks that can save you time and hassle. Its handy smaller trim size makes it easy for you to find essential information, coupled with savvy advice on everything from simple tasks like getting started to intermediate information and hip tips that cover how to use Macs and related hardware. Reveals fac

  15. 镇静镇痛治疗辅助无创机械通气患者的护理%Nursing care on the sedation of patients with non-invasive ventilation

    Institute of Scientific and Technical Information of China (English)

    吕小红; 袁莉萍; 汪君; 吴允东; 蒋莉莉; 周全; 鲁卫华; 王箴

    2015-01-01

    目的:探讨镇静镇痛治疗辅助无创机械通气在重症监护病房(ICU)危重患者中应用的护理策略。方法2012年6月至2013年6月ICU中28例无创机械通气患者辅助镇静镇痛治疗,其间护士密切观察病情变化,监测心率、血压、血氧饱和度等生命体征,定时采用Ramsay评分评估镇静程度,根据镇静目标,调整药物维持剂量。结果尽管治疗过程中存在过度镇静、血流动力学不稳定等并发症,但89.3%(25/28)的患者病情好转。结论护士依据无创机械通气与镇静治疗特点,制订包含治疗有效性及安全性的综合性护理策略,熟悉治疗流程,加强并发症的管理,对提高无创机械通气治疗的耐受性及成功率有重要意义。%Objective To investigate the effect of the nursing care of critically ill patients in intensive care unit(ICU) with non-invasive ventilation assisted by sedation simultaneously. Methods During the intervention phase from June 2012 to June 2013 of 28 patients in ICU treated by non-invasive ventilation, sedatives were adjusted according to Ramsay Scale, and the parameters of the life signs (heart rate, blood pressure, oxygen saturation,etc) were measured by nurses. Results 89.3%(25/28) patients obtained the improvement of the disease despite of the complications such as over-sedation and instable hemodynamics. Conclusion The key points can increase tolerance of non-invasive ventilation and improve clinical outcomes, develop comprehensive nursing strategies on safety and effectiveness of sedation and non-invasive ventilation .

  16. Enterprise Mac Security Mac OS X Snow Leopard Security

    CERN Document Server

    Edge, Stephen Charles; Hunter, Beau; Sullivan, Gene; LeBlanc, Dee-Ann

    2010-01-01

    A common misconception in the Mac community is that Mac's operating system is more secure than others. While this might be true in certain cases, security on the Mac is still a crucial issue. When sharing is enabled or remote control applications are installed, Mac OS X faces a variety of security threats. Enterprise Mac Security: Mac OS X Snow Leopard is a definitive, expert-driven update of the popular, slash-dotted first edition and was written in part as a companion to the SANS Institute course for Mac OS X. It contains detailed Mac OS X security information, and walkthroughs on securing s

  17. Introduction to MAC CRM training

    Science.gov (United States)

    Brown, Donald D.

    1987-01-01

    The author introduces the Military Airlift Command (MAC) and its mission. A brief history of Cockpit Resource Management (CRM) as it relates to MAC is given. He also states why MAC is currently interested in CRM.

  18. Conscious Intravenous Sedation in Dentistry: A Review of Current Therapy.

    Science.gov (United States)

    Southerland, Janet H; Brown, Lawrence R

    2016-04-01

    Several sedation options are used to minimize pain, anxiety, and discomfort during oral surgery procedures. Minimizing or eliminating pain and anxiety for dental care is the primary goal for conscious sedation. Intravenous conscious sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate as well as cardiovascular function. Patients must retain their protective airway reflexes, and respond to and understand verbal communication. The drugs and techniques used must therefore carry a broad margin of safety. PMID:27040288

  19. The complex interplay between delirium, sepsis and sedation

    OpenAIRE

    Kress, John P

    2010-01-01

    Critically ill patients requiring mechanical ventilation frequently suffer from intensive care unit delirium, a syndrome associated with numerous poor measured outcomes. The relationship between delirium, sepsis, and sedation is complex. A discussion of the recent study ('Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS [maximizing efficacy of targeted sedation and reducing neurological dysfunction] randomized controlled...

  20. Enterprise Mac Managed Preferences

    CERN Document Server

    Marczak, Edward

    2010-01-01

    Many systems administrators on the Mac need a way to manage machine configuration after initial setup and deployment. Apple's Managed Preferences system (also known as MCX) is under-documented, often misunderstood, and sometimes outright unknown by sys admins. MCX is usually deployed in conjunction with an OS X server, but it can also be used in Windows environments or where no dedicated server exists at all. Enterprise Mac Managed Preferences is the definitive guide to Apple's Managed Client technology. With this book, you'll get the following: * An example-driven guide to Mac OS X Managed Pr

  1. Analgesia and Sedation After Pediatric Cardiac Surgery

    OpenAIRE

    2010-01-01

    Abstract In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery, has become recognised as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast track and ultra fast track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric in...

  2. McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol

    OpenAIRE

    Bailly, Arthur; Lascarrou, Jean Baptiste; Le Thuaut, Aurelie; Boisrame-Helms, Julie; Kamel, Toufik; Mercier, Emmanuelle; Ricard, Jean Damien; Lemiale, Virginie; Champigneulle, Benoit; Reignier, Jean

    2015-01-01

    Introduction Critically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation and anaesthesia such as hypotension and hypoxaemia. The complication rate increases with the number of intubation attempts. Videolaryngoscopy improves elective endotracheal intubation. McGRATH MAC is the lightest videolaryngoscope and the mos...

  3. Therapeutics and Sedation in Dentistry

    OpenAIRE

    Young, Earle R.

    1988-01-01

    Sedation can help to overcome the fear that prevents many Canadians from accepting dental treatment. This article discusses the indications and contraindications for oral, intramuscular, and inhalation sedation as used by the general dental practitioner for both adult and child patients, with a note on the growing number of specialist dental anesthetists who provide intravenous out-patient sedation. Local anesthesia is discussed with reference to allergic reactions, malignant hyperthermia, an...

  4. Sedation levels during propofol administration for outpatient colonoscopies.

    Science.gov (United States)

    Ramsay, Michael A E; Newman, Kate B; Jacobson, Robert M; Richardson, Charles T; Rogers, Lindsay; Brown, Bertrand J; Hein, H A Tillmann; De Vol, Edward B; Daoud, Yahya A

    2014-01-01

    The levels of sedation required for patients to comfortably undergo colonoscopy with propofol were examined. One hundred patients undergoing colonoscopy with propofol were enrolled. In addition to standard-of-care monitoring, sedation level was monitored with the Patient State Index (PSI) obtained from a brain function monitor, transcutaneous carbon dioxide (tcpCO2) was monitored with the TCM TOSCA monitor, and end-tidal carbon dioxide was monitored via nasal cannula. The Ramsay Sedation Score (RSS) was also assessed and recorded. After baseline data were obtained from the first 40 consecutive patients enrolled in the study, the remaining 60 patients were randomized into two groups. In one group the PSI value was blinded from the anesthesiologist and in the second group the PSI was visible and the impact of this information on the management of the sedation was analyzed. Overall 96% of patients reached levels of deep sedation and 89% reached levels of general anesthesia. When comparing the blinded to PSI versus unblinded groups, the blinded group had a significantly lower PSI and higher RSS and tcpCO2, indicating the blinded group was maintained at a deeper sedation level with more respiratory compromise than the unblinded group. Patients undergoing colonoscopy under propofol sedation delivered by a bolus technique are frequently taken to levels of general anesthesia and are at risk for respiratory depression, airway obstruction, and hemodynamic compromise. PMID:24381393

  5. Sedation and Analgesia in Burn

    Directory of Open Access Journals (Sweden)

    Özkan Akıncı

    2011-07-01

    Full Text Available Burn injury is one of the most serious injuries that mankind may face. In addition to serious inflammation, excessive fluid loss, presence of hemodynamic instability due to intercurrent factors such as debridements, infections and organ failure, very different levels and intensities of pain, psychological problems such as traumatic stress disorder, depression, delirium at different levels that occur in patient with severe burn are the factors which make it difficult to provide the patient comfort. In addition to a mild to moderate level of baseline permanent pain in burn patients, which is due to tissue damage, there is procedural pain as well, which occurs by treatments such as grafting and dressings, that are severe, short-term burst style 'breakthrough' pain. Movement and tactile stimuli are also seen in burn injury as an effect to sensitize the peripheral and central nervous system. Even though many burn centers have established protocols to struggle with the pain, studies show that pain relief still inadequate in burn patients. Therefore, the treatment of burn pain and the prevention of possible emergence of future psychiatric problems suc as post-traumatic stress disorder, the sedative and anxiolytic agents should be used as a recommendation according to the needs and hemodynamic status of individual patient. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 26-30

  6. The patient experience of intensive care

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit;

    2015-01-01

    BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic c...... state, where they face the choice of life or death. Caring nurses and family members play an important role in assisting the patient to transition back to life.......BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic...... countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. OBJECTIVES: The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human...

  7. Macs For Seniors For Dummies

    CERN Document Server

    Chambers, Mark L

    2012-01-01

    You're never too old to fall in love—with your Mac! You took a while, but you are now the proud owner of your first Mac computer. Macs For Seniors For Dummies is just for you. This friendly, accessible guide walks you through choosing a Mac and learning how to use it. You'll find yourself falling head over heels for your Mac in no time. Macs For Seniors For Dummies introduces you to all the basics that you need to know: turning the Mac on and getting connected; using the keyboard and mouse; working with files and folders; navigate around the Mac desktop and OS X Lion; setting up an Inter

  8. MAC calorimeters and applications

    International Nuclear Information System (INIS)

    The MAC detector at PEP features a large solid-angle electromagnetic/hadronic calorimeter system, augmented by magnetic charged-particle tracking, muon analysis and scintillator triggering. Its implementation in the context of electron-positron annihilation physics is described, with emphasis on the utilization of calorimetry

  9. Evaluation of adult outpatient magnetic resonance imaging sedation practices: are patients being sedated optimally?

    International Nuclear Information System (INIS)

    To evaluate the use of anxiolytics in adult outpatient magnetic resonance imaging (MRI) centres and to determine whether utilisation is optimal based on the pharmacology of the drugs used, who prescribes these drugs, and how patients are managed after administration. Identical paper and Web-based surveys were used to anonymously collect data about radiologists' use of anxiolytic agents for adult outpatient MRI examinations. The survey questions were about the type of facility, percentage of studies that require sedation, the drug used and route of administration, who orders the drug, timing of administration, patient monitoring during and observation after the study, use of a dedicated nurse for monitoring, and use of standard sedation and discharge protocols. The χ2 analysis for statistical association among variables was used. Eighty-five of 263 surveys were returned (32% response rate). The radiologist ordered the medication (53%) in slightly more facilities than the referring physician (44%) or the nurse. Forty percent of patients received medication 15-30 minutes before MRI, which is too early for peak effect of oral or sublingual drugs. Lorazepam was most commonly used (64% first choice). Facilities with standard sedation protocols (56%) were more likely to use midazolam than those without standard sedation protocols (17% vs 10%), to have a nurse for monitoring (P = .032), to have standard discharge criteria (P = .001), and to provide written information regarding adverse effects (P = .002). Many outpatients in MRI centres may be scanned before the peak effect of anxiolytics prescribed. A standard sedation protocol in such centres is associated with a more appropriate drug choice, as well as optimized monitoring and postprocedure care. (author)

  10. Sedation and Analgesia in Interventional Radiology

    OpenAIRE

    Tuite, Catherine; Rosenberg, Eric J.

    2005-01-01

    Complex medical procedures requiring the administration of sedation and analgesia are frequently performed in sites outside the operating room. In particular, interventional radiologists must understand basic principles of sedation and analgesia to direct nurses or nurse practitioners to provide adequate conscious sedation. The purpose of this article is to review basic principles of sedation, pharmacologic agents used for sedation and analgesia, practice guidelines, monitoring, and managemen...

  11. Hypnotics and Sedatives

    Science.gov (United States)

    Kabra, Pokar M.; Koo, Howard Y.; Marton, Laurence J.

    In recent years, most large hospitals have observed a marked increase in the admission of patients suffering from drug overdose. Overdose of narcotic drugs, such as the opiates, represent less of a problem on a day-to-day basis than do overdoses of prescribed drugs, such as sedatives and hypnotics. Clinical signs and symptoms for a narcotic drug overdose are very distinct, and in the majority of cases can be easily recognized by the attending physicians without the help of a toxicology laboratory. Loomis (1) reported that the majority of fatal poisonings owed to one, or a combination, of four agents: barbiturates, carbon monoxide, ethyl alcohol, and salicylates. Berry (2) estimated that 5-5'-disubstituted barbiturates were the second commonest cause of fatal poisoning in England, and that the frequency of their use was increasing. Other nonbarbiturate hypnotics involved in coma-producing incidents include glutethimide (Doriden®), methyprylon (Noludar®), and meprobamate (3, 4). In the last five years, diazepam (Valium®) has become one of the leading misused drugs (5).

  12. iMac pocket genius

    CERN Document Server

    Hart-Davis, Guy

    2010-01-01

    If you want to get the very most out of your iMac, put this savvy Portable Genius guide to work. Want to make the most of the new Magic Mouse and the latest iLife apps? Set up a wireless network using your iMac's AirPort card? Watch television on your iMac, or show iMac videos and movies on your television? You'll find cool and useful Genius tips, full-color screenshots, and pages of easy-to-access shortcuts and tools that will save you time and let you enjoy your iMac to the max.

  13. Macs For Dummies, Pocket Edition

    CERN Document Server

    Baig, Edward C

    2011-01-01

    The fun and easy way to make the most of your wonderful Mac. Simply Mac-nificent — all the cool things your Mac can do! This handy guide helps you figure out the nuts and bolts of your Mac. Navigate the Mac desktop, use the Safari Web browser to surf the Internet, e-mail photos to friends and family, create and print documents, rip audio CDs, and more. The fun begins right here!. Open the book and find: How to set up and configure your Mac; Tips for getting around on the Mac desktop; Steps for setting up an e-mail account and browsing the Internet; Details about the free programs that come wit

  14. iMac portable genius

    CERN Document Server

    Hart-Davis, Guy

    2010-01-01

    The most up-to-date coverage on the latest iMac advice, tools, and shortcuts Cool and useful tips, full-color screenshots, and savvy advice show you how to get the most out of your iMac. Fully updated to cover the iMac's latest features and capabilities, this guide is packed with indispensible information on iLife '09 and Mac OS X Snow Leopard, and shows you how to customize your iMac in a way that it will work best for you.Explores all the bells and whistles of the iMac, including the new Magic Mouse, iLife apps such as iPhoto and iMovie, and Mac OS X Snow LeopardShows yo

  15. Mac OS X

    OpenAIRE

    Ma, I

    2001-01-01

    Introduction: Apple Computer has just released its new operating system for the Macintosh Computer OSX, which has been called "the next generation" of computer operating systems. This session will demonstrate the features of the new operating system and compare it to previous operating systems. Details: Mac OS X is a super-modern operating system that combines the power and stability of UNIX with the legendary simplicity and elegance of the Macintosh. Key Features Aqua...

  16. Anxiety in Children Undergoing VCUG: Sedation or No Sedation?

    Directory of Open Access Journals (Sweden)

    David W. Herd

    2008-01-01

    Full Text Available Background. Voiding cystourethrograms are distressing for children and parents. Nonpharmacological methods reduce distress. Pharmacological interventions for VCUG focus on sedation as well as analgesia, anxiolysis, and amnesia. Sedation has cost, time, and safety issues. Which agents and route should we use? Are we sure that sedation does not influence the ability to diagnose vesicoureteric reflux? Methods. Literature search of Medline, EMBASE, and the Cochrane Database. Review of comparative studies found. Results. Seven comparative studies including two randomised controlled trials were reviewed. Midazolam given orally (0.5-0.6 mg/kg or intranasally (0.2 mg/kg is effective with no apparent effect on voiding dynamics. Insufficient evidence to recommend other sedating agents was found. Deeper sedating agents may interfere with voiding dynamics. Conclusion. Midazolam reduces the VCUG distress, causes amnesia, and does not appear to interfere with voiding dynamics. Midazolam combined with simple analgesia is an effective method to reduce distress to children undergoing VCUG.

  17. The fourth suture in MACS facelifting – adressing the neck

    Directory of Open Access Journals (Sweden)

    Kaye, Kai O.

    2014-12-01

    Full Text Available Objective: The MACS facelift alone shows poor results on the medial neck in cases of pronounced, rigid platysmabands (McKinney III–IV°. The original MACS (“Minimal Access Cranial Suspension” facelift delirs excellent results on the midface and leads to sustainably improved outcome on the neck by adding a fourth suture on the platysma. McKinney type I–II platysmabands can be treated only by lateral approach of the ‘fourth suture’, type III–IV should be treated with closed platysma myotomy before.Methods: Between October 2007 and November 2013 a number of 219 patients were treated with the MACS facelift technique accomplished by a fourth suture on the platysma and liposuction or optional lipectomy on the neck. On 47 patients closed transcutaneous platysma myotomy was performed.Results: Surgery time lasted on average 2.5 hours and was performed under sedation with local anesthesia in 85%. Recovery time ranged between 14 to 16 days until the patients were back to work. Due to their health status 54% of our patients had an inpatient arrangement for one night and 46% an outpatient arrangement.Conclusion: The modification of the MACS lift with the ‘fourth suture’ on the platysma keeps the benefits of the original technique but improves the aesthetic outcome on the neck.

  18. iMac for dummies

    CERN Document Server

    Chambers, Mark L

    2014-01-01

    Do it all with your iMac and this bestselling For Dummies guide! You're still a little giddy from finally scoring your new iMac, and you can't wait to get started. Even if you're already in love with your iMac, it helps to have a little guidance to really get the most out of this ultimate all-in-one computer. This updated edition of iMac For Dummies is the ideal way to learn the iMac fundamentals from setting up and personalizing your machine to importing files, making FaceTime video calls, surfing the web, using your favorite programs and apps, and everything in between. Trusted Mac guru Mark

  19. iMac portable genius

    CERN Document Server

    Binder, Kate

    2008-01-01

    Cool and useful tips, full-color screenshots, and savvy advice show you how to get the most out of your iMac. You'll discover exactly what the Apple remote is capable of, how to set up your iMac so that it's customized for multiple users, and all there is to know about Mac OS X's built-in organizational tools. This indispensable guide ramps up the pace and offers you easy-to-access shortcuts so you can start enjoying your iMac to the max.

  20. Learn Excel 2011 for Mac

    CERN Document Server

    Hart-Davis, Guy

    2011-01-01

    Microsoft Excel 2011 for Mac OS X is a powerful application, but many of its most impressive features can be difficult to find. Learn Excel 2011 for Mac by Guy Hart-Davis is a practical, hands-on approach to learning all of the details of Excel 2011 in order to get work done efficiently on Mac OS X. From using formulas and functions to creating databases, from analyzing data to automating tasks, you'll learn everything you need to know to put this powerful application to use for a variety of tasks. What you'll learn * The secrets of the Excel for Mac interface! * How to create effective workbo

  1. Use of opioids and sedatives at End-of-Life

    Directory of Open Access Journals (Sweden)

    Shin Wei Sim

    2014-01-01

    Full Text Available Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore′s government agency websites using search terms such as "opioids," "sedatives," "palliation," "end-of-life-care," "pain management," "palliative care," "cancer pain," "Asia," "Singapore," and "morphine." Findings were classified into three broad groups - system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients′ under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms.

  2. Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE)

    DEFF Research Database (Denmark)

    Froehlich, F; Harris, JK; Wietlisbach, V; Burnand, B; Vader, JP; Gonvers, JJ

    2006-01-01

    BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in...... endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were...... centers. Oxygen desaturation (LT /= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation. CONCLUSIONS...

  3. iMac for dummies

    CERN Document Server

    Chambers, Mark L

    2012-01-01

    The bestselling guide to the ultimate all-in-one computer—now updated and revised throughout! If you're looking for speed, performance, and power, the iMac is the ultimate all-in-one computer. From its superior performance, powerful operating system, and amazing applications, the iMac is one awesome machine, and the fun, friendly, and approachable style of iMac For Dummies is an ideal way to get started with the basics. You'll learn the fundamentals of the iMac including setting up and customizing your iMac and the software that comes with it, importing files from your old computer, send

  4. Macs for seniors for dummies

    CERN Document Server

    Chambers, Mark L

    2009-01-01

    Over 50 and thinking about getting your first computer? A user-friendly Mac is a great choice, and Macs For Seniors For Dummies walks you through choosing one and learning to use it. You won't even need your grandchildren to help! Macs For Seniors For Dummies introduces you to all the basic things you may not have encountered before-how to use the keyboard and mouse, work with files and folders, navigate around the Mac OS X desktop, set up an Internet connection, and much more. You'll learn to:Choose the Mac that's right for you, set it up, run programs and manage files, and hook up a printerU

  5. Windows Mac-tietokoneilla

    OpenAIRE

    Alhainen, Joona

    2015-01-01

    Tämän opinnäytetyön tarkoituksena oli tutkia eri tapoja, joilla Windows-käyttöjärjestelmää ja Windows-ohjelmia voidaan käyttää Mac-tietokoneilla ja selvittää millaiseen käyttöön eri tavat sopivat parhaiten. Työssä tehdään Windowsin asennukset eri tavoilla ja vertaillaan näiden tapojen vaikutusta tietokoneen suorituskykyyn. Windows asennetaan OS X:n Boot Camp -apuohjelman avulla, jolloin tietokoneen voi käynnistää jompaankumpaan käyttöjärjestelmään sekä virtuaalikoneeseen, jolloin Windowsia...

  6. Gotcha! Macs lose their innocence

    CERN Multimedia

    Computer Security Team

    2012-01-01

    Still believe your Mac is secure because Microsoft PCs fall prey to viruses and worms but Macs don’t? Time to wake up! This year has seen the first major compromise of Macs worldwide*. How is yours doing?   The “Flashback” Trojan is affecting Apple’s own variant of Java and compromises Macs via so-called drive-by infections, i.e. when you visit an appropriately prepared (infected!) website - and this might not necessarily be a site with questionable contents, but could well be a popular, reputable one. Security Companies worldwide have been monitoring this particular Trojan for a while and have estimated that more than half a million Macs were compromised. Connected to a few central command and control servers, the compromised Macs were then supporting the malicious activity of the bad guys! Fortunately, the security companies have now been able to take over those command and control servers and stop their destructive drive. So, Mac users, face the f...

  7. Java and Mac OS X

    CERN Document Server

    Davis, T Gene

    2010-01-01

    Learn the guidelines of integrating Java with native Mac OS X applications with this Devloper Reference book. Java is used to create nearly every type of application that exists and is one of the most required skills of employers seeking computer programmers. Java code and its libraries can be integrated with Mac OS X features, and this book shows you how to do just that. You'll learn to write Java programs on OS X and you'll even discover how to integrate them with the Cocoa APIs.: Shows how Java programs can be integrated with any Mac OS X feature, such as NSView widgets or screen savers; Re

  8. Trends in Continuous Deep Sedation until Death between 2007 and 2013: A Repeated Nationwide Survey.

    Directory of Open Access Journals (Sweden)

    Lenzo Robijn

    Full Text Available Continuous deep sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous deep sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians' degree of palliative training.Population-based death certificate study in 2007 and 2013 in Flanders, Belgium. Reporting physicians received questionnaires about medical practices preceding the patient's death. Patient characteristics, clinical characteristics (drugs used, duration, artificial nutrition/hydration, intention and consent, and palliative care training of attending physician were recorded. We posed the following question regarding continuous deep sedation: 'Was the patient continuously and deeply sedated or kept in a coma until death by the use of one or more drugs'.After the initial rise of continuous deep sedation to 14.5% in 2007 (95%CI 13.1%-15.9%, its use decreased to 12.0% in 2013 (95%CI 10.9%-13.2%. Compared with 2007, in 2013 opioids were less often used as sole drug and the decision to use continuous deep sedation was more often preceded by patient request. Compared to non-experts, palliative care experts more often used benzodiazepines and less often opioids, withheld artificial nutrition/hydration more often and performed sedation more often after a request from or with the consent of the patient or family.Worldwide, this study is the first to show a decrease in the prevalence of continuous deep sedation. Despite positive changes in performance and decision-making towards more compliance with due care requirements, there is still room for improvement in the use of recommended drugs and in the involvement of patients and relatives in the

  9. Sedation/general anesthesia for magnetic resonance imaging in paediatrics patients - special considerations and safety

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) study requires the patient to remain motionless for extended periods of time, which can not be achieved in children without special care or drug-induced sleep. There are various methods for sedation / general anaesthesia (GA) in children with their different advantages and disadvantages. The aim of this study was to report our experience with sedation/GA in children who require MRI/computed-tomography (CT) studies. We performed a retrospective review of the sedation/GA records in 34 children aged from 6 months to 12 years; class ASA I-III, undergoing diagnostic MR/CT study. Demographic data, information regarding diagnosis, type of sedation/GA, use of premedication, time to readiness for the procedure after premedication administration, duration of procedure, and the recovery time were obtained. Any adverse events were noted. Imaging study in most of the patients (61.8%) was performed for neurological diseases (delayed neuropsychological development, epilepsy, and cerebral palsy). Sedation/GA with Propofol was administered in 50% (n=17) of patients, in 26.5% (n=9) - Ketamine plus Midazolam; in 20.6% (n=7) - Midazolam alone, and in 9% (n=1) - Thiopental. The time to readiness for the procedure and the recovery time were statistically significantly shorter for patients receiving Propofol, and the observed adverse respiratory events were mild in severity, when compared with patients receiving sedation/GA with another hypnotic agent (p<0.05).The evaluation of the respiratory system before sedation/GA should be carefully performed, as the respiratory diseases could increase the patients' risk of adverse events occurrence. Sedation/GA with Propofol is a method of choice in children with neurological disorders with seizures, increased intracranial pressure and myopathies, undergoing MR/CT study. Crucial for patients' safety and good clinical results is the medical professionals, delivering sedation/GA, to have the knowledge and practical

  10. MacBook portable genius

    CERN Document Server

    Miser, Brad

    2008-01-01

    The Genius is in. You don't have to be a genius to use a MacBook. But if you want to get the very most out of yours, put this savvy Portable Genius guide to work. Want to connect your MacBook to other Macs? Use Expose to its fullest potential? Troubleshoot? You'll find cool and useful Genius tips, insider secrets, full-color screenshots, and pages of easy-to-access shortcuts and tools that will save you loads of time and make your MacBook IQ soar. Portable GENIUS Fun, hip, and straightforward, the new Portable Genius series gives forward-thinking Apple users useful informat

  11. Mac Programming for Absolute Beginners

    CERN Document Server

    Wang, Wallace

    2011-01-01

    Want to learn how to program on your Mac? Not sure where to begin? Best-selling author Wallace Wang will explain how to get started with Cocoa, Objective-C, and Xcode. Whether you are an experienced Windows coder moving to the Mac, or you are completely new to programming, you'll see how the basic design of a Mac OS X program works, how Objective-C differs from other languages you may have used, and how to use the Xcode development environment. Most importantly, you'll learn how to use elements of the Cocoa framework to create windows, store data, and respond to users in your own Mac programs.

  12. Apple MacBook Air

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    当乔布斯手持MacBook Air,放言“there is somthing in air”时,苹果教徒们的信仰再一次得到了“升华”。其实再为MacBook Air来写这样一段文字,多少显得有些多余。

  13. Switching to a Mac For Dummies

    CERN Document Server

    Reinhold, Arnold

    2011-01-01

    Learn how to make the switch from PC to Mac a completely smooth transition The number of Mac users continues to increase significantly each year. If you are one of those people and are eager but also anxious about making the switch, then fear not! This friendly guide skips the jargon to deliver you an easy-to-read, understandable introduction to the Macintosh computer. Computer guru Arnold Reinhold walks you through the Mac OS, user interface, and icons. You'll learn how to set up your Mac, move your files from your PC to your Mac, switch applications, get your Mac online, network your Mac, se

  14. Switching to a Mac portable genius

    CERN Document Server

    McFedries, Paul

    2011-01-01

    Switching from a PC to a Mac is a breeze with this book Anyone considering making the move to Mac from the Windows world will find this book smoothes the way. While Macs are famous for ease of use, there are fundamental differences in Mac and PC ways of thinking, plus there?s the hassle of moving files, calendars, and other essential data from one platform to another. This guide lays out all the information, explains basic Mac procedures for the newcomer, offers great tips on data-sharing (including running Windows applications on a Mac), and provides everything the new Mac user needs to move

  15. Fiverr MacGyver

    Science.gov (United States)

    Hut, Rolf; van de Giesen, Nick; Larson, Martha

    2014-05-01

    Crowdsourcing has become popular over the past years, also for scientific endeavors. There are many Citizen Science projects and crowdfunding platforms, such as Kickstarter, that are make helpful contributions to moving environmental science forward. An interesting underused source of useful crowd-derived contributions to research is the website Fiverr.com. On this platform, thousands of people, acting as small-scale freelance contractors, offer their skills in the form of services. The platform offers a chance for people to take a hobby, skill, or pastime and make it something more by reaching out to a wider audience and by receiving a payment in return for services. As is typical of other crowdsourcing platforms, the tasks are small and usually self contained. As the name Fiverr suggests, offers start at US5 to provide a particular service. Services offered range from graphic design, to messages sung or spoken with various styles or accents, to complete apps for Android or iPhone. Skill providers on the platform can accept a range of variation of definition in the tasks, some can be described in general terms, for others it is more appropriate to provide examples. Fiverr provides a central location for those offering skills and those needing services to find each other, it makes it possible to communicate and exchange files, to make payments, and it provides support for resolving disputes. In all cases, it is important to keep expectations aligned with the nature of the platform: quality can and will vary. Ultimately, the critical contribution of Fiverr is not to replace professional services or otherwise save money, but rather to provide access to a large group of people with specialized skills who are able to make a contribution on short notice. In the context of this session, it can be considered a pool of people with MacGyver skills lying in wait of a MacGyyer task to attack. There are many ways in which Fiverr tasks, which are called 'gigs', can be useful in

  16. Deep sedation for endoscopic retrograde cholangiopacreatography

    OpenAIRE

    Chainaki, Irene G; Manolaraki, Maria M; Paspatis, Gregorios A.

    2011-01-01

    Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retrograde cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the reduction of injuries during the procedure due to inappropriate co-operation. Although most of the studies used a moderate level of sedation, the literature has revealed the superiority of deep sedation and general anesthesia in performing ERCP. The anesthesiologist’s presence i...

  17. Strategies to optimize analgesia and sedation

    OpenAIRE

    Schweickert, William D.; John P Kress

    2008-01-01

    Achieving adequate but not excessive sedation in critically ill, mechanically ventilated patients is a complex process. Analgesics and sedatives employed in this context are extremely potent, and drug requirements and metabolism are unpredictable. Clinicians must have heightened awareness of the potential for enduring effects and are encouraged to employ strategies that maximize benefit while minimizing risk. Successful sedation protocols have three basic components: frequent assessments for ...

  18. Pediatric dental sedation: challenges and opportunities

    OpenAIRE

    Nelson, Travis

    2015-01-01

    Travis M Nelson, Zheng Xu Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA Abstract: High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases th...

  19. Analgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest.

    Science.gov (United States)

    Riker, Richard R; Gagnon, David J; May, Teresa; Seder, David B; Fraser, Gilles L

    2015-12-01

    The approach to sedation, analgesia, and neuromuscular blockade during targeted temperature management (TTM) remains largely unstudied, forcing clinicians to adapt previous research from other patient environments. During TTM, very little data guide drug selection, doses, and specific therapeutic goals. Sedation should be deep enough to prevent awareness during neuromuscular blockade, but titration is complex as metabolism and clearance are delayed for almost all drugs during hypothermia. Deeper sedation is associated with prolonged intensive care unit (ICU) and ventilator therapy, increased delirium and infection, and delayed wakening which can confound early critical neurological assessments, potentially resulting in erroneous prognostication and inappropriate withdrawal of life support. We review the potential therapeutic goals for sedation, analgesia, and neuromuscular blockade during TTM; the adverse events associated with that treatment; data suggesting that TTM and organ dysfunction impair drug metabolism; and controversies and potential benefits of specific monitoring. We also highlight the areas needing better research to guide our therapy. PMID:26670815

  20. Comparison of post-operative ICU sedation between dexmedetomidine and propofol in Indian population

    Directory of Open Access Journals (Sweden)

    Prerana N Shah

    2014-01-01

    Full Text Available Context: Critically ill patients requiring mechanical ventilation frequently need sedatives and analgesics to facilitate their care. Dexmedetomidine, a short-acting alpha-2-agonist, possesses anxiolytic, anesthetic, hypnotic, and analgesic properties. Aims: The objective of this study was to evaluate the efficacy and safety of dexmedetomidine in comparison to propofol in the management of sedation for post-operative intensive care unit (ICU patients, as a sedative agent. Settings and Design: Teaching hospital, A phase III, prospective, open, randomized and comparative. Materials and Methods: Thirty patients who were ambulatory and who required the post-operative mechanical ventilation or post-operative sedation were enrolled, in which 15 patients received Dexmedetomidine and remaining 15 patients received propofol. All these patients were treated for the period of 8 to 24 h. Statistical Analysis Used: Data were analyzed using Student′s t-test and Chi-square test. The value of P < 0.05 was considered as statistically significant. Results: Demographic data were comparable. Pulse rate, respiratory rate and blood pressure were comparable. Depth of sedation and extubation time were similar. To maintain analgesia throughout the study period, patients receiving propofol infusions required significantly more analgesics than patients receiving Dexmedetomidine. Conclusions: Dexmedetomidine appears to be a safe and acceptable ICU sedative agent when both the clinician′s and patient′s perspectives are considered.

  1. Nurse-administered propofol sedation for endoscopy

    DEFF Research Database (Denmark)

    Jensen, J T; Vilmann, P; Horsted, T;

    2011-01-01

    The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.......The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program....

  2. Safe sedation in modern cardiological practice.

    Science.gov (United States)

    Furniss, Stephen S; Sneyd, J Robert

    2015-10-01

    Safe sedation is fundamental to many modern cardiological procedures, and following the publication of the report on safe sedation by the Academy of Medical Royal Colleges, this report discusses sedation specifically in cardiological practice. The major areas within cardiology that use sedation are cardioversion, catheter ablation particularly of atrial fibrillation, transoesophageal echocardiography, implantable device (cardiovascular implantable electronic device) procedures and other procedures such as transcatheter aortic valve replacement. There is increasing demand for cardiological sedation but there is wide geographical variation in its use and there are also growing data to support non-anaesthetists giving sedation. The use of benzodiazepines, particularly for short procedures, is common, but even here good record-keeping and audit together with an understanding of the continuum of sedation and having appropriately trained staff and the necessary facilities are vital. Nurse administration of propofol may be appropriate for some procedures in cardiology that require at least moderate sedation. Appropriate training is essential and the use of capnography and target controlled infusion pumps for propofol administration is recommended. PMID:26085525

  3. Mac OS X ja tietoturva

    OpenAIRE

    Herranen, Joni

    2011-01-01

    Tämän opinnäytetyön tavoitteena on luoda kattava kokonaiskuva Mac OS X -käyttöjärjestelmän sisäänrakennetuista tietoturvaratkaisuista ja selvittää miten tietoturvaratkaisut toteuttavat tietoturvan kolmea perustavoitetta eli luottamuksellisuutta, eheyttä ja saatavuutta. Työn kohderyhmäksi on valittu edistyneemmät tietokoneenkäyttäjät, joilla ei ole aikaisempaa Mac-kokemusta. Teoriaosuudessa syvennytään aluksi Apple-yhtiöön sekä Mac OS X -järjestelmän teknisiin ominaisuuksiin. Osuuden pääta...

  4. Office 2011 for Mac For Dummies

    CERN Document Server

    LeVitus, Bob

    2011-01-01

    Get started with Office 2011 for Mac and discover the creative possibilitiesThe leading suite of productivity software for the Mac, Microsoft Office helps users complete common business tasks, including word processing, e-mail, presentations, financial analysis, and much more. Office 2011 for Mac For Dummies is the perfect companion for Microsoft Office for Mac users upgrading to the newest version, new computer users, and those who may have switched from the Windows version of Office. Written by one of the most popular gurus in the Mac community, Bob "Dr. Mac" LeVitus, the book explains every

  5. Cardiovascular, Antinociceptive and Sedative Effects of Medetomidine Infusion in Sevoflurane Anesthesia in Puppies

    Directory of Open Access Journals (Sweden)

    J Morgaz*, JM Domínguez, R Navarrete, JA Fernández-Sarmiento, P Muñoz-Rascón, RJ Gómez-Villamandos and MM Granados

    2013-07-01

    Full Text Available The objective of this study was to determine the effect of a constant rate infusion of medetomidine in the cortical brain activity and hemodynamic parameters in sevoflurane anesthetized puppies. Six puppies of the age of two weeks old were included in the study and were anaesthetized three times with sevoflurane. On the first anesthesia, each dog’s minimum alveolar concentration (MAC for sevoflurane was determined by the use of the tail clamp method. On the second anesthesia (sevoflurane, the puppies were anesthetized at each of five multiples of their individual’s MAC, 0.75, 1, 1.25, 1.5 and 1.75 MAC, and bispectral index and cardiorespiratory parameters were registered. On the third anesthesia (sevoflurane+ medetomidine, puppies were anesthetized at each of five multiples of their individual’s MAC, and medetomidine (5 µg/kg+2µg/kg/h was administered. Mild cardiovascular depression was observed in sevoflurane+medetomidine in comparison with sevoflurane. Cortical and antinociceptive effects were not observed with medetomidine infusion although a mature EEG response to noxious stimulation would not have developed in puppies. Central alpha-2 adrenoreceptors would be immature in puppies during the first two weeks of life, and for this reason, medetomidine would not produce sedative and analgesic effects in young puppies. More studies have to be performed to support this statement.

  6. The Multidimensional Audioconferencing Classification System (MACS).

    Science.gov (United States)

    Cookson, Peter S.; Chang, Yu-bi

    1995-01-01

    Describes the development of the Multidimensional Audioconferencing Classification System (MACS), an instrument for the tabulation, analysis, and interpretation of audioconferencing instructional interactions. MACS draws on three theoretical and empirical streams: (1) systematic small group interaction analysis; (2) systematic classroom…

  7. Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

    Directory of Open Access Journals (Sweden)

    Mahmoud Hassan Mohamed

    2014-01-01

    Conclusion: We concluded that the combination of dexmedetomidine/nalbuphine is a better alternative to midazolam/nalbuphine in MAC since it provides analgesia, amnesia and sedation with better intraoperative and postoperative patient satisfaction with better surgical field exposure.

  8. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    Energy Technology Data Exchange (ETDEWEB)

    Karian, V.E.; Burrows, P.E.; Connor, L. [Dept. of Radiology, Children' s Hospital, Boston, MA (United States); Zurakowski, D. [Dept. of Biostatistics, Children' s Hospital, Boston, MA (United States); Mason, K.P. [Dept. of Anesthesiology, Children' s Hospital, Boston, MA (United States)

    1999-11-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  9. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    International Nuclear Information System (INIS)

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  10. Comparative study between dexmedetomidine and fentanyl for sedation during mechanical ventilation in post-operative paediatric cardiac surgical patients

    Directory of Open Access Journals (Sweden)

    S R Prasad

    2012-01-01

    Full Text Available Aims and Objectives: To compare the efficacy of sedation and time taken for extubation using dexmedetomidine and fentanyl sedation in post-operative paediatric cardiac surgical patients. Methods: A prospective randomized double-blind study involving 60 children undergoing open heart surgery was conducted. The patients were divided into two groups, each involving 30 patients. One group received fentanyl at 1 μg/kg/h (Group A and the other received dexmedetomidine at 0.5 μg/kg/h (Group B for post-operative sedation with intermittent rescue fentanyl 0.5 μg/kg bolus in either group as per requirement during suctioning. The efficacy of sedation was assessed using the Ramsay sedation score, paediatric intensive care unit sedation score and the tracheal suction score. The time taken for extubation from the stoppage of infusion was noted. Results: Haemodynamic parameters between the two groups were comparable. All sedation scores were comparable in the fentanyl and dexmedetomidine groups. Average time (in minutes required for extubation was 131.0 (±51.06 SD in the dexmedetomidine group compared with 373.0 (±121.4 SD in the fentanyl group. The difference in mean time for extubation was statistically significant. Conclusions: Dexmedetomidine facilitates adequate sedation for mechanical ventilation and also early extubation as compared with fentanyl.

  11. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology

    Directory of Open Access Journals (Sweden)

    Emmanuel Nicolas

    2008-12-01

    Full Text Available Emmanuel Nicolas1,2, Claire Lassauzay1,21CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; 2Université Clermont 1, EA 3847, Faculty of Dentistry, 63000 Clermont-Ferrand, FranceAbstract: Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer’s disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain control, but they have to be adapted to accommodate age-induced physiological modifications, age-related pathologies, and the concomitant treatments. In many situations, routine sedative prescriptions for dental care, such as benzodiazepine or antihistaminics, are not recommended for these patients. Nitrous oxide inhalation together with a specific behavioral threshold is currently the only sedative procedure adapted to cognitively-impaired elderly patients. Nitrous oxide is able to curb stress and its cardiovascular consequences, improve oxygenation, and optimize cooperation during dental care, making not only rehabilitation treatments but also routine dental care a viable option.Keywords: nitrous oxide, oxygen, premix, sedation, gerodontology, dental care

  12. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI).

    Science.gov (United States)

    Mayr, N Patrick; Michel, Jonathan; Bleiziffer, Sabine; Tassani, Peter; Martin, Klaus

    2015-09-01

    Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to "intermediate-risk" patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; reduced procedure time, shorter intensive care unit (ICU) length of stay, reduced need for intraprocedural vasopressor support, and the potential to perform the procedure without the direct presence of an anesthetist for cost-saving reasons. To date, no randomized trial data exists. We reviewed 13 non-randomized studies/registries reporting data from 6,718 patients undergoing TAVI (3,227 performed under sedation). Patient selection, study methods, and endpoints have differed considerably between published studies. Reported rates of in-hospital and longer-term mortality are similar for both groups. Up to 17% of patients undergoing TAVI-S require conversion to general anesthesia during the procedure, primarily due to vascular complications, and urgent intubation is frequently associated with hemodynamic instability. Procedure related factors, including hypotension, may compound preexisting age-specific renal impairment and enhance the risk of acute kidney injury. Hypotonia of the hypopharyngeal muscles in elderly patients, intraprocedural hypercarbia, and certain anesthetic drugs, may increase the aspiration risk in sedated patients. General anesthesia and conscious sedation have both been used successfully to treat patients with severe AS undergoing TAVI with similar reported short and long-term mortality outcomes. The authors believe that the significant incidence of complications and unplanned conversion to general anesthesia during TAVI-S mandates the start-to-finish presence

  13. Cognitive MAC designs for OSA networks

    CERN Document Server

    Derakhshani, Mahsa

    2014-01-01

    This SpringerBrief presents recent advances in the cognitive MAC designs for opportunistic spectrum access (OSA) networks. It covers the basic MAC functionalities and MAC enhancements of IEEE 802.11. Later chapters discuss the existing MAC protocols for OSA and classify them based on characteristic features. The authors provide new research in adaptive carrier sensing-based MAC designs tailored for OSA, which optimize spectrum utilization and ensure a peaceful coexistence of licensed and unlicensed systems. Analytically devised via optimization and game-theoretic approaches, these adaptive M

  14. Take Control of Maintaining Your Mac

    CERN Document Server

    Kissell, Joe

    2009-01-01

    Keep your Mac running smoothly with our easy maintenance program! Regular maintenance is necessary to avoid problems and to ensure your Mac runs at peak performance, but it's hard to know what to do and when to do it. Best-selling author Joe Kissell has now applied his commonsense approach to the task of maintaining your Mac, whether you use Tiger or Leopard! Learn how to start on the right foot; what you should do daily, weekly, monthly, and yearly; and how to prepare for Mac OS X updates. Joe even explains how to monitor your Mac's health and debunks common panaceas. Read this book to lea

  15. Switching to a Mac For Dummies

    CERN Document Server

    Reinhold, Arnold

    2007-01-01

    Thinking of making the switch from your PC to a Mac? Congratulations! You're in for a great, virus-free ride. And Switching to Mac For Dummies makes it smoother than you ever imagined. From buying the Mac that's right for you to transferring your files to breaking your old Windows habits and learning to do things the (much easier) Mac way, it makes the whole process practically effortless. Whether you've been using Windows XP, Vista, or even Linux, you'll find simple, straightforward ways to make your transition go smoothly. That will leave you plenty of time to get familiar with Mac'

  16. Switching to the Mac The Missing Manual

    CERN Document Server

    Pogue, David

    2010-01-01

    Is Windows giving you pause? Ready to make the leap to the Mac instead? There has never been a better time to switch from Windows to Mac, and this incomparable guide will help you make a smooth transition. New York Times columnist and Missing Manuals creator David Pogue gets you past three challenges: transferring your stuff, assembling Mac programs so you can do what you did with Windows, and learning your way around Mac OS X. Learning to use a Mac is not a piece of cake, but once you do, the rewards are oh-so-much better. No viruses, worms, or spyware. No questionable firewalls, inefficien

  17. Mac OS X Lion Server For Dummies

    CERN Document Server

    Rizzo, John

    2011-01-01

    The perfect guide to help administrators set up Apple's Mac OS X Lion Server With the overwhelming popularity of the iPhone and iPad, more Macs are appearing in corporate settings. The newest version of Mac Server is the ideal way to administer a Mac network. This friendly guide explains to both Windows and Mac administrators how to set up and configure the server, including services such as iCal Server, Podcast Producer, Wiki Server, Spotlight Server, iChat Server, File Sharing, Mail Services, and support for iPhone and iPad. It explains how to secure, administer, and troubleshoot the networ

  18. Remimazolam: The future of its sedative potential.

    Science.gov (United States)

    Goudra, Basavana Gouda; Singh, Preet Mohinder

    2014-07-01

    Remimazolam (CNS 7056) is a new drug innovation in anesthesia. It combines the properties of two unique drugs already established in anesthesia - Midazolam and remifentanil. It acts on GABA receptors like midazolam and has organ-independent metabolism like remifentanil. It is likely to be the sedative of the future, as preliminary phase II trials have shown minimal residual effects on prolonged infusions. It has potential to be used as a sedative in ICU and as a novel agent for procedural sedation. Unlike most rapidly acting intravenous sedatives available presently, the propensity to cause apnea is very low. Availability of a specific antagonist (flumazenil) adds to its safety even in cases of overdose. The present review discusses remimazolam's potential as a new drug in anesthesia along with the presently available literary evidence. PMID:25191193

  19. Intra- and inter-individual variation of BIS-index® and Entropy® during controlled sedation with midazolam/remifentanil and dexmedetomidine/remifentanil in healthy volunteers: an interventional study

    Science.gov (United States)

    Haenggi, Matthias; Ypparila-Wolters, Heidi; Hauser, Kathrin; Caviezel, Claudio; Takala, Jukka; Korhonen, Ilkka; Jakob, Stephan M

    2009-01-01

    Introduction We studied intra-individual and inter-individual variability of two online sedation monitors, BIS® and Entropy®, in volunteers under sedation. Methods Ten healthy volunteers were sedated in a stepwise manner with doses of either midazolam and remifentanil or dexmedetomidine and remifentanil. One week later the procedure was repeated with the remaining drug combination. The doses were adjusted to achieve three different sedation levels (Ramsay Scores 2, 3 and 4) and controlled by a computer-driven drug-delivery system to maintain stable plasma concentrations of the drugs. At each level of sedation, BIS® and Entropy® (response entropy and state entropy) values were recorded for 20 minutes. Baseline recordings were obtained before the sedative medications were administered. Results Both inter-individual and intra-individual variability increased as the sedation level deepened. Entropy® values showed greater variability than BIS® values, and the variability was greater during dexmedetomidine/remifentanil sedation than during midazolam/remifentanil sedation. Conclusions The large intra-individual and inter-individual variability of BIS® and Entropy® values in sedated volunteers makes the determination of sedation levels by processed electroencephalogram (EEG) variables impossible. Reports in the literature which draw conclusions based on processed EEG variables obtained from sedated intensive care unit (ICU) patients may be inaccurate due to this variability. Trial registration clinicaltrials.gov Nr. NCT00641563. PMID:19228415

  20. Nonmedical use of sedatives in urban Bengaluru

    OpenAIRE

    Nattala, Prasanthi; Murthy, Pratima; Thennarasu, K.; Cottler, Linda B.

    2014-01-01

    Background: Nonmedical sedative use is emerging as a serious problem in India. However, there is paucity of literature on the patterns of use in the population. Aim: The aim of the present analysis was to explore sedative use patterns in an urban metropolis. Materials and Methods: Data for the present analysis come from the parent study on nonmedical prescription drug use in Bengaluru, India. Participants (n = 717) were recruited using a mall-intercept approach, wherein they were intercepted ...

  1. Safety of Conscious Sedation In Interventional Radiology

    International Nuclear Information System (INIS)

    Purpose: To identify rates of adverse events associated with the use of conscious sedation in interventional radiology.Methods: In a 5-month period, prospective data were collected on patients undergoing conscious sedation for interventional radiology procedures (n = 594). Adverse events were categorized as respiratory, sedative, or major adverse events. Respiratory adverse events were those that required oral airway placement, ambu bag, or jaw thrust. Sedation adverse events were unresponsiveness, oxygen saturation less than 90%, use of flumazenil/naloxone, or agitation. Major adverse events were hypotension, intubation, CPR, or cardiac arrest. The frequency of adverse events for the five most common radiology procedures were determined.Results: The five most common procedures (total n = 541) were biliary tube placement/exchange (n = 182), tunneled catheter placement (n 135), diagnostic arteriography (n = 125), vascular interventions (n = 52), and other catheter insertions (n = 46). Rates for respiratory, sedation, and major adverse events were 4.7%, 4.2%, and 2.0%, respectively. The most frequent major adverse event was hypotension (2.0%). Biliary procedures had the highest rate of total adverse events (p < .05) and respiratory adverse events (p < .05).Conclusion: The frequency of adverse events is low with the use of conscious sedation during interventional procedures. The highest rates occurred during biliary interventions

  2. Quantum MacWilliams Identities

    OpenAIRE

    Shor, Peter; Laflamme, Raymond

    1996-01-01

    We derive a relationship between two different notions of fidelity (entanglement fidelity and average fidelity) for a completely depolarizing quantum channel. This relationship gives rise to a quantum analog of the MacWilliams identities in classical coding theory. These identities relate the weight enumerator of a code to the one of its dual and, with linear programming techniques, provided a powerful tool to investigate the possible existence of codes. The same techniques can be adapted to ...

  3. Towards a standardised approach for evaluating guidelines and guidance documents on palliative sedation: Study protocol

    NARCIS (Netherlands)

    E. Abarshi (Ebun); J.A.C. Rietjens (Judith); A. Caraceni; S. Payne (Sheila); L. Deliens (Luc); L. van den Block (Lieve)

    2014-01-01

    textabstractBackground: Sedation in palliative care has received growing attention in recent years; and so have guidelines, position statements, and related literature that provide recommendations for its practice. Yet little is known collectively about the content, scope and methodological quality

  4. Bispectral index monitoring for conscious sedation in intervention: better, safer, faster

    Energy Technology Data Exchange (ETDEWEB)

    Bell, J.K.; Laasch, H.-U.; Wilbraham, L.; England, R.E.; Morris, J.A.; Martin, D.F. E-mail: derrick.martin@smtr.nhs.uk

    2004-12-01

    AIM: The aim of this study was to compare subjective (Ramsay sedation score, RSS) with objective electroencephalogram-based bispectral index (BIS) assessment, and to validate the appropriate BIS range for measurement of conscious sedation in interventional procedures. MATERIALS AND METHODS: One hundred patients undergoing sedo-analgesia (midazolam and fentanyl) for interventional gastrointestinal procedures were divided into two groups. In group A (n=30) sedation was guided by the RSS with the operator blinded to the BIS recording. In group B (n=70) the operator titrated intravenous sedation to maintain an optimal BIS, predetermined from the results in group A. Recovery time, procedure duration, physiological parameters and unplanned events were recorded in both groups. RESULTS: There was a significant correlation between the BIS and RSS (p<0.001). BIS values of 87.2 and 80.9 corresponded to an RSS of 3 and 4, respectively. The optimal BIS level was defined as 80-85. Fifty-seven point five percent of readings were within this range in group B compared with 26.5% in group A (p<0.001). Sedation approaching general anaesthesia (BIS<60) occurred in 5.5% of patients in group A but not in group B. Mean recovery time, duration of procedure, midazolam and fentanyl doses were significantly reduced in group B. Unplanned events were reduced from 27 to 17%, but this was not statistically significant (p=0.29). CONCLUSION: BIS monitoring enables more effective titration of sedatives to maintain a suitable level of consciousness, whilst reducing procedure time. The BIS offers an objective, safe and reliable measure of sedation, without disturbing either patient or operator. BIS monitoring raises the standard of patient care, and in our view, should be used to augment standard assessment.

  5. Bispectral index monitoring for conscious sedation in intervention: better, safer, faster

    International Nuclear Information System (INIS)

    AIM: The aim of this study was to compare subjective (Ramsay sedation score, RSS) with objective electroencephalogram-based bispectral index (BIS) assessment, and to validate the appropriate BIS range for measurement of conscious sedation in interventional procedures. MATERIALS AND METHODS: One hundred patients undergoing sedo-analgesia (midazolam and fentanyl) for interventional gastrointestinal procedures were divided into two groups. In group A (n=30) sedation was guided by the RSS with the operator blinded to the BIS recording. In group B (n=70) the operator titrated intravenous sedation to maintain an optimal BIS, predetermined from the results in group A. Recovery time, procedure duration, physiological parameters and unplanned events were recorded in both groups. RESULTS: There was a significant correlation between the BIS and RSS (p<0.001). BIS values of 87.2 and 80.9 corresponded to an RSS of 3 and 4, respectively. The optimal BIS level was defined as 80-85. Fifty-seven point five percent of readings were within this range in group B compared with 26.5% in group A (p<0.001). Sedation approaching general anaesthesia (BIS<60) occurred in 5.5% of patients in group A but not in group B. Mean recovery time, duration of procedure, midazolam and fentanyl doses were significantly reduced in group B. Unplanned events were reduced from 27 to 17%, but this was not statistically significant (p=0.29). CONCLUSION: BIS monitoring enables more effective titration of sedatives to maintain a suitable level of consciousness, whilst reducing procedure time. The BIS offers an objective, safe and reliable measure of sedation, without disturbing either patient or operator. BIS monitoring raises the standard of patient care, and in our view, should be used to augment standard assessment

  6. Propofol Effect on Stress Response and Free Radicals in Patient during Surgery and Sedation Procedure

    OpenAIRE

    Theresia Monica Rahardjo

    2015-01-01

    BACKGROUND: Propofol is an intravenous anesthetic used worldwide as an anesthesia induction and maintenance agent. Propofol also used as sedation agent in Intensive Care Unit (ICU). Despite it’s usual anesthesia properties, propofol has an unique pharmacologic characteristic, especially as antioxidant and stress response reduction. These advantages suggested propofol has positive effects when used as an anesthesia agent in surgery or sedation in ICU in conditions when high stress and free rad...

  7. Mac OS X Tiger for Unix Geeks

    CERN Document Server

    Jepson, Brian

    2005-01-01

    If you're one of the many Unix developers drawn to Mac OS X for its Unix core, you'll find yourself in surprisingly unfamiliar territory. Unix and Mac OS X are kissing cousins, but there are enough pitfalls and minefields in going from one to another that even a Unix guru can stumble, and most guides to Mac OS X are written for Mac aficionados. For a Unix developer, approaching Tiger from the Mac side is a bit like learning Russian by reading the Russian side of a Russian-English dictionary. Fortunately, O'Reilly has been the Unix authority for over 25 years, and in Mac OS X Tiger for Unix Gee

  8. Ketamine-propofol sedation in circumcision

    Directory of Open Access Journals (Sweden)

    Handan Gulec

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050. Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050.CONCLUSION: Propofol-ketamine (Ketofol provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

  9. Sedation for pediatric diagnostic imaging: use of pediatric and nursing resources as an alternative to a radiology department sedation team

    International Nuclear Information System (INIS)

    Objective. To develop a pathway to provide safe, effective, and efficient sedation for pediatric diagnostic imaging studies using non-radiology personnel. Materials and methods. A multidisciplinary team considered manpower and training requirements and national sedation standards before designing a sedation pathway, which included scheduling, pre-sedation history and physical, medication protocols, and monitoring. Oral and IV medication protocols were developed based on patient age and weight. Sedation delays were defined as >15 min (IV) or >30 min (PO) from start of sedation to start of imaging. A sedation failure resulted in an incomplete diagnostic imaging study. Failure rates of 124 sedations before and 388 sedations after the pathway were compared.Results. The sedation failure rate for 7 months prior to pathway initiation was 15% (19/124). In the first 25 months after pathway initiation, failures were significantly reduced to 1.5% (6/388) (P55 min). Deviation from the recommended medication protocol accounted for most of the 115 delays. Only minor adverse events were seen (12/388, 3.1%).Conclusion. Implementing a pediatric sedation pathway significantly decreases the sedation failure rate. Pediatric residents and nurses can safely, effectively and efficiently sedate pediatric patients for routine diagnostic imaging procedures without the need for a radiology department sedation team in a department with a small-to-moderate volume of pediatric patients. (orig.)

  10. Teach yourself visually Mac Mini

    CERN Document Server

    Hart-Davis, Guy

    2012-01-01

    The perfect how-to guide for visual learners Apple?s Mac Mini packs a powerful punch is in a small package, including both HDMI and Thunderbolt ports plus the acclaimed OS X. But if you want to get the very most from all this power and versatility, be sure to get this practical visual guide. With full-color, step-by-step instructions as well as screenshots and illustrations on every page, it clearly shows you how to accomplish tasks rather than burying you in pages of text. Discover helpful visuals and how-tos on the OS, hardware specs, Launchpad, the App Store, multimedia capabilities (such

  11. Web Development with the Mac

    CERN Document Server

    Vegh, Aaron

    2010-01-01

    Learn Web development the Apple way and build a business. With a focus on both coding and creative development, this in-depth guide thoroughly covers what you need to know to build winning websites for clients — from what it takes to bring a business online to how to make your site interactive to how to run a freelance web business. In between, you'll master the technical tools of the trade — such as HTML, CSS, JavaScript, PHP, and Ruby on Rails — and learn how to create beautiful interfaces using Photoshop . This book covers everything a fledgling web developer working on a Mac needs to launc

  12. Update in Mechanical Ventilation, Sedation, and Outcomes 2014.

    Science.gov (United States)

    Goligher, Ewan C; Douflé, Ghislaine; Fan, Eddy

    2015-06-15

    Novel approaches to the management of acute respiratory distress syndrome include strategies to enhance alveolar liquid clearance, promote epithelial cell growth and recovery after acute lung injury, and individualize ventilator care on the basis of physiological responses. The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly, and centers providing ECMO must strive to meet stringent quality standards such as those set out by the ECMONet working group. Prognostic tools such as the RESP score can assist clinicians in predicting outcomes for patients with severe acute respiratory failure but do not predict whether ECMO will enhance survival. Evidence continues to grow that novel modes of mechanical ventilation such as neurally adjusted ventilatory assist are feasible and improve patient physiology and patient-ventilator interaction; data on clinical outcomes are limited but supportive. Critical illness causes long-term psychological and function sequelae: the risk of a new psychiatric diagnosis and severe physical impairment is significantly increased in the months after discharge from the intensive care unit. These long-term effects might be amenable to changes in sedation practice and increased early mobilization. Daily sedation discontinuation enhances the validity of routine delirium assessment. Many critically ill patients merit assessment by palliative care clinicians; the demand for palliative care services among critically ill patients is expected to grow. Future trials to test therapies for critical illness must ensure that study designs are adequately powered to detect benefit using realistic event rates. Integrating "big data" approaches into treatment decisions and trial designs offers a potential means of individualizing care to enhance outcomes for critically ill patients. PMID:26075422

  13. Take control the Mac OS X lexicon

    CERN Document Server

    Zardetto, Sharon

    2009-01-01

    This ebook explains a little bit of everything; in fact, it's The Mac OS X (and then some) Lexicon because it's never just you and your Mac. It's you and your Mac and the Web, and your email, and that article you just read that threw 17 new acronyms at you or assumed that you knew all sorts of networking terms. Or it's you and your Mac and Finder features you've never touched, such as burn folders, smart folders, or proxy icons, and that mysterious Services submenu. This book is a great guide for Macintosh users everywhere who have trouble keeping up with the latest jargon, fo

  14. Mac protocols for cyber-physical systems

    CERN Document Server

    Xia, Feng

    2015-01-01

    This book provides a literature review of various wireless MAC protocols and techniques for achieving real-time and reliable communications in the context of cyber-physical systems (CPS). The evaluation analysis of IEEE 802.15.4 for CPS therein will give insights into configuration and optimization of critical design parameters of MAC protocols. In addition, this book also presents the design and evaluation of an adaptive MAC protocol for medical CPS, which exemplifies how to facilitate real-time and reliable communications in CPS by exploiting IEEE 802.15.4 based MAC protocols. This book wil

  15. Teach yourself visually MacBook Pro

    CERN Document Server

    Hart-Davis, Guy

    2014-01-01

    Clear instructions to help visual learners get started with their MacBook Pro Covering all the essential information you need to get up to speed with your MacBook Pro, this new edition provides you with the most up-to-date information on performing everyday tasks quickly and easily. From basics such as powering on or shutting down the MacBook Pro to more advanced tasks such as running Windows applications, this visual guide provides the help and support you need to confidently use your MacBook Pro to its full potential.Empowers you to perform everyday tasks quickly and easilyCovers new hardwa

  16. Take control of troubleshooting your Mac

    CERN Document Server

    Kissell, Joe

    2009-01-01

    Learn how to solve any Mac problem with Joe Kissell's expert advice! We may love our Macs, but they can still suffer significant problems. In this essential guide from best-selling author Joe Kissell, you'll learn 17 basic troubleshooting procedures and how to solve 9 common problems, along with an easy-to-follow way to troubleshoot novel problems. Whether your Mac won't turn on, experiences kernel panics repeatedly, or is glacially slow, this book has the calm, friendly advice you need to find a solution. Following in the footsteps of his critically acclaimed books Take Control of Mac OS X

  17. Macs all-in-one for dummies

    CERN Document Server

    Hutsko, Joe

    2014-01-01

    Your all-in-one guide to unleashing your Mac's full potential It's a Mac world out there. But if you haven't read the instruction manual, you may be neglecting some of your computer's coolest features. Turn to Macs All-in-One For Dummies' jam-packed guide to access the incredible tools within your computer. With this fully updated reference, you will learn how to use Launchpad and Mission Control; protect your Mac; back up and restore data with Time Machine; sync across devices in iCloud; import, organize, and share photos; direct in iMovie; compose in GarageBand; and so much more. The possi

  18. Review on sedation for gastrointestinal tract endoscopy inchildren by non-anesthesiologists

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To present evidence and formulate recommendationsfor sedation in pediatric gastrointestinal (GI)endoscopy by non-anesthesiologists.METHODS: The databases MEDLINE, Cochrane andEMBASE were searched for the following keywords"endoscopy, GI", "endoscopy, digestive system" AND"sedation", "conscious sedation", "moderate sedation","deep sedation" and "hypnotics and sedatives" forpublications in English restricted to the pediatric age.We searched additional information published between January 2011 and January 2014. Searches for (upper) GIendoscopy sedation in pediatrics and sedation guidelinesby non-anesthesiologists for the adult population wereperformed.RESULTS: From the available studies three sedationprotocols are highlighted. Propofol, which seems tooffer the best balance between efficacy and safety israrely used by non-anesthesiologists mainly becauseof legal restrictions. Ketamine and a combination ofa benzodiazepine and an opioid are more frequentlyused. Data regarding other sedatives, anesthetics andadjuvant medications used for pediatric GI endoscopyare also presented.CONCLUSION: General anesthesia by a multidisciplinaryteam led by an anesthesiologist is preferred. The creationof sedation teams led by non-anesthesiologists anda careful selection of anesthetic drugs may offer analternative, but should be in l

  19. Descriptions by General Practitioners and Nurses of Their Collaboration in Continuous Sedation Until Death at Home: In-Depth Qualitative Interviews in Three European Countries

    NARCIS (Netherlands)

    L. Anquinet (Livia); J.A.C. Rietjens (Judith); N. Mathers (Nigel); J. Seymour (Jane); A. van der Heide (Agnes); L. Deliens (Luc)

    2014-01-01

    textabstractContext: One palliative care approach that is increasingly being used at home for relieving intolerable suffering in terminally ill patients is continuous sedation until death. Its provision requires a multidisciplinary team approach, with adequate collaboration and communication. Howeve

  20. Nurse-administered propofol sedation for endoscopy

    DEFF Research Database (Denmark)

    Jensen, J T; Vilmann, P; Horsted, T;

    2011-01-01

    endoscopists and for endoscopy nurses who were administering propofol sedation. The nurses' program comprised a 6-week course including theoretical and practical training in airway management, and the endoscopists' program consisted of 2.5 h of theory and a short course in practical airway management. In the......BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program. PATIENTS AND METHODS: A structured training program was developed both for...

  1. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology

    OpenAIRE

    Emmanuel Nicolas; Claire Lassauzay

    2009-01-01

    Emmanuel Nicolas1,2, Claire Lassauzay1,21CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; 2Université Clermont 1, EA 3847, Faculty of Dentistry, 63000 Clermont-Ferrand, FranceAbstract: Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer’s disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain cont...

  2. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology

    OpenAIRE

    Nicolas, Emmanuel

    2008-01-01

    Emmanuel Nicolas1,2, Claire Lassauzay1,21CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; 2Université Clermont 1, EA 3847, Faculty of Dentistry, 63000 Clermont-Ferrand, FranceAbstract: Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer’s disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain cont...

  3. Relieving suffering at the end of life: practitioners' perspectives on palliative sedation from three European countries.

    Science.gov (United States)

    Seymour, Jane E; Janssens, Rien; Broeckaert, Bert

    2007-04-01

    This paper reports findings from visits to palliative care settings and research units in the UK, Belgium and the Netherlands. The aim was to learn about clinicians' (both nurses and doctors) and academic researchers' understandings and experiences of palliative sedation for managing suffering at the end of life, and their views regarding its clinical, ethical and social implications. The project was linked to two larger studies of technologies used in palliative care. Eleven doctors, 14 nurses and 10 researchers took part in informal interviews. Relevant reports and papers from the academic, clinical and popular press were also collected from the three countries. The study took place in a context in which attention has been drawn towards palliative sedation by the legalisation of euthanasia in the Netherlands and Belgium, and by the re-examination of the legal position on assisted dying in the UK. In this context, palliative sedation has been posited by some as an alternative path of action. We report respondents' views under four headings: understanding and responding to suffering; the relationship between palliative sedation and euthanasia; palliative sedation and artificial hydration; and risks and uncertainties in the clinician-patient/family relationship. We conclude that the three countries can learn from one another about the difficult issues involved in giving compassionate care to those who are suffering immediately before death. Future research should be directed at enabling dialogue between countries: this has already been shown to open the door to the development of improved palliative care and to enhance respect for the different values and histories in each. PMID:17250941

  4. Sedation Monitor for the Office-Based Plastic Surgery Setting

    OpenAIRE

    Girling V, Robert G.W.; Salisbury, Mark

    2007-01-01

    Safety is always the primary concern of surgeons and patients in any office-based procedure. With the growing use of safe intravenous sedation in this setting, a need for a standardized protocol for dissociative anesthesia exists. We have accomplished this task by using a sedation monitoring system, which could easily be implemented in any existing office-based operating setting. Our sedation monitor, abbreviated SeMo, provides a standardized means of monitoring deep intravenous sedation admi...

  5. Changes to the bispectral index and regional cerebral blood flow in a sedative state, caused by midazolam administration

    International Nuclear Information System (INIS)

    Psychosedation, as used in the field of dentistry, is intended to provide trouble-free dental care while maintaining a proper level of sedation. One drug used in psychosedation is midazolam, which is known to have a strong amnestic effect. In the current research, I sought to clarify whether the bispectral index (BIS) using electroencephalogram (EEG) analysis can be used for assessment of optimal sedation in psychosedation, and what effects midazolam has on the cerebrum's mechanism of memory. The subjects were 17 healthy adult volunteers. Intravenous sedation involved a single administration of 0.06 mg/kg midazolam, or 6 mg/kg/h propofol, administered for 5 minutes and then continuously administered for 25 minutes at 3 mg/kg/h. For nitrous oxide inhalation sedation, 10-30% nitrous oxide was used. Clinical sedation and the BIS were measured in a variety of circumstances. To examine the effects of midazolam on the central nervous system, changes in brain oxygen consumption in visual memory tasks were assessed through observing changes in areas of brain activation using 3T fMRI. With intravenous sedation using midazolam or propofol, the BIS decreased immediately after drug administration, and the BIS at which optimal sedation was clinically determined was about 65. In contrast, no decrease in the BIS was noted with nitrous oxide inhalation sedation. In observing areas of brain activation by fMRI, the oxygen consumption mainly of visual cortices in the occipital lobe increased as a result of stimulation by visual memory tasks. Regardless of the amnestic effect midazolam produced in subjects, it did not suppress activation of the visual cortices in the occipital lobe. In intravenous sedation using midazolam or propofol, the BIS is effective in determining optimal sedation, and appropriate perioperative management can be performed using the BIS. However, in nitrous oxide inhalation sedation it appears that the BIS cannot be used to monitor levels of sedation. Amnestic

  6. LabVIEW control solutions on Mac

    OpenAIRE

    Salzmann, Christophe

    2008-01-01

    This presentation show the successful usage of LabVIEW on the Mac with a specific focus on control solutions. First, 15 years of control solutions with LabVIEW on the Mac are reviewed. Then it presents current DAQmx base solutions, using as an example a Spider crane (see http://lawww.epfl.ch/page4506.html) and an inverted pendulum.

  7. George MacDonald's Estimate of Childhood

    Science.gov (United States)

    Pridmore, John

    2007-01-01

    The nineteenth-century fantasy writer George MacDonald believed that "it is better to be a child in a green field than a knight of many orders." In this paper, I shall explore the bearing of this high estimate of childhood on spiritual education. MacDonald explores the spirituality of the child in his essay "A Sketch of Individual Development" and…

  8. Færre indikationer for sedation ved respiratorbehandling

    DEFF Research Database (Denmark)

    Strøm, Thomas; Rian, Omar; Toft, Palle

    2012-01-01

    Critically ill patients undergoing mechanical ventilation have traditionally been deeply sedated. In the latest decade growing evidence supports less sedation as being beneficial for the patients. A daily interruption of sedation has been shown to reduce the length of mechanical ventilation and the...

  9. An assessment of computer-assisted personalized sedation : a sedation delivery system to administer propofol for gastrointestinal endoscopy

    NARCIS (Netherlands)

    Pambianco, Daniel J.; Whitten, Christopher J.; Moerman, Annelies; Struys, Michel M.; Martin, James F.

    2008-01-01

    Background: Demand for colonoscopy and EGD procedures is increasing. Impediments to performing these examinations persist, Patients perceive these procedures as unpleasant and painful. The use of suboptimal sedatives results in inefficiency in endoscopy practices. Improving sedation methods utilizin

  10. Sedation and dissociative anaesthesia in the horse

    OpenAIRE

    Marntell, Stina

    2004-01-01

    The overall aim of this investigation was to study the effects of different drug combinations for premedication and dissociative anaesthesia, to examine their suitability for field conditions and their ability to maintain cardiorespiratory function and provide sufficient analgesia for common, but challenging procedures such as castration. Haemodynamic parameters, pulmonary ventilation-perfusion relationships, and clinical effects were studied during sedation and dissociative anaesthesia. The ...

  11. Respiratory Monitoring for Anesthesia and Sedation

    OpenAIRE

    Anderson, Jay A.

    1987-01-01

    This article reviews the theory and practice of routine respiratory monitoring during anesthesia and sedation. Oxygen monitoring and capnography methods are reviewed. The current ventilation monitoring system of choice is considered a combination of the pulse oximeter and capnography. Guidelines are provided for monitoring standards.

  12. Comparison of CSMA based MAC protocols of wireless sensor networks

    CERN Document Server

    singh, Himanshu

    2012-01-01

    Energy conservation has been an important area of interest in Wireless Sensor networks (WSNs). Medium Access Control (MAC) protocols play an important role in energy conservation. In this paper, we describe CSMA based MAC protocols for WSN and analyze the simulation results of these protocols. We implemented S-MAC, T-MAC, B-MAC, B-MAC+, X-MAC, DMAC and Wise-MAC in TOSSIM, a simulator which unlike other simulators simulates the same code running on real hardware. Previous surveys mainly focused on the classification of MAC protocols according to the techniques being used or problem dealt with and presented a theoretical evaluation of protocols. This paper presents the comparative study of CSMA based protocols for WSNs, showing which MAC protocol is suitable in a particular environment and supports the arguments with the simulation results. The comparative study can be used to find the best suited MAC protocol for wireless sensor networks in different environments.

  13. Beginning Mac OS X Snow Leopard programming

    CERN Document Server

    Trent, Michael

    2010-01-01

    Michael Trent is a technical reviewer for numerous books and magazine articles and the coauthor of Beginning Mac OS X Programming with Drew McCormack. Drew McCormack is an experienced computational scientist, founder of the ""The Mental Faculty""-an independent company developing software for the Mac and iPhone-and the coauthor of Beginning Mac OS X Programming with Michael Trent. Wrox Beginning guides are crafted to make learning programming languages and technologies easier than you think, providing a structured, tutorial format that will guide you through all the techniques involved.

  14. Mac OS X for Unix Geeks (Leopard)

    CERN Document Server

    Rothman, Ernest E; Rosen, Rich

    2009-01-01

    If you've been lured to Mac OS X because of its Unix roots, this invaluable book serves as a bridge between Apple's Darwin OS and the more traditional Unix systems. The new edition offers a complete tour of Mac OS X's Unix shell for Leopard and Tiger, and helps you find the facilities that replace or correspond to standard Unix utilities. Learn how to compile code, link to libraries, and port Unix software to Mac OS X and much more with this concise guide.

  15. Fast arithmetic in MacLISP

    Science.gov (United States)

    Steele, G. L., Jr.

    1977-01-01

    MacLISP provides a compiler which produces numerical code competitive in speed with some FORTRAN implementations and yet compatible with the rest of the MacLISP system. All numerical programs can be run under the MacLISP interpreter. Additional declarations to the compiler specify type information which allows the generation of optimized numerical code which generally does not require the garbage collection of temporary numerical results. Array accesses are almost as fast as in FORTRAN, and permit the use of dynamically allocated arrays of varying dimensions. The implementation decisions regarding user interface, data representations, and interfacing conventions are discussed which allow the generation of fast numerical LISP code.

  16. Learn Office 2011 for Mac OS X

    CERN Document Server

    Hart-Davis, Guy

    2011-01-01

    Office for Mac remains the leading productivity suite for Mac, with Apple's iWork and the free OpenOffice.org trailing far behind. And now it's being updated with a cleaner interface and more compatibility with Exchange and SharePoint. Learn Office 2011 for Mac OS X offers a practical, hands-on approach to using Office 2011 applications to create and edit documents and get work done efficiently. You'll learn how to customize Office, design, create, and share documents, manipulate data in a spreadsheet, and create lively presentations. You'll also discover how to organize your email, contacts,

  17. Office 2008 for Mac for dummies

    CERN Document Server

    LeVitus, Bob

    2013-01-01

    Office 2008 for Mac is here, with great new enhancements to all your favorite office productivity tools. Who better than "Dr. Mac, "Bob LeVitus, to show you how to load and use them all? From choosing the best version for your needs to managing your life with your online calendar, Office 2008 For Mac For Dummies covers what you need to know. It compares the Student/Teacher Edition, Standard Edition, and Professional Edition, then walks you through installing your preferred version and keeping it up to date. You'll find out all the things you can do with Word, Excel, PowerPoint, and Entourage,

  18. Mac OS X Lion portable genius

    CERN Document Server

    Spivey, Dwight

    2012-01-01

    Two e-books, Mac OS X Lion Portable Genius and MacBook Pro Portable Genius, Third Edition, bundled in one package Books in the Portable Genius series provide readers with the most accessible, useful information possible, including plenty of tips and techniques for the most-used features in a product or software. These e-books will show you what you may not find out by just working with your MacBook Pro and OS X Lion. Genius icons present smart or innovative ways to do something, saving time and hassle. Easy-to-find information gives you the essentials plus insightful tips on how to navigate

  19. An Evaluation of Intranasal Sufentanil and Dexmedetomidine for Pediatric Dental Sedation

    Directory of Open Access Journals (Sweden)

    James M. Hitt

    2014-03-01

    Full Text Available Conscious or moderate sedation is routinely used to facilitate the dental care of the pre- or un-cooperative child. Dexmedetomidine (DEX has little respiratory depressant effect, possibly making it a safer option when used as an adjunct to either opioids or benzodiazepines. Unlike intranasal (IN midazolam, IN application of DEX and sufentanil (SUF does not appear to cause much discomfort. Further, although DEX lacks respiratory depressive effects, it is an α2-agonist that can cause hypotension and bradycardia when given in high doses or during prolonged periods of administration. The aim of this feasibility study was to prospectively assess IN DEX/SUF as a potential sedation regimen for pediatric dental procedures. After IRB approval and informed consent, children (aged 3–7 years; n = 20 from our dental clinic were recruited. All patients received 2 μg/kg (max 40 μg of IN DEX 45 min before the procedure, followed 30 min later by 1 μg/kg (max 20 μg of IN SUF. An independent observer rated the effects of sedation using the Ohio State University Behavior Rating Scale (OSUBRS and University of Michigan Sedation Scale (UMSS. The dentist and the parent also assessed the efficacy of sedation. Dental procedures were well tolerated and none were aborted. The mean OSUBRS procedure score was 2.1, the UMSS procedure score was 1.6, and all scores returned to baseline after the procedure. The average dentist rated quality of sedation was 7.6 across the 20 subjects. After discharge, parents reported one child with prolonged drowsiness and one child who vomited at home. The use of IN DEX supplemented with IN SUF provided both an effective and tolerable form of moderate sedation. Although onset and recovery are slower than with oral (PO midazolam and transmucosal fentanyl, the quality of the sedation may be better with less risk of respiratory depression. Results from this preliminary study showed no major complications from IN delivery of these agents.

  20. H-MAC: A Hybrid MAC Protocol for Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    S. Mehta

    2010-03-01

    Full Text Available In this paper, we propose a hybrid medium access control protocol (H-MAC for wireless sensor networks. It is based on the IEEE 802.11’s power saving mechanism (PSM and slotted aloha, andutilizes multiple slots dynamically to improve performance. Existing MAC protocols for sensor networks reduce energy consumptions by introducing variation in an active/sleep mechanism. But they may notprovide energy efficiency in varying traffic conditions as well as they did not address Quality of Service (QoS issues. H-MAC, the propose MAC protocol maintains energy efficiency as well as QoS issues like latency, throughput, and channel utilization. Our numerical results show that H-MAC has significant improvements in QoS parameters than the existing MAC protocols for sensor networks while consuming comparable amount of energy.

  1. CR-MAC: A multichannel MAC protocol for cognitive radio ad hoc networks

    CERN Document Server

    Kamruzzaman, S M

    2010-01-01

    This paper proposes a cross-layer based cognitive radio multichannel medium access control (MAC) protocol with TDMA, which integrate the spectrum sensing at physical (PHY) layer and the packet scheduling at MAC layer, for the ad hoc wireless networks. The IEEE 802.11 standard allows for the use of multiple channels available at the PHY layer, but its MAC protocol is designed only for a single channel. A single channel MAC protocol does not work well in a multichannel environment, because of the multichannel hidden terminal problem. Our proposed protocol enables secondary users (SUs) to utilize multiple channels by switching channels dynamically, thus increasing network throughput. In our proposed protocol, each SU is equipped with only one spectrum agile transceiver, but solves the multichannel hidden terminal problem using temporal synchronization. The proposed cognitive radio MAC (CR-MAC) protocol allows SUs to identify and use the unused frequency spectrum in a way that constrains the level of interference...

  2. H-MAC: A Hybrid MAC Protocol for Wireless Sensor Networks

    CERN Document Server

    Mehta, S; 10.5121/ijcnc.2010.2208

    2010-01-01

    In this paper, we propose a hybrid medium access control protocol (H-MAC) for wireless sensor networks. It is based on the IEEE 802.11's power saving mechanism (PSM) and slotted aloha, and utilizes multiple slots dynamically to improve performance. Existing MAC protocols for sensor networks reduce energy consumptions by introducing variation in an active/sleep mechanism. But they may not provide energy efficiency in varying traffic conditions as well as they did not address Quality of Service (QoS) issues. H-MAC, the propose MAC protocol maintains energy efficiency as well as QoS issues like latency, throughput, and channel utilization. Our numerical results show that H-MAC has significant improvements in QoS parameters than the existing MAC protocols for sensor networks while consuming comparable amount of energy.

  3. Analgesics and sedatives in vascular interventionist radiologic

    International Nuclear Information System (INIS)

    Interventionist radiology routinely requires the use of different drugs (analgesics and sedatives) in the course of a procedure. Aside from their therapeutic action, these drugs can produce secondary or undesirable effects, making necessary an in-depth knowledge of them to assure their safe and efficient management. The aim of this work is to provide the vascular interventionist radiologist with additional information on the management of those drugs that contribute to minimizing patient discomfort and pain in interventionist procedures. Author

  4. Learn Mac OS X Snow Leopard

    CERN Document Server

    Meyers, Scott

    2009-01-01

    You're smart and savvy, but also busy. This comprehensive guide to Apple's Mac OS X 10.6, Snow Leopard, gives you everything you need to know to live a happy, productive Mac life. Learn Mac OS X Snow Leopard will have you up and connected lickity split. With a minimum of overhead and a maximum of useful information, you'll cover a lot of ground in the time it takes other books to get you plugged in. If this isn't your first experience with Mac OS X, skip right to the "What's New in Snow Leopard" sections. You may also find yourself using this book as a quick refresher course or a way

  5. Teach yourself visually MacBook Air

    CERN Document Server

    Hart-Davis, Guy

    2013-01-01

    Get the most out of the latest MacBook Air with this easy-to-read visual guide Who doesn't love the MacBook Air? It's light as a feather, yet delivers heavyweight functionality. If you want clear, practical, visual instructions on how to use your new MacBook Air, this is the book for you. Using tons of illustrations and step-by-step explanations, Teach Yourself VISUALLY MacBook Air gets you up and running by clearly showing you how to do everything. From the basics to everything the new OS X operating system brings to the table, this book guides you through. Walks you through all the new fea

  6. Enhanced Sleep Mode MAC Control for EPON

    DEFF Research Database (Denmark)

    Yan, Ying; Dittmann, Lars

    2011-01-01

    This paper introduces sleep mode operations for EPON. New MAC control functions are proposed to schedule sleep periods. Traffic profiles are considered to optimize energy efficiency and network performances. Simulation results are analyzed in OPNET modeler.......This paper introduces sleep mode operations for EPON. New MAC control functions are proposed to schedule sleep periods. Traffic profiles are considered to optimize energy efficiency and network performances. Simulation results are analyzed in OPNET modeler....

  7. Macintosh Troubleshooting Pocket Guide for Mac OS

    CERN Document Server

    Lerner, David; Corporation, Tekserve

    2009-01-01

    The Macintosh Troubleshooting Pocket Guide covers the most common user hardware and software trouble. It's not just a book for Mac OS X (although it includes tips for OS X and Jaguar), it's for anyone who owns a Mac of any type-- there are software tips going back as far as OS 6. This slim guide distills the answers to the urgent questions that Tekserve's employee's answer every week into a handy guide that fits in your back pocket or alongside your keyboard.

  8. WLAN throughput improvement via distributed queuing MAC

    OpenAIRE

    Alonso Zárate, Luis Gonzaga; Ferrús Ferré, Ramón Antonio; Agustí Comes, Ramon

    2005-01-01

    This paper analyzes the performance of a MAC scheme for wireless local area networks (WLANs) that makes use of distributed queues to improve radio channel utilization. Analytical values for the maximum throughput performance are derived as a function of the system parameters. The obtained results show that the proposed scheme outperforms the legacy 802.11 MAC protocol in terms of maximum stable throughput. This benefit is obtained from eliminating back-off periods and collisions in data packe...

  9. Variable TDMA MAC Protocol For WDM EPON

    Institute of Scientific and Technical Information of China (English)

    Minsuk; Jung; Yongseok; Chang; Jonghoon; Eom; Sungho; Kim

    2003-01-01

    A MAC(Media Access Control) protocol, one of the most important technologies for an EPON(Ethernet Passive Optical Network), contains a scheduling algorithm to avoid collisions in shared links and assigns an effective bandwidth when ONUs (Optical Network Units) transfer signals upward. The current paper proposes a MAC Protocol that operates a TDMA(Time method with a variable slot assignment to overcome short of bandwidth using by the number of n wavelength., the next generation access network. To verify ...

  10. 12 CFR 615.5174 - Farmer Mac securities.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Farmer Mac securities. 615.5174 Section 615....5174 Farmer Mac securities. (a) General authority. You may purchase and hold mortgage securities that... Corporation (Farmer Mac securities). You may purchase and hold Farmer Mac securities for the purposes...

  11. Dental treatment for people with challenging behaviour: general anaesthesia or sedation?

    Science.gov (United States)

    Manley, M C; Skelly, A M; Hamilton, A G

    2000-04-01

    The dental care of people with severe learning disability and challenging behaviour presents many problems. The maintenance of oral health by regular examination, prevention and treatment may be difficult because of the limitations in patient cooperation. In many cases the diagnosis of orofacial pain may need to be discounted as a cause of uncharacteristic and sometimes aggressive behaviour. In such cases the use of general anaesthesia for examination and treatment would seem to be the obvious option but this strategy has limitations. This paper undertakes a focused review of sedation techniques as an alternative to general anaesthesia in the treatment of people with challenging behaviour. The use of novel techniques of sedation combining intravenous with oral or intranasal routes is described with patients treated in a community dental health centre. All patients had previously received treatment using general anaesthesia. The techniques described proved effective and safe for use in the primary care setting. PMID:10816923

  12. Efficacy and safety of oral triclofos as sedative for children undergoing sleep electroencephalogram: An observational study

    Science.gov (United States)

    Jain, Puneet; Sharma, Suvasini; Sharma, Ankita; Goel, Shaiphali; Jose, Anjali; Aneja, Satinder

    2016-01-01

    Objectives: Triclofos may be a better sedative in view of better palatability and less gastric irritation as compared to chloral hydrate. This study aimed to assess the efficacy of triclofos (a commonly used sedative in India) as a sedative for sleep electroencephalogram (EEG) study in children. Methods: This prospective observational study was carried out in a tertiary care pediatric center. Consecutive children aged 6 months to 5 years referred for sleep EEG evaluation were recruited. Their clinical details were noted in a proforma after an informed consent. After a trial for natural sleep, oral triclofos was administered. Sleep parameters and adverse effects were noted. Results: One-hundred and sixty children were then enrolled. EEG was successfully recorded in 149 (93.1%) children. Median latency of sleep onset was 30 min and median duration of sleep was 90 min. The adverse effects in the following 24 h were mild and included dizziness, irritability, and vomiting. Conclusions: Oral triclofos was found to be an effective sedative for EEG in children with minimal adverse effects.

  13. Mac protocols for wireless sensor network (wsn): a comparative study

    International Nuclear Information System (INIS)

    Data communication between nodes is carried out under Medium Access Control (MAC) protocol which is defined at data link layer. The MAC protocols are responsible to communicate and coordinate between nodes according to the defined standards in WSN (Wireless Sensor Networks). The design of a MAC protocol should also address the issues of energy efficiency and transmission efficiency. There are number of MAC protocols that exist in the literature proposed for WSN. In this paper, nine MAC protocols which includes S-MAC, T-MAC, Wise-MAC, Mu-MAC, Z-MAC, A-MAC, D-MAC, B-MAC and B-MAC+ for WSN have been explored, studied and analyzed. These nine protocols are classified in contention based and hybrid (combination of contention and schedule based) MAC protocols. The goal of this comparative study is to provide a basis for MAC protocols and to highlight different mechanisms used with respect to parameters for the evaluation of energy and transmission efficiency in WSN. This study also aims to give reader a better understanding of the concepts, processes and flow of information used in these MAC protocols for WSN. A comparison with respect to energy reservation scheme, idle listening avoidance, latency, fairness, data synchronization, and throughput maximization has been presented. It was analyzed that contention based MAC protocols are less energy efficient as compared to hybrid MAC protocols. From the analysis of contention based MAC protocols in term of energy consumption, it was being observed that protocols based on preamble sampling consume lesser energy than protocols based on static or dynamic sleep schedule. (author)

  14. Sedation versus general anaesthesia in paediatric patients undergoing chest CT

    International Nuclear Information System (INIS)

    Objective: CT of the chest in paediatric patients often requires sedation or general anaesthesia to minimize motion artefacts. Both sedation and general anaesthesia are associated with atelectasis which obscures the underlying pulmonary pathology. We conducted a prospective study to compare these two methods with respect to degree of motion artefacts and extent of atelectasis. Material and Methods: Nineteen patients undergoing 22 chest CT examinations were randomly selected for either sedation or general anaesthesia. The total area of atelectasis and the degree of motion artefacts were measured. Results: The mean percentage of atelectasis was 6.67% for general anaesthesia and 0.01% for sedation (p=0.01). There was no significant difference in the quality of the images between the sedation patients and the general anaesthesia patients. Conclusion: Whenever the clinical condition permits it, sedation rather than general anaesthesia should be given to paediatric patients undergoing chest CT. (orig.)

  15. Augmenting sedation with hypnosis in drug-dependent patients.

    OpenAIRE

    Lu, D. P.; Lu, G. P.; Hersh, E. V.

    1995-01-01

    The successful use of conscious sedation in patients physically dependent on centrally acting drugs is problematic for the dental anesthesiologist because of the concomitant development of tolerance to standard sedative agents. Dosage requirements necessary to adequately sedate these patients are often higher than recommended and carry an increased risk of drug overdose. The following report summarizes our experience with 18 drug-dependent patients in whom hypnosis was employed in conjunction...

  16. Comparative Study of Three Sedative Techniques During Shock Wave Lithotripsy

    OpenAIRE

    Wafaa G. Ahmed

    2009-01-01

    Background: Many authors found that dexmedetomidine is an effective, safe drug for sedation during extracorporeal shock wave lithotripsy (ESWL). Dexmedetomidine is a lipophilic 2-agonist ,which sedates patients by reducing sympathetic activity and the level of arousal ,thus patients lie calmly in beds but are easily roused to full consciousness. In the present study, the sedative, haemodynamics, and respiratory effects, and recovery time of dexmedetomidine and dexmedetomidine/fentanyl combina...

  17. Oral transmucosal administration of dexmedetomidine for sedation in 4 dogs

    OpenAIRE

    Cohen, Anne E.; Bennett, Sara L.

    2015-01-01

    Injectable dexmedetomidine (DM) is widely used for sedation, restraint, anxiolysis, and analgesia in veterinary medicine. Oral transmucosal dexmedetomidine (OTM DM) has been evaluated in horses, cats, and humans, but not in dogs. In this case series, OTM DM (mean dose of 32.6 μg/kg body weight) was given in the buccal pouch to 4 aggressive dogs in a hospital setting. Two of the dogs were subsequently euthanized, and in the other 2, sedation was reversed with atipamezole. Satisfactory sedation...

  18. Optimizing sedation in patients with acute brain injury.

    Science.gov (United States)

    Oddo, Mauro; Crippa, Ilaria Alice; Mehta, Sangeeta; Menon, David; Payen, Jean-Francois; Taccone, Fabio Silvio; Citerio, Giuseppe

    2016-01-01

    Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradigm of minimal sedation can be translated to the neuro-ICU (NICU) is unclear. In patients with ABI, sedation has 'general' indications (control of anxiety, pain, discomfort, agitation, facilitation of mechanical ventilation) and 'neuro-specific' indications (reduction of cerebral metabolic demand, improved brain tolerance to ischaemia). Sedation also is an essential therapeutic component of intracranial pressure therapy, targeted temperature management and seizure control. Given the lack of large trials which have evaluated clinically relevant endpoints, sedative selection depends on the effect of each agent on cerebral and systemic haemodynamics. Titration and withdrawal of sedation in the NICU setting has to be balanced between the risk that interrupting sedation might exacerbate brain injury (e.g. intracranial pressure elevation) and the potential benefits of enhanced neurological function and reduced complications. In this review, we provide a concise summary of cerebral physiologic effects of sedatives and analgesics, the advantages/disadvantages of each agent, the comparative effects of standard sedatives (propofol and midazolam) and the emerging role of alternative drugs (ketamine). We suggest a pragmatic approach for the use of sedation-analgesia in the NICU, focusing on some practical aspects, including optimal titration and management of sedation withdrawal according to ABI severity. PMID:27145814

  19. SA-MAC:Self-Stabilizing Adaptive MAC Protocol for Wireless Sensor Networks

    Institute of Scientific and Technical Information of China (English)

    波澄; 韩君泽; 李向阳; 王昱; 肖波

    2014-01-01

    A common method of prolonging the lifetime of wireless sensor networks is to use low power duty cycling protocol. Existing protocols consist of two categories: sender-initiated and receiver-initiated. In this paper, we present SA-MAC, a self-stabilizing adaptive MAC protocol for wireless sensor networks. SA-MAC dynamically adjusts the transmission time-slot, waking up time-slot, and packet detection pattern according to current network working condition, such as packet length and wake-up patterns of neighboring nodes. In the long run, every sensor node will find its own transmission phase so that the network will enter a stable stage when the network load and qualities are static. We conduct extensive experiments to evaluate the energy consumption, packet reception rate of SA-MAC in real sensor networking systems. Our results indicate that SA-MAC outperforms other existing protocols.

  20. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients

    Directory of Open Access Journals (Sweden)

    Kenneth A. Scheppke

    2014-11-01

    Full Text Available Introduction: Violent and agitated patients pose a serious challenge for emergency medical services (EMS personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS, is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population. Methods: We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. We identified 52 patients as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine. Results: Review of records demonstrated that almost all patients (50/52 were rapidly sedated and in all but three patients no negative side effects were noted during the prehospital care. All patients were subsequently transported to the hospital before ketamine effects wore off. Conclusion: Ketamine may be safely and effectively used by trained paramedics following a specific protocol. The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access. [West J Emerg Med. 2014;15(7:–0.

  1. A Study of MAC Protocols for WBANs

    Directory of Open Access Journals (Sweden)

    Sana Ullah

    2009-12-01

    Full Text Available The seamless integration of low-power, miniaturised, invasive/non-invasive lightweight sensor nodes have contributed to the development of a proactive and unobtrusive Wireless Body Area Network (WBAN. A WBAN provides long-term health monitoring of a patient without any constraint on his/her normal dailylife activities. This monitoring requires the low-power operation of invasive/non-invasive sensor nodes. In other words, a power-efficient Medium Access Control (MAC protocol is required to satisfy the stringent WBAN requirements, including low-power consumption. In this paper, we first outline the WBAN requirements that are important for the design of a low-power MAC protocol. Then we study low-power MAC protocols proposed/investigated for a WBAN with emphasis on their strengths and weaknesses. We also review different power-efficient mechanisms for a WBAN. In addition, useful suggestions are given to help the MAC designers to develop a low-power MAC protocol that will satisfy the stringent requirements.

  2. A study of MAC protocols for WBANs.

    Science.gov (United States)

    Ullah, Sana; Shen, Bin; Islam, S M Riazul; Khan, Pervez; Saleem, Shahnaz; Kwak, Kyung Sup

    2010-01-01

    The seamless integration of low-power, miniaturised, invasive/non-invasive lightweight sensor nodes have contributed to the development of a proactive and unobtrusive Wireless Body Area Network (WBAN). A WBAN provides long-term health monitoring of a patient without any constraint on his/her normal dailylife activities. This monitoring requires the low-power operation of invasive/non-invasive sensor nodes. In other words, a power-efficient Medium Access Control (MAC) protocol is required to satisfy the stringent WBAN requirements, including low-power consumption. In this paper, we first outline the WBAN requirements that are important for the design of a low-power MAC protocol. Then we study low-power MAC protocols proposed/investigated for a WBAN with emphasis on their strengths and weaknesses. We also review different power-efficient mechanisms for a WBAN. In addition, useful suggestions are given to help the MAC designers to develop a low-power MAC protocol that will satisfy the stringent requirements. PMID:22315531

  3. Sedative medications outside the operating room and the pharmacology of sedatives

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2015-01-01

    PURPOSE OF REVIEW: There is a growing medical demand for suitable sedatives and analgesics to support the ongoing progress in diagnostic procedures and imaging techniques. This review provides an update of the pharmacology of the most commonly used drugs used for these procedures and shortly ment...

  4. Dexmedetomidine sedation in painful posterior segment surgery

    Directory of Open Access Journals (Sweden)

    Mansour A

    2012-12-01

    Full Text Available Ahmad Mansour,1,2 Samar Taha31Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Rafik Hariri University Hospital, Beirut, Lebanon; 3Department of Anesthesiology, American University of Beirut, Beirut, LebanonPurpose: To present a case series on the use of dexmedetomidine (Precedex sedation in painful posterior segment surgery performed under topical anesthesia, similar to its use in cataract surgery.Methods: A prospective review of cases that had posterior segment surgery under topical anesthesia and that needed sedation. Dexmedetomidine-loading infusion was 1 mcg/kg over 10 minutes, followed by a maintenance infusion (0.5 mcg/kg/h.Results: Nine patients were operated on under topical anesthesia: two scleral buckle, five cryopexy, one scleral laceration, and one pars plana vitrectomy with very dense laser therapy in an albinotic fundus; six patients had retinal detachment. General or local anesthesia were not possible due to medical or ocular morbidities, use of anticoagulants, or the surgery plan changed intraoperatively when new pathologies were discovered. The surgeon achieved good surgical control in eight of nine cases, with one patient having ocular and bodily movements that were disturbing. Six patients had no pain, while three patients reported mild pain. No adverse effects were noted and all patients had successful surgical outcomes. Heart rate, blood pressure, and oxygen saturation were well controlled throughout the procedures. The most frequent adverse reactions of dexmedetomidine reported in the literature in less than 5% (hypotension, bradycardia, and dry mouth were not recorded in the present study.Conclusion: When a surgeon has planned to do a pars plana vitrectomy under topical anesthesia and the surgical situation dictates the addition of cryopexy, scleral buckle, or intense laser retinopexy, then sedation with dexmedetomidine can help in the control of ocular pain in the majority of cases, with good

  5. A systematic review of capnography for sedation.

    Science.gov (United States)

    Conway, A; Douglas, C; Sutherland, J R

    2016-04-01

    We included six trials with 2524 participants. Capnography reduced hypoxaemic episodes, relative risk (95% CI) 0.71 (0.56-0.91), p = 0.02, but the quality of evidence was poor due to high risks of performance bias and detection bias and substantial statistical heterogeneity. The reduction in hypoxaemic episodes was statistically homogeneous in the subgroup of three trials of 1823 adults sedated for colonoscopy, relative risk (95% CI) 0.59 (0.48-0.73), p capnography affected other outcomes, including assisted ventilation, relative risk (95% CI) 0.58 (0.26-1.27), p = 0.17. PMID:26792775

  6. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016.

    Science.gov (United States)

    Coté, Charles J; Wilson, Stephen

    2016-07-01

    The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. PMID:27354454

  7. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016.

    Science.gov (United States)

    Coté, Charles J; Wilson, Stephen

    2016-01-01

    The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. PMID:27557912

  8. Moderate sedation for MRI in young children with autism

    Energy Technology Data Exchange (ETDEWEB)

    Ross, Allison Kinder [Duke University Medical Center, Division of Pediatric Anesthesia, Durham (United States); Hazlett, Heather Cody; Garrett, Nancy T. [University of North Carolina School of Medicine, Department of Psychiatry, Chapel Hill, NC (United States); Wilkerson, Christy [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Piven, Joseph [University of North Carolina School of Medicine, Departments of Psychiatry and Pediatrics, Chapel Hill, NC (United States)

    2005-09-01

    Autism is a pervasive neurodevelopmental disorder. Because of the deficits associated with the condition, sedation of children with autism has been considered more challenging than sedation of other children. To test this hypothesis, we compared children with autism against clinical controls to determine differences in requirements for moderate sedation for MRI. Children ages 18-36 months with autism (group 1, n = 41) and children with no autistic behavior (group 2, n = 42) were sedated with a combination of pentobarbital and fentanyl per sedation service protocol. The sedation nurse was consistent for all patients, and all were sedated to achieve a Modified Ramsay Score of 4. Demographics and doses of sedatives were recorded and compared. There were no sedation failures in either group. Children in group 1 (autism) were significantly older than group 2 (32.02{+-}3.6 months vs 28.16{+-}6.7 months) and weighed significantly more (14.87{+-}2.1 kg vs 13.42{+-}2.2 kg). When compared on a per-kilogram basis, however, group 1 had a significantly lower fentanyl requirement than group 2 (1.25{+-}0.55 mcg/kg vs 1.57{+-}0.81 mcg/kg), but no significant difference was found in pentobarbital dosing between groups 1 and 2, respectively (4.92{+-}0.92 mg/kg vs 5.21{+-}1.6 mg/kg). Autistic children in this age range are not more difficult to sedate and do not require higher doses of sedative agents for noninvasive imaging studies. (orig.)

  9. Moderate sedation for MRI in young children with autism

    International Nuclear Information System (INIS)

    Autism is a pervasive neurodevelopmental disorder. Because of the deficits associated with the condition, sedation of children with autism has been considered more challenging than sedation of other children. To test this hypothesis, we compared children with autism against clinical controls to determine differences in requirements for moderate sedation for MRI. Children ages 18-36 months with autism (group 1, n = 41) and children with no autistic behavior (group 2, n = 42) were sedated with a combination of pentobarbital and fentanyl per sedation service protocol. The sedation nurse was consistent for all patients, and all were sedated to achieve a Modified Ramsay Score of 4. Demographics and doses of sedatives were recorded and compared. There were no sedation failures in either group. Children in group 1 (autism) were significantly older than group 2 (32.02±3.6 months vs 28.16±6.7 months) and weighed significantly more (14.87±2.1 kg vs 13.42±2.2 kg). When compared on a per-kilogram basis, however, group 1 had a significantly lower fentanyl requirement than group 2 (1.25±0.55 mcg/kg vs 1.57±0.81 mcg/kg), but no significant difference was found in pentobarbital dosing between groups 1 and 2, respectively (4.92±0.92 mg/kg vs 5.21±1.6 mg/kg). Autistic children in this age range are not more difficult to sedate and do not require higher doses of sedative agents for noninvasive imaging studies. (orig.)

  10. Patient-controlled sedation with propofol/remifentanil versus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study

    Directory of Open Access Journals (Sweden)

    Sherif S Sultan

    2014-01-01

    Full Text Available Context: Many techniques are used for sedation of colonoscopies. Patient-controlled sedation (PCS is utilizing many drugs or drug combinations. Aims: The aim of this study is to compare the safety and feasibility of propofol/remifentanil versus propofol/alfentanil given to sedate patients undergoing outpatient colonoscopies through a patient-controlled technique. Settings and Design: Controlled randomized and double-blind study. Materials and Methods: A total of 80 patients were randomly divided into two groups; PA group received a combination of propofol/alfentanil and PR group received propofol/remifentanil combination. Patients were monitored for heart rate (HR, blood pressure (BP, oxygen saturation, and Ramsay sedation scale (RSS. Times of the following events were recorded; initiation of sedation, insertion and removal of the colonoscope, recovery and discharge. Five intervals were calculated; time to sedation, procedure time, postprocedure time, procedure room time, and postanesthesia care unit (PACU time. Endoscopist and patient satisfaction scores were obtained. Statistical Analysis Used: Unpaired Student′s t-test was used to compare between the two groups. Paired Student′s t-test was used to compare baseline readings with readings after 30 min of sedation in the same group when needed. Results: Both groups showed slowing of the HR and decrease in mean arterial BP. HR and mean arterial BP were significantly lower 5 and 10 min after initiation of sedation in PR group when compared with PA group. Both HR and mean arterial BP returned to presedation readings 30 min after initiation of sedation in PR group but not in PA group. No differences between the two groups concerning oxygen saturation, RSS, endoscopist and patient satisfaction scores. Postprocedure and PACU times were significantly prolonged in PA group. Conclusion: PCS with either remifentanil/propofol or alfentanil/propofol for patients undergoing outpatient colonoscopy is safe

  11. Shared decision making after MacIntyre.

    Science.gov (United States)

    Tilburt, Jon

    2011-04-01

    This paper explores the practical consequences that Enlightenment ideals had on morality as it applies to clinical practice, using Alisdair MacIntyre's conceptualization and critique of the Enlightenment as its reference point. Taking the perspective of a practicing clinician, I critically examine the historical origins of ideas that made shared decision making (SDM) a necessary and ideal model of clinician-patient relationship. I then build on MacIntyre's critique of Enlightenment thought and examine its implications for conceptions of shared decision-making that use an Enlightenment justification, as well as examining contemporary threats to SDM that the Enlightenment made possible. I conclude by offering an alternative framing of SDM that fits with the clinician's duty to act on behalf of and along with patients but that avoids the tenuous Enlightenment assumptions that MacIntyre's work so vocally critiques. PMID:21378085

  12. MacBook Pro Portable Genius

    CERN Document Server

    Miser, Brad

    2011-01-01

    Tips and techniques for forward-thinking MacBook Pro users Now that you have a MacBook Pro, you need just one more accessory, your very own copy of MacBook Pro Portable Genius, Third Edition. This handy, compact book lets you in on a wealth of tips and tricks, so you get the very most out of Apple's very popular notebook. Discover the latest on the most recent release of iLife, get the skinny on the new Intel Core i7 and i5 processors in the Pro, see how to go wireless in a smart way, and much more. The book is easy to navigate, doesn't skimp on the essentials, and helps you save time and avoi

  13. Office 2011 for Mac All-in-One For Dummies

    CERN Document Server

    Bajaj, Geetesh

    2011-01-01

    Get up to speed on the revolutionary changes in Office for the MacThe 2011 version of the Microsoft Office productivity suite for the Mac sports major changes from what Mac users are accustomed to. This soup-to-nuts guide gets the Mac crowd up to date quickly and easily. Individual minibooks thoroughly cover the Project Gallery, Word, Excel, PowerPoint, Outlook (new for Mac), and the Project Center. You'll learn how the new Office integrates with the Windows version, how to use and customize the new Ribbon interface, and much more.Office for Mac is the most popular office productivity suite fo

  14. Teach yourself visually MacBook

    CERN Document Server

    Miser, Brad

    2008-01-01

    If you prefer instructions that show you how to do something and skip the long-winded explanations, then this book is for you. You?ll find clear, step-by-step screen shots that show you how to tackle more than 160 MacBook tasks. Each task-based spread includes easy, visual directions for performing necessary operations, including using the Dock and Dashboard, managing Expos? and Spaces, video chatting with iChat, and creating albums and photos in iPhoto. Full-color screen shots demonstrate each task so that you can get started using your MacBook today.

  15. Variable TDMA MAC Protocol For WDM EPON

    Institute of Scientific and Technical Information of China (English)

    Minsuk Jung; Yongseok Chang; Jonghoon Eom; Sungho Kim

    2003-01-01

    A MAC(Media Access Control) protocol, one of the most important technologies for an EPON(Ethernet Passive Optical Network), contains a scheduling algorithm to avoid collisions in shared links and assigns an effective bandwidth when ONUs (Optical Network Units) transfer signals upward. The current paper proposes a MAC Protocol that operates a TDMA(Time method with a variable slot assignment to overcome short of bandwidth using by the number of n wavelength., the next generation access network. To verify the above, the current study also implements an EPON model using OPNET as the simulation tool.

  16. Mac OS X Snow Leopard pocket guide

    CERN Document Server

    Seiblod, Chris

    2009-01-01

    Whether you're new to the Mac or a longtime user, this handy book is the quickest way to get up to speed on Snow Leopard. Packed with concise information in an easy-to-read format, Mac OS X Snow Leopard Pocket Guide covers what you need to know and is an ideal resource for problem-solving on the fly. This book goes right to the heart of Snow Leopard, with details on system preferences, built-in applications, and utilities. You'll also find configuration tips, keyboard shortcuts, guides for troubleshooting, lots of step-by-step instructions, and more. Learn about new features and changes s

  17. Problematising Practice: MacIntyre and Management

    OpenAIRE

    Kavanagh, Donncha

    2013-01-01

    Alasdair MacIntyre's distinction between institutions and practices helps illuminate how powerful institutional forces frame and constrain the practice of organizational research as well as the output and positioning of scholarly journals like Organization.  Yet his conceptual frame is limited, not least because it is unclear whether the activity of managing is, or is not, a practice.  This paper builds on MacIntyre's ideas by incorporating Aristotle's concepts of poíēsis, praxis, téchnē and ...

  18. MacBook Pro Portable Genius

    CERN Document Server

    Miser, Brad

    2012-01-01

    Discover loads of tips and techniques for the newest MacBook Pro You're already ahead of the game with a MacBook Pro. Now you can get even more out the popular Apple notebook with the new edition of this handy, compact book. Crammed with savvy insights and tips on key tools and shortcuts, this book will help you increase your productivity and keep your Apple digital lifestyle on track. From desktop sharing and wireless networking to running Windows applications, this book avoids fluff, doesn't skimp on the essentials, saves you time and hassle, and shows you what you most want to know. Include

  19. Sedation and Anesthesia Options for Pediatric Patients in the Radiation Oncology Suite

    Directory of Open Access Journals (Sweden)

    Eric A. Harris

    2010-01-01

    Full Text Available External beam radiation therapy (XRT has become one of the cornerstones in the management of pediatric oncology cases. While the procedure itself is painless, the anxiety it causes may necessitate the provision of sedation or anesthesia for the patient. This review paper will briefly review the XRT procedure itself so that the anesthesia provider has an understanding of what is occurring during the simulation and treatment phases. We will then examine several currently used regimens for the provision of pediatric sedation in the XRT suite as well as a discussion of when and how general anesthesia should be performed if deemed necessary. Standards of care with respect to patient monitoring will be addressed. We will conclude with a survey of the developing field of radiation-based therapy administered outside of the XRT suite.

  20. Propofol-Based Sedation Versus General Anesthesia for Endoscopic Submucosal Dissection.

    Science.gov (United States)

    Yurtlu, Derya Arslan; Aslan, Fatih; Ayvat, Pinar; Isik, Yasemin; Karakus, Nesli; Ünsal, Belkis; Kizilkaya, Mehmet

    2016-05-01

    The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gag reflex, nausea, vomiting, cough, number of desaturation episodes (SpO2 fentanyl were significantly higher (P < 0.05). Anesthesia time, postoperative anesthesia care unit, and hospital stay durations were not significantly different between the groups.General anesthesia increased dissection speed and enhanced endoscopist performance when compared with propofol-based sedation technique. PMID:27196474

  1. Effects of metoclopramide on emesis in cats sedated with xylazine hydrochloride.

    Science.gov (United States)

    Kolahian, Saeed; Jarolmasjed, Seyedhosein

    2010-12-01

    The prophylactic anti-emetic effect of five dosages of metoclopramide (0.2, 0.4, 0.6, 0.8 and 1mg/kg, IM) was evaluated against saline solution, both injected 1h before administration of xylazine in cats. Saline was administered to cats (day 0) followed by sequentially increasing dosages of metoclopramide at 1-week intervals. After xylazine injection, all cats were carefully observed to record the frequency of emesis and the time until onset of the first emetic episode. The onset of sedation in these cats was also studied. Prior treatment with each dosage of metoclopramide significantly reduced the frequency of emetic episodes (Psedation only at the dose of 1mg/kg. Metoclopramide may be used as a prophylactic anti-emetic in cats sedated with xylazine hydrochloride. PMID:20817585

  2. Efficacy of Chloral Hydrate-Hydroxyzine and Chloral Hydrate-Midazolam in Pediatric Magnetic Resonance Imaging Sedation

    Directory of Open Access Journals (Sweden)

    Razieh FALLAH

    2014-04-01

    implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr 2012;24:225-32.3. Mason KP, Prescilla R, Fontaine PJ, Zurakowski D. Pediatric CT sedation: comparison of dexmedetomidine and pentobarbital. AJR Am J Roentgenol 2011;196(2:W194-8.4. Schulte-Uentrop L, Goepfert MS. Anaesthesia or sedation for MRI in children. Curr Opin Anaesthesiol 2010;23(4:513-7.5. Freeman JM. The risks of sedation for electroencephalograms: data at last. Pediatrics 2001; 108(1:178.6. Cortellazzi P, Lamperti M, Minati L, Falcone C, Pantaleoni C, Caldiroli D. Sedation of neurologically impaired children undergoing MRI: a sequential approach. Paediatr Anaesth 2007;17(7:630-6.7. Haselkorn T, Whittemore AS, Udaltsova N, Friedman GD. Short-term chloral hydrate administration and cancer in humans. Drug Saf 2006; 29(1:67-77.8. Costa LR, Costa PS, Brasileiro SV, Bendo CB, Viegas CM, Paiva SM. Post-Discharge Adverse Events following Pediatric Sedation with High Doses of Oral Medication. J Pediatr 2012;160(5:807-13.9. da Costa LR, da Costa PS, Lima AR. A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation. Braz Dent J 2007;18(4:334-40.10. Klein EJ, Brown JC, Kobayashi A, Osincup D, Seidel K. A randomized clinical trial comparing oral, aerosolized intranasal, and aerosolized buccal midazolam. Ann Emerg Med 2011;58(4:323-9.11. Johnson E, Briskie D, Majewski R, Edwards S, Reynolds P. The physiologic and behavioral effects of oral and intranasal midazolam in pediatric dental patients. Pediatr Dent 2010;32(3:229-38.12. Wetzel RC. Anesthesia, Perioperative Care, and Sedation. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 359-60.13. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update

  3. Optimized Sedation Improves Colonoscopy Quality Long-Term

    OpenAIRE

    Konstantinos Triantafyllou; Sioulas, Athanasios D; Theodora Kalli; Nikolaos Misailidis; Dimitrios Polymeros; Papanikolaou, Ioannis S; George Karamanolis; Ladas, Spiros D.

    2015-01-01

    Background. Quality monitoring and improvement is prerequisite for efficient colonoscopy. Aim. To assess the effects of increased sedation administration on colonoscopy performance. Materials and Methods. During Era 1 we prospectively measured four colonoscopy quality indicators: sedation administration, colonoscopy completion rate, adenoma detection rate, and early complications rate in three cohorts: cohort A: intention for total colonoscopy cases; cohort B: cohort A excluding bowel obstruc...

  4. The MacNew Heart Disease health-related quality of life instrument: A summary

    Directory of Open Access Journals (Sweden)

    Guyatt Gordon

    2004-01-01

    Full Text Available Abstract Background The measurement of health, the effects of disease, and the impact of health care include not only an indication of changes in disease frequency and severity but also an estimate of patients' perception of health status before and after treatment. One of the more important developments in health care in the past decade may be the recognition that the patient's perspective is as legitimate and valid as the clinician's in monitoring health care outcomes. This has lead to the development of instruments to quantify the patients' perception of their health status before and after treatment. Methods We review evidence supporting the measurement properties of the MacNew Heart Disease Health-related Quality of Life [MacNew] Questionnaire which was designed to evaluate how daily activities and physical, emotional, and social functioning are affected by coronary heart disease and its treatment. Results Reliability was demonstrated by using internal consistency and the intraclass correlation coefficients for the three domains in the Dutch, English, Farsi, German, and Spanish versions of the MacNew. With internal consistency and intraclass correlation coefficients =>0.73, reliability is high. Validity of the MacNew was examined with factor analysis and three core underlying factors, physical, emotional, and social, were identified, explaining 63.0 – 66.5% of the observed variance and replicated in the translations with psychometric data. Construct validity of the MacNew was further demonstrated by extensive substantiation of the logical relationships, defined a priori, between items and other comparison tools. The MacNew is responsive and sensitive to changes in HRQL following various interventions for patients with heart disease with 11 of 13 effect size statistics >0.80. Taking an average of 10 minutes or less to complete, the respondent-burden for the MacNew is low and its acceptability is demonstrated by response rates of over 90

  5. Bispectral index monitoring of sedation depth in pediatric dental patients.

    Science.gov (United States)

    Haberland, Christel M; Baker, Suher; Liu, Haibei

    2011-01-01

    The bispectral index (BIS) monitor records electroencephalogram waveforms and provides an objective measure of the hypnotic effect of a sedative drug on brain activity. The aim of this pilot study was to use the BIS monitor to evaluate the depth of procedural sedation in pediatric dental patients and to assess if the BIS monitor readings correlate with a validated pediatric sedation scale, the University of Michigan Sedation Scale (UMSS), in determining the level of sedation in these patients. Thirty-five pediatric dental patients requiring sedation were studied prospectively. A baseline BIS reading was obtained and during the procedure an independent observer recorded the BIS every 5 minutes. The operator, who was blinded to the BIS results, determined the UMSS scale at the same 5-minute interval. The patients were monitored postoperatively for 1 hour. There was a significant but moderate correlation between BIS values and UMSS scores (Spearman's rank correlation r  =  -0.574, P < .0001). Percentage of agreement and kappa coefficient using all the observations were also calculated. The percentage of agreement was 37.8%, the kappa coefficient was 0.18 (P < .0001), and the weighted kappa coefficient 0.26 (P < .0001). A lack of correlation was noted between the deeper levels of UMSS sedation scores and BIS values. This study demonstrated a significant correlation between BIS values and the UMSS score in pediatric dental patients undergoing mild to moderate sedation. Based on our results, it appears that the BIS monitor may be useful during mild or moderate sedations to establish the level of sedation objectively without the need to stimulate the patient. PMID:21679042

  6. Entropy and bispectral index for assessment of sedation, analgesia and the effects of unpleasant stimuli in critically ill patients: an observational study

    Science.gov (United States)

    Haenggi, Matthias; Ypparila-Wolters, Heidi; Bieri, Christine; Steiner, Carola; Takala, Jukka; Korhonen, Ilkka; Jakob, Stephan M

    2008-01-01

    Introduction Sedative and analgesic drugs are frequently used in critically ill patients. Their overuse may prolong mechanical ventilation and length of stay in the intensive care unit. Guidelines recommend use of sedation protocols that include sedation scores and trials of sedation cessation to minimize drug use. We evaluated processed electroencephalography (response and state entropy and bispectral index) as an adjunct to monitoring effects of commonly used sedative and analgesic drugs and intratracheal suctioning. Methods Electrodes for monitoring bispectral index and entropy were placed on the foreheads of 44 critically ill patients requiring mechanical ventilation and who previously had no brain dysfunction. Sedation was targeted individually using the Ramsay Sedation Scale, recorded every 2 hours or more frequently. Use of and indications for sedative and analgesic drugs and intratracheal suctioning were recorded manually and using a camera. At the end of the study, processed electroencephalographical and haemodynamic variables collected before and after each drug application and tracheal suctioning were analyzed. Ramsay score was used for comparison with processed electroencephalography when assessed within 15 minutes of an intervention. Results The indications for boli of sedative drugs exhibited statistically significant, albeit clinically irrelevant, differences in terms of their association with processed electroencephalographical parameters. Electroencephalographical variables decreased significantly after bolus, but a specific pattern in electroencephalographical variables before drug administration was not identified. The same was true for opiate administration. At both 30 minutes and 2 minutes before intratracheal suctioning, there was no difference in electroencephalographical or clinical signs in patients who had or had not received drugs 10 minutes before suctioning. Among patients who received drugs, electroencephalographical parameters

  7. The Big Mac Standard: A statistical Illustration

    OpenAIRE

    Yukinobu Kitamura; Hiroshi Fujiki

    2004-01-01

    We demonstrate a statistical procedure for selecting the most suitable empirical model to test an economic theory, using the example of the test for purchasing power parity based on the Big Mac Index. Our results show that supporting evidence for purchasing power parity, conditional on the Balassa-Samuelson effect, depends crucially on the selection of models, sample periods and economies used for estimations.

  8. Exposure histories of lunar meteorites - ALHA81005, MAC88104, MAC88105, and Y791197

    Science.gov (United States)

    Nishiizumi, K.; Arnold, J. R.; Klein, J.; Fink, D.; Middleton, R.; Kubik, P. W.; Sharma, P.; Elmore, D.; Reedy, R. C.

    1991-01-01

    The cosmogenic radionuclides Ca-41, Cl-36, Al-26, and Be-10 in the Allan Hills 81005, MacAlpine Hills 88104, MacAlpine Hills 88105, and Yamato 791197 meteorites were measured by accelerator mass spectrometry. Mn-53 in Allan Hills 81005 and Yamato 791197 was measured by neutron activation. These four lunar meteorites experienced similar histories. They were ejected from near the surface of the moon ranging in depth down to 400 g/sq cm and had very short transition times (less than 0.1 Ma) from the moon to the earth. A comparison of the cosmogenic nuclide concentrations in MacAlpine Hills 88104 and MacAlpine Hills 88105 clearly indicates that they are a pair from the same fall.

  9. Sedation in the ICU Less is more

    DEFF Research Database (Denmark)

    Strom, T.

    2012-01-01

    hospital stay. Secondary endpoints were: a no sedation strategy would reduce secondary organ failure such as kidney injury and would not increase the risk of post-traumatic stress disorder after hospital discharge. Methods: We randomized 140 critically ill patients in need of mechanical ventilation. The...... with a neuropsychologist to assess Post Traumatic Stress Disorder (PTSD), depression and general psychological and physical health. Results: 27 patients died or were successfully weaned from mechanical ventilation within 48 hours and were excluded from further analysis. Patients from the awake...... compared to the awake intervention group (25 (51 %), P=0.012). 26 patients were interviewed approximately 2 years after randomization, 13 from each group. No difference was seen between the groups with respects to Post Traumatic Stress Disorder, depression and general psychological and physical health...

  10. CR-MAC: A Multichannel MAC Protocol for Cognitive Radio AD HOC Networks

    Directory of Open Access Journals (Sweden)

    S. M. Kamruzzaman

    2010-09-01

    Full Text Available This paper proposes a cross-layer based cognitive radio multichannel medium access control (MACprotocol with TDMA, which integrate the spectrum sensing at physical (PHY layer and the packetscheduling at MAC layer, for the ad hoc wireless networks. The IEEE 802.11 standard allows for the useof multiple channels available at the PHY layer, but its MAC protocol is designed only for a singlechannel. A single channel MAC protocol does not work well in a multichannel environment, because ofthe multichannel hidden terminal problem. Our proposed protocol enables secondary users (SUs toutilize multiple channels by switching channels dynamically, thus increasing network throughput. In ourproposed protocol, each SU is equipped with only one spectrum agile transceiver, but solves themultichannel hidden terminal problem using temporal synchronization. The proposed cognitive radioMAC (CR-MAC protocol allows SUs to identify and use the unused frequency spectrum in a way thatconstrains the level of interference to the primary users (PUs. Our scheme improves network throughputsignificantly, especially when the network is highly congested. The simulation results show that ourproposed CR-MAC protocol successfully exploits multiple channels and significantly improves networkperformance by using the licensed spectrum band opportunistically and protects PUs from interference,even in hidden terminal situations.

  11. Chloral hydrate sedation in radiology: retrospective audit of reduced dose

    Energy Technology Data Exchange (ETDEWEB)

    Bracken, Jennifer [Children' s University Hospital, Radiology Department, Dublin (Ireland); Royal Children' s Hospital, Department of Medical Imaging, Parkville, Victoria (Australia); Heaslip, Ingrid; Ryan, Stephanie [Children' s University Hospital, Radiology Department, Dublin (Ireland)

    2012-03-15

    Chloral hydrate (CH) is safe and effective for sedation of suitable children. The purpose of this study was to assess whether adequate sedation is achieved with reduced CH doses. We retrospectively recorded outpatient CH sedations over 1 year. We defined standard doses of CH as 50 mg/kg (infants) and 75 mg/kg (children >1 year). A reduced dose was defined as at least 20% lower than the standard dose. In total, 653 children received CH sedation (age, 1 month-3 years 10 months), 42% were given a reduced initial dose. Augmentation dose was required in 10.9% of all children, and in a higher proportion of children >1 year (15.7%) compared to infants (5.7%; P < 0.001). Sedation was successful in 96.7%, and more frequently successful in infants (98.3%) than children >1 year (95.3%; P = 0.03). A reduced initial dose had no negative effect on outcome (P = 0.19) or time to sedation. No significant complications were seen. We advocate sedation with reduced CH doses (40 mg/kg for infants; 60 mg/kg for children >1 year of age) for outpatient imaging procedures when the child is judged to be quiet or sleepy on arrival. (orig.)

  12. Oral transmucosal administration of dexmedetomidine for sedation in 4 dogs.

    Science.gov (United States)

    Cohen, Anne E; Bennett, Sara L

    2015-11-01

    Injectable dexmedetomidine (DM) is widely used for sedation, restraint, anxiolysis, and analgesia in veterinary medicine. Oral transmucosal dexmedetomidine (OTM DM) has been evaluated in horses, cats, and humans, but not in dogs. In this case series, OTM DM (mean dose of 32.6 μg/kg body weight) was given in the buccal pouch to 4 aggressive dogs in a hospital setting. Two of the dogs were subsequently euthanized, and in the other 2, sedation was reversed with atipamezole. Satisfactory sedation was achieved in all cases. PMID:26538668

  13. Isolation and characterisation of human gingival margin-derived STRO-1/MACS1 and MACS2 cell populations

    Institute of Scientific and Technical Information of China (English)

    Karim M Fawzy El-Sayed; Sebastian Paris; Christian Graetz; Neemat Kassem; Mohamed Mekhemar; Hendrick Ungefroren; Fred Fandrich; Christof Dorfer

    2015-01-01

    Recently, gingival margin-derived stem/progenitor cells isolated via STRO-1/magnetic activated cell sorting (MACS) showed remarkable periodontal regenerative potential in vivo. As a second-stage investigation, the present study’s aim was to perform in vitro characterisation and comparison of the stem/progenitor cell characteristics of sorted STRO-1-positive (MACS1) and STRO-1-negative (MACS2) cell populations from the human free gingival margin. Cells were isolated from the free gingiva using a minimally invasive technique and were magnetically sorted using anti-STRO-1 antibodies. Subsequently, the MACS1 and MACS2 cell fractions were characterized by flow cytometry for expression of CD14, CD34, CD45, CD73, CD90, CD105, CD146/MUC18 and STRO-1. Colony-forming unit (CFU) and multilineage differentiation potential were assayed for both cell fractions. Mineralisation marker expression was examined using real-time polymerase chain reaction (PCR). MACS1 and MACS2 cell fractions showed plastic adherence. MACS1 cells, in contrast to MACS2 cells, showed all of the predefined mesenchymal stem/progenitor cell characteristics and a significantly higher number of CFUs (P,0.01). More than 95%of MACS1 cells expressed CD105, CD90 and CD73;lacked the haematopoietic markers CD45, CD34 and CD14, and expressed STRO-1 and CD146/MUC18. MACS2 cells showed a different surface marker expression profile, with almost no expression of CD14 or STRO-1, and more than 95%of these cells expressed CD73, CD90 and CD146/MUC18, as well as the haematopoietic markers CD34 and CD45 and CD105. MACS1 cells could be differentiated along osteoblastic, adipocytic and chondroblastic lineages. In contrast, MACS2 cells demonstrated slight osteogenic potential. Unstimulated MACS1 cells showed significantly higher expression of collagen I (P,0.05) and collagen III (P,0.01), whereas MACS2 cells demonstrated higher expression of osteonectin (P,0.05;Mann–Whitney). The present study is the first to compare gingival

  14. MacBook All-in-One For Dummies

    CERN Document Server

    Chambers, Mark L

    2011-01-01

    Get comfortable and confident with your MacBook! Combining the fun-but-straightforward content of nine minibooks, this new edition of MacBook All-in-One For Dummies delivers helpful coverage of the rich features and essential tools you need to know to use the MacBook to its fullest potential. You'll learn an array of MacBook basics while veteran author Mark Chambers walks you through setting up your MacBook, running programs, finding files with Finder, searching with Spotlight, keeping track with Address Book, enjoying music with iTunes, creating cool multimedia projects with iLife, and more.

  15. Nurse administered propofol sedation for pulmonary endoscopies requires a specific protocol

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Banning, Anne-Marie; Clementsen, Paul; Hammering, Anne; Hornslet, Pernille; Horsted, Tina; Vilmann, Peter

    2012-01-01

    This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit's "gastroenterologic nurse-administered propofol sedation (NAPS) guideline".......This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit's "gastroenterologic nurse-administered propofol sedation (NAPS) guideline"....

  16. Improved b lifetime measurement from MAC

    International Nuclear Information System (INIS)

    Two recent publications, from the MAC and Mark II collaborations, have reported the somewhat surprising result that the lifetime of particles made up of b quarks is in the 1 to 2 picosecond range, or somewhat longer than the lifetimes of charm particles. Although the charm decays are favored transitions while those of b particles depend upon off-diagonal elements of the weak flavor mixing matrix, the smallness of the b decay rates in face of the large available phase space indicates that the off-diagonal elements are indeed very small. The possibility for complete determination of the mixing matrix was brought significantly nearer by the availability of the lifetime information; what is needed now is to reduce the uncertainty of the measurements, which was about 33% for both experiments. We describe here an extension of the b lifetime study with the MAC detector, incorporating some new data and improvements in the analysis. 12 references

  17. Improved b lifetime measurement from MAC

    International Nuclear Information System (INIS)

    Two recent publications, from the MAC and Mark II collaborations, have reported the somewhat surprising result that the lifetime of particles made up of b quarks is in the 1 to 2 picosecond range, or somewhat longer than the lifetimes of charm particles. Although the charm decays are favored transitions while those of b particles depend upon off-diagonal elements of the weak flavor mixing matrix, the smallness of the b decay rates in face of the large available phase space indicates that the off-diagonal elements are indeed very small. The possibility for complete determination of the mixing matrix was brought significantly nearer by the availability of the lifetime information; what is needed now is to reduce the uncertainty of the measurements, which was about 33% for both experiments. We describe here an extension of the b lifetime study with the MAC detector, incorporating some new data and improvements in the analysis

  18. MacBook Pro portable genius

    CERN Document Server

    Gruman, Galen

    2013-01-01

    Learn the skills, tools and shortcuts you need in order to make the most of your MacBook Pro This easy-to-use, compact guide skips the fluff and gets right to the essentials so that you can maximize all the latest features of the MacBook Pro. Packed with savvy insights and tips on key tools and shortcuts, this handy book aims to help you increase your productivity and save you time and hassle. From desktop sharing and wireless networking to running Windows applications and more, this book shows you what you want to know. Includes the latest version of OS X, iCloud, FaceTime, and moreCovers al

  19. MAC Design for Optical Wireless Communications

    OpenAIRE

    Li, Yiyang

    2011-01-01

    This thesis mainly focuses on the higher layer protocol design for optical wireless communication (OWC) networks in two different optical bands: (1) medium access control (MAC) protocol design and neighbor discovery methods for deep ultraviolet (UV) outdoor communications (UVOC), and (2) configuration of indoor visible light communication (VLC) networks. For UVOC, solar blind and non-line-of-sight (NLOS) operations are attractive. Light beams from UV light-emitting diode (LED) arrays propagat...

  20. A Study of MAC Protocols for WBANs

    OpenAIRE

    Sana Ullah; Bin Shen; S. M. Riazul Islam; Pervez Khan; Shahnaz Saleem; Kyung Sup Kwak

    2009-01-01

    The seamless integration of low-power, miniaturised, invasive/non-invasive lightweight sensor nodes have contributed to the development of a proactive and unobtrusive Wireless Body Area Network (WBAN). A WBAN provides long-term health monitoring of a patient without any constraint on his/her normal dailylife activities. This monitoring requires the low-power operation of invasive/non-invasive sensor nodes. In other words, a power-efficient Medium Access Control (MAC) protocol is required to s...

  1. Moderate and deep nurse-administered propofol sedation is safe

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Møller, Ann; Hornslet, Pernille; Konge, Lars; Vilmann, Peter

    2015-01-01

    INTRODUCTION: Non-anaesthesiologist-administered propofol sedation (NAPS/NAAP) is increasingly used in many countries. Most regimens aim for light or moderate sedation. Little evidence on safety of deep NAPS sedation is available. The aim of this study was to explore the safety of intermittent deep...... propofol dose was 331.6 mg (standard deviation = 179.4 mg). The overall rate of hypoxia was 3.2%, and the rate ofhypotension was 3.1%. Assisted ventilation was needed in 0.5%. Age (p < 0.001), American Society of Anesthesiologists (ASA) class 3 (p = 0.017) and total propofol dose (p = 0.001) were...... associated with a higher rate of adverse events. CONCLUSION: Safety during intermittent deep sedation with NAPS was good. Age, ASA class 3 and total propofol dose were correlated with a higher rate of adverse events. Patients aged 60 years or more needed more handling during adverse events. FUNDING: Arvid...

  2. Moderate and deep nurse-administered propofol sedation is safe

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Møller, Ann; Hornslet, Pernille; Konge, Lars; Vilmann, Peter

    2015-01-01

    INTRODUCTION: Non-anaesthesiologist-administered propofol sedation (NAPS/NAAP) is increasingly used in many countries. Most regimens aim for light or moderate sedation. Little evidence on safety of deep NAPS sedation is available. The aim of this study was to explore the safety of intermittent deep...... propofol dose was 331.6 mg (standard deviation = 179.4 mg). The overall rate of hypoxia was 3.2%, and the rate of hypotension was 3.1%. Assisted ventilation was needed in 0.5%. Age (p < 0.001), American Society of Anesthesiologists (ASA) class 3 (p = 0.017) and total propofol dose (p = 0.001) were...... associated with a higher rate of adverse events. CONCLUSION: Safety during intermittent deep sedation with NAPS was good. Age, ASA class 3 and total propofol dose were correlated with a higher rate of adverse events. Patients aged 60 years or more needed more handling during adverse events. FUNDING: Arvid...

  3. Power Saving MAC Protocols for WSNs and Optimization of S-MAC Protocol

    Directory of Open Access Journals (Sweden)

    Simarpreet Kaur

    2012-11-01

    Full Text Available Low power MAC protocols have received a lot of consideration in the last few years because of their influence on the lifetime of wireless sensor networks. Since, sensors typically operate on batteries, replacement of which is often difficult. A lot of work has been done to minimize the energy expenditure and prolong the sensor lifetime through energy efficient designs, across layers. Meanwhile, the sensor network should be able to maintain a certain throughput in order to fulfill the QoS requirements of the end user, and to ensure the constancy of the network. This paper introduces different types of MAC protocols used for WSNs and proposes S‐MAC, a Medium‐Access Control protocol designed for Wireless Sensor Networks. S‐MAC uses a few innovative techniques to reduce energy consumption and support selfconfiguration. A new protocol is suggested to improve the energy efficiency, latency and throughput of existing MAC protocol for WSNs. A modification of the protocol is then proposed to eliminate the need for some nodes to stay awake longer than the other nodes which improves the energy efficiency, latency and throughput and hence increases the life span of a wireless sensor network.

  4. Balanced propofol sedation administered by nonanesthesiologists: The first Italian experience

    Institute of Scientific and Technical Information of China (English)

    Alessandro Repici; Eva Vitetta; Daniel de Paula Pessoa Ferreira; Silvio Danese; Massimo Arosio; Alberto Malesci; Nico Pagano; Cesare Hassan; Alessandra Carlino; Giacomo Rando; Giuseppe Strangio; Fabio Romeo; Angelo Zullo; Elisa Ferrara

    2011-01-01

    AIM: To assess the efficacy and safety of a balanced approach using midazolam in combination with propofol, administered by non-anesthesiologists, in a large series of diagnostic colonoscopies.METHODS: Consecutive patients undergoing diagnostic colonoscopy were sedated with a single dose of midazolam (0.05 mg/kg) and low-dose propofol (starter bolus of 0.5 mg/kg and repeated boluses of 10 to 20 mg). Induction time and deepest level of sedation, adverse and serious adverse events, as well as recovery times, were prospectively assessed. Cecal intubation and adenoma detection rates were also collected.RESULTS: Overall, 1593 eligible patients were included. The median dose of propofol administered was 70 mg (range: 40-120 mg), and the median dose of midazolam was 2.3 mg (range: 2-4 mg). Median induction time of sedation was 3 min (range: 1-4 min), and median recovery time was 23 min (range: 10-40 min). A moderate level of sedation was achieved in 1561 (98%) patients, whilst a deep sedation occurred in 32 (2%) cases. Transient oxygen desaturation requiring further oxygen supplementation occurred in 8 (0.46%; 95% CI: 0.2%-0.8%) patients. No serious adverse event was observed. Cecal intubation and adenoma detection rates were 93.5% and 23.4% (27.8% for male and 18.5% for female, subjects), respectively.CONCLUSION: A balanced sedation protocol provided a minimalization of the dose of propofol needed to target a moderate sedation for colonoscopy, resulting in a high safety profile for non-anesthesiologist propofol sedation.

  5. Factors Influencing Challenging Colonoscopies During Anesthesiologist-Assisted Deep Sedation

    OpenAIRE

    Fabrizio Cardin; Nadia Minicuci; Alessandra Andreotti; Elisa Granziera; Carmelo Militello

    2016-01-01

    Background/Aim: Increased demand for colon cancer screening procedures can significantly impact on routine colonoscopy management at dedicated facilities, prompting a review of the factors that can negatively affect workflow. Although potential adverse effects and impact on costs of deep sedation have been documented elsewhere, this study focuses on variables that can influence performance of colonoscopy in deep sedation and interfere with normal procedure scheduling in settings where the pre...

  6. The effects of preoperative anxiety on intravenous sedation.

    OpenAIRE

    Osborn, Timothy M.; Sandler, Noah A.

    2004-01-01

    Anxiety is known to cause feelings of uneasiness, tension, and nervousness, and previous studies have noted that anxiety and its effects may have an effect on out-patient sedation for patients undergoing surgical procedures. In this study, we assess the effects of anxiety on 25 outpatients undergoing intravenous sedation for third molar extraction. Before the procedure, subjects completed the State-Trait Anxiety Inventory, and intraoperative patient movement was assessed using a subjective sc...

  7. Optimizing sedation in patients with acute brain injury

    OpenAIRE

    Oddo, Mauro; Crippa, Ilaria Alice; Mehta, Sangeeta; Menon, David; Payen, Jean-Francois; Taccone, Fabio Silvio; Citerio, Giuseppe

    2016-01-01

    Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradi...

  8. Comparison between intravenous and intramuscular administration of ketamine in children sedation referred to emergency department

    OpenAIRE

    Behnaz Boroumand Rezazadeh; Hamid Zamani Moghadam; Mohammad Gharavifard

    2014-01-01

    Ketamine, among wide variety of sedative drugs, has shown beneficial effects when using during the procedural sedation, specifically in pediatrics. Various parameters should be considered in order to perform a safe and effective procedural sedation including optimum dosage of the sedative, administration methods of sedation, and need for applying any adjuvant drug. In this study, we aimed to review the studies, which have compared the efficacy of the different ways of the injection of ketamin...

  9. Chloral hydrate sedation in radiology: retrospective audit of reduced dose

    International Nuclear Information System (INIS)

    Chloral hydrate (CH) is safe and effective for sedation of suitable children. The purpose of this study was to assess whether adequate sedation is achieved with reduced CH doses. We retrospectively recorded outpatient CH sedations over 1 year. We defined standard doses of CH as 50 mg/kg (infants) and 75 mg/kg (children >1 year). A reduced dose was defined as at least 20% lower than the standard dose. In total, 653 children received CH sedation (age, 1 month-3 years 10 months), 42% were given a reduced initial dose. Augmentation dose was required in 10.9% of all children, and in a higher proportion of children >1 year (15.7%) compared to infants (5.7%; P 1 year (95.3%; P = 0.03). A reduced initial dose had no negative effect on outcome (P = 0.19) or time to sedation. No significant complications were seen. We advocate sedation with reduced CH doses (40 mg/kg for infants; 60 mg/kg for children >1 year of age) for outpatient imaging procedures when the child is judged to be quiet or sleepy on arrival. (orig.)

  10. Xylazine (veterinary sedative use in Puerto Rico

    Directory of Open Access Journals (Sweden)

    Torruella Rafael A

    2011-04-01

    Full Text Available Abstract Human xylazine use in Puerto Rico merits particular attention for its unprecedented scale and depth. Although Puerto Rican injecting drug users (IDUs have reported using this drug since the early 2000s, little is being done in the research and service delivery sectors as it is claimed that xylazine severely impacts the health of its users. This report provides information on xylazine use and its associated harms. Data from one semi-structured interview collected in New York City (2007-2008 as part of a larger research study with migrant Puerto Rican drug users is presented as a case study. Xylazine, a veterinary sedative, is an adulterant and complement to other drugs and its chronic use is reported to be associated with physical deterioration. Because human xylazine use has been reported in other locations outside of Puerto Rico, this substance could also emerge as an adulterant in other markets to the levels currently experienced in Puerto Rico. Research and interventions are needed to provide adequate services on the island, better understand how the use of xylazine affects its users, and to reduce the possibility of increased xylazine use on the state-side.

  11. W-MAC: A Workload-Aware MAC Protocol for Heterogeneous Convergecast in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Dongming Lu

    2011-02-01

    Full Text Available The power consumption and latency of existing MAC protocols for wireless sensor networks (WSNs are high in heterogeneous convergecast, where each sensor node generates different amounts of data in one convergecast operation. To solve this problem, we present W-MAC, a workload-aware MAC protocol for heterogeneous convergecast in WSNs. A subtree-based iterative cascading scheduling mechanism and a workload-aware time slice allocation mechanism are proposed to minimize the power consumption of nodes, while offering a low data latency. In addition, an efficient schedule adjustment mechanism is provided for adapting to data traffic variation and network topology change. Analytical and simulation results show that the proposed protocol provides a significant energy saving and latency reduction in heterogeneous convergecast, and can effectively support data aggregation to further improve the performance.

  12. An assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients

    OpenAIRE

    Naumann Terryn; Wilbur Kerry; Bandali Shakeel; Marra Carlo; Frighetto Luciana; Jewesson Peter

    2004-01-01

    Abstract Background Hospitalization can significantly disrupt sleeping patterns. In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. The primary objectives of this study were to assess sleep disturbance and its determinants including the use of drugs with sedating properties. Methods This...

  13. MFT-MAC: A Duty-Cycle MAC Protocol Using Multiframe Transmission for Wireless Sensor Networks

    OpenAIRE

    EunJin Lee; Jeong Woo Jwa; HeungSoo Kim

    2013-01-01

    In many sensor network applications, energy efficiency and latency are major design criteria because battery-operated sensor nodes limit network lifetime. In this paper, we propose a new contention-based duty-cycle MAC protocol using a synchronized approach for use in wireless sensor networks. In the proposed MFT-MAC protocol, we use a control frame that considers the number of DATA frames to be transmitted to the next node in order to improve the energy efficiency and reduce the end-to-end d...

  14. Clustering of capnogram features to track state transitions during procedural sedation.

    Science.gov (United States)

    Mieloszyk, Rebecca J; Guo, Margaret G; Verghese, George C; Andolfatto, Gary; Heldt, Thomas; Krauss, Baruch S

    2015-08-01

    Procedural sedation has allowed many painful interventions to be conducted outside the operating room. During such procedures, it is important to maintain an appropriate level of sedation to minimize the risk of respiratory depression if patients are over-sedated and added pain or anxiety if under-sedated. However, there is currently no objective way to measure the patient's evolving level of sedation during a procedure. We investigated the use of capnography-derived features as an objective measure of sedation level. Time-based capnograms were recorded from 30 patients during sedation for cardioversion. Through causal k-means clustering of selected features, we sequentially assigned each exhalation to one of three distinct clusters, or states. Transitions between these states correlated to events during sedation (drug administration, procedure start and end, and clinical interventions). Similar clustering of capnogram recordings from 26 healthy, non-sedated subjects did not reveal distinctly separated states. PMID:26736604

  15. Wireless Sensor Networks Energy-Efficient MAC Protocol

    Science.gov (United States)

    Lijuan, Du; Yuanpeng, Wang; WeiPeng, Jing

    This paper presents a new wireless sensor network energy-efficient MAC protocol, ES-MAC protocol, and shows the results of simulation experiments. During the transmission the nodes do not send ACK packages while use a small amount of new information packets, so they can reduce unnecessary energy loss and wasted time. The theoretical analysis and simulation results show that ES-MAC protocol reduces energy consumption while reducing network latency and improving network throughput.

  16. Towards Secure and Practical MACs for Body Sensor Networks

    OpenAIRE

    Gong, Z; Hartel, P.H.; Nikova, S.I.; Zhu, Bo

    2009-01-01

    Wireless sensor network (WSN) commonly requires lower level security for public information gathering, whilst body sensor network (BSN) must be secured with strong authenticity to protect personal health information. First in this paper, some practical problems with the Message Authentication Codes (MACs), which are suggested in the current security architectures for WSN, are reconsidered. The analysis exploits the fact that the recommended MACs for WSN, e.g., TinySec (CBC-MAC), MiniSec (OCB-...

  17. MAC Address as a Key for Data Encryption

    OpenAIRE

    Al-Husainy, Dr. Mohammed Abbas Fadhil

    2013-01-01

    In computer networking, the Media Access Control (MAC) address is a unique value associated with a network adapter. MAC addresses are also known as hardware addresses or physical addresses. TCP/IP and other mainstream networking architectures generally adopt the OSI model. MAC addresses function at the data link layer (layer 2 in the OSI model). They allow computers to uniquely identify themselves on a network at this relatively low level. In this paper, suggested data encryption technique is...

  18. Essential Mac OS X panther server administration integrating Mac OS X server into heterogeneous networks

    CERN Document Server

    Bartosh, Michael

    2004-01-01

    If you've ever wondered how to safely manipulate Mac OS X Panther Server's many underlying configuration files or needed to explain AFP permission mapping--this book's for you. From the command line to Apple's graphical tools, the book provides insight into this powerful server software. Topics covered include installation, deployment, server management, web application services, data gathering, and more

  19. A Mobile Automated Characterization System (MACS) for indoor floor characterization

    International Nuclear Information System (INIS)

    The Savannah River Technology Center (SRTC) and Oak Ridge National Laboratory are developing an advanced Mobile Automated Characterization System (MACS) to characterize indoor contaminated floors. MACS is based upon Semi-Intelligent Mobile Observing Navigator (SIMON), an earlier floor characterization system developed at SRTC. MACS will feature enhanced navigation systems, operator interface, and an interface to simplify integration of additional sensors. The enhanced navigation system will provide the capability to survey large open areas much more accurately than is now possible with SIMON, which is better suited for hallways and corridors that provide the means for recalibrating position and heading. MACS operator interface is designed to facilitate MACS's use as a tool for health physicists, thus eliminating the need for additional training in the robot's control language. Initial implementation of MACS will use radiation detectors. Additional sensors, such as PCB sensors currently being developed, will be integrated on MACS in the future. Initial use of MACS will be focused toward obtaining comparative results with manual methods. Surveys will be conducted both manually and with MACS to compare relative costs and data quality. While clear cost benefits anticipated, data quality benefits should be even more significant

  20. Mac OS X Snow Leopard Server For Dummies

    CERN Document Server

    Rizzo, John

    2009-01-01

    Making Everything Easier!. Mac OS® X Snow Leopard Server for Dummies. Learn to::;. Set up and configure a Mac network with Snow Leopard Server;. Administer, secure, and troubleshoot the network;. Incorporate a Mac subnet into a Windows Active Directory® domain;. Take advantage of Unix® power and security. John Rizzo. Want to set up and administer a network even if you don't have an IT department? Read on!. Like everything Mac, Snow Leopard Server was designed to be easy to set up and use. Still, there are so many options and features that this book will save you heaps of time and effort. It wa

  1. Study on intracellular trafficking of Mac-1 by direct visualization

    Institute of Scientific and Technical Information of China (English)

    YAN Ming; MAO Jifang; WEI Yi; ZHONG Jigen; YANG Shengsheng; XU Renbao

    2004-01-01

    Previously, we constructed DNA vectors containing cDNA of Mac-1 subunits (CD11b or CD18b) fused with fluorescence protein (FP). cDNA fragments and the DNA constructs were then transfected into CHO cells (as CHO-Mac-1-FP). The structure and function of Mac-1-FP obtained from the CHO-Mac-1-FP cells are nearly identical to that expressed in wild type leukocytes. In the present study, the intracellular trafficking of Mac-1 was visualized directly by monitoring the fluorescent intensities of YFP-CD18 and PE-conjugated monoclonal antibody against CD11b under a confocal microscope in CHO-Mac-1-FP cells. The results indicate that: (ⅰ) although Mac-1 was not detected in the cell membrane at resting state, it had been translocated and clustered into the cell membrane by 1 h and internalized 2 h after PMA stimulation, at which point the fluorescence intensity began to diminish gradually, probably due to partial degradation of Mac-1. The fluorescence of CD18 and CD11b reappeared on the cell membrane 1 h after re-treatment with PMA, suggesting the recycling of non-degraded Mac-1. (ⅱ) The adhesion rate of CHO-Mac-1-FP to magnetic beads coupled ICAM-1 increased within 4 h after their initial interaction, accompanied by the clustering of Mac-1-FP. After 8 h,the adhesion rate declined and fluorescence also decreased simultaneously. The pattern of change in fluorescence in CHO-Mac-1-FP cells elicited by ICAM-1 beads was similar to that elicited by PMA, suggesting that endocytosis and degradation of Mac-1 occurred after the interaction with ICAM-1. Thus, we conclude that the intracellular trafficking of Mac-1 after activation is associated with membrane translocation, endocytosis, degradation and recycling. These changes are in parallel with the adhesion of CHO-Mac-1-FP cells with ICAM-1, and may be involved in the adhesion and detachment of leukocytes. The detachment of leukocytes may be caused by endocytosis of Mac-1.

  2. Energy-efficient MAC protocols for Wireless Sensor Networks

    Institute of Scientific and Technical Information of China (English)

    Li De-liang; Peng Fei

    2009-01-01

    Designing energy-efficient Medium Access Control (MAC) protocols has a significant influence on the energy performance of wireless sensor network (WSN). In this paper we present a survey of the recent typical MAC protocols regarding energy efficiency for WSN. According to channel access policies, we classify these protocols into four categories: contention-based, TDMA-based, hybrid, and cross layer protocols, in which the advantages and disadvantages in each class of MAC protocols are discussed. Finally, we point out open research issues that need to carry on to achieve high energy efficiency for the design of MAC protocols in WSN.

  3. DCP, a distributed-control polling mac protocol

    OpenAIRE

    Conti, Marco; Gregori, Enrico; Lenzini, Luciano

    1990-01-01

    This paper describes and analyzes a novel MAC protocol named Distributed-Control Polling (DCP), which has been designed to bring together the most interesting features of distributed-control MAC protocols (e.g., DQDB) and centralized token-passing MAC protocols (e.g. FASNET, FDDI, EXPRESS_NET). From the fully?distributed MAC protocols, DCP acquires the capability to guarantee both a complete utilization of the medium capacity and an access delay of only a few slots at light loads. From the ce...

  4. Anaesthesia with sevoflurane in pigeons: minimal anaesthetic concentration (MAC) determination and investigation of cardiorespiratory variables at 1 MAC.

    Science.gov (United States)

    Botman, J; Gabriel, F; Dugdale, A H A; Vandeweerd, J-M

    2016-05-28

    The objective of the study was to determine the minimal anaesthetic concentration (MAC) of sevoflurane (SEVO) in pigeons and investigate the effects of 1 MAC SEVO anaesthesia on cardiovascular and respiratory variables compared with the awake state. This is a prospective, experimental study. Animals were seven healthy adult pigeons. After acclimatisation to handling, heart rate (HR), heart rhythm, respiratory rate (fR), end-expired carbon dioxide tension (PE'CO2), inspired CO2 tension, indirect systolic arterial blood pressure (SAP) and cloacal temperature were measured to determine baseline, 'awake' values. Pigeons were then anaesthetised with SEVO and MAC was determined by the 'bracketing' method. The same variables were monitored during a 40 minute period at 1.0 MAC SEVO for each bird. Mean MAC was 3.0±0.6 per cent for SEVO. During maintenance of anaesthesia at 1.0 MAC, SAP decreased significantly (Ppigeons. PMID:27083873

  5. An Energy Efficient Analysis of S-MAC And H-MAC Protocols for Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    P.T.Kalaivaani

    2013-04-01

    Full Text Available Wireless Sensor Networks (WSNs is an interesting topic to the researchers because of its variousapplications. The applications are health monitoring and environmental monitoring, Industrial ProcessMonitoring, Target detection, Target tracking, Energy Efficiency, Disaster Management and MilitarySecurity Systems. The wireless medium requires highly optimized medium Access Protocols to avoidinterferences. Limited resources have driven the research towards energy consumption of MACfunctionalities. Two Medium Access Control (MAC protocol performances are analyzed by using the MAClayer frame work for wireless sensor networks. In this paper an energy efficient analysis of S-MAC and HMACprotocols for wireless sensor networks is proposed with spatial correlation concept. Two MACprotocols such as Sensor MAC (S-MAC and Hybrid MAC (H-MAC protocols are proposed to analyze theperformance of Wireless Sensor Network using four different Parameters such as End to End delay, PacketDelivery Ratio, Packet Drop Rate and Energy Consumption. Performance analysis is carried out by usingthe simulation tool NS2.

  6. November 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2012-12-01

    Full Text Available No abstract available. Article truncated at 150 words. Mehta S, Burry L, Cook D, Fergusson D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol. JAMA 2012;308:1985-92. PDFThis study was a multi-center, randomized controlled trial that compared protocolized sedation with protocolized sedation plus daily sedation interruption. The protocol used to titrate benzodiazepine and opioid infusions incorporated a validated scale (Sedation-agitation Scale (SAS or Richmond Agitation Sedation Scale (RASS in order to maintain a comfortable but arousable state. Four hundred and thirty mechanically ventilated, critically ill patients were recruited from medical and surgical ICUs in 16 institutions in North America. The study showed no benefit in the group that underwent daily sedation interruption - length of intubation was 7 days, length of ICU stay was 10 days and length of hospital stay was 20 days in both groups. There was no significant difference in the incidence of delirium (53 vs. ...

  7. Is opiate action in cough due to sedation?

    Science.gov (United States)

    Dickinson, Rebecca S.; Morjaria, Jaymin B.; Wright, Caroline E.

    2014-01-01

    Objectives: Opiates have been used for cough suppression for centuries. It is unclear whether this antitussive action is due to their known sedative effects. We aimed to assess correlation between cough suppression and opiate usage. Methods: We performed a post hoc analysis of two published trials with three opioids. In study one, patients with chronic cough were treated with 4 weeks of modified release morphine sulphate (5 mg twice daily) or placebo in a double-blinded placebo-controlled fashion. Cough suppression was assessed subjectively by the Leicester Cough Questionnaire and objectively by citric acid aerosol (CAA) induced cough challenge. In study 2, normal volunteers were given single doses of placebo, codeine 30 mg or dextromethorphan 50 mg and cough suppression assessed using the CAA-induced cough challenge. Sedation was contemporaneously assessed by direct questioning. Results: There were 14 episodes of patient-reported sedation; 2 with modified release morphine sulphate, 9 with codeine and 3 with dextromethorphan. There was no correlation between change in the Leicester Cough Questionnaire or the CAA-induced cough challenge and reported sedation. Conclusion: This observational study suggests that sedation is unlikely to underlie the antitussive properties of these opioids. Eliciting the mechanism of these medications in cough may be a target for future tailored drug development. PMID:25177477

  8. Female Patients Require a Higher Propofol Infusion Rate for Sedation.

    Science.gov (United States)

    Maeda, Shigeru; Tomoyasu, Yumiko; Higuchi, Hitoshi; Honda, Yuka; Ishii-Maruhama, Minako; Miyawaki, Takuya

    2016-01-01

    Sedation may minimize physiologic and behavioral stress responses. In our facility, the infusion rate of propofol is adjusted according to the bispectral index (BIS) in all cases of implant-related surgery; multivariate analysis of retrospective data enabled us to extract independent factors that affect the dose of propofol in sedation that are considered useful indicators for achieving adequate sedation. The study population comprised all patients undergoing implant-related surgery under intravenous sedation in Okayama University Hospital from April 2009 to March 2013. The infusion rate of propofol was adjusted to maintain the BIS value at 70-80. The outcome was the average infusion rate of propofol, and potential predictor variables were age, sex, body weight, treatment time, and amount of midazolam. Independent variables that affected the average infusion rate of propofol were extracted with multiple regression analysis. One hundred twenty-five subjects were enrolled. In the multiple regression analysis, female sex was shown to be significantly associated with a higher average infusion rate of propofol. Females may require a higher infusion rate of propofol than males to achieve adequate sedation while undergoing implant-related surgery. PMID:27269663

  9. TreeMAC: Localized TDMA MAC protocol for real-time high-data-rate sensor networks

    Science.gov (United States)

    Song, W.-Z.; Huang, R.; Shirazi, B.; LaHusen, R.

    2009-01-01

    Earlier sensor network MAC protocols focus on energy conservation in low-duty cycle applications, while some recent applications involve real-time high-data-rate signals. This motivates us to design an innovative localized TDMA MAC protocol to achieve high throughput and low congestion in data collection sensor networks, besides energy conservation. TreeMAC divides a time cycle into frames and each frame into slots. A parent node determines the children's frame assignment based on their relative bandwidth demand, and each node calculates its own slot assignment based on its hop-count to the sink. This innovative 2-dimensional frame-slot assignment algorithm has the following nice theory properties. First, given any node, at any time slot, there is at most one active sender in its neighborhood (including itself). Second, the packet scheduling with TreeMAC is bufferless, which therefore minimizes the probability of network congestion. Third, the data throughput to the gateway is at least 1/3 of the optimum assuming reliable links. Our experiments on a 24-node testbed show that TreeMAC protocol significantly improves network throughput, fairness, and energy efficiency compared to TinyOS's default CSMA MAC protocol and a recent TDMA MAC protocol Funneling-MAC. Partial results of this paper were published in Song, Huang, Shirazi and Lahusen [W.-Z. Song, R. Huang, B. Shirazi, and R. Lahusen, TreeMAC: Localized TDMA MAC protocol for high-throughput and fairness in sensor networks, in: The 7th Annual IEEE International Conference on Pervasive Computing and Communications, PerCom, March 2009]. Our new contributions include analyses of the performance of TreeMAC from various aspects. We also present more implementation detail and evaluate TreeMAC from other aspects. ?? 2009 Elsevier B.V.

  10. A COMPARITIVE STUDY TO EVALUATE EFICACY OF IV INFUSION OF DEXMEDETOMIDINE VERSUS IV INFUSION OF PROPOFOL FOR POST - OPERATIVE ICU SEDATION

    Directory of Open Access Journals (Sweden)

    Vindhya

    2014-12-01

    Full Text Available Patients requiring mechanical ventilation usually needs adequate sedation and analgesia to facilitate their care. Dexmedetomidine , a short - acting alpha - 2 - agonist , possesses anxiolytic , anesthetic , hypnotic , and analgesic properties. AIM : The objective of this study is to evaluate and compare the safety and efficacy of iv infusion of Dexmedetomidine with iv infusion of propofol for sedation in post - operative ICU patients. MATERIALS AND METHODS: Fifty patients who were ambulatory and who required the post - operative me chanical ventilation or post - operative sedation were enrolled , in which 25 patients received Dexmedetomidine and remaining 25 patients received propofol. All these patients were treated for the period of 8 to 24 h. STATISTICAL ANALYSIS USED: Data were anal yzed using Student's t - test and Chi - square test. The value of P < 0.05 was considered as statistically significant. RESULTS: Demographic data were comparable. Pulse rate , respiratory rate and blood pressure were comparable. Depth of sedation is similar. To maintain analgesia throughout the study period , patients receiving propofol infusions required significantly more analgesics than patients receiving Dexmedetomidine. CONCLUSIONS: Dexmedetomidine appears to be a safe and acceptable ICU sedative agent .

  11. Effects of pretest stimulative and sedative music on grip strength.

    Science.gov (United States)

    Karageorghis, C I; Drew, K M; Terry, P C

    1996-12-01

    The purpose of the present study was to investigate the effects of stimulative (energizing) and sedative (relaxing) music on grip strength. A 2 x 3 (gender x condition) repeated-measures analysis of variance and post hoc tests showed that participants (N = 50) evidenced higher grip strength after listening to stimulative music (M = 43.94 kg.force) than after sedative music or a white noise control condition. Sedative music yielded lower scores than white noise. Men evidenced higher grip strength than women, but there was no interaction between gender and music condition. It was concluded that a simple motoric task such as grip strength provides a sensitive measure of psychophysical responses to music. PMID:9017751

  12. Registered nurse-administered sedation for gastrointestinalendoscopic procedure

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    The rising use of nonanesthesiologist-administeredsedation for gastrointestinal endoscopy has clinicalsignificances. Most endoscopic patients require someforms of sedation and/or anesthesia. The goals ofthis sedation are to guard the patient's safety, minimizephysical discomfort, to control behavior and todiminish psychological responses. Generally, moderatesedation for these procedures has been offered by thenon-anesthesiologist by using benzodiazepines and/oropioids. Anesthesiologists and non-anesthesiologistpersonnel will need to work together for these challengesand for safety of the patients. The sedationtraining courses including clinical skills and knowledgeare necessary for the registered nurses to facilitate thepatient safety and the successful procedure. However,appropriate patient selection and preparation, adequatemonitoring and regular training will ensure that the useof nurse-administered sedation is a feasible and safetechnique for gastrointestinal endoscopic procedures.

  13. Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: a retrospective study

    Directory of Open Access Journals (Sweden)

    Jenvey Wendy I

    2007-03-01

    Full Text Available Abstract Background Experience suggests that patients with alcohol and other drug use disorders (AOD are commonly cared for in our intensive care units (ICU's and require more sedation. We sought to determine the impact of AOD on sedation requirement and mechanical ventilation (MV duration. Methods Retrospective review of randomly selected records of adult patients undergoing MV in the medical ICU. Diagnoses of AOD were identified using strict criteria in Diagnostic and Statistical Manual of Mental Disorders, and through review of medical records and toxicology results. Results Of the 70 MV patients reviewed, 27 had AOD (39%. Implicated substances were alcohol in 22 patients, cocaine in 5, heroin in 2, opioids in 2, marijuana in 2. There was no difference between AOD and non-AOD patients in age, race, or reason for MV, but patients with AOD were more likely to be male (21 versus 15, p Conclusion The prevalence of AOD among medical ICU patients undergoing MV is high. Patients with AOD receive higher doses of sedation than their non-AOD counterparts to achieve similar RASS scores but do not undergo longer duration of MV.

  14. Multi-channel MAC Protocol in Cognitive Radio Networks

    Directory of Open Access Journals (Sweden)

    Yongli Sun

    2013-11-01

    Full Text Available Since cognitive wireless network (CRN has the characteristic of secondary use, it can enable the device to dynamically access available spectrum without interference to primary users (PUs, which can effectively alleviate contradiction between the lack of spectrum resources and the growing demand for wireless access. However, Medium Access Control (MAC protocol as CRN core components, can achieve competition access of the licensed spectrum and coordination control, which will maximize spectrum utilization efficiency and network throughput. The contribution of this survey is threefold. First, we analyze the characteristics of the existed multi- channel MAC protocol in CRN; Second, according to the different ways of spectrum access in CRNs, the multi-channel MAC protocols are classified into time-slotted based MAC protocol, control channel based MAC protocol and hybrid MAC protocol, and the paper emphatically analyzed the advantages and disadvantages of these multi-channel MAC protocols; Finally, the paper explores the difficulties and the challenges of multi-channel MAC protocols design in cognitive wireless network.

  15. Counter Measures to Combat Misuses of MAC Address Spoofing Techniques

    Directory of Open Access Journals (Sweden)

    Alok Pandey

    2012-03-01

    Full Text Available In a computer network several communicating devices are connected to a common shared communication medium. A network interfacing card or a wireless network card is typically used to connect computers on a network. This gives rise to the need of unique identification mechanism to be followed for each of the connected devices. Media Access Control (MAC addressing is used to properly identify communicating devices. The term MAC spoofing refers to a situation when somebody changes the MAC address of his computer or the network communicating device to impersonate someone else based upon this MAC address identification. Although MAC spoofing may be essential in some situations yet it has become potential threat for the network security as it sets ground for formulating and launching different types of Attacks like ARP Spoofing, DNS Poisoning, Denial of Services, Session Hijacking, Man in the Middle Attack etc. on a network. The purpose of this paper is to spread the awareness about MAC addressing, MAC spoofing techniques normally used, different types of attacks that can be based upon MAC spoofing and some of the counter measures that can be adopted by common network users.

  16. Steven MacCall: Winner of LJ's 2010 Teaching Award

    Science.gov (United States)

    Berry, John N., III

    2010-01-01

    This article profiles Steven L. MacCall, winner of "Library Journal's" 2010 Teaching Award. An associate professor at the School of Library and Information Studies (SLIS) at the University of Alabama, Tuscaloosa, MacCall was nominated by Kathie Popadin, known as "Kpop" to the members of her cohort in the online MLIS program at SLIS. Sixteen of…

  17. Paradox applications integration ATP's for MAC and mass balance programs

    International Nuclear Information System (INIS)

    The K Basins Materials Accounting (MAC) and Material Balance (MBA) database system were set up to run under one common applications program. This Acceptance Test Plan (ATP) describes how the code was to be tested to verify its correctness. The scope of the tests is minimal, since both MAC and MBA have already been tested in detail as stand-alone programs

  18. Sedative effects of intramuscular alfaxalone administered to cats

    OpenAIRE

    Tamura, Jun; ISHIZUKA, Tomohito; FUKUI, Sho; OYAMA, Norihiko; KAWASE, Kodai; Itami, Takaharu; MIYOSHI, Kenjiro; Sano, Tadashi; PASLOSKE, Kirby; YAMASHITA, Kazuto

    2015-01-01

    The sedative effects of intramuscular (IM) alfaxalone in 2-hydroxypropyl-beta-cyclodextrin (alfaxalone-HPCD) were evaluated in cats. The cats were treated with alfaxalone-HPCD in five occasions with a minimum 14-day interval between treatments: an IM injection of 1.0 mg/kg (IM1), 2.5 mg/kg (IM2.5), 5 mg/kg (IM5) or 10 mg/kg (IM10), or an intravenous injection of 5 mg/kg (IV5). The sedative effects were evaluated subjectively using a composite measurement scoring system (a maximum score of 16)...

  19. Energy Efficient MAC Protocols for Wireless Sensor Network: A Survey

    Directory of Open Access Journals (Sweden)

    Eleazar Chukwuka

    2013-08-01

    Full Text Available Wireless Sensor Network (WSN is an attractive choice for a variety of applications as no wiredinfrastructure is needed. Other wireless networks are not as energy constrained as WSNs, because theymay be plugged into the mains supply or equipped with batteries that are rechargeable and replaceable.Among others, one of the main sources of energy depletion in WSN is communications controlled by theMedium Access Control (MAC protocols. An extensive survey of energy efficient MAC protocols ispresented in this article. We categorise WSN MAC protocols in the following categories: controlled access(CA, random access (RA, slotted protocols (SP and hybrid protocols (HP. We further discuss howenergy efficient MAC protocols have developed from fixed sleep/wake cycles through adaptive to dynamiccycles, thus becoming more responsive to traffic load variations. Finally we present open researchquestions on MAC layer design for WSNs in terms of energy efficiency.

  20. A Sensing Error Aware MAC Protocol for Cognitive Radio Networks

    CERN Document Server

    Hu, Donglin

    2011-01-01

    Cognitive radios (CR) are intelligent radio devices that can sense the radio environment and adapt to changes in the radio environment. Spectrum sensing and spectrum access are the two key CR functions. In this paper, we present a spectrum sensing error aware MAC protocol for a CR network collocated with multiple primary networks. We explicitly consider both types of sensing errors in the CR MAC design, since such errors are inevitable for practical spectrum sensors and more important, such errors could have significant impact on the performance of the CR MAC protocol. Two spectrum sensing polices are presented, with which secondary users collaboratively sense the licensed channels. The sensing policies are then incorporated into p-Persistent CSMA to coordinate opportunistic spectrum access for CR network users. We present an analysis of the interference and throughput performance of the proposed CR MAC, and find the analysis highly accurate in our simulation studies. The proposed sensing error aware CR MAC p...

  1. The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department

    OpenAIRE

    Downes Michael A; Calver Leonie A; Page Colin B; Bryant Jenni L; Isbister Geoffrey K

    2010-01-01

    Abstract Background Acute behavioural disturbance (ABD) is an increasing problem in emergency departments. This study aimed to determine the impact of a structured intramuscular (IM) sedation protocol on the duration of ABD in the emergency department. Methods A historical control study was undertaken comparing 58 patients who required physical restraint and parenteral sedation with the structured IM sedation protocol, to 73 historical controls treated predominantly by intravenous sedation, a...

  2. TR-MAC: an energy-efficient MAC protocol exploiting transmitted reference modulation for wireless sensor networks

    NARCIS (Netherlands)

    Morshed, Sarwar; Heijenk, Geert

    2014-01-01

    The medium access control (MAC) protocol determines the energy consumption of a wireless sensor node by specifying the listening, transmitting or sleeping time. Therefore MAC protocols play an important role in minimizing the overall energy consumption in a typical wireless sensor network (WSN). Usi

  3. Cultural changes in ICU sedation management

    DEFF Research Database (Denmark)

    Egerod, Ingrid

    2009-01-01

    semistructured interview guide. One experienced doctor was selected at each of the seven largest intensive care units in Denmark. Interpretational analysis was performed by comprehensive overview, individual case analysis, cross-case analysis, and integrated thematic analysis and identification of emerging...

  4. Use of Flumazenil to Provide Adequate Recovery Time Post-Midazolom Infusion in a General Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    MOJTABA MOJTAHEDZADEH

    1999-08-01

    Full Text Available Sedation permits patients to tolerate the various treatment modalities to which they are subjected. However it may sometimes cause prolonged sedation in critically ill patients. Flumazenil, a benzo¬diazepine antagonist, reverses midazolam-induced sedation and amnesia. We prospectively designed a double-blind randomized study to evaluate the effects of flumazenil on thirty (30 Iranian General Intensive Care Unit (ICU patients. They were requiring mechanical ventilation for more than 12 hours and they were sedated by midazolam infusions. Sedation levels were measured hourly during the infusion, at the end of the infusion, and at 5, 15, 30, 60, and 120 min after cessation of the mida¬zolam infusion. Reversal of sedation was observed in all patients who received flumazenil, and re-sedation occurred in seven of these patients. Reversal was not seen in any of the patients who receiv-ed placebo.

  5. Effect-site targeted patient-controlled sedation with propofol : comparison with anaesthetist administration for colonoscopy

    NARCIS (Netherlands)

    Stonell, CA; Leslie, K; Absalom, AR

    2006-01-01

    Patient-controlled sedation (PCS) allows patients to match their sedation requirement to perceived discomfort. The significant delay in onset of sedation may be overcome with effect-site steered target controlled infusion, but previously only trials in volunteers have been carried out. We therefore

  6. Sedation and renal impairment in critically ill patients: a post hoc analysis of a randomized trial

    DEFF Research Database (Denmark)

    Strøm, Thomas; Johansen, Rasmus R.; Prahl, Jens O;

    2011-01-01

    need for vasoactive drugs, diminishes the need for extra fluids and lowers the risk of acute kidney injury. METHODS: We performed an evaluation on the database from our previous trial of 140 patients randomized to either no sedation vs. sedation with a daily interruption of sedatives (Clinical...

  7. Anxiolytic and sedative effects of Byrsocarpus coccineus Schum. and Thonn. (Connaraceae extract

    Directory of Open Access Journals (Sweden)

    A J Akindele

    2010-03-01

    possibly due to the presence of flavonoids, alkaloids, and terpenoids in the plant extract. These chemical constituents have been reported to be responsible for anxiolytic and sedative effects observed in different plant extracts (Houghton, 1999; Dhawan et al., 2001; Carlini, 2003. The findings in this study justify the use of the plant as a sedative in Traditional African Medicine, while also suggesting a potential usefulness in the treatment of anxiety. Industrial relevance: Herbal remedies (HRs constitute a strong component of traditional, complementary and alternative medicine. In most developing countries, HRs play a critical role in the management of various diseases owing to the challenges confronting the appropriate delivery of official health care to millions of people in remote and rural communities. In realization of the inherent value of HRs to primary health care and the fact that over three quarters of the world’s population rely mainly on plants for health care, the World Health Organization (WHO has advocated for the proper identification, sensible exploitation, scientific development and appropriate utilization of herbal medicines which provide safe and effective remedies in medicare (Wambebe, 1998. Pharmacological and toxicological evaluations are therefore critical in drug and standardized phytomedicine development. Results obtained from this study scientifically reveal the aqueous leaf extract of B. coccineus as a potential herbal remedy and source of bioactive compound(s for the treatment of certain central nervous system disorders in humans.          

  8. Does type of instrument influence colonoscopy performance and sedation practice?

    Institute of Scientific and Technical Information of China (English)

    Ramesh P Arasaradnam; Paul D Hurlstone

    2007-01-01

    @@ TO THE EDITOR In the UK, clear guidelines exist as to the expected levelof competence an individual endoscopist should achieve.This is of utmost importance given the variance inpractice among endoscopic departments as highlightedby the National Colonoscopy audit in 2002[1]. The auditedvariables included sedation practice, caecal completion andcomtlication rates, but not the Wpe of instrument used.

  9. The impact of sedation on pulse pressure variation

    Czech Academy of Sciences Publication Activity Database

    Zvoníček, V.; Jurák, Pavel; Halámek, Josef; Kružliak, P.; Vondra, Vlastimil; Leinveber, P.; Cundrle, I.; Pavlík, M.; Suk, P.; Šrámek, V.

    2015-01-01

    Roč. 28, č. 4 (2015), s. 203-207. ISSN 1036-7314 R&D Projects: GA MŠk(CZ) LO1212 Institutional support: RVO:68081731 Keywords : pulse pressure variation * sedation * heart lung interactions * mechanical ventilation * brain death * oesophageal pressure Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 1.562, year: 2014

  10. Terminal sedation and euthanasia: A comparison of clinical practices

    NARCIS (Netherlands)

    J.A.C. Rietjens (Judith); J.J.M. van Delden (Johannes); A. van der Heide (Agnes); A.M. Vrakking (Astrid); B.D. Onwuteaka-Philipsen (Bregje); P.J. van der Maas (Paul); G. van der Wal (Gerrit)

    2006-01-01

    textabstractBackground: An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Methods: Personal interviews were held with a nationwide stratified sample o

  11. Cardiorespiratory compromise under conscious sedation during upper gastrointestinal endoscopy

    International Nuclear Information System (INIS)

    To compare the cardiorespiratory effects of benzodiazepine and midazolam used for sedation in patients undergoing upper gastrointestinal endoscopy with cardiorespiratory changes in the non-sedated patients. A total of 252 adult patients without previous cardiorespiratory co-morbidity, undergoing upper gastrointestinal endoscopy were recruited. They were randomly allocated in to group I (placebo with saline administration), group II (diazepam administered) and group III (midazolam administered). The pulse rate, blood pressure, ECG and peripheral oxygen saturation (SpO/sub 2/ ) was noted at baseline, after pre-medication, during endoscopy and post endoscopy. Statistical analysis was done by paired t-test, Chi-square test and ANOVA as applicable. There was no difference in baseline record of the three groups. Significant fall in SpO/sub 2/ was noted in all the groups, more marked in the sedated one during endoscopy. Tachycardia developed in all the three groups and settled within 5 minutes of endoscopy. Blood pressure remained more stable in the sedated group. ECG changes included atrial and ventricular premature contraction in all the three groups. (author)

  12. Manufacturing process of high quality phytopreparation on example of herbal sedative

    Directory of Open Access Journals (Sweden)

    Đorđević Sofija

    2013-01-01

    Full Text Available Introduction. Rational phytotherapy is a modern concept of using plant-originated drugs which has emerged from the need to improve phytotherapy in order to make the use of herbal remedies more efficient and safer. The aim of this study was to give the health-care workers more information on the manufacturing process of high quality phytopreparation following principles of Good Manufacturing Practice and Good Laboratory Practice on the example of herbal sedative, Odoval S® capsules. Material and Methods. This study was designed to reflect the production process of a high-quality and safe herbal remedy, starting from defining the formulation and the production procedure to the quality control of raw materials, characterization of the final product, and testing stability of active ingredients in the capsules. Results. Formulation of the phytopreparation, validation of the production process, quality control and stability testing, all together have resulted in the production of capsules with defined valeric acid content (1 mg valeric acid per capsule. Discussion. The preparation is recommended to relieve the symptoms caused by chronic stress (anxiety, irritability, fatigue, lack of concentration, heart palpitations and for mild insomnia. Conclusion. This paper presents the complete cycle of the production of a phytopreparation on the example of a new herbal sedative - Odoval S® capsules.

  13. Traducir con ordenadores Mac, ¿es posible?

    Directory of Open Access Journals (Sweden)

    Fernando Vidal Carballido

    2009-06-01

    Full Text Available El creciente éxito de los productos de Apple y el impulso que esto ha supuesto para su sistema operativo, Mac OS X, hace que cada vez haya más traductores que se planteen la opción de dejar de utilizar Windows a favor del sistema operativo de Apple. En el presente artículo se ofrece una perspectiva general sobre la situación actual y las distintas opciones, desde el uso de Windows en ordenadores Mac hasta el abandono completo de Microsoft Windows para usar Mac OS X en exclusiva. ----------------------------------- Translating with Mac. Is it possible? The growing success of Apple's products and the resulting popularity of its operating system, Mac OS X, are moving an increasing number of translators to consider the replacement of their Windows by the Apple's OS. This article offers an overview of the current situation and different options available, from using Windows on Mac computers to completely migrating from Microsoft Windows to Mac OS X.

  14. Sedative effects of intramuscular alfaxalone administered to cats.

    Science.gov (United States)

    Tamura, Jun; Ishizuka, Tomohito; Fukui, Sho; Oyama, Norihiko; Kawase, Kodai; Itami, Takaharu; Miyoshi, Kenjiro; Sano, Tadashi; Pasloske, Kirby; Yamashita, Kazuto

    2015-08-01

    The sedative effects of intramuscular (IM) alfaxalone in 2-hydroxypropyl-beta-cyclodextrin (alfaxalone-HPCD) were evaluated in cats. The cats were treated with alfaxalone-HPCD in five occasions with a minimum 14-day interval between treatments: an IM injection of 1.0 mg/kg (IM1), 2.5 mg/kg (IM2.5), 5 mg/kg (IM5) or 10 mg/kg (IM10), or an intravenous injection of 5 mg/kg (IV5). The sedative effects were evaluated subjectively using a composite measurement scoring system (a maximum score of 16). Cardio-respiratory variables were measured non-invasively. The median sedation scores peaked at 10 min (score 9), 15 min (score 14), 10 min (score 16), 10 to 20 min (score 16) and 2 to 5 min (score 16) after the IM1, IM2.5, IM5, IM10 and IV5 treatments, respectively. The IM5 treatment produced longer lasting sedation, compared to the IV5 treatment. Durations of maintenance of lateral recumbency after the IM10 treatment (115 ± 22 min) were longer than those after the IM2.5 (40 ± 15 min), IM5 (76 ± 21 min) and IV5 treatments (50 ± 5 min). Cardio-respiratory variables remained within clinically acceptable ranges, except for each one cat that showed hypotension (sedative effect at 2.5 to 10 mg/kg in healthy cats. Hypotension may occur at higher IM doses of alfaxalone-HPCD. PMID:25786416

  15. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.

    Science.gov (United States)

    Jarzyna, Donna; Jungquist, Carla R; Pasero, Chris; Willens, Joyce S; Nisbet, Allison; Oakes, Linda; Dempsey, Susan J; Santangelo, Diane; Polomano, Rosemary C

    2011-09-01

    As the complexity of analgesic therapies increases, priorities of care must be established to balance aggressive pain management with measures to prevent or minimize adverse events and to ensure high quality and safe care. Opioid analgesia remains the primary pharmacologic intervention for managing pain in hospitalized patients. Unintended advancing sedation and respiratory depression are two of the most serious opioid-related adverse events. Multiple factors, including opioid dosage, route of administration, duration of therapy, patient-specific factors, and desired goals of therapy, can influence the occurrence of these adverse events. Furthermore, there is an urgent need to educate all members of the health care team about the dangers and potential attributes of administration of sedating medications concomitant with opioid analgesia and the importance of initiating rational multimodal analgesic plans to help avoid adverse events. Nurses play an important role in: 1) identifying patients at risk for unintended advancing sedation and respiratory depression from opioid therapy; 2) implementing plans of care to assess and monitor patients; and 3) intervening to prevent the worsening of adverse events. Despite the frequency of opioid-induced sedation, there are no universally accepted guidelines to direct effective and safe assessment and monitoring practices for patients receiving opioid analgesia. Moreover, there is a paucity of information and no consensus about the benefits of technology-supported monitoring, such as pulse oximetry (measuring oxygen saturation) and capnography (measuring end-tidal carbon dioxide), in hospitalized patients receiving opioids for pain therapy. To date, there have not been any randomized clinical trials to establish the value of technologic monitoring in preventing adverse respiratory events. Additionally, the use of technology-supported monitoring is costly, with far-reaching implications for hospital and nursing practices. As a

  16. Strategies for Optimal MAC Parameters Tuning in IEEE 802.15.6 Wearable Wireless Sensor Networks.

    Science.gov (United States)

    Alam, Muhammad Mahtab; Ben Hamida, Elyes

    2015-09-01

    Wireless body area networks (WBAN) has penetrated immensely in revolutionizing the classical heath-care system. Recently, number of WBAN applications has emerged which introduce potential limits to existing solutions. In particular, IEEE 802.15.6 standard has provided great flexibility, provisions and capabilities to deal emerging applications. In this paper, we investigate the application-specific throughput analysis by fine-tuning the physical (PHY) and medium access control (MAC) parameters of the IEEE 802.15.6 standard. Based on PHY characterizations in narrow band, at the MAC layer, carrier sense multiple access collision avoidance (CSMA/CA) and scheduled access protocols are extensively analyzed. It is concluded that, IEEE 802.15.6 standard can satisfy most of the WBANs applications throughput requirements by maximum achieving 680 Kbps. However, those emerging applications which require high quality audio or video transmissions, standard is not able to meet their constraints. Moreover, delay, energy efficiency and successful packet reception are considered as key performance metrics for comparing the MAC protocols. CSMA/CA protocol provides the best results to meet the delay constraints of medical and non-medical WBAN applications. Whereas, the scheduled access approach, performs very well both in energy efficiency and packet reception ratio. PMID:26266628

  17. MacRuby Ruby and Cocoa on OS X

    CERN Document Server

    Aimonetti, Matt

    2011-01-01

    Want to build native Mac OS X applications with a sleek, developer-friendly alternative to Objective-C? MacRuby is an ideal choice. This in-depth guide shows you how Apple's implementation of Ruby gives you access to all the features available to Objective-C programmers. You'll get clear, detailed explanations of MacRuby, including quick programming techniques such as prototyping. Perfect for programmers at any level, this book is packed with code samples and complete project examples. If you use Ruby, you can tap your skills to take advantage of Interface Builder, Cocoa libraries, the Objec

  18. Cooperative Energy Harvesting-Adaptive MAC Protocol for WBANs

    Science.gov (United States)

    Esteves, Volker; Antonopoulos, Angelos; Kartsakli, Elli; Puig-Vidal, Manel; Miribel-Català, Pere; Verikoukis, Christos

    2015-01-01

    In this paper, we introduce a cooperative medium access control (MAC) protocol, named cooperative energy harvesting (CEH)-MAC, that adapts its operation to the energy harvesting (EH) conditions in wireless body area networks (WBANs). In particular, the proposed protocol exploits the EH information in order to set an idle time that allows the relay nodes to charge their batteries and complete the cooperation phase successfully. Extensive simulations have shown that CEH-MAC significantly improves the network performance in terms of throughput, delay and energy efficiency compared to the cooperative operation of the baseline IEEE 802.15.6 standard. PMID:26029950

  19. MacWilliams Identity for Codes with the Rank Metric

    Directory of Open Access Journals (Sweden)

    Gadouleau Maximilien

    2008-01-01

    Full Text Available Abstract The MacWilliams identity, which relates the weight distribution of a code to the weight distribution of its dual code, is useful in determining the weight distribution of codes. In this paper, we derive the MacWilliams identity for linear codes with the rank metric, and our identity has a different form than that by Delsarte. Using our MacWilliams identity, we also derive related identities for rank metric codes. These identities parallel the binomial and power moment identities derived for codes with the Hamming metric.

  20. Handling Deafness Problem of Scheduled Multi-Channel Polling MACs

    Science.gov (United States)

    Jiang, Fulong; Liu, Hao; Shi, Longxing

    Combining scheduled channel polling with channel diversity is a promising way for a MAC protocol to achieve high energy efficiency and performance under both light and heavy traffic conditions. However, the deafness problem may cancel out the benefit of channel diversity. In this paper, we first investigate the deafness problem of scheduled multi-channel polling MACs with experiments. Then we propose and evaluate two schemes to handle the deafness problem. Our experiment shows that deafness is a significant reason for performance degradation in scheduled multi-channel polling MACs. A proper scheme should be chosen depending on the traffic pattern and the design objective.

  1. Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review.

    Science.gov (United States)

    Gazal, Giath; Fareed, Wamiq Musheer; Zafar, Muhammad Sohail; Al-Samadani, Khalid H

    2016-07-01

    For fearful and uncooperative children behavioral management techniques are used. In order to control the pain and anxiety in pedodontic patients, pharmacologic sedation, anesthesia and analgesia are commonly used. Midazolam is commonly used as an oral sedation agent in children; it has several features such as safety of use, quick onset and certain degree of amnesia that makes it a desirable sedation agent in children. This review paper discusses various aspects of oral midazolam, ketamine and their combinations in conscious sedation including, advantages of oral route of sedation, pharmacokinetics, range of oral doses, and antagonists for clinical dental treatment procedures. PMID:27330369

  2. +Psychometric evaluation of the MacDQoL individualised measure of the impact of macular degeneration on quality of life

    Directory of Open Access Journals (Sweden)

    ffytche Timothy

    2005-04-01

    Full Text Available Abstract Background The MacDQoL is an individualised measure of the impact of macular degeneration (MD on quality of life (QoL. There is preliminary evidence of its psychometric properties and sensitivity to severity of MD. The aim of this study was to carry out further psychometric evaluation with a larger sample and investigate the measure's sensitivity to MD severity. Methods Patients with MD (n = 156: 99 women, 57 men, mean age 79 ± 13 years, recruited from eye clinics (one NHS, one private completed the MacDQoL by telephone interview and later underwent a clinic vision assessment including near and distance visual acuity (VA, comfortable near VA, contrast sensitivity, colour recognition, recovery from glare and presence or absence of distortion or scotoma in the central 10° of the visual field. Results The completion rate for the MacDQoL items was 99.8%. Of the 26 items, three were dropped from the measure due to redundancy. A fourth was retained in the questionnaire but excluded when computing the scale score. Principal components analysis and Cronbach's alpha (0.944 supported combining the remaining 22 items in a single scale. Lower MacDQoL scores, indicating more negative impact of MD on QoL, were associated with poorer distance VA (better eye r = -0.431 p Conclusion The MacDQoL 22-item scale has excellent internal consistency reliability and a single-factor structure. The measure is acceptable to respondents and the generic QoL item, MD-specific QoL item and average weighted impact score are related to several measures of vision. The MacDQoL demonstrates that MD has considerable negative impact on many aspects of QoL, particularly independence, leisure activities, dealing with personal affairs and mobility. The measure may be valuable for use in clinical trials and routine clinical care.

  3. PAD-MAC: primary user activity-aware distributed MAC for multi-channel cognitive radio networks.

    Science.gov (United States)

    Ali, Amjad; Piran, Md Jalil; Kim, Hansoo; Yun, Jihyeok; Suh, Doug Young

    2015-01-01

    Cognitive radio (CR) has emerged as a promising technology to solve problems related to spectrum scarcity and provides a ubiquitous wireless access environment. CR-enabled secondary users (SUs) exploit spectrum white spaces opportunistically and immediately vacate the acquired licensed channels as primary users (PUs) arrive. Accessing the licensed channels without the prior knowledge of PU traffic patterns causes severe throughput degradation due to excessive channel switching and PU-to-SU collisions. Therefore, it is significantly important to design a PU activity-aware medium access control (MAC) protocol for cognitive radio networks (CRNs). In this paper, we first propose a licensed channel usage pattern identification scheme, based on a two-state Markov model, and then estimate the future idle slots using previous observations of the channels. Furthermore, based on these past observations, we compute the rank of each available licensed channel that gives SU transmission success assessment during the estimated idle slot. Secondly, we propose a PU activity-aware distributed MAC (PAD-MAC) protocol for heterogeneous multi-channel CRNs that selects the best channel for each SU to enhance its throughput. PAD-MAC controls SU activities by allowing them to exploit the licensed channels only for the duration of estimated idle slots and enables predictive and fast channel switching. To evaluate the performance of the proposed PAD-MAC, we compare it with the distributed QoS-aware MAC (QC-MAC) and listen-before-talk MAC schemes. Extensive numerical results show the significant improvements of the PAD-MAC in terms of the SU throughput, SU channel switching rate and PU-to-SU collision rate. PMID:25831084

  4. The MacNuclide nuclear data environment

    International Nuclear Information System (INIS)

    Advance in technology have produced intriguing tools that can be applied to problems in nuclear science. Information management in nuclear science is an example of how technology is not quickly exploited. The U.S. Department of Energy supports an extensive program to evaluate published nuclear properties and store them in an electronic data base. Much of the evaluation effort has focused on producing the journal Nuclear Data Sheets and the publication Table of Isotopes. Although the electronic data base can itself be a valuable source of information, the software used to access is was designed using decades-old technologies. The authors of this paper have developed a novel data-base management system for nuclear properties. The application is known as MacNuclide. It is a nuclear data-base environment that uses the highly interactive and intuitive windowing environmentsof desk-top computers. The environment is designed around that image of the chart of nuclides. Questions are posed to the data base by placing constraints on properties and defining collections of nuclides to be used in data-base seraches. Results are displayed either as a simple list of nuclides that meet the imposed constraints or as a color chart of nuclides

  5. Infecting Windows, Linux & Mac in one go

    CERN Multimedia

    Computer Security Team

    2012-01-01

    Still love bashing on Windows as you believe it is an insecure operating system? Hold on a second! Just recently, a vulnerability has been published for Java 7.   It affects Windows/Linux PCs and Macs, Internet Explorer, Safari and Firefox. In fact, it affects all computers that have enabled the Java 7 plug-in in their browser (Java 6 and earlier is not affected). Once you visit a malicious website (and there are plenty already out in the wild), your computer is infected… That's "Game Over" for you.      And this is not the first time. For a while now, attackers have not been targeting the operating system itself, but rather aiming at vulnerabilities inherent in e.g. your Acrobat Reader, Adobe Flash or Java programmes. All these are standard plug-ins added into your favourite web browser which make your web-surfing comfortable (or impossible when you un-install them). A single compromised web-site, however, is sufficient to prob...

  6. A fuzzy logic cooperative MAC for MANET

    Institute of Scientific and Technical Information of China (English)

    WANG Zhao-xiang; XIA Hai-lun; DING Wei

    2008-01-01

    In both wireless local area networks (WLAN) andmobile ad hoc networks(MANET), the IEEE 802.11e mediumaccess control (MAC) protocol is proposed for an effectivequality of service (QoS) solution. A number of studies havebeen done to enhance the performance of 802.11e in MANETby independently adjusting contention window (CW) size ofeach access category(AC) in every node. However, without thecooperation between the high priority flows and lower priorityflows, the QoS goal of high priority flows cannot achieveeffectively. In this article, a fuzzy logic based cooperative MACprotocol (FLCMAC) is proposed to cooperate amongst networkflows and dynamically adjust access probability of each lowpriority flow affecting the high priority flows to satisfy theftQoS requirement. The simulation results indicate that comparedto the enhanced distributed channel access (EDCA) scheme of802.11e, the FLCMAC consistently excels, in terms ofthroughput and delay under moderate and heavy backgroundtraffic both in single-hop and multi-hop scenarios.

  7. Competition at the Wireless Sensor Network MAC Layer: Low Power Probing interfering with X-MAC

    International Nuclear Information System (INIS)

    Wireless Sensor Networks (WSNs) combine sensors with computer networks and enable very dense, in-situ and live measurements of data over a large area. Since this emerging technology has the potential to be embedded almost everywhere for numberless applications, interference between different networks can become a serious issue. For most WSNs, it is assumed today that the network medium access is non-competitive. On the basis of X-MAC interfered by Low Power Probing, this paper shows the danger and the effects of different sensor networks communicating on a single wireless channel of the 2.4 GHz band, which is used by the IEEE 802.15.4 standard.

  8. 324Mbps WLAN Equipment with MAC Frame Aggregation for High MAC-SAP Throughput

    OpenAIRE

    Suguru Kameda; Hiroyuki Nakase; Fumio Ishizu; Yoji Isota; Yoshihiko Shirokura; Akinori Fujimura; Yukimasa Nagai; Hiroshi Oguma; Kazuo Tsubouchi

    2006-01-01

    We developed a high speed wireless LAN prototype in the 5GHz band. Maximum transmission rate of the developed WLAN equipment was 324Mbit/sec using 6 multi-channels of 802.11a. We proposed a novel frame aggregation scheme to improve MAC efficiency. The proposed frame aggregation scheme ...

  9. Efficacy and safety of deep sedation by non-anesthesiologists for cardiac MRI in children

    International Nuclear Information System (INIS)

    Cardiac MRI has become widespread to characterize cardiac lesions in children. No study has examined the role of deep sedation performed by non-anesthesiologists for this investigation. We hypothesized that deep sedation provided by non-anesthesiologists can be provided with a similar safety and efficacy profile to general anesthesia provided by anesthesiologists. This is a retrospective chart review of children who underwent cardiac MRI over a 5-year period. The following data were collected from the medical records: demographic data, cardiac lesion, American Society of Anesthesiologists (ASA) physical status, sedation type, provider, medications, sedation duration and adverse events or interventions. Image and sedation adequacy were recorded. Of 1,465 studies identified, 1,197 met inclusion criteria; 43 studies (3.6%) used general anesthesia, 506 (42.3%) had deep sedation and eight (0.7%) required anxiolysis only. The remaining 640 studies (53.5%) were performed without sedation. There were two complications in the general anesthesia group (4.7%) versus 17 in the deep sedation group (3.4%). Sedation was considered inadequate in 22 of the 506 deep sedation patients (4.3%). Adequate images were obtained in 95.3% of general anesthesia patients versus 86.6% of deep sedation patients. There was no difference in the incidence of adverse events or cardiac MRI image adequacy for children receiving general anesthesia by anesthesiologists versus deep sedation by non-anesthesiologists. In summary, this study demonstrates that an appropriately trained sedation provider can provide deep sedation for cardiac MRI without the need for general anesthesia in selected cases. (orig.)

  10. Efficacy and safety of deep sedation by non-anesthesiologists for cardiac MRI in children

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Rini [University of Ottawa, Department of Pediatrics, Division of Emergency Medicine, Children' s Hospital of Eastern Ontario, Ottawa (Canada); Petrillo-Albarano, Toni; Stockwell, Jana A. [Emory University School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Atlanta, GA (United States); Children' s Sedation Services, Children' s Healthcare of Atlanta at Egleston, Atlanta, GA (United States); Parks, W.J. [Emory University School of Medicine, Department of Pediatrics, Division of Cardiology, Children' s Healthcare of Atlanta, Sibley Heart Center, Atlanta, GA (United States); Linzer, Jeffrey F. [Children' s Sedation Services, Children' s Healthcare of Atlanta at Egleston, Atlanta, GA (United States); Emory University School of Medicine, Department of Pediatrics, Division of Emergency Medicine, Atlanta, GA (United States)

    2013-03-15

    Cardiac MRI has become widespread to characterize cardiac lesions in children. No study has examined the role of deep sedation performed by non-anesthesiologists for this investigation. We hypothesized that deep sedation provided by non-anesthesiologists can be provided with a similar safety and efficacy profile to general anesthesia provided by anesthesiologists. This is a retrospective chart review of children who underwent cardiac MRI over a 5-year period. The following data were collected from the medical records: demographic data, cardiac lesion, American Society of Anesthesiologists (ASA) physical status, sedation type, provider, medications, sedation duration and adverse events or interventions. Image and sedation adequacy were recorded. Of 1,465 studies identified, 1,197 met inclusion criteria; 43 studies (3.6%) used general anesthesia, 506 (42.3%) had deep sedation and eight (0.7%) required anxiolysis only. The remaining 640 studies (53.5%) were performed without sedation. There were two complications in the general anesthesia group (4.7%) versus 17 in the deep sedation group (3.4%). Sedation was considered inadequate in 22 of the 506 deep sedation patients (4.3%). Adequate images were obtained in 95.3% of general anesthesia patients versus 86.6% of deep sedation patients. There was no difference in the incidence of adverse events or cardiac MRI image adequacy for children receiving general anesthesia by anesthesiologists versus deep sedation by non-anesthesiologists. In summary, this study demonstrates that an appropriately trained sedation provider can provide deep sedation for cardiac MRI without the need for general anesthesia in selected cases. (orig.)

  11. Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis.

    Science.gov (United States)

    Roh, Go Un; Kim, Youngsoon; Ha, Sang Hee; Jeong, Kyu Hee; Choi, Sumin; Han, Dong Woo

    2016-06-01

    Sedation can increase patient comfort during spinal anaesthesia. Understanding the relationship between the propofol effect-site concentration (Ce) and patient sedation level could help clinicians achieve the desired sedation level with minimal side effects. We aimed to model the relationship between the propofol Ce and adequate and deep sedation and also incorporate covariates. Thirty patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. Propofol was administered via an effect-site target-controlled infusion device using the Schnider pharmacokinetic model. The pharmacodynamic models for both adequate sedation [Observer's Assessment of Alertness/Sedation (OAA/S) scores of 3-4] and deep sedation (OAA/S scores of 1-2) were developed using nonlinear mixed-effects modelling. Increments in the propofol Ce were associated with increased depths of sedation. In the basic model, the estimated population Ce50 values for adequate and deep sedation were 0.94 and 1.52 μg/ml, respectively. The inclusion of the patient's age and sensory block level for adequate sedation and of age for deep sedation as covariates significantly improved the basic model by decreasing the objective function's minimum value from 10696.72 to 10677.92 (p = 0.0003). The simulated Ce50 values for adequate sedation in 20-year-old patients with a T12 sensory level and in 80-year-old patients with a T4 level were 1.63 and 0.53 μg/ml, respectively. Both age and sensory block level should be considered for adequate sedation, and the propofol concentration should be reduced for elderly patients with a high spinal block to avoid unnecessarily deep levels of sedation. PMID:26612706

  12. Mac OS X : Tiger edition the missing manual

    CERN Document Server

    Pogue, David

    2005-01-01

    You can set your watch to it: As soon as Apple comes out with another version of Mac OS X, David Pogue hits the streets with another meticulous Missing Manual to cover it with a wealth of detail. The new Mac OS X 10.4, better known as Tiger, is faster than its predecessors, but nothing's too fast for Pogue and Mac OS X: The Missing Manual. There are many reasons why this is the most popular computer book of all time. With its hallmark objectivity, the Tiger Edition thoroughly explores the latest features to grace the Mac OS. Which ones work well and which do not? What should you look for? Th

  13. Rating of new outlet structures for MacFarlane Reservoir

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Memorandum explaining the new work on the outlet structure at MacFarlane Reservoir. Flow measurements were taken at different staff gage elevations and this data is...

  14. MAC layer security issues in wireless mesh networks

    Science.gov (United States)

    Reddy, K. Ganesh; Thilagam, P. Santhi

    2016-03-01

    Wireless Mesh Networks (WMNs) have emerged as a promising technology for a broad range of applications due to their self-organizing, self-configuring and self-healing capability, in addition to their low cost and easy maintenance. Securing WMNs is more challenging and complex issue due to their inherent characteristics such as shared wireless medium, multi-hop and inter-network communication, highly dynamic network topology and decentralized architecture. These vulnerable features expose the WMNs to several types of attacks in MAC layer. The existing MAC layer standards and implementations are inadequate to secure these features and fail to provide comprehensive security solutions to protect both backbone and client mesh. Hence, there is a need for developing efficient, scalable and integrated security solutions for WMNs. In this paper, we classify the MAC layer attacks and analyze the existing countermeasures. Based on attacks classification and countermeasures analysis, we derive the research directions to enhance the MAC layer security for WMNs.

  15. Design and Implementation of an Efficient 64 bit MAC

    Directory of Open Access Journals (Sweden)

    Mohammad Shabber Hasan Khan

    2015-08-01

    Full Text Available The design of optimized 64 bit multiplier and accumulator (MAC unit is implemented in this paper. MAC unit plays major role in many of the digital signal processing (DSP applications. The MAC unit is designed with the combinations of multipliers and adders. In the proposed method MAC unit is implemented using Vedic multiplier and the adder is done with ripple carry adder .The components are reduced by implementing Vedic multiplier using the techniques of Vedic mathematics that have been modified to improve performance. a high speed processor depends significantly on the multiplier as it is one of the key hardware blocks in most digital signal processing systems as well as in general processors. The area is optimized effectively using Vedic multiplier .The total design implemented using Xilinx.

  16. Big Mac arvestab raha ostujõudu / Harli Uljas

    Index Scriptorium Estoniae

    Uljas, Harli

    2005-01-01

    The Economist võrdleb maailma valuutade suhestamiseks Big Mac'i burgeri hindu 120 riigis, kuna see meetod võimaldab saada ülevaate riikide elanikkonna tegelikust ostujõust. Tabel: Hamburgeri standard

  17. Aeronautical Mobile Airport Communications System (AeroMACS)

    Science.gov (United States)

    Budinger, James M.; Hall, Edward

    2011-01-01

    To help increase the capacity and efficiency of the nation s airports, a secure wideband wireless communications system is proposed for use on the airport surface. This paper provides an overview of the research and development process for the Aeronautical Mobile Airport Communications System (AeroMACS). AeroMACS is based on a specific commercial profile of the Institute of Electrical and Electronics Engineers (IEEE) 802.16 standard known as Wireless Worldwide Interoperability for Microwave Access or WiMAX (WiMax Forum). The paper includes background on the need for global interoperability in air/ground data communications, describes potential AeroMACS applications, addresses allocated frequency spectrum constraints, summarizes the international standardization process, and provides findings and recommendations from the world s first AeroMACS prototype implemented in Cleveland, Ohio, USA.

  18. Mechatronical Aided Concept (MAC) in Intelligent Transport Vehicles Design

    OpenAIRE

    Pavel Pavlasek

    2003-01-01

    This article deals with the principles of synergy effect of mechatronical aided concept (MAC) to the design of intelligent transport vehicles products applying CA technologies and virtual reality design methods. Also includes presentation of intelligent railway vehicle development.

  19. After MacIntyre : Kaasaegsest vooruseetikast / Meego Remmel

    Index Scriptorium Estoniae

    Remmel, Meego

    2006-01-01

    Alasdair MacIntyre panus 20. sajandi eetikasse. Tema käsitlus vooruseetikast ja vooruseetilisest perspektiivist, mida on võimalik näha komplekselt, vaadeldes voorust, praktikat, narratiivi ja traditsiooni mõisteid

  20. Construction of MIMO MAC Codes Achieving the Pigeon Hole Bound

    CERN Document Server

    Ernvall, Toni

    2012-01-01

    This paper provides a general construction method for multiple-input multiple-output multiple access channel codes (MIMO MAC codes) that have so called generalized full rank property. The achieved constructions give a positive answer to the question whether it is generally possible to reach the so called pigeon hole bound, that is an upper bound for the decay of determinants of MIMO-MAC channel codes.

  1. Electronic and Mac Protocol Characterization of RFID Modules

    OpenAIRE

    Nejah, Nasri; Abdennaceur, Kachouri; Laurent, Andrieux; Mounir, Samet

    2010-01-01

    In this chapter we detailed the RFID technology and we making the extraction of pattern from the electronic modules comprising the RFID system (base station and transponder). Finally we presented a comparison study on the MAC layer of the OSI model. Especially we have presented a tree of accesses method for wireless networks and we have modeled CSMA based o MAC protocol for RFID networks in NS2.

  2. On the Development of Low Power MAC Protocol for WBANs

    OpenAIRE

    Sana Ullah; Pervez Khan; Kyung Sup Kwak

    2009-01-01

    Current advances in wireless communication, microelectronics, semiconductor technologies, and intelligent sensors have contributed to the development of unobtrusive WBANs. These networks provide long term health monitoring of patients without any constraint in their normal activities. Traditional MAC protocols do not accommodate the assorted WBAN traffic requirements in a power efficient manner. In this paper, we present a brief discussion on the development process of a low power MAC protoco...

  3. Proposal Of DQRAP/CDMA MAC protocol optimization

    OpenAIRE

    Giovanini, G; Alonso Zárate, Luis Gonzaga; Agustí Comes, Ramon

    2001-01-01

    Future third-generation mobile communication systems will need MAC protocols suitable for multimedia CDMA radio communications. DQRAP/CDMA (distributed queueing random access protocol/CDMA) is a general purpose MAC protocol oriented to the CDMA environment. Analytical model expressions and computer simulations have shown its capacity to achieve near-optimum performance under certain traffic scenarios. Starting from the DQRAP/CDMA specification presented in Alonso et al. (2000), we propose som...

  4. MAC and baseband processors for RF-MIMO WLAN

    OpenAIRE

    Stamenkovic, Zoran; Tittelbach-Helmrich, Klaus; Krstic, Milos; Ibáñez Díaz, Jesús María; Elvira Arregui, Víctor; Santamaría Caballero, Luis Ignacio

    2011-01-01

    The article describes hardware solutions for the IEEE 802.11 medium access control (MAC) layer and IEEE 802.11a digital baseband in an RF-MIMO WLAN transceiver that performs the signal combining in the analogue domain. Architecture and implementation details of the MAC processor including a hardware accelerator and a 16-bit MACphysical layer (PHY) interface are presented. The proposed hardware solution is tested and verified using a PHY link emulator. Architecture, design, implementation, and...

  5. A Patterned Preamble MAC Protocol for Wireless Sensor Networks

    Science.gov (United States)

    Joe, Inwhee

    In this paper, we propose a novel MAC protocol with the patterned preamble technique to improve performance in terms of low power, channel utilization, and delay in wireless sensor networks. B-MAC is one of typical MAC protocols for wireless sensor networks using the duty cycle in order to achieve low-power operation. Since it works in an asynchronous fashion, B-MAC employs extended preamble and preamble sampling techniques. Even if it has outstanding performance in idle state, the overhead of these techniques is very large when packets are sent and received, because there is a lot of waste in the traditional preamble method. Instead of the simple preamble, our proposed MAC solution is to introduce more intelligent preamble with some patterns consisting of 2 phases (Tx phase & Ack phase). With this concept we implement real source code working on the mica2 platform with Tinyos-1.x version. Also, the test setup is presented, and the test results demonstrate that the proposed protocol provides better performance in terms of delay compared to B-MAC.

  6. A Sensing Error Aware MAC Protocol for Cognitive Radio Networks

    Directory of Open Access Journals (Sweden)

    Donglin Hu

    2012-08-01

    Full Text Available Cognitive radios (CR are intelligent radio devices that can sense the radio environment and adapt to changes in the radio environment. Spectrum sensing and spectrum access are the two key CR functions. In this paper, we present a spectrum sensing error aware MAC protocol for a CR network collocated with multiple primary networks. We explicitly consider both types of sensing errors in the CR MAC design, since such errors are inevitable for practical spectrum sensors and more importantly, such errors could have significant impact on the performance of the CR MAC protocol. Two spectrum sensing polices are presented, with which secondary users collaboratively sense the licensed channels. The sensing policies are then incorporated into p-Persistent CSMA to coordinate opportunistic spectrum access for CR network users.We present an analysis of the interference and throughput performance of the proposed CR MAC, and find the analysis highly accurate in our simulation studies. The proposed sensing error aware CR MAC protocol outperforms two existing approaches with considerable margins in our simulations, which justify the importance of considering spectrum sensing errors in CR MAC design.

  7. Plant-Derived Compounds with Potential Sedative and Anxiolytic Activities

    Directory of Open Access Journals (Sweden)

    Theresa Ibibia Edewor-Kuponiyi

    2013-07-01

    Full Text Available A wide variety of active phytochemicals such as flavonoids, alkaloids, saponins, etc., have been isolated and identified in different plants. Pharmacological and chemical investigations of medicinal plants have provided important advances in therapeutic approach to several pathologies as well as extremely useful tools for the theoretical study of physiology and pharmacology. With increased use of herbal medicine, medicinal plants are receiving more attention from the scientific and pharmaceutical communities. Several compounds have been isolated and evaluated for their sedative and anxiolytic properties. Although most of the reported works are more of academic interest and very few find entry at clinical trials; one is hopeful that as more discoveries of sedative and anxiolytic compounds from plants are made, it will lead to generation of more effective drugs.

  8. Sedation for pediatric neuroradiological examinations. Retrospective study of 160 cases

    International Nuclear Information System (INIS)

    A retrospective study of 160 pediatric neuroradiological examinations was conducted to determine the efficacy and safety of two sedation regimens (figs. 1, 2). For CT purposes, 150 patients (fig. 3) were orally given monosodium trichlorethyl phosphate syrup (100 mg/kg, with repeat 50 mg/kg if necessary), and for cerebral angiography, 15 patients (fig. 4) were intramuscularly administered a modified D.P.T. cocktail (pentazocine, chlorpromadine, promethazine). Failure rate in the oral syrup group was 6%, and in the D.P.T. group 6.7%. Diagnostic-quality images were obtained in 99.3% and 100%, respectively, of the two groups. There were neither mortality nor significant complications (table 3). It was concluded that each method had proved acceptably safe and effective, and that measures can be taken to further decrease complications and sedation failures. (author)

  9. Gender differences when using sedative music during colonoscopy

    OpenAIRE

    Björkman, Ida; Karlsson, Frida; Lundberg, Ann; Hollman Frisman, Gunilla

    2013-01-01

    Colonoscopy is a procedure often experienced as uncomfortable and worrying. Music has been reported to reduce discomfort during colonoscopy; however, no study in a Swedish setting has been found. The purpose of this randomized controlled trial was to analyze the effects of sedative music on patients' experience of anxiety, pain, relaxation, and well-being during colonoscopy. Prior to colonoscopy, adult patients (n = 120), aged 18–80 years, were randomly assigned to either an intervention grou...

  10. Supraorbital transcutaneous neurostimulation has sedative effects in healthy subjects

    OpenAIRE

    Piquet Maxime; Balestra Costantino; Sava Simona L; Schoenen Jean E

    2011-01-01

    Abstract Background Transcutaneous neurostimulation (TNS) at extracephalic sites is a well known treatment of pain. Thanks to recent technical progress, the Cefaly® device now also allows supraorbital TNS. During observational clinical studies, several patients reported decreased vigilance or even sleepiness during a session of supraorbital TNS. We decided therefore to explore in more detail the potential sedative effect of supraorbital TNS, using standardized psychophysical tests in healthy ...

  11. Analysis for commonly prescribed non-sedating antihistamines

    Directory of Open Access Journals (Sweden)

    Michael E. El-Kommos

    2015-03-01

    Full Text Available A comprehensive review with 185 references for the analysis of commonly prescribed members of an important class of drugs, non-sedating antihistamines (NSAs, is presented. The review covers most of the methods described for the analysis of cetirizine (CTZ, ebastine (EBS, fexofenadine (FXD, ketotifen (KET and loratadine (LOR in pure forms, in different pharmaceutical dosage forms and in biological fluids. The review covers the period from 1991 till now.

  12. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI)

    OpenAIRE

    Mayr, N. Patrick; Michel, Jonathan; Bleiziffer, Sabine; Tassani, Peter; Martin, Klaus

    2015-01-01

    Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to “intermediate-risk” patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; r...

  13. Gender differences when using sedative music during colonoscopy.

    Science.gov (United States)

    Björkman, Ida; Karlsson, Frida; Lundberg, Ann; Frisman, Gunilla Hollman

    2013-01-01

    Colonoscopy is a procedure often experienced as uncomfortable and worrying. Music has been reported to reduce discomfort during colonoscopy; however, no study in a Swedish setting has been found. The purpose of this randomized controlled trial was to analyze the effects of sedative music on patients' experience of anxiety, pain, relaxation, and well-being during colonoscopy. Prior to colonoscopy, adult patients (n = 120), aged 18-80 years, were randomly assigned to either an intervention group (n = 60) who listened to sedative instrumental music with 60-80 beats per minute during the colonoscopy or a control group. After the colonoscopy, both groups completed a questionnaire on anxiety, the State Trait Anxiety Inventory, and an anxiety Visual Analogue Scale. Pain, relaxation, and well-being were also measured with Visual Analogue Scales. Women in the intervention group had a lower level of anxiety during the colonoscopy than those in the control group (p = .007) and well-being was significantly higher in the intervention group, especially among men, than in the controls (p = .006 and p = .025, respectively). Men in the intervention group were more relaxed during the colonoscopy than those in the control group (p = .065). Listening to sedative music decreased anxiety among women and increased well-being among men during colonoscopy. PMID:23364361

  14. The Effect of Intravenous Dexmedetomidine on Spinal Block and Sedation

    Directory of Open Access Journals (Sweden)

    Abdurrahman Ekici

    2015-03-01

    Material and Methods: Our randomised, double-blind study was applied to ASA I-III, 18-75 years old 50 patients scheduled for transurethral surgery. The patients were divided into two groups and spinal anesthesia with 5% levobupivacaine 12.5 mg was administered to all patients. Intravenous dexmedetomidine was received 1 and micro;g/kg for loading dose before 0.5 and micro;g/kg/hour infusion to Group D (n=25. Saline infusion was given 1 and micro;g/kg for loading dose before 0.5 and micro;g/kg/hour infusion to Group S (n=25. Systolic, diastolic and mean arterial pressure, heart rate, peripheral oxygen saturation values, pain and sedation score, the level and duration of motor and sensorial block, recovery and patient comfort score and side effects were recorded. Results: Time to reach maximum block level and duration of spinal anesthesia were longer in Group D than Group S. Sedation scores were significantly higher in Group D than Group S intraoperatively (except 1th minute and postoperatively 10th and 15th minutes. The incidence of side effects, postoperative recovery and patient comfort values were similar between the groups. Conclusion: We found that dexmedetomidine prolongs duration of motor block, provides safe and effective sedation without increasing the incidence of side effect in the patients under spinal anesthesia. [Cukurova Med J 2015; 40(1.000: 55-62

  15. Learning Unix for Mac OS X Tiger Unlock the Power of Unix

    CERN Document Server

    Taylor, Dave

    2005-01-01

    Thoroughly revised and updated for Mac OS X Tiger, this new edition introduces Mac users to the Terminal application and shows you how to navigate the command interface, explore hundreds of Unix applications that come with the Mac, and, most importantly, how to take advantage of both the Mac and Unix interfaces. If you want to master the command-line, this gentle guide to using Unix on Mac OS X Tiger is well worth its cover price

  16. Design of a Novel Optimized MAC Unit using Modified Fault Tolerant Vedic Multiplier

    OpenAIRE

    Deepa, R.; Shanmugam, A.

    2014-01-01

    In this study, the design of optimized Multiplication and Accumulation (MAC) unit with modified Vedic multiplier is presented. To design a MAC unit, efficient multiplier is used to increase speed and to reduce area and power. Conventional MAC is designed using without fault tolerant Vedic multiplier. But it consumes more area and power. And also less delay. So MAC unit is changed to design the efficient Vedic multiplier. Conventional MAC unit with regular Vedic multiplier is not working for s...

  17. Comparison between intravenous and intramuscular administration of ketamine in children sedation referred to emergency department

    Directory of Open Access Journals (Sweden)

    Behnaz Boroumand Rezazadeh

    2014-12-01

    Full Text Available Ketamine, among wide variety of sedative drugs, has shown beneficial effects when using during the procedural sedation, specifically in pediatrics. Various parameters should be considered in order to perform a safe and effective procedural sedation including optimum dosage of the sedative, administration methods of sedation, and need for applying any adjuvant drug. In this study, we aimed to review the studies, which have compared the efficacy of the different ways of the injection of ketamine such as intravenous or intramuscular ketamine application. Based on data obtained from the related articles, efficacy and safety of these two methods of ketamine usage in the pediatric procedural sedation were widely similar, but the intravenously administration of the ketamine can be proposed as the preferable mode.

  18. Victor Bérard et la Macédoine

    Directory of Open Access Journals (Sweden)

    Ivan Savev

    2011-01-01

    Full Text Available Un helléniste convaincu, Victor Bérard, en vient, au début du XXe siècle à soutenir l’existence de « Macédoniens » et le slogan « la Macédoine aux Macédoniens”.Le Congrès de Berlin en 1878 avait laissé la Macédoine aux mains des Ottomans. La Grèce, la Serbie et la Bulgarie, parvenues à ses limites et prévoyant le retrait futur des Ottomans peaufinent les arguments linguistiques et historiques qui justifieront leurs revendications territoriales. Victor Bérard, un helléniste respecté et bon connaisseur de la région sud balkanique, effectue des enquêtes en Macédoine en 1896 et 1903 qu’il publie à Paris.Cette étude montre comment, dans le contexte de la propagande nationaliste des prétendants à la possession de la Macédoine, Victor Bérard en vient progressivement à affirmer qu’il existe une population autochtone, les Macédoniens. Il soutient leur programme pour la constitution d’une fédération ou confédération avec le slogan « la Macédoine aux Macédoniens » ce qui fait toute l’actualité de ses ouvrages.In 1878, the Congress of Berlin had left Macedonia in the hands of the Ottomans. Greece, Serbia and Bulgaria had reached its limits. Anticipating the Ottoman retreat, they polish language and historical arguments that will justify their territorial claims. Victor Bérard, a respected Hellenist and a good expert of the southern Balkans, is doing researches in Macedonia in 1896 and 1903. These will be later published in Paris.This study shows how, in the context of the nationalist propaganda build-up made by the candidates for the possession of Macedonia, Victor Bérard comes progressively to assert the existence of a native population: the Macedonians. He supports their program for the forming of a federation or confederation which slogan would be “Macedonia to Macedonians”. This makes his works very topical.

  19. Cooperative MIMO Transmissions in WSN Using Threshold Based MAC Protocol

    Directory of Open Access Journals (Sweden)

    J. Vidhya

    2010-08-01

    Full Text Available Sensor networks require robust and efficient communication protocols to maximise the network lifetime.Radio irregularity, channel fading and interference results in larger energy consumption and latency forpacket transmission over wireless channel. Cooperative multi-input multi-output (MIMO schemes whenincorporated in wireless senor network (WSN can significantly improve the communicationperformance. An inefficiently designed medium access control (MAC protocol however, may diminishthe performance gains of MIMO operation. Hence, this paper proposes a distributed threshold basedMAC protocol for cooperative MIMO transmissions using space time block codes (STBC. The protocoluses a thresholding scheme that is updated dynamically based on the queue length at the sending node toachieve lesser energy consumption and minimise latency ensuring the stability of transmission queues atthe nodes. STBC and code combining techniques are applied to utilise the inherent spatial diversity inwireless cooperative MIMO systems. Simulation results are provided to evaluate the performance of theproposed protocol and are compared with fixed group size cooperative MIMO MAC protocols with andwithout STBC coding. Results show that the proposed protocol outperforms point to point communicationas well as cooperative MIMO MAC protocols that use fixed group sizes. STBC technique for the proposedMAC protocol provides significant energy savings and minimises the packet delay by leveraging MIMOdiversity gains.

  20. Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

    OpenAIRE

    Maria Sammartino; Barbara Volpe; Fabio Sbaraglia; Rossella Garra; Alessandro D'Addessi

    2010-01-01

    Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of res...

  1. Sedative Drug Use among King Saud University Medical Students: A Cross-Sectional Sampling Study

    OpenAIRE

    Al-Sayed, Ahmed A.; Abdualltef H. Al-Rashoudi; Al-Eisa, Abdulrhman A.; Addar, Abdullah M.; Al-Hargan, Abdullah H.; Albaraa A. Al-Jerian; Al-Omair, Abdullah A.; Al-Sheddi, Ahmed I.; Hussam I. Al-Nowaiser; Al-Kathiri, Omar A.; Al-Hassan, Abdullah H.

    2014-01-01

    Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire fro...

  2. Intravenous labetolol in treating hypertensive crisis following dexmedetomidine infusion for procedural sedation.

    Science.gov (United States)

    Muthiah, Thilaka; Moni, Amarnath; Mathews, Lailu; Balaji, Sudarshan

    2016-03-01

    Dexmedetomidine is widely used for procedural sedation because of its unique combination of sedation, analgesia, and anxiolysis with minimal respiratory depression. Transient hypertension has been reported during the use of dexmedetomidine which is usually benign and is taken over by the hypotensive response on continuing the infusion. We report a case of hypertensive crisis following dexmedetomidine infusion used for procedural sedation, necessitating discontinuation of the infusion and treatment of hypertension. The dilemmas involved in treating hypertension caused by dexmedetomidine are discussed. PMID:26897444

  3. Sedation for Gastrointestinal Endoscopic Procedures in the Elderly: Getting Safer but Still Not Nearly Safe Enough

    OpenAIRE

    Lord, David; Bell, G D; Gray, A; Quine, A; Bowles, J; Romaya, C; de la Iglesia, Beatriz; Reynolds, Alan; Rayward-Smith, Vic

    2006-01-01

    Previously published UK reports showed that excessively large doses of benzodiazepines and opiates were being commonly used to sedate elderly patients for gastrointestinal (GI) endoscopy. This unsafe practice has lead to avoidable morbidity and mortality. We have taken the opportunity provided by recent reports to examine whether GI endoscopy sedation practice in the elderly has improved in the light of this evidence and the publication of guidelines in which specific recommendations on sedat...

  4. Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy

    DEFF Research Database (Denmark)

    Burtea, Daniela Elena; Dimitriu, Anca; Maloş, Anca Elena;

    2015-01-01

    the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become...... an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and meta-analyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination...

  5. Office for iPad and Mac for dummies

    CERN Document Server

    Weverka, Peter

    2015-01-01

    The easy way to work with Office on your iPad or Mac Are you a Mac user who isn't accustomed to working with Microsoft Office? Consider this friendly guide your go-to reference! Written in plain English and packed with easy-to-follow, step-by-step instructions, Office for iPad and Mac For Dummies walks you through every facet of Office, from installing the software and opening files to working with Word, Excel, PowerPoint, and Outlook-and beyond. Plus, you'll discover how to manage files, share content and collaborate online through social media, and find help when you need it. Two things a

  6. SACRB-MAC: A High-Capacity MAC Protocol for Cognitive Radio Sensor Networks in Smart Grid.

    Science.gov (United States)

    Yang, Zhutian; Shi, Zhenguo; Jin, Chunlin

    2016-01-01

    The Cognitive Radio Sensor Network (CRSN) is considered as a viable solution to enhance various aspects of the electric power grid and to realize a smart grid. However, several challenges for CRSNs are generated due to the harsh wireless environment in a smart grid. As a result, throughput and reliability become critical issues. On the other hand, the spectrum aggregation technique is expected to play an important role in CRSNs in a smart grid. By using spectrum aggregation, the throughput of CRSNs can be improved efficiently, so as to address the unique challenges of CRSNs in a smart grid. In this regard, we proposed Spectrum Aggregation Cognitive Receiver-Based MAC (SACRB-MAC), which employs the spectrum aggregation technique to improve the throughput performance of CRSNs in a smart grid. Moreover, SACRB-MAC is a receiver-based MAC protocol, which can provide a good reliability performance. Analytical and simulation results demonstrate that SACRB-MAC is a promising solution for CRSNs in a smart grid. PMID:27043573

  7. Factors influencing challenging colonoscopies during anesthesiologist-assisted deep sedation

    Directory of Open Access Journals (Sweden)

    Fabrizio Cardin

    2016-01-01

    Full Text Available Background/Aim: Increased demand for colon cancer screening procedures can significantly impact on routine colonoscopy management at dedicated facilities, prompting a review of the factors that can negatively affect workflow. Although potential adverse effects and impact on costs of deep sedation have been documented elsewhere, this study focuses on variables that can influence performance of colonoscopy in deep sedation and interfere with normal procedure scheduling in settings where the presence of an anesthesiologist is mandatory. Patients and Methods: We performed a cross-sectional study of the activities of a colonoscopy screening unit, applying Bayesian Network (BN analysis, designed to assess interdependencies among variables that can affect a process in complex, multidimensional systems. The study was performed at a teaching hospital where endoscopists and anesthesiologists of varying work experience operate on a rota basis. During a six-month period, we analyzed 1485 consecutive colonoscopies performed under deep propofol sedation, administered by an anesthesiologist via hand-controlled syringe. The BN was constructed with the variables: Gender, age, ASA status, bowel preparation, baseline blood pressure, endoscopist′s experience, anesthesiologist′s experience, presence of polypectomy, and the target node, "challenging procedure." This previously undefined category refers to any events disrupting the scheduled rota. Result and Conclusion: Two distinct networks were identified. One deals mainly with relationships among the variables, patients′ demographic and clinical characteristics (procedures with polypectomy, ASA and baseline blood pressure. The other explains relationships among the variables, "challenging procedure," bowel preparation, and endoscopist′s experience. The factors associated with the anesthesiologist′s activity do not influence challenging colonoscopies.

  8. Vehicle Health Management Communications Requirements for AeroMACS

    Science.gov (United States)

    Kerczewski, Robert J.; Clements, Donna J.; Apaza, Rafael D.

    2012-01-01

    As the development of standards for the aeronautical mobile airport communications system (AeroMACS) progresses, the process of identifying and quantifying appropriate uses for the system is progressing. In addition to defining important elements of AeroMACS standards, indentifying the systems uses impacts AeroMACS bandwidth requirements. Although an initial 59 MHz spectrum allocation for AeroMACS was established in 2007, the allocation may be inadequate; studies have indicated that 100 MHz or more of spectrum may be required to support airport surface communications. Hence additional spectrum allocations have been proposed. Vehicle health management (VHM) systems, which can produce large volumes of vehicle health data, were not considered in the original bandwidth requirements analyses, and are therefore of interest in supporting proposals for additional AeroMACS spectrum. VHM systems are an emerging development in air vehicle safety, and preliminary estimates of the amount of data that will be produced and transmitted off an aircraft, both in flight and on the ground, have been prepared based on estimates of data produced by on-board vehicle health sensors and initial concepts of data processing approaches. This allowed an initial estimate of VHM data transmission requirements for the airport surface. More recently, vehicle-level systems designed to process and analyze VHM data and draw conclusions on the current state of vehicle health have been undergoing testing and evaluation. These systems make use of vehicle system data that is mostly different from VHM data considered previously for airport surface transmission, and produce processed system outputs that will be also need to be archived, thus generating additional data load for AeroMACS. This paper provides an analysis of airport surface data transmission requirements resulting from the vehicle level reasoning systems, within the context of overall VHM data requirements.

  9. Nitrousoxide as a conscious sedative in minor oral surgical procedure

    Directory of Open Access Journals (Sweden)

    Rakesh Mohan

    2015-01-01

    Full Text Available Nitrous oxide (N 2 O is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably. However, as a single agent, it has an impressive safety and is excellent for providing minimal and moderate sedation for apprehensive minor oral surgical procedure. In this article, action of N 2 O in overcoming the anxiety and pain of the patient during the minor oral surgery and its advantages and disadvantages, have been reviewed.

  10. Fault Tolerant Wireless Sensor Mac Protocol for Efficient Collision Avoidance

    Directory of Open Access Journals (Sweden)

    Abhishek Samanta

    2010-06-01

    Full Text Available In sensor networks communication by broadcast methods involves many hazards, especially collision.Several MAC layer protocols have been proposed to resolve the problem of collision namely ARBP,where the best achieved success rate is 90%. We hereby propose a MAC protocol which achieves agreater success rate (Success rate is defined as the percentage of delivered packets at the source reachingthe destination successfully by reducing the number of collisions, but by trading off the averagepropagation delay of transmission. Our proposed protocols are also shown to be more energy efficient interms of energy dissipation per message delivery, compared to the currently existing protocol.

  11. Z-MAC an Analytical Model for Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Ramchand V

    2011-12-01

    Full Text Available This paper presents an analytical model for estimat ing throughput and energy consumption in Z-MAC protocol for Wireless Sensor Networks. The analytic al design includes transmission power control and transmission of frames through one hop, two hop and multi hop. Proposed model reduces collision under low contention level as well as high contention lev el with the use of explicit contention notification . The proposed protocol has been simulated using MATLAB. The simulations reveal better results for throughpu t and energy consumption of the proposed model as com pared to Z-MAC protoco

  12. Materiaalivirtojen tehostaminen Mac Steel Oy:ssä

    OpenAIRE

    Toivonen, Mika

    2011-01-01

    Työssä tutkitaan Mac Steel Oy:n materiaalivirta ongelmia, ongelman lähteitä ja keinoja päästä ongelmista eroon. Mac Steelin tuotanto on keskitytty suuriin kappaleisiin, jotka aiheuttavat tietynlaisia ongelmia materiaalien ja valmiiden tuotteiden käsittelyssä. Asiakaskunta on laaja johon kuuluu maamme johtavia alumiiniveneiden ja ajoneuvoteollisuuden yrityksiä, lisäksi tuotteita valmistetaan teräsrakenne teollisuuden tarpeisiin. Lähtökohtana on tutkia Lean ajatusmaailmaa ja sieltä löytää ne...

  13. Alasdair MacIntyre: relatividad conceptual, tomismo y liberalismo

    Directory of Open Access Journals (Sweden)

    Carlos Isler S.

    2011-01-01

    Full Text Available Influenciado por Thomas Kuhn, Alasdair MacIntyre presenta una teoría conceptualmente relativista sobre las tradiciones de investigación, la cual pretende no sólo describir la estructura de las distintas tradiciones, sino también encontrar un principioque permita resolver las disputas entre ellas. Se expone esta teoría y se analiza su compatibilidad con el tomismo, tradición a la que MacIntyre dice pertenecer, y con el liberalismo, tradición a la que critica con vigor.

  14. Beyond MacIntyre: Grounding the business as practice debate

    OpenAIRE

    Kavanagh, Donncha

    2012-01-01

    Alasdair MacIntyre’s distinction between institutions and practices helps illuminate how powerful institutional forces frame and constrain the practice of organizational research as well as the output and positioning of scholarly journals. Yet his conceptual frame is limited, not least because it is unclear whether the activity of managing is, or is not, a practice. This paper builds on MacIntyre’s ideas by incorporating Aristotle’s concepts of poíēsis, praxis, téchnē and ...

  15. Decentralised Learning MACs for Collision-free Access in WLANs

    CERN Document Server

    Fang, Minyu; Duffy, Ken R; Leith, Douglas J

    2010-01-01

    By combining the features of CSMA and TDMA, fully decentralised WLAN MAC schemes have recently been proposed that converge to collision-free schedules. In this paper we describe a MAC with optimal long-run throughput that is almost decentralised. We then design two scheme that are practically realisable, decentralised approximations of this optimal scheme and operate with different amounts of sensing information. We achieve this by (1) introducing learning algorithms that can substantially speed up convergence to collision free operation; (2) developing a decentralised schedule length adaptation scheme that provides long-run fair (uniform) access to the medium while maintaining collision-free access for arbitrary numbers of stations.

  16. Effects of deep sedation or general anesthesia on cardiac function in mice undergoing cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Kutschke William

    2009-05-01

    Full Text Available Abstract Background Genetically engineered mouse models of human cardiovascular disease provide an opportunity to understand critical pathophysiological mechanisms. Cardiovascular magnetic resonance (CMR provides precise reproducible assessment of cardiac structure and function, but, in contrast to echocardiography, requires that the animal be immobilized during image acquisition. General anesthetic regimens yield satisfactory images, but have the potential to significantly perturb cardiac function. The purpose of this study was to assess the effects of general anesthesia and a new deep sedation regimen, respectively, on cardiac function in mice as determined by CMR, and to compare them to results obtained in mildly sedated conscious mice by echocardiography. Results In 6 mildly sedated normal conscious mice assessed by echo, heart rate was 615 ± 25 min-1 (mean ± SE and left ventricular ejection fraction (LVEF was 0.94 ± 0.01. In the CMR studies of normal mice, heart rate was slightly lower during deep sedation with morphine/midazolam (583 ± 30 min-1, but the difference was not statistically significant. General anesthesia with 1% inhaled isoflurane significantly depressed heart rate (468 ± 7 min-1, p In mice with ischemic LV failure, ejection fraction measurements were comparable when performed during light sedation, deep sedation, and general anesthesia, respectively. Contrast-to-noise ratios were similar during deep sedation and during general anesthesia, indicating comparable image quality. Left ventricular mass measurements made by CMR during deep sedation were nearly identical to those made during general anesthesia (r2 = 0.99, mean absolute difference Conclusion In mice with normal cardiac function, CMR during deep sedation causes significantly less depression of heart rate and ejection fraction than imaging during general anesthesia with isoflurane. In mice with heart failure, the sedation/anesthesia regimen had no clear impact on

  17. The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department

    Directory of Open Access Journals (Sweden)

    Downes Michael A

    2010-06-01

    Full Text Available Abstract Background Acute behavioural disturbance (ABD is an increasing problem in emergency departments. This study aimed to determine the impact of a structured intramuscular (IM sedation protocol on the duration of ABD in the emergency department. Methods A historical control study was undertaken comparing 58 patients who required physical restraint and parenteral sedation with the structured IM sedation protocol, to 73 historical controls treated predominantly by intravenous sedation, according to individual clinician preference. The primary outcome was the duration of the ABD defined as the time security staff were required. Secondary outcomes were the requirement for additional sedation, drug related-adverse effects and patient and staff injuries. Results The median duration of the ABD in patients with the new sedation protocol was 21 minutes (IQR: 15 to 35 minutes; Range: 5 to 78 minutes compared to a median duration of 30 minutes (IQR: 15 to 50 minutes; Range: 5 to 135 minutes in the historical controls which was significantly different (p = 0.03. With IM sedation only 27 of 58 patients (47%; 95% CI: 34% to 60% required further sedation compared to 64 of 73 historical controls (88%; 95%CI: 77% to 94%. There were six (10% drug-related adverse events with the new IM protocol [oxygen desaturation (5, oxygen desaturation/airway obstruction (1] compared to 10 (14% in the historical controls [oxygen desaturation (5, hypoventilation (4 and aspiration (1]. Injuries to staff occurred with three patients using the new sedation protocol and in seven of the historical controls. Two patients were injured during the new protocol and two of the historical controls. Conclusion The use of a standardised IM sedation protocol was simple, more effective and as safe for management of ABD compared to predominantly intravenous sedation.

  18. Directional Medium Access Control (MAC Protocols in Wireless Ad Hoc and Sensor Networks: A Survey

    Directory of Open Access Journals (Sweden)

    David Tung Chong Wong

    2015-06-01

    Full Text Available This survey paper presents the state-of-the-art directional medium access control (MAC protocols in wireless ad hoc and sensor networks (WAHSNs. The key benefits of directional antennas over omni-directional antennas are longer communication range, less multipath interference, more spatial reuse, more secure communications, higher throughput and reduced latency. However, directional antennas lead to single-/multi-channel directional hidden/exposed terminals, deafness and neighborhood, head-of-line blocking, and MAC-layer capture which need to be overcome. Addressing these problems and benefits for directional antennas to MAC protocols leads to many classes of directional MAC protocols in WAHSNs. These classes of directional MAC protocols presented in this survey paper include single-channel, multi-channel, cooperative and cognitive directional MACs. Single-channel directional MAC protocols can be classified as contention-based or non-contention-based or hybrid-based, while multi-channel directional MAC protocols commonly use a common control channel for control packets/tones and one or more data channels for directional data transmissions. Cooperative directional MAC protocols improve throughput in WAHSNs via directional multi-rate/single-relay/multiple-relay/two frequency channels/polarization, while cognitive directional MAC protocols leverage on conventional directional MAC protocols with new twists to address dynamic spectrum access. All of these directional MAC protocols are the pillars for the design of future directional MAC protocols in WAHSNs.

  19. Bromoderma mimicking pyoderma gangrenosum caused by commercial sedatives.

    Science.gov (United States)

    Oda, Fumiko; Tohyama, Mikiko; Murakami, Akiko; Kanno, Kazuhisa; Sonobe, Naomi; Sayama, Koji

    2016-05-01

    Bromoderma is a rare skin disorder caused by bromide intake. It presents as single or multiple papillomatous nodules or plaques, and ulcers studded with small pustules on the face or limbs. The clinical features of bromoderma are similar to those of pyoderma gangrenosum. A 41-year-old Japanese woman was diagnosed with pyoderma gangrenosum 11 years prior to presentation. Pyoderma had repeatedly appeared over her entire body despite treatment. She also frequently complained of syncopal episodes. She was admitted to our hospital after loss of consciousness and an episode of generalized convulsion. Laboratory tests revealed a negative serum anion gap and hyperchloremia. Her serum bromide level was significantly elevated, suggesting bromide intoxication. The patient had a 10-year history of high serum bromide levels. After the intake of bromide-containing sedatives was stopped, there was no recurrence of pyoderma in the absence of treatment. In conclusion, this case was diagnosed as bromoderma with commercial sedative-induced bromide intoxication. Although the US Food and Drug Administration have banned the use of bromides, over-the-counter (OTC) treatments containing bromides are still used in Japan and other countries. Long-term use of OTC medicines containing bromvalerylurea may result in the development of bromoderma. If unclarified neurological or psychiatric symptoms are associated with pyoderma, we propose measurement of the patient's serum chloride concentration. Determination of hyperchloremia is helpful for the diagnosis of chronic intoxication with bromides. PMID:26507105

  20. Anesthetic strategy during endovascular therapy: General anesthesia or conscious sedation? (GOLIATH - General or Local Anesthesia in Intra Arterial Therapy) A single-center randomized trial

    DEFF Research Database (Denmark)

    Simonsen, Claus Z; Sørensen, Leif H; Juul, Niels;

    2016-01-01

    RATIONALE: Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes...... compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. AIM AND HYPOTHESIS: The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether...... study. Patients with acute ischemic stroke, scheduled for endovascular therapy, are randomized to receive either general anesthesia or conscious sedation. STUDY OUTCOMES: The primary outcome measure is infarct growth after 48-72 h (determined by serial diffusion-weighted magnetic resonance imaging...

  1. RE-MAC: A Reliable Energy Efficient MAC Protocol For Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Santhosh Simon

    2013-03-01

    Full Text Available Wireless sensor networks are considered to be a promising area to equip scientists with the capability of developing real-time monitoring systems. This paper discusses the design and development of a wireless sensor network (WSN that can be used for monitoring purposes in the agricultural fields. This battery-powered sensor node makes the network deployment easy but limit the lifetime of the network to the limited capacity of these batteries. The main source of energy wastage in modern sensor networks is idle listening and overhearing. Duty cycling is a proven mechanism to overcome the energy wastage through idle listening. In this paper we introduce a new MAC protocol named as REMAC that minimizes the idle listening by allowing nodes to remain in sleep state until it is necessary to wakeup. It also allows the participating nodes to wake up during the sleep time, perform the data transfer and return to sleep state thereby minimizing the chances for over hearing. We show the performance of REMAC through detailed simulations in NS-2 and also compare the performance evaluation with similar synchronous protocols that employ duty cycling. In the analysis REMAC proves to be saving much energy as compared to others.

  2. High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Hornslet, Pernille; Konge, Lars;

    2016-01-01

    BACKGROUND AND STUDY AIMS: Whereas data on moderate nurse-administered propofol sedation (NAPS) efficacy and safety for standard endoscopy is abundant, few reports on the use of deep sedation by endoscopy nurses during advanced endoscopy, such as Endoscopic Retrograde Cholangiopancreatography (ER...

  3. Sedative Drug Use among King Saud University Medical Students: A Cross-Sectional Sampling Study.

    Science.gov (United States)

    Al-Sayed, Ahmed A; Al-Rashoudi, Abdualltef H; Al-Eisa, Abdulrhman A; Addar, Abdullah M; Al-Hargan, Abdullah H; Al-Jerian, Albaraa A; Al-Omair, Abdullah A; Al-Sheddi, Ahmed I; Al-Nowaiser, Hussam I; Al-Kathiri, Omar A; Al-Hassan, Abdullah H

    2014-01-01

    Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire from students enrolled at the King Saud University College of Medicine in 2011. The questionnaires collected data regarding social and demographic variables, sleep patterns, and the use of stimulant and sedative drugs since enrollment. Sedatives were defined as any pharmaceutical preparations that induce sleep. Results and Discussion. Of the 729 students who returned questionnaires, 17.0% reported sedative drug use at some time since enrollment. Higher academic year, lower grade point average, regular exercise, fewer hours of sleep per day, poorer quality of sleep, and the presence of sleeping disorders were found to be significantly associated with sedative drug use. Conclusions. Further study is required to increase our understanding of sedative drug use patterns in this relatively high-risk group, as such understanding will help in the development of early intervention programs. PMID:24551449

  4. Effects of sedation on echocardiographic variables of left atrial and left ventricular function in healthy cats.

    Science.gov (United States)

    Ward, Jessica L; Schober, Karsten E; Fuentes, Virginia Luis; Bonagura, John D

    2012-10-01

    Although sedation is frequently used to facilitate patient compliance in feline echocardiography, the effects of sedative drugs on echocardiographic variables have been poorly documented. This study investigated the effects of two sedation protocols on echocardiographic indices in healthy cats, with special emphasis on the assessment of left atrial size and function, as well as left ventricular diastolic performance. Seven cats underwent echocardiography (transthoracic two-dimensional, spectral Doppler, color flow Doppler and tissue Doppler imaging) before and after sedation with both acepromazine (0.1 mg/kg IM) and butorphanol (0.25 mg/kg IM), or acepromazine (0.1 mg/kg IM), butorphanol (0.25 mg/kg IM) and ketamine (1.5 mg/kg IV). Heart rate increased significantly following acepromazine/butorphanol/ketamine (mean±SD of increase, 40±26 beats/min) and non-invasive systolic blood pressure decreased significantly following acepromazine/butorphanol (mean±SD of decrease, 12±19 mmHg). The majority of echocardiographic variables were not significantly different after sedation compared with baseline values. Both sedation protocols resulted in mildly decreased left ventricular end-diastolic dimension and mildly increased left ventricular end-diastolic wall thickness. This study therefore failed to demonstrate clinically meaningful effects of these sedation protocols on echocardiographic measurements, suggesting that sedation with acepromazine, butorphanol and/or ketamine can be used to facilitate echocardiography in healthy cats. PMID:22577049

  5. Sedative Drug Use among King Saud University Medical Students: A Cross-Sectional Sampling Study

    Directory of Open Access Journals (Sweden)

    Ahmed A. Al-Sayed

    2014-01-01

    Full Text Available Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire from students enrolled at the King Saud University College of Medicine in 2011. The questionnaires collected data regarding social and demographic variables, sleep patterns, and the use of stimulant and sedative drugs since enrollment. Sedatives were defined as any pharmaceutical preparations that induce sleep. Results and Discussion. Of the 729 students who returned questionnaires, 17.0% reported sedative drug use at some time since enrollment. Higher academic year, lower grade point average, regular exercise, fewer hours of sleep per day, poorer quality of sleep, and the presence of sleeping disorders were found to be significantly associated with sedative drug use. Conclusions. Further study is required to increase our understanding of sedative drug use patterns in this relatively high-risk group, as such understanding will help in the development of early intervention programs.

  6. Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study.

    NARCIS (Netherlands)

    Reuzel, R.P.B.; Hasselaar, J.G.J.; Vissers, K.C.P.; Wilt, G.J. van der; Groenewoud, J.M.M.; Crul, B.J.P.

    2008-01-01

    To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the pr

  7. MAC mini acceptance test procedures, software Version 3.3

    International Nuclear Information System (INIS)

    The K Basins Materials Accounting (MAC) programs had some improvements made to it to to change slightly the access authorized users had to the modification of critical data. This ATP describes how the code was to be tested to verify its correctness

  8. Cooperative MIMO Transmissions in WSN Using Threshold Based MAC Protocol

    OpenAIRE

    Vidhya, J.; Dananjayan, P.

    2010-01-01

    Sensor networks require robust and efficient communication protocols to maximise the network lifetime.Radio irregularity, channel fading and interference results in larger energy consumption and latency forpacket transmission over wireless channel. Cooperative multi-input multi-output (MIMO) schemes whenincorporated in wireless senor network (WSN) can significantly improve the communicationperformance. An inefficiently designed medium access control (MAC) protocol however, may diminishthe per...

  9. MacDowell-Mansouri gravity and Cartan geometry

    International Nuclear Information System (INIS)

    The geometric content of the MacDowell-Mansouri formulation of general relativity is best understood in terms of Cartan geometry. In particular, Cartan geometry gives clear geometric meaning to the MacDowell-Mansouri trick of combining the Levi-Civita connection and coframe field, or soldering form, into a single physical field. The Cartan perspective allows us to view physical spacetime as tangentially approximated by an arbitrary homogeneous 'model spacetime', including not only the flat Minkowski model, as is implicitly used in standard general relativity, but also de Sitter, anti-de Sitter or other models. A 'Cartan connection' gives a prescription for parallel transport from one 'tangent model spacetime' to another, along any path, giving a natural interpretation of the MacDowell-Mansouri connection as 'rolling' the model spacetime along physical spacetime. I explain Cartan geometry, and 'Cartan gauge theory', in which the gauge field is replaced by a Cartan connection. In particular, I discuss MacDowell-Mansouri gravity, as well as its more recent reformulation in terms of BF theory, in the context of Cartan connections.

  10. Mechatronical Aided Concept (MAC in Intelligent Transport Vehicles Design

    Directory of Open Access Journals (Sweden)

    Pavel Pavlasek

    2003-01-01

    Full Text Available This article deals with the principles of synergy effect of mechatronical aided concept (MAC to the design of intelligent transport vehicles products applying CA technologies and virtual reality design methods. Also includes presentation of intelligent railway vehicle development.

  11. Distributed MAC Protocol Supporting Physical-Layer Network Coding

    CERN Document Server

    Wang, Shiqiang; Wang, Xingwei; Jamalipour, Abbas

    2011-01-01

    Physical-layer network coding (PNC) is a promising approach for wireless networks. It allows nodes to transmit simultaneously. Due to the difficulties of scheduling simultaneous transmissions, existing works on PNC are based on simplified medium access control (MAC) protocols, which are not applicable to general multi-hop wireless networks, to the best of our knowledge. In this paper, we propose a distributed MAC protocol that supports PNC in multi-hop wireless networks. The proposed MAC protocol is based on the carrier sense multiple access (CSMA) strategy and can be regarded as an extension to the IEEE 802.11 MAC protocol. In the proposed protocol, each node collects information on the queue status of its neighboring nodes. When a node finds that there is an opportunity for some of its neighbors to perform PNC, it notifies its corresponding neighboring nodes and initiates the process of packet exchange using PNC, with the node itself as a relay. During the packet exchange process, the relay also works as a ...

  12. God, Sport Philosophy, Kinesiology: A MacIntyrean Examination

    Science.gov (United States)

    Twietmeyer, Gregg

    2015-01-01

    Sport philosophy is in crisis. This subdiscipline of kinesiology garners little to no respect and few tenure track lines in kinesiology departments. Why is this the case? Why isn't philosophy held in greater esteem? Is it possible that philosopher Alasdair MacIntyre's (2009) diagnosis found in "God, Philosophy, Universities" could…

  13. Simulation for a New Real-time Ethernet MAC Protocol

    Institute of Scientific and Technical Information of China (English)

    Shen Gang(沈钢); Cai Yunze; Xu Xiaoming; He Xing; Zhang Weidong

    2004-01-01

    A method for modeling broadcast protocols in OPNET is introduced by illustrating a simulation of a new real-time Ethernet MAC protocol. The details of network models in OPNET are given and the procedure in modeling is introduced. Simulation results verify that the protocol is correct and efficient.

  14. Unconscious sedation/analgesia with propofol versus conscious sedation with fentanyl/midazolam for catheter ablation of atrial fibrillation: a prospective, randomized study

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-bo; MA Chang-sheng; DONG Jian-zeng; ZHAO Wen-du; LIU Xing-peng; KANG Jun-ping; LONG De-yong; YU Rong-hui; HU Fu-li; LIU Xiao-hui

    2007-01-01

    @@ Catheter ablation of atrial fibrillation (AF) has been increased dramatically recently.1 However, it is an unpleasant procedure with intolerable pain without sedation. Propofol and fentanyl/midazolam have been widely used in painful clinical examination and cardiovascular procedures with established safety and efficacy.2,3 Propofol, alfentanyl and midazolam were administrated for catheter ablation in some electrophysiological labs for a less painful procedure.4However, there is few published work on the sedation regimen for catheter ablation of AF.

  15. The rise of empirical research in medical ethics: a MacIntyrean critique and proposal.

    Science.gov (United States)

    Lawrence, Ryan E; Curlin, Farr A

    2011-04-01

    Hume's is/ought distinction has long limited the role of empirical research in ethics, saying that data about what something is cannot yield conclusions about the way things ought to be. However, interest in empirical research in ethics has been growing despite this countervailing principle. We attribute some of this increased interest to a conceptual breakdown of the is/ought distinction. MacIntyre, in reviewing the history of the is/ought distinction, argues that is and ought are not strictly separate realms but exist in a close relationship that is clarified by adopting a teleological orientation. We propose that, instead of recovering a teleological orientation, society tends to generate its own goals via democratic methods like those described by Rousseau or adopt agnosticism about teleology such as described by Richard Rorty. In both latter scenarios, the distinction between is and ought is obscured, and the role for empirical research grows, but for controversial reasons. MacIntyre warns that the is/ought distinction should remain, but reminds ethicists to make careful arguments about when and why it is legitimate to move from is to ought. PMID:21339390

  16. An Energy-Efficient MAC Protocol for Medical Emergency Monitoring Body Sensor Networks.

    Science.gov (United States)

    Zhang, Chongqing; Wang, Yinglong; Liang, Yongquan; Shu, Minglei; Chen, Changfang

    2016-01-01

    Medical emergency monitoring body sensor networks (BSNs) monitor the occurrence of medical emergencies and are helpful for the daily care of the elderly and chronically ill people. Such BSNs are characterized by rare traffic when there is no emergency occurring, high real-time and reliable requirements of emergency data and demand for a fast wake-up mechanism for waking up all nodes when an emergency happens. A beacon-enabled MAC protocol is specially designed to meet the demands of medical emergency monitoring BSNs. The rarity of traffic is exploited to improve energy efficiency. By adopting a long superframe structure to avoid unnecessary beacons and allocating most of the superframe to be inactive periods, the duty cycle is reduced to an extremely low level to save energy. Short active time slots are interposed into the superframe and shared by all of the nodes to deliver the emergency data in a low-delay and reliable way to meet the real-time and reliable requirements. The interposition slots can also be used by the coordinator to broadcast network demands to wake-up all nodes in a low-delay and energy-efficient way. Experiments display that the proposed MAC protocol works well in BSNs with low emergency data traffic. PMID:26999145

  17. An Energy-Efficient MAC Protocol for Medical Emergency Monitoring Body Sensor Networks

    Science.gov (United States)

    Zhang, Chongqing; Wang, Yinglong; Liang, Yongquan; Shu, Minglei; Chen, Changfang

    2016-01-01

    Medical emergency monitoring body sensor networks (BSNs) monitor the occurrence of medical emergencies and are helpful for the daily care of the elderly and chronically ill people. Such BSNs are characterized by rare traffic when there is no emergency occurring, high real-time and reliable requirements of emergency data and demand for a fast wake-up mechanism for waking up all nodes when an emergency happens. A beacon-enabled MAC protocol is specially designed to meet the demands of medical emergency monitoring BSNs. The rarity of traffic is exploited to improve energy efficiency. By adopting a long superframe structure to avoid unnecessary beacons and allocating most of the superframe to be inactive periods, the duty cycle is reduced to an extremely low level to save energy. Short active time slots are interposed into the superframe and shared by all of the nodes to deliver the emergency data in a low-delay and reliable way to meet the real-time and reliable requirements. The interposition slots can also be used by the coordinator to broadcast network demands to wake-up all nodes in a low-delay and energy-efficient way. Experiments display that the proposed MAC protocol works well in BSNs with low emergency data traffic. PMID:26999145

  18. EVALUATION OF SEDATIVE ACTIVITY OF AQUEOUS EXTRACT OF VIGNA TRILOBATA (L. VERDC. LEAVES

    Directory of Open Access Journals (Sweden)

    Ahir Chetan D

    2011-04-01

    Full Text Available The aim of present study is to evaluate the sedative activity of aqueous extract of Vigna trilobata (L verdc. Leaves using experimental animal models. In the present study aqueous extract of the Vigna trilobata leaves (AEVTL was used to investigate the sedative activity using Rotarod apparatus and Photoactometer in mice at a dose of 200 and 400 mg/kg of body weight and compared to standard diazepam (5mg/kg, i.p.. The result obtained from this study revealed that AEVTL possessed significant (p<0.05 and p<0.01 sedative activity at a dose of 200 and 400 mg/kg by reducing locomotor activity and fall off time in mice in a dose dependent manner. The results of this study justify the use of the leaves as sedative in traditional medicine. Further studies may be directed at characterizing the bioactive ingredients that are responsible for the observed sedative activity in the plant.

  19. Assessing the use of the Index of Sedation Need in oral surgery.

    Science.gov (United States)

    Gerrard, G

    2016-03-25

    Objective This article evaluates the use of the Index of Sedation Need in oral surgery.Design Service evaluation and audit.Setting Oral surgery department of a London dental teaching hospital.Subjects (materials) and methods Patients attending for oral surgery procedures with sedation which had been arranged without reference to the IOSN tool completed the IOSN and a patient questionnaire. Operators completed a similar questionnaire. The IOSN was calculated and the questionnaire responses analysed using SPSS.Results 56% of the patients in this study (n = 105) were receiving sedation appropriately according to the IOSN tool. When the questionnaire responses were analysed depending on sedation need, no statistical difference was found using Fisher's exact test or Pearson Chi-Square (p tool were considered by the operator to have been untreatable without it.Conclusion This study raises questions over the validity and reliability of the IOSN tool as a method of defining sedation need. PMID:27012345

  20. Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

    Directory of Open Access Journals (Sweden)

    Maria Sammartino

    2010-01-01

    Full Text Available Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation.

  1. Non-sedating antihistamine drugs and cardiac arrhythmias -- biased risk estimates from spontaneous reporting systems?

    DEFF Research Database (Denmark)

    De Bruin, M L; van Puijenbroek, E P; Egberts, A C G;

    2002-01-01

    AIMS: This study used spontaneous reports of adverse events to estimate the risk for developing cardiac arrhythmias due to the systemic use of non-sedating antihistamine drugs and compared the risk estimate before and after the regulatory action to recall the over-the-counter status of some of...... patients were using non-sedating antihistamines. In general non-sedating antihistamines are associated with cardiac arrhythmia to a higher extent in comparison with other drugs (ADR reporting odds ratio 2.05 [95% CI: 1.45, 2.89]). The association between arrhythmias and non-sedating antihistamine drugs...... calculated before 1998 was not significantly higher than 1 (OR 1.37 [95% CI: 0.85, 2.23]), whereas the risk estimate calculated after the governmental decision did significantly differ from 1 (OR 4.19 [95% CI: 2.49, 7.05]). CONCLUSIONS: Our data suggest that non-sedating antihistamines might have an...

  2. Assessment of the effects of ketamine-fentanyl combination versus propofol-remifentanil combination for sedation during endoscopic retrograde cholangiopancreatography

    OpenAIRE

    Heidari, Sayed Morteza; Loghmani, Parisa

    2014-01-01

    Background: Endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and treatment procedure is used in most biliary tract and pancreatic. Either sedation or general anesthesia could be considered for this procedure. Combining a sedative with an opioid agent can provide effective moderate sedation. This study compared the impact of ketamine-fentanyl (KF) versus propofol-remifentanil (PR) on sedation scale in patients undergoing ERCP. Materials and Methods: As a double-blinded ran...

  3. 78 FR 65541 - Federal Agricultural Mortgage Corporation Funding and Fiscal Affairs; Farmer Mac Liquidity...

    Science.gov (United States)

    2013-11-01

    ... 75 FR 27951 (May 19, 2010). \\12\\ See 76 FR 71798 supra. By a letter dated April 17, 2013, Farmer Mac... detail in the proposed rule imposes the FCA's business judgments on Farmer Mac's board. \\22\\ See 76 FR... change, pending the adoption of final liquidity rules for Farmer Mac. See 77 FR 66375, supra at...

  4. Design of an autonomous decentralized MAC protocol for wireless sensor networks

    OpenAIRE

    Hoesel, van, CPM Stan; Dal Pont, L.; Havinga, P.J.M.

    2003-01-01

    In this document the design of a MAC protocol for wireless sensor networks is discussed. The autonomous decentralized TDMA based MAC protocol minimizes power consumtion by efficiency implementing unicast/omnicast, scheduled rendezvous times and wakeup calls. The MAC protocol is an ongoing research topic in the European research project EYES.

  5. Feeding response of sport fish after electrical immobilization, chemical sedation, or both

    Science.gov (United States)

    Meinertz, Jeffery R.; Fredricks, Kim T.; Ambrose, Ryan D.; Jackan, Leanna M.; Wise, Jeremy K.

    2012-01-01

    Fishery managers frequently capture wild fish for a variety of fishery management activities. Though some activities can be accomplished without immobilizing the fish, others are accomplished more readily, humanely, and safely (for both the handler and the fish) when fish are immobilized by physical (e.g., electrical immobilization) or chemical sedation. A concern regarding the use of chemical sedatives is that chemical residues may remain in the fillet tissue after the fish recovers from sedation. If those residues are harmful to humans, there is some risk that a postsedated fish released to public waters may be caught and consumed by an angler. To characterize this risk, a series of four trials were conducted. Three trials assessed feeding activity after hatchery-reared fish were electrically immobilized, chemically sedated, or both, and one trial assessed the likelihood of an angler catching a wild fish that had been electrically immobilized and chemically sedated. Results from the first trial indicated that the feeding activity of laboratory habituated fish was variable among and within species after electrical immobilization, chemical sedation, or both. Results from the second trial indicated that the resumption of feeding activity was rapid after being mildly sedated for 45 min. Results from the third trial indicated that the feeding activity of outdoor, hatchery-reared fish was relatively aggressive after fish had been chemically sedated. Results from the fourth trial indicated that the probability of capturing wild fish in a more natural environment by angling after fish had been electrically immobilized and chemically sedated is not likely, i.e., in a group of five fish caught, 3 out of 100 times one would be a fish that had been sedated.

  6. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks

    Science.gov (United States)

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-01-01

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes. PMID:27171085

  7. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks.

    Science.gov (United States)

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-01-01

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes. PMID:27171085

  8. A SIMULATION-BASED PERFORMANCE COMPARISON OF MANETS CDS CREATION ALGORITHMS USING IDEAL MAC AND IEEE 802.11 MAC

    Directory of Open Access Journals (Sweden)

    Khalid A. Almahorg

    2013-11-01

    Full Text Available Mobile Ad Hoc networks (MANETs are gaining increased interest due to their wide range of potential applications in civilian and military sectors. The self-control, self-organization, topology dynamism, and bandwidth limitation of the wireless communication channel make implementation of MANETs a challenging task. The Connected Dominating Set (CDS has been proposed to facilitate MANETs realization. Minimizing the CDS size has several advantages; however, this minimization is NP complete problem; therefore, approximation algorithms are used to tackle this problem. The fastest CDS creation algorithm is Wu and Li algorithm; however, it generates a relatively high signaling overhead. Utilizing the location information of network members reduces the signaling overhead of Wu and Li algorithm. In this paper, we compare the performance of Wu and Li algorithm with its Location-Information-Based version under two types of Medium Access Control protocols, and several network sizes. The MAC protocols used are: a virtual ideal MAC protocol, and the IEEE 802.11 MAC protocol. The use of a virtual ideal MAC enables us to investigate how the real-world performance of these algorithms deviates from their ideal-conditions counterpart. The simulator used in this research is the ns-2 network simulator.

  9. The analgesic and sedative properties of dexmedetomidine infusion after uvulopalatopharyngoplasty

    Directory of Open Access Journals (Sweden)

    W.Abd El Megid ¹* and Ahmed M. Nassar

    2009-09-01

    Full Text Available Background: Dexmedetomidine is an alpha2 - adrenergic agonist with sedative and analgesic properties. This study aimed to investigate if the use of continuous dexmedetomidine infusion with i.v. morphine patient-controlled analgesia (PCA could improve postoperative analgesia while reducing opioid consumption and opioid-related side effects. Materials & methods: In this prospective randomized, double-blinded, controlled study, 24 patients with obstructive sleep apnea syndrome undergoing uvulopalatopharyngoplasty were assigned to two groups. Group D received a loading dose of dexmedetomidine 1µg kg¯¹ i.v., 30 min before the anticipated end of surgery, followed by a continuous infusion at a rate of 0.6 µg kg¯¹ hr¯¹ for 24 hr. Group P received a volume-matched bolus and infusion of placebo. In both groups, postoperative pain was initially controlled by i.v. morphine titration and then PCA with morphine. Cumulative PCA morphine consumption, pain intensities, sedation scores, cardiovascular and respiratory variables and narcotic-related adverse effects were recorded for 48 h after operation. Results: Extubation time was significantly prolonged in dexmedetomidine group (16±7 vs. 11±6 min p=0.074 in the placebo group. Visual analogue scale scores were significantly greater during the first 2h after tracheal extubation in the placebo group than in the dexmedetomidine group. The time to first analgesic request was significantly longer in the dexmedetomidine group than in the placebo group (21±11 vs. 9±4min; p=0.002. Compared with group P, patients in group D required 52.7% less morphine by PCA during the first 24h postoperative period, whereas levels of sedation were similar between the 2 groups at each observational time point. Fewer patients in group D experienced nausea and vomiting than those in group P (P< 0.05. There was no bradycardia, hypotension, or respiratory depression. Continuous dexmedetomidine infusion may be a useful anesthetic

  10. Carbon dioxide insufflation during colonoscopy in deeply sedated patients

    Institute of Scientific and Technical Information of China (English)

    Rajvinder Singh; Eu Nice Neo; Nazree Nordeen; Ganesananthan Shanmuganathan; Angelie Ashby; Sharon Drummond; Garry Nind

    2012-01-01

    AIM:To compare the impact of carbon dioxide (CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubation rates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air (P =0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively (P =0.012).The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO2) (P =0.0155) and by the patient 0.82 (air) and 0.46 (CO2) (P =0.0228).The level of abdominal bloating was 0.97 (air) and 0.36 (CO2) (P =0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insuffiation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.

  11. The Superconvergence Phenomenon and Proof of the MAC Scheme for the Stokes Equations on Non-uniform Rectangular Meshes

    KAUST Repository

    Li, Jichun

    2014-12-02

    For decades, the widely used finite difference method on staggered grids, also known as the marker and cell (MAC) method, has been one of the simplest and most effective numerical schemes for solving the Stokes equations and Navier–Stokes equations. Its superconvergence on uniform meshes has been observed by Nicolaides (SIAM J Numer Anal 29(6):1579–1591, 1992), but the rigorous proof is never given. Its behavior on non-uniform grids is not well studied, since most publications only consider uniform grids. In this work, we develop the MAC scheme on non-uniform rectangular meshes, and for the first time we theoretically prove that the superconvergence phenomenon (i.e., second order convergence in the (Formula presented.) norm for both velocity and pressure) holds true for the MAC method on non-uniform rectangular meshes. With a careful and accurate analysis of various sources of errors, we observe that even though the local truncation errors are only first order in terms of mesh size, the global errors after summation are second order due to the amazing cancellation of local errors. This observation leads to the elegant superconvergence analysis even with non-uniform meshes. Numerical results are given to verify our theoretical analysis.

  12. Mac OS X Snow Leopard for Power Users Advanced Capabilities and Techniques

    CERN Document Server

    Granneman, Scott

    2010-01-01

    Mac OS X Snow Leopard for Power Users: Advanced Capabilities and Techniques is for Mac OS X users who want to go beyond the obvious, the standard, and the easy. If want to dig deeper into Mac OS X and maximize your skills and productivity using the world's slickest and most elegant operating system, then this is the book for you. Written by Scott Granneman, an experienced teacher, developer, and consultant, Mac OS X for Power Users helps you push Mac OS X to the max, unveiling advanced techniques and options that you may have not known even existed. Create custom workflows and apps with Automa

  13. Use of Airtraq, C-Mac, and Glidescope laryngoscope is better than Macintosh in novice medical students′ hands: A manikin study

    Directory of Open Access Journals (Sweden)

    Abdullah M Kaki

    2011-01-01

    Full Text Available Background and Aim: Obtaining patent airway is a crucial task for many physicians. When opportunities to practice intubations on patients are really limited, skill gaining methods are needed. We conducted a study among novice 6 th year medical students to assess their ability to intubate the trachea in normal airway in manikin using four airway tools. Setting and Design: Prospective, cohort study conducted at simulation center of university-based, tertiary care hospital. Methods: Fifty medical students performed either oral or nasal tracheal intubation using the following four intubating tools: C-Mac videolaryngoscope, Glidescope, and Airtraq in comparison with regular Macintosh laryngoscope. Intubation time, visualization of glottic opening, ease of intubation, satisfaction of participants, incidence of dental trauma, and the need for optimization manoeuvres′ use among different airway tools were recorded. Results: In oral intubation, Airtraq was better than others in regard to intubation time, glottic opening, ease of intubation, and the need for external laryngeal pressure application, followed by Glidescope, C-Mac, and finally Macintosh laryngoscope ( P<0.001. Airtraq and Glidescope associated with less dental trauma than C-Mac and Macintosh. In nasal route, fastest intubation time was reported with Airtraq followed by Glidescope, C-Mac, and lastly Macintosh. Airtraq, Glidescope, and C-Mac were similar to each other and better than the Macintosh in regard to ease of intubation, satisfaction, and number of attempts (P≤0.008. Conclusions: New devices like Airtraq, Glidescope, and C-Mac are better than the regular Macintosh when used by novice medical students for oral and nasal intubation on manikin.

  14. Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam.

    Science.gov (United States)

    das Neves, Jose Francisco Nunes Pereira; das Neves Araújo, Mariana Moraes Pereira; de Paiva Araújo, Fernando; Ferreira, Clarice Martins; Duarte, Fabiana Baeta Neves; Pace, Fabio Heleno; Ornellas, Laura Cotta; Baron, Todd H; Ferreira, Lincoln Eduardo Villela Vieira de Castro

    2016-01-01

    Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction. PMID:27108817

  15. The Efficacy of Two Intravenous Sedative Drugs in Management of Uncooperative Children for Dental Treatments

    Directory of Open Access Journals (Sweden)

    Nasser Kaviani

    2015-03-01

    Full Text Available Statement of the Problem: Some children do not show an appropriate coopera-tion with their dentist. A number of them cannot be managed by local anesthesia and the usual techniques used to control behaviors, so further steps are required to control their pain and anxiety. Pharmaceutical control is recommended through sedation or general anesthesia. Purpose: This study was aimed to evaluate two groups of drugs in intravenous sedation method. Materials and Method: In this clinical trial intervention study, patients were randomly divided into two groups of 18 and 20 and each group received either intravenous midazolam-ketamine or midazolam-fentanyl. During the procedure, 0.25mg midazolam was administered to both groups if needed. The scores of intraoperative sedation and operation conditions were evaluated and recorded by dental sedation teacher groups (DSTG system in the 10th, 20th, 30th and 40th minutes of the operation. The results were analyzed by SPSS (version 16 using independent T-test, Wilcoxon, Mann-Whitney and Pearson Chi-Square tests as appropriated. Results: There was no significant difference between the two groups in sedation period (p= 0.55, recovery time (p= 0.18, Frankl score (p= 0.83(, score of in-traoperative sedation and operating conditions (p> 0.05, and sedation complications (p= 0.612. In addition, no complication occurred in recovery. Conclusion: There was no significant difference between the two drug groups; both were appropriate in controlling children’s behavior.

  16. Challenging Propofol Sedation in Gastrointestinal Endoscopy: High Risk Patients and High Risk Procedures

    Directory of Open Access Journals (Sweden)

    Eduardo Redondo-Cerezo

    2012-12-01

    Full Text Available Sedation is increasingly becoming a must for most endoscopic procedures. Non-anesthesiologist administration of propofol is the standard of practice in many European countries. Nevertheless, despite anesthesiology societies concerns about sedation guided by endoscopist, practitioners find some limits to propofol administration, related to high risk patients or high risk and complex procedures, which can be long lasting and technically challenging. The main patient related risk factors for sedation are elderly patients, obesity, ASA≥3 patients, individuals with craniofacial abnormalities or with pharyngolaringeal tumors, patients with an acute gastrointestinal bleeding, under pain medications, sedatives, antidepressants, or who consume significant amounts of alcohol or drugs. Procedure related risk factors have more to do with the duration and complexity of the procedure than with other factors, in which considering a general anesthesia allows the endoscopist to concentrate on a difficult task. Published papers addressing the most challenging sedation groups in endoscopy are exploring and even trespassing previously assumed frontiers, and new scenarios are opening to the endoscopist, increasing his/her autonomy, reducing costs and giving patients levels of comfort previously unknown. In this review we analyse each risk group determining the ones in which a sedation protocol could be widely applied, and other in which the published evidence does not guarantee a safe endoscopist guided propofol sedation.

  17. Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

    LENUS (Irish Health Repository)

    Harewood, G C

    2012-02-01

    BACKGROUND: In behavioural economics, a \\'nudge\\' describes configuration of a choice to encourage a certain action without taking away freedom of choice. AIM: To determine the impact of a \\'nudge\\' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. METHODS: Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. RESULTS: Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. CONCLUSIONS: These findings demonstrate that \\'nudge\\' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of \\'nudges\\' in impacting other aspects of endoscopic practice.

  18. Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

    LENUS (Irish Health Repository)

    Harewood, G C

    2011-05-17

    Background  In behavioural economics, a \\'nudge\\' describes configuration of a choice to encourage a certain action without taking away freedom of choice. Aim  To determine the impact of a \\'nudge\\' strategy - prefilling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice. Methods  Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3 mL or 5 mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Results  Overall, 120 patients received sedation for EGD [59 (5 mL), 61 (3 mL)] and 86 patients were sedated for colonoscopy [38 (5 mL), 48 (3 mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2 mg) vs. 3-mL group (3.3 mg), (P < 0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1 mg) vs. 3-mL group (3.3 mg), (P < 0.0001). There was no significant difference in mean meperidine dose (42.1 mg vs. 42.8 mg, P = 0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. Conclusions  These findings demonstrate that \\'nudge\\' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of \\'nudges\\' in impacting other aspects of endoscopic practice.

  19. On the Development of Low Power MAC Protocol for WBANs

    CERN Document Server

    Ullah, Sana; Kwak, Kyung Sup

    2009-01-01

    Current advances in wireless communication, microelectronics, semiconductor technologies, and intelligent sensors have contributed to the development of unobtrusive WBANs. These networks provide long term health monitoring of patients without any constraint in their normal activities. Traditional MAC protocols do not accommodate the assorted WBAN traffic requirements in a power efficient manner. In this paper, we present a brief discussion on the development process of a low power MAC protocol for WBANs. We observe the behavior of a beacon-enabled IEEE 802.15.4 for on-body sensor networks. We further propose a low power technique called traffic based wakeup mechanism for a WBAN that exploits the traffic patterns of the BAN Nodes to ensure power efficient and reliable communication.

  20. ENERGY EFFICIENT MAC PROTOCOLS FOR WIRELESS SENSOR NETWORKS: A SURVEY

    Directory of Open Access Journals (Sweden)

    Bhavana Narain

    2011-09-01

    Full Text Available Use of Wireless sensor networks have been widely seen in the fields of target detection and tracking,environmental monitoring, industrial process monitoring, and tactical systems.In wireless sensornetworks nodes work with a incomplete power source, energy efficient operations in an important factorof the nodes in wireless sensor network. Energy conservation plays important role in different layers ofthe TCP/IP protocol suit, and for MAC layer it is the effective part. Therefore, to work in wirelesscommunicating sensors network, we use MAC protocol which improve energy efficiency by increasingsleep duration, decreasing idle listening and overhearing, and eliminating hidden terminal problem orcollision of packets. In this paper First section we describe the accessible energy –efficient MACprotocols for sensor networks their energy saving method. In Second section we discuss the architectureof same protocols and then compare same protocols depending on their Advantages and Disadvantages

  1. Activity Modelling and Comparative Evaluation of WSN MAC Security Attacks

    DEFF Research Database (Denmark)

    Pawar, Pranav M.; Nielsen, Rasmus Hjorth; Prasad, Neeli R.;

    2012-01-01

    Applications of wireless sensor networks (WSNs) are growing tremendously in the domains of habitat, tele-health, industry monitoring, vehicular networks, home automation and agriculture. This trend is a strong motivation for malicious users to increase their focus on WSNs and to develop...... and initiate security attacks that disturb the normal functioning of the network in a severe manner. Such attacks affect the performance of the network by increasing the energy consumption, by reducing throughput and by inducing long delays. Of all existing WSN attacks, MAC layer attacks are considered....... The second aim of the paper is to simulate these attacks on hybrid MAC mechanisms, which shows the performance degradation of aWSN under the considered attacks. The modelling and implementation of the security attacks give an actual view of the network which can be useful in further investigating secure...

  2. EL CERRO DE POTOSÍ Y EL DIOS PACHACÁMAC THE CERRO DE POTOSÍ AND THE PACHACÁMAC GOD

    Directory of Open Access Journals (Sweden)

    Teresa Gisbert

    2010-06-01

    Full Text Available En este trabajo se plantea que el Cerro de Potosí se ocultó a los españoles por ser el santuario más importante de la región, el cual estaba dedicado al dios Pachacámac. Los testimonios que indican que el cerro de Potosí era "Apu" (Cerro o Señor adorado son abundantes, pero es el cronista Arzans de Orsúa y Vela (año 1736 quien dice que este "Apu" pertenecía a Pachacámac, dios del mundo subterráneo. Una tradición recogida cerca del salar de Uyuni dice lo mismo; finalmente un sacrificio realizado en el siglo XVI a orillas del lago Titicaca en honor a Pachacámac, muestra la presencia de este dios en el Collasuyo. Cuando los incas llegaron a Potosí introdujeron el culto al Sol y cuando llegaron los españoles identificaron el cerro con la Virgen María la cual, a su vez, se identificó con la Pachamama o Madre Tierra.In this essay it is argued that "Cerro de Potosf' was hidden from the Spanish conquerors because it was the region's most important huaca or sanctuary, due to the fact that it was dedicated to the god Pachacámac. Abundant testimonies (colonial documents indicate that "Cerro de Potosf was a worshipped "Apu" (Mountain, Señor or Lord, nevertheless chronicler Orzans de Orsúa y Vela (1736 stated that this "Apu" belonged to Pachacámac, god of the underworld. A tradition collected near the Salar de Uyuni states the same; finally, a sacrifice in honor of Pachacámac that occurred during the 16th century on the shores of Lake Titicaca, shows the presence of this god in the Collasuyo. When the Incas reached Potosí, they introduced worship of the Sun, and when the Spanish conquerors arrived, they identified the "Cerro de Potosf with the Virgin Mary which at the same time was identified with Pachamama or Mother Earth.

  3. An assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients

    Directory of Open Access Journals (Sweden)

    Naumann Terryn

    2004-03-01

    Full Text Available Abstract Background Hospitalization can significantly disrupt sleeping patterns. In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. The primary objectives of this study were to assess sleep disturbance and its determinants including the use of drugs with sedating properties. Methods This single-centre prospective study involved an assessment of sleep quality for consenting patients admitted to the general medicine and family practice units of an acute care Canadian hospital. A validated Verran and Snyder-Halpern (VSH Sleep Scale measuring sleep disturbance, sleep effectiveness, and sleep supplementation was completed daily by patients and scores were compared to population statistics. Patients were also asked to identify factors influencing sleep while in hospital, and sedating drug use prior to and during hospitalization was also assessed. Results During the 70-day study period, 100 patients completed at least one sleep questionnaire. There was a relatively even distribution of males versus females, most patients were in their 8th decade of life, retired, and suffered from multiple chronic diseases. The median self-reported pre-admission sleep duration for participants was 8 hours and our review of PharmaNetR profiles revealed that 35 (35% patients had received a dispensed prescription for a hypnotic or antidepressant drug in the 3-month period prior to admission. Benzodiazepines were the most common sedating drugs prescribed. Over 300 sleep disturbance, effective and supplementation scores were completed. Sleep disturbance scores across all study days ranged 16–681, sleep effectiveness scores ranged 54–402, while sleep supplementation scores ranged between 0–358. Patients tended to have worse sleep scores as compared to healthy non

  4. ITER management advisory committee (MAC) meeting in Naka

    International Nuclear Information System (INIS)

    The ITER Management Advisory Committee (MAC) Meeting was held on 28 June 2000 in Moskow, Russia. The main topics were the consideration of the report by the director on the ITER EDA status, the review of the work program, the review of the joint fund, the review of a schedule of ITER meetings and initial discussion and consideration on the disposition of R and D hardware and facilities and other dispositions relating to the termination of the EDA

  5. Energy harvesting aware hybrid MAC protocol for WBANs

    OpenAIRE

    Ibarra, Ernesto; Antonopoulos, Angelos; KARTSAKLI, Elli; Verikoukis, Christos

    2013-01-01

    In this paper, we propose a hybrid polling Medium Access Control (MAC) protocol with Human Energy Harvesting capabilities, called HEH-BMAC, designed for Wireless Body Area Networks (WBANs). The proposed protocol uses a dynamic schedule algorithm to combine User Identification polling (ID) and Probabilistic Contention (PC) random access, adapting the network operation to the random, time-varying nature of the human energy harvesting sources. HEH-BMAC offers different levels of node priorities ...

  6. Tournament MAC with Constant Size Congestion Window for WLAN

    OpenAIRE

    Galtier, Jérôme

    2007-01-01

    In the context of radio distributed networks, we present a generalized approach for the Medium Access Control (MAC) with fixed congestion window. Our protocol is quite simple to analyze and can be used in a lot of different situations. We give mathematical evidence showing that our performance is tight, in the sense that no protocol with fixed congestion window can do better. We also place ourselves in the WiFi/WiMAX framework, and show experimental results enlightening collision reduction of...

  7. An Efficient MAC Protocol for WLAN based on OFDM modulation

    Science.gov (United States)

    Michelini, Marco; Fantacci, Romano; Giacomelli, Marco

    2002-11-01

    We propose and analyze a MAC protocol aptly designed for WLAN, based on OFDM modulation. The goal of the analysis is to provide an efficient tool to deliver to voice and data terminals acceptable QoS connections, overcoming the problem of large number of retransmissions, high delays and low reliability. Simulation results show that, in a real environment, the proposed algorithm is able to achieve good performance in terms of throughput and message delivery delay.

  8. LHC@home online tutorial for Mac users - recording

    CERN Document Server

    CERN. Geneva

    2016-01-01

    A step-by-step online tutorial about LHC@home for Mac users by Alexandre Racine. It contains detailed instructions on how-to-join this volunteer computing project.  There are 3 screen capture videos with the real installation process accelerated attached to the event page. This 5' video is linked from http://lhcathome.web.cern.ch/join-us Also from the CDS e-learning category.

  9. Visual cortex reactivity in sedated children examined with perfusion MRI (FAIR)

    DEFF Research Database (Denmark)

    Born, A P; Rostrup, E; Miranda, M J;

    2002-01-01

    Sleeping and sedated children can respond to visual stimulation with a decrease in blood oxygenation level dependent (BOLD) functional MRI signal response. The contribution of metabolic and hemodynamic parameters to this inverse signal response is incompletely understood. It has been hypothesized...... explanation for the negative BOLD response. Future studies will have to address if this response pattern is a consequence of age or sleep/sedation......Sleeping and sedated children can respond to visual stimulation with a decrease in blood oxygenation level dependent (BOLD) functional MRI signal response. The contribution of metabolic and hemodynamic parameters to this inverse signal response is incompletely understood. It has been hypothesized...

  10. Sedation and Analgesia in Children with Developmental Disabilities and Neurologic Disorders

    Directory of Open Access Journals (Sweden)

    Todd J. Kilbaugh

    2010-01-01

    Full Text Available Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy. The overall objectives of this paper are (1 to provide an overview on recent studies that highlight the increased risk for respiratory complications following sedation and analgesia in children with developmental disabilities and neurologic disorders, (2 to provide a better understanding of sedatives and analgesic medications which are commonly used in children with developmental disabilities and neurologic disorders on the central nervous system.

  11. Improvisation of MAC Protocol for Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    P. Iswarya

    2013-05-01

    Full Text Available Wireless sensor networks are collection of sensor nodes connected via wireless LAN links. The information gathered at sensor node is propagates in the form of radio signal to control room via multi hop communication. In the networks, many sensors where lying in same channel to pass message, so as well as minimize the power efficient and delay for sensor networks. An Efficient Medium Access (MAC protocol is critical for the performance of a Wireless Sensor Networks (WSN, especially in terms of energy consumption. IMAC is a Time Division Multiple Access (TDMA scheme that extents the common single hop TDMA to a multi hop sensor network, using a high-powered base station to synchronize the nodes and to schedule their transmission and receptions. The protocol first enables the base station together with topology (connectivity information. A scheduling algorithm, then determines when each node should receive data and the access point announces the transmission schedule to the other nodes. The performance of EEMAC is compared to existing protocols based on simulations in NS2 (network simulator. In this paper, we discuss about the Energy Efficiency of the MAC (EEMAC and improvising the MAC protocol (IMAC, based on simulation results we show that IMAC has smaller energy and delay compared to EEMAC

  12. EL CERRO DE POTOSÍ Y EL DIOS PACHACÁMAC THE CERRO DE POTOSÍ AND THE PACHACÁMAC GOD

    OpenAIRE

    Teresa Gisbert

    2010-01-01

    En este trabajo se plantea que el Cerro de Potosí se ocultó a los españoles por ser el santuario más importante de la región, el cual estaba dedicado al dios Pachacámac. Los testimonios que indican que el cerro de Potosí era "Apu" (Cerro o Señor) adorado son abundantes, pero es el cronista Arzans de Orsúa y Vela (año 1736) quien dice que este "Apu" pertenecía a Pachacámac, dios del mundo subterráneo. Una tradición recogida cerca del salar de Uyuni dice lo mismo; finalmente un sacrificio reali...

  13. Awareness of bispectral index monitoring system among the critical care nursing personnel in a tertiary care hospital of India

    Directory of Open Access Journals (Sweden)

    Shikha Thakur

    2011-01-01

    Full Text Available Background: Bispectral index monitoring system (BIS is one of the several systems used to measure the effects of anaesthetic and sedative drugs on the brain and to track changes in the patient′s level of sedation and hypnosis. BIS monitoring provides information clinically relevant to the adjustment of dosages of sedating medication. It can help the nursing personnel in preventing under- and over sedation among intensive care unit (ICU patients. Objective: The present study was conducted to assess the knowledge of nursing personnel working in the ICU regarding BIS. Methods: Fifty-four subjects participated in the study. A structured questionnaire was developed to assess the knowledge of the nursing personnel regarding BIS. Focus group discussions were held among the nursing personnel to know their views regarding BIS. Results: Mean age (years of the subjects was 30.7΁7.19 (21-47 years, with a female preponderance. Although the use of BIS in ICU is not common, majority (94.44% were aware of BIS and its purpose. 79.62% of the subjects knew about its implication in patient care. The mean knowledge score of the subjects was 11.87΁2.43 (maximum score being 15. Conclusion: There exists an awareness among the critical care nursing staff in our institution regarding BIS and its clinical implications. Its use in the critical care setting may benefit the patients in terms of providing optimal sedation.

  14. Down-Regulated MAC30 Expression Inhibits Proliferation and Mobility of Human Gastric Cancer Cells

    Directory of Open Access Journals (Sweden)

    Xiao-Yan Xu

    2014-05-01

    Full Text Available Background: Gastric cancer is one of the most common cancers in the world. MAC30/Transmembrane protein 97 (TMEM97 is aberrantly up-regulated in many human carcinoma cells. However, the function of MAC30 in gastric carcinoma cells is not studied. Material and Methods: To investigate the function of MAC30 in gastric carcinoma, we used RNA silencing technology to knock down the expression of MAC30 in gastric cancer cells BGC-823 and AGS. Real-time quantitative PCR and Western blot were used to analyze the mRNA level and the related protein expression. The localization of MAC30 and lamellipodia was observed by immunofluorescence. The biological phenotypes of gastric cells were examined by cell proliferation assay, cell cycle analysis, apoptosis assay, cell migration and invasion assay. Results: We found that down-regulation of MAC30 expression efficiently inhibited the proliferation of gastric cancer cells. Furthermore, the mobility of gastric cancer cells was also inhibited by down-regulation of MAC30. Moreover, we found that MAC30 knockdown inhibited AKT phosphorylation and reduced the expression of cyclinB1 and WAVE2. Conclusion: To our knowledge, this is the first report investigating the effect of MAC30 on growth, cell cycle, migration, and invasion in gastric carcinoma cells via suppressing AKT signaling pathway. MAC30 may be a potential therapeutic target for treatment of gastric carcinoma.

  15. Adverse events and outcomes of procedural sedation and analgesia in major trauma patients

    Directory of Open Access Journals (Sweden)

    Robert S Green

    2015-01-01

    Full Text Available Context: Trauma patients requiring procedural sedation and analgesia (PSA may have increased risk of adverse events (AEs and poor outcomes. Aims: To determine the incidence of AEs in adult major trauma patients who received PSA and to evaluate their postprocedural outcomes. Settings and Design: Retrospective analysis of adult patients (age >16 who received PSA between 2006 and 2014 at a Canadian academic tertiary care center. Materials and Methods: We compared the incidence of PSA-related AEs in trauma patients with nontrauma patients. Postprocedural outcomes including Intensive Care Unit admission, length of hospital stay, and mortality were compared between trauma patients who did or did not receive PSA. Statistical Analysis Used: Descriptive statistics and multivariable logistic regression. Results: Overall, 4324 patients received PSA during their procedure, of which 101 were trauma patients (107 procedures. The majority (77% of these 101 trauma patients were male, relatively healthy (78% with American Society of Anesthesiologists Physical Status [ASA-PS] 1, and most (85% of the 107 procedures were orthopedic manipulations. PSA-related AEs were experienced by 45.5% of the trauma group and 45.9% of the nontrauma group. In the trauma group, the most common AEs were tachypnea (23% and hypotension (20%. After controlling for age, gender, and ASA-PS, trauma patients were more likely than nontrauma patients to develop hypotension (odds ratio 1.79; 95% confidence interval 1.11-2.89. Conclusion: Although trauma patients were more likely than nontrauma patients to develop hypotension during PSA, their outcomes were not worse compared to trauma patients who did not have PSA.

  16. Caudal block and emergence delirium in pediatric patients: Is it analgesia or sedation?

    Directory of Open Access Journals (Sweden)

    Aparna Sinha

    2012-01-01

    Full Text Available Background: Emergence delirium (ED although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine, BK (bupivacaine and ketamine, or NC (no caudal, soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED scores were significantly higher in the NC group (P<0.05. Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia.

  17. Development of the CoMac Adherence Descriptor™: a linguistically-based survey for segmenting patients on their worldviews

    OpenAIRE

    Connor UM; Mac Neill Jr RS; Mzumara HR; Sandy R

    2015-01-01

    Ulla M Connor,1 Robert S Mac Neill Jr,1 Howard R Mzumara,2 Robert Sandy1 1International Center for Intercultural Communication (ICIC), Indiana University – Purdue University, Indianapolis, IN, USA; 2Testing Center – Division of Planning and Institutional Improvement, Indiana University – Purdue University, Indianapolis, IN, USA Abstract: Nonadherence to prescribed medication and healthy behaviors is a pressing health care issue. Much research has been conducted in this are...

  18. Development of the CoMac Adherence Descriptor™: a linguistically-based survey for segmenting patients on their worldviews

    OpenAIRE

    Connor, Ulla

    2015-01-01

    Ulla M Connor,1 Robert S Mac Neill Jr,1 Howard R Mzumara,2 Robert Sandy1 1International Center for Intercultural Communication (ICIC), Indiana University – Purdue University, Indianapolis, IN, USA; 2Testing Center – Division of Planning and Institutional Improvement, Indiana University – Purdue University, Indianapolis, IN, USA Abstract: Nonadherence to prescribed medication and healthy behaviors is a pressing health care issue. Much research has been conducted...

  19. Spectral entropy as a monitor of depth of propofol induced sedation.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    OBJECTIVE: The aim of this prospective, observational study was to evaluate State and Response entropy (Entropy(TM) Monitor, GE Healthcare, Finland), indices as measures of moderate ("conscious") sedation in healthy adult patients receiving a low dose propofol infusion. Sedation was evaluated using: (I) the responsiveness component of the OAA\\/S scale (Observer\\'s Assessment of Alertness\\/Sedation scale) and (II) multi-channel electroencephalogram (EEG) interpretation by a clinical expert. METHODS: 12 ASA I patients were recruited. A target-controlled infusion of propofol was administered (using Schnider\\'s pharmacokinetic model) with an initial effect site concentration set to 0.5 microg ml(-1). A 4 minute equilibrium period was allowed. This concentration was increased at 4 minute intervals by 0.5 microg ml(-1) to a maximum of 2.0 microg ml(-1). State (SE) and Response (RE), entropy values were recorded for each 4 minute epoch together with clinical sedation scores (OAA\\/S) and continuous multi-channel EEG. The multi-channel EEG recorded during the final minute of each 4 minute epoch or "patient\\/time unit" was presented to a neurophysiologist who assigned a label "sedated\\/not sedated". SE\\/RE values were compared in patient\\/time units with clinical or EEG evidence of sedation versus those without. RESULTS: Mean SE and RE values were less in patient\\/time units when clinical evidence of sedation was present, [mean = 86.8 (95% CI, 84.0-88.3) and 94.3 (95%CI, 92-96.1)], P = 0.002 and P = 0.001, respectively. In patient\\/time units assigned the label "sedated" by the clinical neurophysiologist assessing the multi-channel EEG, SE and RE values were less [mean = 87.5 (95% CI, 86.3-88.4) and 95.0 (95% CI, 93.8-96.1)] P = 0.001 and P < 0.001, respectively. CONCLUSIONS: A statistically significant decrease in SE and RE values was demonstrated in patient\\/time units in which clinical or EEG evidence of sedation was present. We conclude that spectral entropy

  20. Visual cortex reactivity in sedated children examined with perfusion MRI (FAIR)

    DEFF Research Database (Denmark)

    Born, A.P.; Rostrup, Egill; Miranda Gimenez-Ricco, Maria Jo; Larsson, H.B.W.; Lou, H.C.

    2002-01-01

    Sleeping and sedated children can respond to visual stimulation with a decrease in blood oxygenation level dependent (BOLD) functional MRI signal response. The contribution of metabolic and hemodynamic parameters to this inverse signal response is incompletely understood. It has been hypothesized...... explanation for the negative BOLD response. Future studies will have to address if this response pattern is a consequence of age or sleep/sedation...

  1. Sleep/sedation in children undergoing EEG testing: a comparison of chloral hydrate and music therapy.

    Science.gov (United States)

    Loewy, Joanne; Hallan, Cathrine; Friedman, Eliezer; Martinez, Christine

    2006-12-01

    This study included a total of 60 pediatric patients ranging from 1 month through 5 years of age. The effects of chloral hydrate and music therapy were evaluated and compared as means of safe and effective ways to achieve sleep/sedation in infants and toddlers undergoing EEG testing. The results of the study indicate that music therapy may be a cost-effective, risk-free alternative to pharmacological sedation. PMID:17285817

  2. Perceived Stress, Alexithymia, and Psychological Health as Predictors of Sedative Abuse

    OpenAIRE

    Gilan, Nader Rajabi; Zakiei, Ali; Reshadat, Sohyla; Komasi, Saeid; Ghasemi, Seyed Ramin

    2015-01-01

    Background The harmful effects of sedative medications and substances in conjunction with limited research regarding predictive psychological constructs of drug abuse necessitate further investigation of associated factors. Therefore, the present study aimed to elucidate the roles of perceived stress, alexithymia, and psychological health as predictors of sedative abuse in medical students. Methods In this cross-sectional study, 548 students at Kermanshah University of Medical Sciences, Iran,...

  3. Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients Sedated for Psychomotor Agitation: A Pilot Study

    OpenAIRE

    Deitch, Kenneth; Rowden, Adam; Damiron, Kathia; Lares, Claudia; Oqroshidze, Nino; Aguilera, Elizabeth

    2014-01-01

    Introduction: The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED. Methods: Adult patients wh...

  4. Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients Sedated For Psychomotor Agitation: Pilot Study

    OpenAIRE

    Deitch, Kenneth; Rowden, Adam; Damiron, Kathia; Lares, Claudia; Oqroshidze, Nino; Aguilera, Elizabeth

    2014-01-01

    Introduction The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED. Methods Adult patients who met eligi...

  5. Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult

    OpenAIRE

    Jung, Jae Wook; Cheol Go, Gwang; Jeon, Sang Yoon; Bang, Sira; LEE, Ki Hwa; Kim, Yong Han; Kim, Dong-Kie

    2013-01-01

    Atrial septal defect (ASD) is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography (TEE) is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine (DEX), which is a highly selective α2-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation.

  6. Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult.

    Science.gov (United States)

    Jung, Jae Wook; Cheol Go, Gwang; Jeon, Sang Yoon; Bang, Sira; Lee, Ki Hwa; Kim, Yong Han; Kim, Dong-Kie

    2013-11-01

    Atrial septal defect (ASD) is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography (TEE) is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine (DEX), which is a highly selective α2-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation. PMID:24550975

  7. Nalbuphine Sedation in a Patient with Long Term, High Dose Chemotherapeutically Controlled Psychosis

    OpenAIRE

    Kelly, Maureen; Howell, Robert M.

    1985-01-01

    Consideration of which pharmacologic agent to use when a patient requires sedation prior to an oral surgery procedure entails a number of factors, including past medical history, current medications and dose level, duration of administration, pharmacologic interactions, and the dental needs of the patient. The case described in this report illustrates the importance of consideration of these factors in a patient who required sedation prior to oral surgery while taking 800 mg chlorpromazine, 3...

  8. Complications of IV sedation for dental treatment in individuals with intellectual disability

    OpenAIRE

    Chaza Kouchaji

    2015-01-01

    Few studies have looked at the incidence of complications performed with IV sedation for dental treatment. The purposes of this study were to (1) delineate the nature and frequency of postdental treatment complications associated with dental treatment under IV sedation in individuals with intellectual disability, and (2) correlate morbidity reports with patient’s gender, age, and duration of dental procedures. Materials and methods: 28 Patients with intellectual disability, 13 females and ...

  9. Sedation with etomidate-fentanyl versus propofol-fentanyl in colonoscopies: A prospective randomized study

    OpenAIRE

    Banihashem, Nadia; Alijanpour, Ebrahim; Basirat, Majid; Shokri Shirvany, Javad; Kashifard, Mehrdad; Taheri, Hasan; Savadkohi, Shahriyar; Hosseini, Vahid; Solimanian, Seyed Sedigheh

    2015-01-01

    Background: The combination of propofol-fentanyl for sedation during colonoscopy is characterized by high prevalence of side effects. Etomidate-fentanyl provides fewer hemodynamic and respiratory complications. The aim of our study was to compare the safety and efficacy of propofol-fentanyl and etomidate-fentanyl for conscious sedation in elective colonoscopy. Methods: This double-blind clinical trial was conducted on 90 patients aged between 18- 55 years old who were candidates for elective ...

  10. Effect of sedation with detomidine and butorphanol on pulmonary gas exchange in the horse

    OpenAIRE

    Morgan Karin; Funkquist Pia; Edner Anna; Marntell Stina; Nyman Görel; Hedenstierna Göran

    2009-01-01

    Abstract Background Sedation with α2-agonists in the horse is reported to be accompanied by impairment of arterial oxygenation. The present study was undertaken to investigate pulmonary gas exchange using the Multiple Inert Gas Elimination Technique (MIGET), during sedation with the α2-agonist detomidine alone and in combination with the opioid butorphanol. Methods Seven Standardbred trotter horses aged 3–7 years and weighing 380–520 kg, were studied. The protocol consisted of three consecuti...

  11. Capnography monitoring during procedural sedation and analgesia: a systematic review protocol

    OpenAIRE

    Conway, Aaron; Douglas, Clint; Sutherland, Joanna

    2015-01-01

    Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inade...

  12. Capnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage

    OpenAIRE

    Schlag, Christoph; Wörner, Alexandra; Wagenpfeil, Stefan; Kochs, Eberhard F.; Schmid, Roland M; von Delius, Stefan

    2013-01-01

    BACKGROUND: Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea.OBJECTIVE: To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage (PTCD).METHODS: Twenty consecutive patients scheduled for PTCD were included in the study. All patients were sedated during the ...

  13. Evaluation of Pharyngeal Function between No Bolus and Bolus Propofol Induced Sedation for Advanced Upper Endoscopy

    OpenAIRE

    Shinsuke Kiriyama; Hiroshi Naitoh; Minoru Fukuchi; Takaharu Fukasawa; Kana Saito; Yuichi Tabe; Hayato Yamauchi; Tomonori Yoshida; Hiroyuki Kuwano

    2014-01-01

    This study aimed to assess pharyngeal function between no bolus and bolus propofol induced sedation during gastric endoscopic submucosal dissection. A retrospective study was conducted involving consecutive gastric cancer patients. Patients in the no bolus group received a 3 mg/kg/h maintenance dose of propofol after the initiation of sedation without bolus injection. All patients in the bolus group received the same maintenance dose of propofol with bolus 0.5 mg/kg propofol injection. Pharyn...

  14. Challenging Propofol Sedation in Gastrointestinal Endoscopy: High Risk Patients and High Risk Procedures

    OpenAIRE

    Eduardo Redondo-Cerezo

    2012-01-01

    Sedation is increasingly becoming a must for most endoscopic procedures. Non-anesthesiologist administration of propofol is the standard of practice in many European countries. Nevertheless, despite anesthesiology societies concerns about sedation guided by endoscopist, practitioners find some limits to propofol administration, related to high risk patients or high risk and complex procedures, which can be long lasting and technically challenging. The main patient related risk factors for...

  15. Current methods of sedation in dental patients - a systematic review of the literature

    Science.gov (United States)

    Silvestre-Rangil, Javier; Cutando-Soriano, Antonio; López-Jiménez, Julián

    2016-01-01

    Objetive The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. Study Design A systematic literature review of the PubMed MEDLINE database was carried out using the key words “conscious sedation,” “drugs,” and “dentistry.” A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review. Results A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2O) are also effective sedative drugs. Conclusions Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective. Key words:Conscious sedation, drugs, dentistry. PMID:27475684

  16. Preoperative anxiety and propofol requirement in conscious sedation for ovum retrieval.

    OpenAIRE

    Hong, Jeong-Yeon; Kang, Inn Soo; Koong, Mi Kyoung; Yoon, Hee Jo; Jee, Young Suck; Park, Jeong Wook; Park, Mi Hyun

    2003-01-01

    The purpose of the present study was to evaluate the correlation among the trial number of in vitro fertilization (IVF), preoperative anxiety, and propofol requirement for conscious sedation. One hundred and twenty six Korean women undergoing oocyte retrieval were enrolled. The target-controlled infusion by the anesthesiologist was conducted with initial target propofol concentration of 2.5 microg/mL, which was manipulated until the sedation score 3 and desired clinical end point were achieve...

  17. Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation (NONSEDA Trial)

    DEFF Research Database (Denmark)

    Toft, Palle; Olsen, Hanne Tanghus; Jørgensen, Helene Korvenius; Strøm, Thomas; Nibro, Helle Lykkeskov; Oxlund, Jacob; Wian, Karl-Andre; Ytrebø, Lars Marius; Kroken, Bjørn Anders; Chew, Michelle

    2014-01-01

    , patients with severe head trauma, coma at admission or status epilepticus, patients treated with therapeutic hypothermia, patients with PaO2/FiO2 < 9 where sedation might be necessary to ensure sufficient oxygenation or place the patient in prone position.Experimental intervention is non...... mortality with a type I error risk of 5% and a type II error risk of 20% (power at 80%). DISCUSSION: The trial investigates potential benefits of non-sedation. This might have large impact on the future treatment of mechanically ventilated critically ill patients.Trial register: ClinicalTrials.gov NCT...

  18. In vivo sedative and muscle relaxants activity of Diospyros lotus L

    Institute of Scientific and Technical Information of China (English)

    Abdur; Rauf; Ghias; Uddin; Bina; Shaheen; Siddiqui; Haroon; Khan

    2015-01-01

    Objective: To evaluate the sedative effect of Diospyros lotus L(D. lotus) extract in mice using the open field and Rota rod tests.Methods: For the sedative and muscle relaxants activities of extract/fractions of the plant, invivo open field and phenobarbitone-induced sleeping time were used, while the Roda rod test was employed in animals for the assessment of muscle relaxant activity.Results: Results from this investigation revealed that the extracts of D. lotus have exhibited significant sedative effect in mice(45.98%) at 100 mg/kg i.p. When the extract was partitioned with different solvents, the n-hexane fraction was inactive whereas the chloroform fraction was the most active with 82.67% sedative effect at 50 and 100 mg/kg i.p. On the other hand,the ethyl acetate and n-butanol fractions displayed significant sedative effects(55.65% and40.87%, respectively) at 100 mg/kg i.p. Among the tested extract/fractions, only chloroform and ethyl acetate fractions showed significant(P < 0.05) muscle relaxant activity in the Rota rod test.Conclusions: In short, our study provided scientific background to the traditional uses of D.lotus as sedative.

  19. Supraorbital transcutaneous neurostimulation has sedative effects in healthy subjects

    Directory of Open Access Journals (Sweden)

    Piquet Maxime

    2011-10-01

    Full Text Available Abstract Background Transcutaneous neurostimulation (TNS at extracephalic sites is a well known treatment of pain. Thanks to recent technical progress, the Cefaly® device now also allows supraorbital TNS. During observational clinical studies, several patients reported decreased vigilance or even sleepiness during a session of supraorbital TNS. We decided therefore to explore in more detail the potential sedative effect of supraorbital TNS, using standardized psychophysical tests in healthy volunteers. Methods We performed a double-blind cross-over sham-controlled study on 30 healthy subjects. They underwent a series of 4 vigilance tests (Psychomotor Vigilance Task, Critical Flicker Fusion Frequency, Fatigue Visual Numeric Scale, d2 test. Each subject was tested under 4 different experimental conditions: without the neurostimulation device, with sham supraorbital TNS, with low frequency supraorbital TNS and with high frequency supraorbital TNS. Results As judged by the results of three tests (Psychomotor Vigilance Task, Critical Flicker Fusion Frequency, Fatigue Visual Numeric Scale there was a statistically significant (p Conclusion Supraorbital high frequency TNS applied with the Cefaly® device decreases vigilance in healthy volunteers. Additional studies are needed to determine the duration of this effect, the underlying mechanisms and the possible relation with the stimulation parameters. Meanwhile, this effect opens interesting perspectives for the treatment of hyperarousal states and, possibly, insomnia.

  20. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  1. Parameters of anesthesia/sedation in children receiving radiotherapy

    International Nuclear Information System (INIS)

    Previous reports establish low risk of complications in pediatric treatments under anesthesia/sedation (A/S) in the outpatient setting. Here, we present our institutional experience with A/S by age and gender in children receiving daily proton RT. After Institutional Review Board approval, we reviewed our center’s records between 9/9/2004 and 6/30/2013 with respect to age and gender of A/S requirement in our pediatric patients (defined as patients ≤18 years of age). Of 390 patients treated in this era, 182 were girls. Children aged ≤3 invariably required A/S; and by age 7–8, approximately half of patients do not. For pediatric patients ≥ 12 years of age, approximately 10% may require A/S for different reasons. There was no difference by gender. Beyond age 3, the requirement for A/S decreases in an age-dependent fashion, with a small cadre of older children having difficulty enough with sustained immobilization that A/S is necessary. In our experience, there is no difference in A/S requirement by gender

  2. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127

  3. TMAC: Timestamp-Ordered MAC Protocol for Wireless Mesh Networks

    KAUST Repository

    Nawab, Faisal

    2011-05-01

    Wireless Mesh Networks (WMNs) have emerged to meet a need for a self-organized and self-configured multi-hop wireless network infrastructure. Low cost infrastructure and ease of deployment have made WMNs an attractive technology for last mile access. However, 802.11 based WMNs are subject to serious fairness issues. With backlogged TCP traffic, nodes which are two or more hops away from the gateway are subject to starvation, while the one-hop away node saturates the channel with its own local traffic. We study the interactions of TCP and IEEE 802.11 MAC in WMNs to aid us in understanding and overcoming the unfairness problem. We propose a Markov chain to capture the behavior of TCP sessions, particularly the impact on network throughput performance due to the effect of queue utilization and packet relaying. A closed form solution is derived to numerically derive the throughput. Based on the developed model, we propose a distributed MAC protocol called Timestamp-ordered MAC (TMAC), aiming to alleviate the unfairness problem in WMNs via a manipulative per-node scheduling mechanism which takes advantage of the age of each packet as a priority metric. Simulation is conducted to validate our model and to illustrate the fairness characteristics of TMAC. Our results show that TMAC achieves excellent resource allocation fairness while maintaining above 90% of maximum link capacity in parking lot and large grid topologies. Our work illuminates the factors affecting TCP fairness in WMNs. Our theoretical and empirical findings can be used in future research to develop more fairness-aware protocols for WMNs.

  4. Disruption of the MacMARCKS gene prevents cranial neural tube closure and results in anencephaly.

    OpenAIRE

    Chen, J; Chang, S.; Duncan, S A; Okano, H J; Fishell, G.; Aderem, A

    1996-01-01

    MacMARCKS is a member of the MARCKS family of protein kinase C (PKC) substrates. Biochemical evidence demonstrates that these proteins integrate calcium and PKC-dependent signals to regulate actin structure at the membrane. We report here that deletion of the MacMARCKS gene prevents cranial neural tube closure in the developing brain, resulting in anencephaly. This suggests a central role for MacMARCKS and the PKC signal transduction pathway in the folding of the anterior neural plate during ...

  5. Independent Metalloregulation of Ace1 and Mac1 in Saccharomyces cerevisiae

    OpenAIRE

    Keller, Greg; Bird, Amanda; Winge, Dennis R.

    2005-01-01

    Ace1 and Mac1 undergo reciprocal copper metalloregulation in yeast cells. Mac1 is functional as a transcriptional activator in copper-deficient cells, whereas Ace1 is a transcriptional activator in copper-replete cells. Cells undergoing a transition from copper-deficient to copper-sufficient conditions through a switch in the growth medium show a rapid inactivation of Mac1 and a corresponding rise in Ace1 activation. Cells analyzed after the transition show a massive accumulation of cellular ...

  6. Expression analysis of MAC30 in human pancreatic cancer and tumors of the gastrointestinal tract

    OpenAIRE

    Kayed, Hany; Kleeff, Jörg; Ding, J.; Hammer, J.; Giese, T; Zentgraf, H; Büchler, M W; Friess, Helmut

    2004-01-01

    Meningioma-associated protein, MAC30, is a protein with unknown function and cellular localization that is differentially expressed in certain malignancies. In the present study, the expression of MAC30 in a variety of normal and cancerous human gastrointestinal tissues, with special emphasis on pancreatic tissues was analyzed. Quantitative RT-PCR was utilized to compare MAC30 expression levels. In situ hybridization and immunohistochemistry were carried ou...

  7. Subcellular localization and dynamics of Mac-1 (alpha m beta 2) in human neutrophils.

    OpenAIRE

    Sengeløv, H.; Kjeldsen, L; Diamond, M S; Springer, T A; Borregaard, N

    1993-01-01

    The subcellular localization of Mac-1 was determined in resting and stimulated human neutrophils after disruption by nitrogen cavitation and fractionation on two-layer Percoll density gradients. Light membranes were further separated by high voltage free flow electrophoresis. Mac-1 was determined by an ELISA with monoclonal antibodies that were specific for the alpha-chain (CD11b). In unstimulated neutrophils, 75% of Mac-1 colocalized with specific granules including gelatinase granules, 20% ...

  8. Cooperative Communications inWireless Local Area Networks: MAC Protocol Design and Multi-layer Solutions

    OpenAIRE

    He, Xin

    2012-01-01

    This dissertation addresses cooperative communications and proposes multi-layer solu- tions for wireless local area networks, focusing on cooperative MAC design. The coop- erative MAC design starts from CSMA/CA based wireless networks. Three key issues of cooperation from the MAC layer are dealt with: i.e., when to cooperate (opportunistic cooperation), whom to cooperate with (relay selection), and how to protect cooperative transmissions (message procedure design). In addition...

  9. Opportunistic scheduling for WLAN systems using cross-layer techniques and a distributed MAC

    OpenAIRE

    Cateura, A; Alonso Zárate, Luis Gonzaga; Verikoukis, Christos

    2005-01-01

    This paper proposes a novel Cross-Layer optimization mechanism for WLAN systems and analyses its performance in terms of throughput and mean packet delay. The proposed scheme makes use of a MAC-PHY interaction and a nearoptimum distributed MAC to improve radio channel utilisation. The proposed technique allows the MAC layer to improve the system efficiency by means of certain PHY information knowledge. Simulation results show that the obtained benefits are quite remark...

  10. Detection of Masqueraded Wireless Access Using 802.11 MAC Layer Fingerprints

    OpenAIRE

    Idland, Christer; Jelle, Thomas; Mjølsnes, Stig Frode

    2013-01-01

    Many wireless Internet access operators prefer open local area network (WLAN) access because this reduces the need for user assistance for a variety of smaller devices. A 802.11 MAC spoofer masquerades as an authorized user and gains access by using an already whitelisted MAC address. We consider the scenario where the spoofer waits until the authorized user has finished the session, and then uses the still whitelisted MAC address for the network access. We propose and experiment with “implem...

  11. Performance evaluation of IEEE 802.11 MAC layer in supporting delay sensitive services

    OpenAIRE

    Jyotsna Sengupta; Gurpreet Singh Grewal

    2010-01-01

    Providing QoS requirements like good throughput and minimum access delay are challenging tasks with regard to 802.11 WLAN protocols and Medium Access Control (MAC) functions. IEEE 802.11 MAC layer supports two main protocols: DCF (Distributed Coordination Function) and EDCF (Enhanced Distributed Coordination Function). During the evaluation of EDCF, the performance of various access categories was thedetermining factor. Two scenarios, with same Physical and MAC parameters, one implementing th...

  12. Tournament MAC with Constant Size Congestion Window for WLAN

    CERN Document Server

    Galtier, Jerome

    2007-01-01

    In the context of radio distributed networks, we present a generalized approach for the Medium Access Control (MAC) with fixed congestion window. Our protocol is quite simple to analyze and can be used in a lot of different situations. We give mathematical evidence showing that our performance is tight, in the sense that no protocol with fixed congestion window can do better. We also place ourselves in the WiFi/WiMAX framework, and show experimental results enlightening collision reduction of 14% to 21% compared to the best known other methods. We show channel capacity improvement, and fairness considerations.

  13. Mac configuration management at the Los Alamos National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Marcus, Allan B [Los Alamos National Laboratory

    2010-01-01

    The Los Alamos National Laboratory (LANL) had a need for central configuration management of non-Windows computers. LANL has three to five thousand Macs and an equal number of Linux based systems. The primary goal was to be able to inventory all non-windows systems and patch Mc OS X systems. LANL examined a number of commercial and open source solutions and ultimately selected Puppet. This paper will discuss why we chose Puppet, how we implemented it, and some lessons we learned along the way.

  14. NUEVOS PERFILES LABORALES. EL CASO DE TECÁMAC

    OpenAIRE

    Edgar Torres Escalona; Miguel Ángel Morales Sánchez; Víctor Manuel García Pliego

    2010-01-01

    El presente estudio tiene por objetivo describir la evolución y situación de las PYME ante el impacto de la economía mundial, después del neoliberalismo y más específicamente las PYMES del área de Tecámac estado de México, el trabajo busca establecen la situación del sector comercial industria y de servicios, con respecto al personal laboral que demanda, a partir de sus necesidades de actividades más complejas que la cultura laboral tradicional no tienen. El trabajo en su aspecto metodológico...

  15. A Performance Comparison of Two Real Time WLAN MAC Protocols

    Institute of Scientific and Technical Information of China (English)

    CAO Chun-sheng; LI Feng; ZHANG Wei-dong

    2007-01-01

    By modifying the IEEE 802.11 wireless local area network (WLAN) medium access protocol (MAC), a contention based and a polling based protocol are proposed to deal with the case every station possesses two classes of frame in real time applications. Both protocols can ensure the real time frame only need to wait a determinable bounded time. These two protocols are introduced briefly and a performance comparison between them is made. Simulation results show that each protocol has advantage over the others in certain network condition.

  16. Power-Controlled MAC Protocols with Dynamic Neighbor Prediction for Ad hoc Networks

    Institute of Scientific and Technical Information of China (English)

    LI Meng; ZHANG Lin; XIAO Yong-kang; SHAN Xiu-ming

    2004-01-01

    Energy and bandwidth are the scarce resources in ad hoc networks because most of the mobile nodes are battery-supplied and share the exclusive wireless medium. Integrating the power control into MAC protocol is a promising technique to fully exploit these precious resources of ad hoc wireless networks. In this paper, a new intelligent power-controlled Medium Access Control (MAC) (iMAC) protocol with dynamic neighbor prediction is proposed. Through the elaborate design of the distributed transmit-receive strategy of mobile nodes, iMAC greatly outperforms the prevailing IEEE 802.11 MAC protocols in not only energy conservation but also network throughput. Using the Dynamic Neighbor Prediction (DNP), iMAC performs well in mobile scenes. To the best of our knowledge, iMAC is the first protocol that considers the performance deterioration of power-controlled MAC protocols in mobile scenes and then proposes a solution. Simulation results indicate that DNP is important and necessary for power-controlled MAC protocols in mobile ad hoc networks.

  17. Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia

    Directory of Open Access Journals (Sweden)

    Ashraf Ghali

    2011-01-01

    Full Text Available Purpose: The purpose of this study was to evaluate the hemodynamic, respiratory effects, the recovery profile, surgeons, and patients satisfaction with dexmedetomidine sedation compared with those of propofol sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia. Methods: Sixty patients were enrolled in this prospective, single-blind, randomized study. The patients were divided into two groups to receive either dexmedetomidine (group D or propofol (group P. Sedation level was titrated to a Ramsay sedation scale (RSS of 3. Hemodynamic and respiratory effects, postoperative recovery time, analgesic effects, surgeons and patients satisfaction were assessed. Results: Both groups provided a similar significant reduction in heart rate and mean arterial pressure compared with baseline values. The respiratory rate values of the dexmedetomidine group were significantly higher than those in the propofol group. The oxygen saturation values of the dexmedetomidine group were significantly higher than those of the propofol group. The expired CO 2 was similar in both groups. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both groups. Dexmedetomidine patients have significantly lower visual analog scale for pain than propofol patients. The surgeon satisfaction with patients′ sedation was similar for both groups. The patients′ satisfaction was higher in the dexmedetomidine group. Conclusion: Dexmedetomidine at similar sedation levels with propofol was associated with equivalent hemodynamic effects, maintaining an adequate respiratory function, similar time of discharge from PACU, better analgesic properties, similar surgeon′s satisfaction, and higher patient′s satisfaction. Thus, dexmedetomidine may prove to be a valuable adjuvant for sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia.

  18. Midazolam administration at a department of pediatric radiology: Conscious sedation for diagnostic imaging studies

    International Nuclear Information System (INIS)

    The aims of the study were to evaluate the usefulness of midazolam administration for sedation prior to some diagnostic examinations in children and to present the requirements and rules for sedation in departments of pediatric radiology. From Oct. 2001 to Aug. 2005, two hundred children were investigated after conscious sedation with midazolam. The examinations were: voiding cystourethrography (129), voiding sonocystography (64), barium enema (3), ultrasonography (1), urography (1), X-ray of facial bone (1), and brain CT (1). The children's age-range was 4 months to 13 years 9 months. The decision for sedation was based on conversation with the child and/or parents, their experience with previous examinations, emotional status of the child, and exclusion of contraindications (renal insufficiency, hepatic failure, respiratory/circulatory insufficiency, allergy to benzodiazepines in anamnesis). Midazolam was given orally in a dose of 0.5 mg/kg body weight, 15-20 minutes before examination (already at the department of pediatric radiology). The parents were informed of the possible side effects and what to do after the procedure. All diagnostic procedures with conscious sedation were well tolerated by the children and accepted by the parents. The parents with experience from previous diagnostic procedures indicated that they would want their child to have midazolam again if the examination needed to be repeated. No significant complications were observed in the children receiving midazolam and few adverse effect on voiding during cystourethrography. In three children (2.5, 3, and 5 years old), paradoxical reactions occurred (psychomotor agitation) which disappeared spontaneously after some minutes and had no influence on the procedure. Application of midazolam for conscious sedation diminished anxiety and discomfort from diagnostic procedures and short anterograde amnesia protected the child's mind from painful experience. Conscious sedation should be widely used in

  19. Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function

    Directory of Open Access Journals (Sweden)

    G. Yetkin

    2007-12-01

    Full Text Available Upper gastrointestinal endoscopy is often accompanied by tachycardia which is known to be an important pathogenic factor in the development of myocardial ischemia. The pathogenesis of tachycardia is unknown but the condition is thought to be due to the endocrine response to endoscopy. The purpose of the present study was to investigate the effects of sedation on the endocrine response and cardiorespiratory function. Forty patients scheduled for diagnostic upper gastrointestinal endoscopy were randomized into 2 groups. While the patients in the first group did not receive sedation during upper gastrointestinal endoscopy, the patients in the second group were sedated with intravenous midazolam at the dose of 5 mg for those under 65 years or 2.5 mg for those aged 65 years or more. Midazolam was administered by slow infusion. In both groups, blood pressure, ECG tracing, heart rate, and peripheral oxygen saturation (SpO2 were monitored during endoscopy. In addition, blood samples for the determination of cortisol, glucose and C-reactive protein levels were obtained from patients in both groups prior to and following endoscopy. Heart rate and systolic arterial pressure changes were within normal limits in both groups. Comparison of the two groups regarding the values of these two parameters did not reveal a significant difference, while a statistically significant reduction in SpO2 was found in the sedation group. No significant differences in serum cortisol, glucose or C-reactive protein levels were observed between the sedated and non-sedated group. Sedation with midazolam did not reduce the endocrine response and the tachycardia developing during upper gastrointestinal endoscopy, but increased the reduction in SpO2.

  20. Circadian Modulation of Alcohol-Induced Sedation and Recovery in Male and Female Drosophila.

    Science.gov (United States)

    De Nobrega, Aliza K; Lyons, Lisa C

    2016-04-01

    Delineating the factors that affect behavioral and neurological responses to alcohol is critical to facilitate measures for preventing or treating alcohol abuse. The high degree of conserved molecular and physiological processes makes Drosophila melanogaster a valuable model for investigating circadian interactions with alcohol-induced behaviors and examining sex-specific differences in alcohol sensitivity. We found that wild-type Drosophila exhibited rhythms in alcohol-induced sedation under light-dark and constant dark conditions with considerably greater alcohol exposure necessary to induce sedation during the late (subjective) day and peak sensitivity to alcohol occurring during the late (subjective) night. The circadian clock also modulated the recovery from alcohol-induced sedation with flies regaining motor control significantly faster during the late (subjective) day. As predicted, the circadian rhythms in sedation and recovery were absent in flies with a mutation in the circadian gene period or arrhythmic flies housed in constant light conditions. Flies lacking a functional circadian clock were more sensitive to the effects of alcohol with significantly longer recovery times. Similar to other animals and humans, Drosophila exhibit sex-specific differences in alcohol sensitivity. We investigated whether the circadian clock modulated the rhythms in the loss-of-righting reflex, alcohol-induced sedation, and recovery differently in males and females. We found that both sexes demonstrated circadian rhythms in the loss-of-righting reflex and sedation with the differences in alcohol sensitivity between males and females most pronounced during the late subjective day. Recovery of motor reflexes following alcohol sedation also exhibited circadian modulation in male and female flies, although the circadian clock did not modulate the difference in recovery times between the sexes. These studies provide a framework outlining how the circadian clock modulates alcohol

  1. Similarities and differences between continuous sedation until death and euthanasia: professional caregivers' attitudes and experiences: a focus group study

    OpenAIRE

    Anquinet, Livia; Raus, Kasper; Sterckx, Sigrid; Smets, Tinne; Deliens, Luc; Rietjens, Judith

    2013-01-01

    Background: According to various guidelines about continuous sedation until death, this practice can and should be clearly distinguished from euthanasia, which is legalized in Belgium. Aim: To explore professional caregivers' perceptions of the similarities and differences between continuous sedation until death and euthanasia. Design: Qualitative data were gathered through focus groups. Questions pertained to participants' perceptions of continuous sedation. The focus groups were recorded an...

  2. Determination of a sedative protocol for use in California sea lions (Zalophus californianus) with neurologic abnormalities undergoing electroencephalographic examination.

    Science.gov (United States)

    Dennison, Sophie; Haulena, Martin; Williams, D Colette; Dawson, John; Yandell, Brian S; Gulland, Frances M D

    2008-12-01

    Sedation in sea lions exhibiting abnormal neurologic signs may require modification of established sedatior protocols because of the likely interaction between effects of the sedative and physiologic changes in diseased animals The effects of two sedative combinations, 0.07 mg/kg medetomidine and 0.07 mg/kg medetomidine plus 0.2 mg/kg butorphanol, were compared between California sea lions (Zalophus californianus) with signs of neurologic dysfunctior (n=33) and without neurologic signs (n=8). Sedation depth was scored on a scale of 0 (no effect) to 4 (profound sedation) assessed by response to auditory, tactile, and visual stimuli at the time of perceived maximal sedative effect In the medetomidine-alone group, sea lions with neurologic signs attained a median sedation score of 4 compared to a median sedation score of 1 in the clinically normal sea lions. Sea lions with and without neurologic signs giver medetomidine-butorphanol attained a median sedation score of 4. No statistically significant difference in time to induction and respiratory rate was found between the two sedation protocols in all sea lions. In the sea lions with neurologic signs, the recovery time from medetomidine-butorphanol sedation was prolonged (P < 0.01) and minimum recorded heart rates, although remaining within normal physiologic limits, were lower (P = 0.02) when compared to the sea lions administered medetomidine alone. Muscle jerks were observed in many animals given medetomidine-butorphanol and were detrimental to the diagnostic quality of the electroencephalogram (EEG) recording. Medetomidine alone at a dose rate of 0.07 mg/kg thus provides adequate and safe sedation in sea lions with neurologic signs undergoing EEG evaluation. PMID:19110694

  3. MAC-Bridging for Multi-PHYs Communication in BAN

    Directory of Open Access Journals (Sweden)

    Kyung Sup Kwak

    2010-11-01

    Full Text Available Body Area Network (BAN is a collection of low-power, miniaturised, and intelligent sensor nodes that are used for unobtrusive and ambulatory health monitoring of a patient without any additional constraints. These nodes operate on different frequency bands or Multiple Physical Layers (Multi-PHYs. Additionally, some BAN applications demand a logical connection between different nodes working on different Multi-PHYs. In this paper, the idea of controlling Multi-PHYs using one MAC protocol is introduced. Unlike existing procedures where different nodes working on different channels are connected at the link layer bridging/switching, the proposed procedure called bridging logically connects them at the MAC layer. In other words, the bridge is used to relay or filter packets between different PHYs in the same BAN. Numerical approximations are presented to analyze the stochastic behaviour of the bridges, all of them having Multi-PHYs interfaces. The MICS and the ISM bands are regarded as PHY1 and PHY2, respectively. The performance results are presented for PHY2 (given that data is already received from PHY1 in terms of probability of successful transmission, number of failed requests, power consumption, and delay. Simulations are conducted to validate the analytical results. It can be seen that the deployment of multiple bridges along with the corresponding nodes allows Multi-PHYs communication with high transmission probability, low power consumption, and tolerable delay.

  4. Is Kyoto Fatally Flawed? An Analysis with MacGEM

    International Nuclear Information System (INIS)

    In this paper we present some numerical simulations with the MacGEM model to evaluate the consequences of the recent Marrakesh agreements and the defection of the USA for the Kyoto Protocol. MacGEM is a global marginal abatement cost model for carbon emissions from fossil fuel use based on the GEM-E3-World general equilibrium. Nonparticipation of the USA causes the equilibrium carbon price in Annex B countries to fall by approximately 50% since an important share of permit demand falls out. Carbon sinks enhancement activities enable Parties to fulfil their reduction commitment at lower compliance costs and cause the equilibrium permit price to decrease by 40%. Finally, it is shown that the former Soviet Union and central European countries have substantial monopoly power in the Kyoto carbon permit market. We conclude that the recent accords have eroded completely the Kyoto Protocol's emission targets but that they have the merit to have saved the international climate change negotiation framework

  5. Ímynd M.A.C. Cosmetics

    OpenAIRE

    Ásrún Ísleifsdóttir 1991

    2016-01-01

    Í þessari ritgerð er ímynd M.A.C Cosmetics könnuð. Snyrtivöruiðnaðurinn hefur lengi verið til staðar en þó aldrei verið jafn vinsæll og í dag. Förðunarfræðingum og förðunarskólum fer ört fjölgandi og aukning í kaupum á snyrtivörum helst í hendur við þá fjölgun. Þessar staðreyndir valda því að samkeppnin á snyrtivörumarkaðnum er mikil og ímynd snyrtivörumerkja hefur aldrei verið jafn mikilvæg og nú. M.A.C Cosmetics er gríðarlega vinsælt snyrtivörumerki um heim allan og vinsældir þess gera ...

  6. Learning Microsoft Excel 2011 for Mac video training DVD

    CERN Document Server

    Vaccaro, Guy

    2011-01-01

    In this video tutorial for Microsoft Excel 2011 For Mac, expert author Guy Vaccaro teaches you to effectively utilize the features and functions of Excel through project based learning. You will complete various projects, and along they way learn to leverage the power of the most important features Excel 2011 has to offer the Mac user. Starting your training course with the creation of a spreadsheet to record and monitor sales data, you will learn the basics of what you can do with a spreadsheet. You will then move on to creating a Profit and Loss report, learning formulas along the way. Moving to score sheets for a sports day, you will discover conditional based formatting, lookups, and more. You then create a functional expense claim form, advancing your Excel expertise. Moving on to a sales contact management sheet, you will discover how you can manipulate text, and even create mail merges from Excel. Finally, you will utilize all your knowledge thus far to create a sales report, including charts, pivot ta...

  7. Analgesic, Sedative and Hemodynamic Effects of Dexmedetomidine Following Major Abdominal Surgeries: A Randomized, Double Blinded Comparative Study with Morphine

    Directory of Open Access Journals (Sweden)

    Khaled Taha

    2003-09-01

    Full Text Available This was a randomized double-blinded study; in which 60 ASAI-II adult patients scheduled for major abdominal surgeries (colostomy, radical cystectomy, major gynecological surgery, and abdominal vascular surgery were received standard general anesthesia. Twenty minutes before the anticipated end of surgery, patients were randomized into two equal groups: dexmedetomidine group (group D and morphine group (group M. Group D received dexmedetomidine IV infusion 4µg/kg/h for 15 minutes (1µg/Kg followed by 0.4µg/kg/h for 3h. Group M received morphine sulfate IV (0.07mg/kg. All patients were given a morphine patient controlled analgesia (PCA pump in the post anesthesia care unit (PACU, delivering IV morphine 2mg with a lockout time of 5 minutes if pain score assessed through visual analog scale (VAS was more than 5 at any given 5-min assessment. During the PACU recovery period, morphine consumption; pain and sedation scores; hemodynamic variables (heart rate, mean arterial blood pressure, oxygen saturation and respiratory rate; and postoperative nausea, retching and vomiting (PONV were recorded every 30 min for 3h (study period by a member of staff blinded to the treatment. The study demonstrated that the use of dexmedetomidine led to significant decrease in the total amount of morphine consumed throughout the entire PACU recovery period (P0.05; significant decrease in mean arterial pressure (P0.05; without any significant changes in oxygen saturation (P<0.05 or respiratory rate (P<0.05. In conclusion, dexmedetomidine exhibited both analgesic and sedative properties. The associated cardiovascular protective pharmacological profile and the lack of respiratory depression made it potentially extremely interesting for postoperative analgesia after major abdominal surgeries.

  8. Is Radical Bowel Cancer Resection Under Local Anaesthesia and Sedation Feasible?

    Science.gov (United States)

    Sebastian, J; Sran, H; Marzouk, D

    2015-08-01

    Some patients with bowel cancer have significant comorbidities, making them unfit for major surgery under general anaesthesia. However, treatment without surgery offers no possibility of cure, and furthermore, symptom control may be poor. We investigated the possibility of performing these resections under local anaesthesia in patients with a slim body habitus in a cohort of patients rejected for general anaesthesia. Eight patients (4 M, 4 F) aged 77-89 were included in this study. All had significant comorbidities and were deemed unfit for general anaesthesia by the consultant anaesthetist in charge of pre assessing high-risk patients. All patients had undergone a thorough assessment, which included P-POSSUM scoring. The recruited patients underwent a careful and fully informed consenting process, leading to standard cancer resections. These resections occurred between 2005 and 2012, under combined local anaesthesia and sedation. The operations undertaken were four right hemicolectomies (for caecal cancer), two Hartmann's procedures (for sigmoid cancer), one Hartmann's procedure with en bloc small bowel resection (for sigmoid cancer invading small bowel) and one transverse colectomy (for mid transverse colon cancer). Seven patients survived radical surgery without complications, although one died from an unrelated cause 8 months after surgery. One of these surviving patients subsequently underwent CABG and further bowel surgery under GA 2 years later for a metachronous sigmoid cancer. There was one postoperative death due to cardiogenic shock on the third postoperative day. Radical cancer resections under local anaesthesia are feasible in suitably selected high-risk patients with acceptable mortality and comparable medium- to long-term results. PMID:26702231

  9. Conscious sedation for endoscopic and non-endoscopic interventional gastrointestinal procedures: meeting patients' expectations, missing the standard

    International Nuclear Information System (INIS)

    AIM: To assess the level of sedation, patient satisfaction and frequency of unplanned events with conscious sedation for interventional procedures. MATERIALS AND METHODS: One hundred and seventeen patients were assessed prospectively before, during and after procedures. Blood pressure, pulse, oxygen saturation and sedation level were monitored and patients followed up after 24 h. Sedation was scored after drugs were given in accordance with an established protocol. Doses were recorded, as were patients' weight, age and ASA grade and any unplanned events and their management. RESULTS: Seventy-six of the 117 patients (65%) had no unplanned event, 20 (17.1%) became agitated, 15 (12.8%) hypotensive, three (2.6%) hypoxic and three (2.6%) had more than one response. Twelve patients required active management. Fifty-two (44.4%) had a sedation level of ≤3 (responsive to verbal commands), but 39 (33.3%) reached level 6. Median doses were midazolam 6 mg (1-20 mg) and pethidine 50 mg (12.5-100 mg). Ninety-three percent were satisfied with their sedation. No adverse effects were observed after 24 h. CONCLUSION: Despite using a sedation protocol, unplanned events occurred in 35% (95% CI=27-44%) of patients, although not all required active management. The sedation levels reached in some exceeded guidelines. Unplanned events were commoner with increased sedation level. Patient satisfaction was high and no permanent damage was observed

  10. Serum Mac-2 binding protein is a novel biomarker for chronic pancreatitis

    Science.gov (United States)

    Maekawa, Tomohiro; Kamada, Yoshihiro; Ebisutani, Yusuke; Ueda, Makiko; Hata, Tomoki; Kawamoto, Koichi; Takamatsu, Shinji; Mizutani, Kayo; Shimomura, Mayuka; Sobajima, Tomoaki; Fujii, Hironobu; Nakayama, Kotarosumitomo; Nishino, Kimihiro; Yamada, Makoto; Kumada, Takashi; Ito, Toshifumi; Eguchi, Hidetoshi; Nagano, Hiroaki; Miyoshi, Eiji

    2016-01-01

    AIM: To determine the efficacy of Mac-2 binding protein (Mac-2bp) for diagnosis of chronic pancreatitis. METHODS: Fifty-nine healthy volunteers (HV), 162 patients with chronic pancreatitis (CP), and 94 patients with pancreatic ductal adenocarcinoma (PDAC) were enrolled in this study. We measured serum Mac-2bp using our developed enzyme-linked immunosorbent assay kit. Additional biochemical variables were measured using an automated analyzer (including aminotransferase, alanine aminotransferase, γ-glutamyltransferase, alkaline phosphatase, triglyceride, C-reactive protein, and amylase levels) or chemiluminescent enzyme immunoassay (carbohydrate antigen 19-9 and carcinoembryonic antigen). The ability of Mac-2bp to predict CP diagnosis accurately was assessed using receiver operating characteristic (ROC) analyses. RESULTS: Serum Mac-2bp levels were significantly increased in CP patients compared to HV (P < 0.0001) and PDAC patients (P < 0.0001). Area under the ROC curve values of Mac-2bp for the discrimination of CP from HV and PDAC were 0.727 and 0.784, respectively. Multivariate analyses demonstrated that serum Mac-2bp levels were independent determinants for CP diagnosis from HV and PDAC patients. Immunohistological staining showed that Mac-2bp was expressed faintly in the pancreas tissues of both CP and PDAC patients. Serum aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, alkaline phosphatase, and triglyceride levels were significantly higher in patients with CP or PDAC. Serum Mac-2bp levels were highly correlated with protein levels of alanine aminotransferase, γ-glutamyltransferase, and C-reactive protein, but not amylase, suggesting that the damaged liver produces Mac-2bp. CONCLUSION: Measurement of serum Mac-2bp may be a novel and useful biomarker for CP diagnosis as well as liver fibrosis in the general population. PMID:27158210

  11. A Systematic Review of Factors Associated With Utilization of Monitored Anesthesia Care for Gastrointestinal Endoscopy

    Science.gov (United States)

    Saleh, Ashraf; Rubenstein, Joel H.

    2016-01-01

    Utilization of monitored anesthesia care (MAC) for gastrointestinal endoscopy has increased markedly over the past decade, leading to significant additional health care expenditures. However, the extent to which certain patient-, provider-, and facility-level factors lead to MAC utilization is unclear. A systematic review of 13 studies evaluating influential factors associated with MAC utilization for colonoscopy and/or esophagogastroduodenoscopy was conducted. Multiple studies revealed significant increases in MAC utilization since the early 2000s, with substantial regional variation. The most influential patient-related factors associated with MAC utilization include female sex and diagnostic procedural indication. Other patient-related factors with weaker associations or conflicting evidence include older age, comorbidity, higher patient income, and white/non-Hispanic race. The impact of patient substance use and/or prescription medication use has been minimally studied. The strongest provider- and facility-level factors associated with MAC use are a surgeon endoscopist and nonhospital site of service. Other factors with weaker associations include facility endoscopy volume and endoscopist years of experience. Further qualitative and quantitative health services research is needed to better understand the root cause of the rising trend of MAC utilization and to develop policies for encouraging appropriate use of MAC. PMID:27493596

  12. Effects of excitative and sedative music on subjective and physiological relaxation.

    Science.gov (United States)

    Iwanaga, M; Tsukamoto, M

    1997-08-01

    Previous investigations using heart rate as a measure have not clarified the excitative-sedative effects of music. One of the sources of this failure was considered to be use of the index of heart rate. The present purpose was to examine the excitative-sedative effect of music on indices of the sympathetic and the parasympathetic nervous activities through spectral analysis of heart rate. The presented stimuli were three excitative musical pieces and three sedative ones. Subjective feelings about music were measured by an adjective checklist concerning musical activity. Heart-rate variabilities divided into two components of Low Frequency, mainly affected by the sympathetic nervous system and of High Frequency, mainly affected by the parasympathetic nervous system. Six types of heart-rate indices were employed: (1) mean increments from posttrial base, (2) coefficient of variances of heart rate, (3) mean powers of Low Frequency, (4) coefficient of component variances of Low Frequency, (5) mean powers of High Frequency, and (6) coefficient of component variances of High Frequency. From the factor analysis based on responses to an adjective checklist, there was a single major activity factor. Activity scores showed some were high during excitative pieces and others low during sedative ones. For heart rate, excitative-sedative effects of music were observed only in indices related to High Frequency. This result suggests that musical effect was observed in measures of the parasympathetic nervous system but not in the sympathetic nervous system. PMID:9293589

  13. Ketamine and midazolam sedation for pediatric gastroinntestinal endoscopy in the Arab world

    Institute of Scientific and Technical Information of China (English)

    Mohamad-Iqbal S Miqdady; Wail A Hayajneh; Ruba Abdelhadi; Mark A Gilger

    2011-01-01

    AIM: To evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation during pediatric endoscopy in the Arab world. METHODS: A retrospective cohort study of all pediatric endoscopic procedures performed between 2002-2008 at the shared endoscopy suite of King Abdullah University Hospital, Jordan University of Science & Technology, Jordan was conducted. All children were > 1 year old and weighed > 10 kg with American Society of Anesthesiologists class 1 or 2. Analysis was performed in terms of sedation-related complications (desaturation, respiratory distress, apnea, bradycardia, cardiac arrest, emergence reactions), adequacy of sedation, need for sedation reversal, or failure to complete the procedure. RESULTS: A total of 301 patients (including 160 males) with a mean age of 9.26 years (range, 1-18 years) were included. All were premedicated with atropine; and 79.4% (239/301) had effective and uneventful sedation. And 248 (82.4%) of the 301 patients received a mean dose of 0.16 mg/kg (range, 0.07-0.39) midazolam and 1.06 mg/kg (range, 0.31-2.67) ketamine, respectively within the recommended dosage guidelines. Recommended maximum midazolam dose was exceeded in 17.6% patients [34 female (F):19 male (M), P = 0.003] and ketamine in 2.7% (3 M:5 F). Maximum midazolam dose was more likely to be exceeded than ketamine (P 1 year and weighing > 10 kg without co-morbidities.

  14. Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study

    Energy Technology Data Exchange (ETDEWEB)

    Stokland, E.; Jacobsson, B.; Ljung, B. [Dept. of Paediatric Radiology and Clinical Physiology, The Queen Silvia Children' s Hospital, Gothenburg (Sweden); Andreasson, S. [Dept. of Paediatric Anaesthesiology, The Queen Silvia Children' s Hospital, Gothenburg (Sweden); Jodal, U. [Dept. of Paediatrics, The Queen Silvia Children' s Hospital, Gothenburg (Sweden)

    2003-04-01

    Background: Sedation with midazolam facilitates the performance of diagnostic procedures in children, including voiding cystourethrography (VCUG). However, the influence of sedation on voiding and imaging results have not been adequately evaluated. Objective: Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination. Materials and methods: The study was prospective, randomized and double-blind, and included 95 children, 48 in the midazolam group (median age 2.2 years) and 47 in the placebo group (median age 3.2 years). The evaluation included the child's/parent's experience of the VCUG, as well as the examination results. Results: The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group (P < 0.001). Forty-six of 48 children sedated with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo (NS). There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups. Conclusions: When sedation is required to perform VCUG in children, midazolam can be used without negative effect on the outcome of the examination. (orig.)

  15. Optimization of contrast-enhanced multidetector abdominal computed tomography in sedated canine patients.

    Science.gov (United States)

    Fields, Erica L; Robertson, Ian D; Brown, James C

    2012-01-01

    A major disadvantage of computed tomography for abdominal screening in dogs has been the need for general anesthesia to prevent motion artifacts. With multidetector helical CT, it is possible to decrease examination time, allowing patients to be scanned under sedation. It is also desirable to decrease tube loading to prolong x-ray tube life. To develop a protocol that will allow for examination of sedated patients with minimal image artifacts, milliamperage (mA) and helical pitch were varied, providing 16 experimental scan protocols. A standard clinical protocol was also tested, providing 17 protocols for evaluation. These protocols were tested, using a standard CT phantom, canine tissues in a water bath, and a canine cadaver. The cadaver images were scored semiquantitatively by three reviewers to determine the protocol with the best combination of speed and minimal image artifact. The optimized protocol was then applied to 27 sedated canine patients of three body weight categories. The images obtained were compared to the standard protocol by two reviewers for presence of motion, streak, and quantum mottle artifacts. There was significantly more streak artifact noted by one observer using the optimized study protocol, but no significant difference in any other category. Scanning under sedation was well tolerated in all patients, and sedated CT examination is a promising tool for screening abdominal disease in dogs. PMID:22612282

  16. Dutch physicians on the role of the family in continuous sedation.

    Science.gov (United States)

    van Tol, Donald G; Kouwenhoven, Pauline; van der Vegt, Bea; Weyers, Heleen

    2015-03-01

    In order to relieve intractable suffering of a terminal patient, doctors may decide to continuously sedate a patient until the end of life. Little research is done on the role the family plays during the process of continuous sedation. This study aims to get a view of doctors' experiences with continuous sedation, and the role of the family throughout that process. We held in-depth interviews with 48 doctors (19 general practitioners, 16 nursing home doctors and 18 medical specialists). Participants were selected varying in experience and opinions concerning end-of-life decisions. Dutch physicians experience the role of family in continuous sedation as important and potentially difficult. Difficulties may rise especially during the final stages when the patient is no longer conscious and family members are waiting for death to come. Disagreement may arise between physician and family, concerning the dignity of the dying process or the question whether the sedated patient is suffering or not. Some physicians report they hastened the dying process, in order to relieve the families' suffering. PMID:24595486

  17. Medetomidine sedation in dogs and cats: a review of its pharmacology, antagonism and dose.

    Science.gov (United States)

    Cullen, L K

    1996-09-01

    Medetomidine is a relatively new sedative analgesic in dogs and cats but some precautions are required when using it. It is a potent alpha 2-adrenoceptor agonist and stimulates receptors centrally to produce dose-dependent sedation and analgesia and receptors centrally and peripherally to cause marked bradycardia and decrease the cardiac output. While hypotension occurs frequently, higher doses of the sedative can raise the blood pressure due to an affect on peripheral receptors. Slowing of the respiratory rate is a frequent effect of medetomidine with some dogs showing signs of cyanosis. Other actions that follow medetomidine use are slowing of gastrointestinal motility, hypothermia, changes to endocrine function and, occasionally, vomiting and muscle twitching. The clinical use of medetomidine in dogs and cats is discussed. Recommended dose rates are presented along with precautions that should be taken when it is used alone for sedation, as an anaesthetic premedicant or in combination with ketamine, propofol or opioids. Hypoxaemia occurs frequently in dogs given medetomidine and propofol. The actions of medetomidine can be rapidly reversed with the specific alpha 2-adrenoceptor antagonist, atipamezole, which is an advantage because undesirable and sedative actions of medetomidine can be terminated. PMID:8885463

  18. Risk of sedation for diagnostic esophagogastroduodenoscopy in obstructive sleep apnea patients

    Directory of Open Access Journals (Sweden)

    Jae Myung Cha

    2013-01-01

    Full Text Available AIM: To investigate whether patients with obstructive sleep apnea (OSA are at risk of sedation-related complications during diagnostic esophagogastroduodenoscopy (EGD. METHODS: A prospective study was performed in consecutive patients with OSA, who were confirmed with full-night polysomnography between July 2010 and April 2011. The occurrence of cardiopulmonary complications related to sedation during diagnostic EGD was compared between OSA and control groups. RESULTS: During the study period, 31 patients with OSA and 65 controls were enrolled. Compared with the control group, a higher dosage of midazolam was administered (P = 0.000 and a higher proportion of deep sedation was performed (P = 0.024 in the OSA group. However, all adverse events, including sedation failure, paradoxical responses, snoring or apnea, hypoxia, hypotension, oxygen or flumazenil administration, and other adverse events were not different between the two groups (all P > 0.1. Patients with OSA were not predisposed to hypoxia with multivariate logistic regression analysis (P = 0.068. CONCLUSION: In patients with OSA, this limited sized study did not disclose an increased risk of cardiopulmonary complications during diagnostic EGD under sedation.

  19. Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study

    International Nuclear Information System (INIS)

    Background: Sedation with midazolam facilitates the performance of diagnostic procedures in children, including voiding cystourethrography (VCUG). However, the influence of sedation on voiding and imaging results have not been adequately evaluated. Objective: Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination. Materials and methods: The study was prospective, randomized and double-blind, and included 95 children, 48 in the midazolam group (median age 2.2 years) and 47 in the placebo group (median age 3.2 years). The evaluation included the child's/parent's experience of the VCUG, as well as the examination results. Results: The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group (P < 0.001). Forty-six of 48 children sedated with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo (NS). There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups. Conclusions: When sedation is required to perform VCUG in children, midazolam can be used without negative effect on the outcome of the examination. (orig.)

  20. FF-MAC : Fast Forward IEEE 802.15.4 MAC Protocol for Real-Time Data Transmission

    Directory of Open Access Journals (Sweden)

    Khalid EL GHOLAMI

    2013-02-01

    Full Text Available This paper presents a Fast Forward MAC layer designed for hard real-time applications in wireless sensor networks. This protocol is an enhancement to the IEEE 802.15.4 standard MAC layer proposed for Low-Rate Personal Area Network. The energy conservation mechanism proposed by the current standard is quite efficient and very flexible. This flexibility comes from the ability to configure different duty cycles to meet specific application’s requirements. However, this mechanism has a considerable impact on the end-to-end delay. Our approach resolves the energy delay trade-off by avoiding the storage of the real-time data in the coordinator during sleep time.A new superframe structure is adopted and a deterministic reception scheduling is used. All the simulations were done using the network simulator 2 ‘NS-2’. The simulations outcomes show that this new proposed protocol performs better than the currentstandard and reduces considerably the end-to-end delay even in low duty cycle networks. Our protocol can also provide a delay bound for all network configurations which allows a better choice of the duty cycle for the required delay.

  1. 78 FR 65145 - Federal Agricultural Mortgage Corporation Funding and Fiscal Affairs; Farmer Mac Capital Planning

    Science.gov (United States)

    2013-10-31

    ... distributions before making them. \\1\\ 78 FR 5320. II. Background A. Farmer Mac Farmer Mac is an institution of... Plans, 76 FR 74631 (December 1, 2011); the FRS's proposed rule, Enhanced Prudential Standards and Early Remediation Requirements for Covered Companies, 77 FR 594 (January 5, 2012); the U.S. banking agencies'...

  2. 75 FR 27951 - Federal Agricultural Mortgage Corporation Funding and Fiscal Affairs; Farmer Mac Investments and...

    Science.gov (United States)

    2010-05-19

    .... 2279aa-2279cc et seq.) \\2\\ See section 8.13 of the Act. A fundamental premise of finance is the natural... purpose embedded in its corporate mission that arises from having been created by an act of Congress. The... by Farmer Mac, are known as the ``Farmer Mac II'' program. During 2008, the markets in corporate...

  3. HYBRID MAC PROTOCOL FOR WIRELESS SENSOR NETWORKS USED IN TIME CRITICAL APPLICATIONS

    Directory of Open Access Journals (Sweden)

    Pandeeswaran Chelliah

    2014-05-01

    Full Text Available In this paper a H-MAC protocol (Hybrid Medium Access Control protocol has been proposed, which is an energy efficient and low latency MAC protocol which uses node ID method to assign priority for certain wireless sensor nodes that are assumed to be present in critical loops for an industrial process control domain. H-MAC overcomes some of the limitations in the existing approaches. In the case of industrial automation scenario, certain sensor loops are found to be time critical, where data’s have to be transferred without any further delay, as failure in immediate transmission leads to catastrophic results for humans as well as machinery in industrial domain. The proposed H-MAC protocol is simulated in NS2 environment, from the result it is observed that the proposed protocol provides better performance compared to the conventional MAC protocols mentioned in the recent literature for the conceded problem. A MAC protocol which provides both energy saving mechanism and that can handle emergency situation is the most desired for any industry. In any industry time and mission critical scenarios requires strict timeliness and reliability along with the energy efficiency. However there are dynamic and harsh environmental conditions for which the MAC protocol must survive and do transmission accordingly. The dynamic changes in topology must also be adapted so that the nodes are in constant link to the destination. Most of the existing MAC protocols have been identified as they face a number of limitations for industrial application domain.

  4. Geochemistry and petrography of the MacAlpine Hills lunar meteorites

    Science.gov (United States)

    Lindstrom, Marilyn M.; Mckay, David S.; Wentworth, Susan J.; Martinez, Rene R.; Mittlefehldt, David W.; Wang, Ming-Sheng; Lipschutz, Michael E.

    1991-01-01

    MacAlpine Hills 88104 and 88105, anorthositic lunar meteorites recovered form the same area in Antartica, are characterized. Petrographic studies show that MAC88104/5 is a polymict breccia dominated by impact melt clasts. It is better classified as a fragmental breccia than a regolith breccia. The bulk composition is ferroan and highly aluminous (Al2O3-28 percent).

  5. Scheduled MAC in Beacon Overlay Networks for Underwater Localization and Time-Synchronization

    NARCIS (Netherlands)

    Kleunen, van Wouter; Meratnia, Nirvana; Havinga, Paul J.M.

    2011-01-01

    In this article we introduce a MAC protocol designed for underwater localization and time-synchronisation. The MAC protocol assumes a network of static reference nodes and allows blind nodes to be localized by listening-only to the beacon messages. Such a system is known to be very scalable. We show

  6. Self-Admitted Pretensions of Mac Users on a Predominantly PC University Campus

    Science.gov (United States)

    Firmin, Michael W.; Wood, Whitney L. Muhlenkamp; Firmin, Ruth L.; Wood, Jordan C.

    2010-01-01

    The present qualitative research study addressed the overall research question of college students' pretention dynamics in the context of a university setting. Thirty-five Mac users were interviewed on a university campus that exclusively supports PC machines. Mac users shared four self-admitted pretensions related to using Macintosh computers.…

  7. Quantitation of intracellular Mac-1 (CD11b/CD18) pools in human neutrophils.

    Science.gov (United States)

    Jones, D H; Anderson, D C; Burr, B L; Rudloff, H E; Smith, C W; Krater, S S; Schmalstieg, F C

    1988-12-01

    The adhesive glycoprotein Mac-1 (CD11b/CD18) of the CD11/CD18 complex contributes to multiple neutrophil inflammatory functions. Activation of neutrophils by chemotactic stimuli results in a rapid, protein synthesis-independent increase in surface Mac-1 derived from incompletely defined intracellular compartments. Therefore, we developed a novel quantitative lectin immunoblot technique to define intracellular pools of Mac-1 in subcellular neutrophil fractions resolved on discontinuous Percoll gradients. In cavitates of unstimulated neutrophils, 30% and 26% of total Mac-1 was identified in beta [1.10 gm/ml; vitamin B12 binding protein (vit B12 B.P.)-rich] or pre-gamma (1.07 gm/ml; vit B12 B.P.-poor) granular fractions, respectively, whereas 24% was associated with the plasma membrane-rich gamma (1.06 gm/ml) fractions. N-formyl-methionyl-leucyl-phenylalanine (fMLP) stimulation (10(-8) M, 15 min, 37 degrees C) significantly diminished Mac-1 in pre-gamma (-18% of total, P less than 0.05) but not beta fractions (+6% of total). Under these conditions, the content of Mac-1 in gamma fractions increased 13% in association with four- to eightfold increase in surface Mac-1 expression (OKM-1 binding). These findings suggest that chemotactic stimuli increase plasma membrane and/or surface Mac-1 on human neutrophils by mobilizing a novel intracellular granule pool. PMID:2903896

  8. Comparison of proposed Solar Energy Harvesting Energy Efficient MAC (SEHEE-MAC with ZigBee and Preamble MAC for SHM in Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    Mrs. Swati V. Sankpal

    2011-09-01

    Full Text Available Wireless sensor networks are appealing to researchers due to their wide range of application potential in areas such as target detection and tracking, environmental monitoring, industrial processmonitoring, and tactical systems. Wireless sensors and sensor networks are emerging as sensing paradigms that the structural engineering field has begun to consider as substitutes for traditional tethered monitoring. Energy consumption is a perennial issue in the design of wireless sensor networks which typically rely on portable sources like batteries for power. Energy consumption is a prime issue in the design of wireless sensor networks which typically rely on portable sources like batteries for power. To improve the life time of WSN in outdoor application like SHM,this work evaluate the performance of new proposed scheme-Solar Energy Harvesting Energy Efficient Multiple Access Control(SEHEE-MAC.The results are compared with ZigBee and Preamble protocols for solar harvesting sensor networks, focusing on energy required for sending uplink data packets and node lifetime. We analyzed the performance based on these two metrics.

  9. Research on low-latency MAC protocols for wireless sensor networks

    Science.gov (United States)

    He, Chenguang; Sha, Xuejun; Lee, Chankil

    2007-11-01

    Energy-efficient should not be the only design goal in MAC protocols for wireless sensor networks, which involve the use of battery-operated computing and sensing devices. Low-latency operation becomes the same important as energy-efficient in the case that the traffic load is very heavy or the real-time constrain is used in applications like tracking or locating. This paper introduces some causes of traditional time delays which are inherent in a multi-hops network using existing WSN MAC protocols, illuminates the importance of low-latency MAC design for wireless sensor networks, and presents three MACs as examples of low-latency protocols designed specially for sleep delay, wait delay and wakeup delay in wireless sensor networks, respectively. The paper also discusses design trade-offs with emphasis on low-latency and points out their advantages and disadvantages, together with some design considerations and suggestions for MAC protocols for future applications and researches.

  10. An Energy-Efficient, Application-Oriented Control Algorithm for MAC Protocols in WSN

    Science.gov (United States)

    Li, Deliang; Peng, Fei; Qian, Depei

    Energy efficiency has been a main concern in wireless sensor networks where Medium Access Control (MAC) protocol plays an important role. However, current MAC protocols designed for energy saving have seldom considered multiple applications coexisting in WSN with variation of traffic load dynamics and different QoS requirements. In this paper, we propose an adaptive control algorithm at MAC layer to promote energy efficiency. We focus on the tradeoff relation between collisions and control overhead as a reflection of traffic load and propose to balance the tradeoff under the constraints of QoS options. We integrate the algorithm into S-MAC and verify it through NS-2 platform. The results demonstrate the algorithm achieves observable improvement in energy performance while meeting QoS requirement for different coexisting applications in comparison with S-MAC.

  11. Design of a Novel Optimized MAC Unit using Modified Fault Tolerant Vedic Multiplier

    Directory of Open Access Journals (Sweden)

    R. Deepa

    2014-08-01

    Full Text Available In this study, the design of optimized Multiplication and Accumulation (MAC unit with modified Vedic multiplier is presented. To design a MAC unit, efficient multiplier is used to increase speed and to reduce area and power. Conventional MAC is designed using without fault tolerant Vedic multiplier. But it consumes more area and power. And also less delay. So MAC unit is changed to design the efficient Vedic multiplier. Conventional MAC unit with regular Vedic multiplier is not working for some of the inputs condition. To overcome this fault, novel Vedic multiplier is proposed and designed using less half adder and Full Adder. Simulation is carried out using Modelsim 6.3c. Synthesis and Implementation is carried out using Xilinx and FPGA Spartan 3.

  12. Interference Analysis Status and Plans for Aeronautical Mobile Airport Communications System (AeroMACS)

    Science.gov (United States)

    Kerczewski, Robert J.; Wilson, Jeffrey D.

    2010-01-01

    Interference issues related to the operation of an aeronautical mobile airport communications system (AeroMACS) in the C-Band (specifically 5091-5150 MHz) is being investigated. The issue of primary interest is co-channel interference from AeroMACS into mobile-satellite system (MSS) feeder uplinks. The effort is focusing on establishing practical limits on AeroMACS transmissions from airports so that the threshold of interference into MSS is not exceeded. The analyses are being performed with the software package Visualyse Professional, developed by Transfinite Systems Limited. Results with omni-directional antennas and plans to extend the models to represent AeroMACS more accurately will be presented. These models should enable realistic analyses of emerging AeroMACS designs to be developed from NASA Test Bed, RTCA 223, and European results.

  13. The identification of MacSe in Streptococcus equi ssp. equi

    Institute of Scientific and Technical Information of China (English)

    Jiande YANG; Yanfei LIU; Jun XU; Jifei MA

    2009-01-01

    Streptococcus equi subsp, equi (S. equi ssp. equi) causes equine strangles, a highly contagious and widespread purulent lymphadenitis of the head and neck. We have identified MacSe, a novel protein of S. equi, by screening a phage library of 3-8 kb random DNA fragments of S. equi CF32. MacSe shares 62% and 67.5% amino acid homology with Mac5005 and Mac8345 of S. pyogenes respectively. Expression during infection was shown by strong reactivity of the protein with convalescent sera and mucosal wash IgA of ponies infected by commingling exposure. Release into the culture medium was detected during the log phase of growth. Dose dependent anti-phagocytic activity for equine neutrophils involved interaction of MacSe with C3 and neutrophils.

  14. Self-Adaptive and Energy-Efficient MAC Protocol Based on Event-Driven

    Directory of Open Access Journals (Sweden)

    Xin Hou

    2013-01-01

    Full Text Available Combined with WSN MAC layer protocol characteristics and design requirements, according to the characteristic of WSN monitoring application requirements, this paper puts forward a method based on event driven MAC protocol. The agreement algorithm is to solve the problem of network congestion and node energy unnecessary consumption cause by a large number of redundant monitoring data transceiver. It is a kind of adaptive low power consumption of the MAC layer protocol, which is pointed out based on theoretical foundation of S_MAC protocol, made use of the event driven mechanism system theory, combined with event driven mechanism and the characteristics of the WSN. It has the periodic dormancy mechanism of S_MAC protocol, in the premise of the reliability data, to reduce data redundancy and communication delay time, improve the overall network throughput, to ensure the safety and reliability of the network, which can greatly extends  the node of working time.

  15. Energy efficient TDMA-based MAC protocol associated with GAF for wireless sensor networks

    Institute of Scientific and Technical Information of China (English)

    XIAO Xiao; ZHENG Bao-yu; YAN Zhen-ya; CHEN Chao

    2007-01-01

    The design of media access control (MAC) protocol for wireless sensor networks (WSNs) with the idea of cross layer attracts more and more attention. People can improve the MAC protocol by obtaining certain information regarding the network layer and physical layer. This article synthesizes and optimizes certain cross-layer protocols which have existed. On the basis of the routing, topology information in the network layer, and transmission power information in the physical layer, the time slot assignment algorithm has been improved in the MAC layer.By using geographical adaptive fidelity algorithm (GAF) to divide the grids, controlling of transmission power and scheduling the work/sleep duty cycle for sensor nodes, a new MAC protocol has been proposed to decrease energy consumption and enlarge the lifetime of WSNs. Simulation results show that the MAC protocol functions well.

  16. Opportunistic Pathogens Mycobacterium Avium Complex (MAC) and Legionella spp. Colonise Model Shower

    Science.gov (United States)

    Whiley, Harriet; Giglio, Steven; Bentham, Richard

    2015-01-01

    Legionella spp. and Mycobacterium avium complex (MAC) are opportunistic pathogens of public health concern. Hot water systems, including showers, have been identified as a potential source of infection. This paper describes the colonization of Legionella and MAC on the flexible tubing within a model potable shower system, utilizing thermostatic mixing and a flexible shower head. A MAC qPCR method of enumeration was also developed. MAC and Legionella spp. were detected within the biofilm at maximum concentrations of 7.0 × 104 and 2.0 × 103 copies/cm2 PVC tubing respectively. No significant changes were observed between sample of the flexible shower tubing that dried between uses and those that remained filled with water. This suggested the “unhooking” showerheads and allowing them to dry is not an effective method to reduce the risk of Legionella or MAC colonisation. PMID:26213977

  17. Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach

    Science.gov (United States)

    Chellathurai, Burnice Nalina Kumari; Thiagarajan, Ramakrishnan; Jayakumaran, SelvaKumar; Devadoss, Pradeep; Elavazhagan

    2016-01-01

    Epilepsy, characterized by the risk of recurrent seizures, is a chronic disease that afflicts about 5% of the world's population. The main dental problems associated with epileptic patients include gingival hyperplasia, minor oral injuries, tooth trauma, and prosthodontic problems, which require the dental treatment. Stress and fear are the most common triggering factors for the epilepsy in dental chair. Therefore, a more appropriate method of treating such epileptic patients may be warranted. Conscious sedation is a technique of providing good anesthesia and analgesia to patients, the main advantage of which is the patient's rapid return to presentation levels. Midazolam used as a sedative agent has anticonvulsant properties. This case report highlights a case requiring multiple dental procedures carried out in a high risk epileptic patient under conscious sedation. PMID:27041847

  18. Sedation with dexmedetomidine for conducting electroencephalogram in a patient with Angelman syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Magda Lourenço Fernandes

    2016-04-01

    Full Text Available ABSTRACT INTRODUCTION: Angelman syndrome is characterized by severe mental retardation and speech and seizure disorders. This rare genetic condition is associated with changes in GABAA receptor. Patients with Angelman syndrome need to be sedated during an electroencephalogram ordered for diagnostic purposes or evolutionary control. Dexmedetomidine, whose action is independent of GABA receptor, promotes a sleep similar to physiological sleep and can facilitate the performing of this examination in patients with Angelman syndrome. CASE REPORT: Female patient, 14 years old, with Angelman syndrome; electroencephalogram done under sedation with dexmedetomidine. The procedure was uneventful and bradycardia or respiratory depression was not recorded. The examination was successfully interpreted and epileptiform activity was not observed. CONCLUSION: Dexmedetomidine promoted satisfactory sedation, was well tolerated and enabled the interpretation of the electroencephalogram in a patient with Angelman syndrome and seizure disorder.

  19. Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach.

    Science.gov (United States)

    Chellathurai, Burnice Nalina Kumari; Thiagarajan, Ramakrishnan; Jayakumaran, SelvaKumar; Devadoss, Pradeep; Elavazhagan

    2016-01-01

    Epilepsy, characterized by the risk of recurrent seizures, is a chronic disease that afflicts about 5% of the world's population. The main dental problems associated with epileptic patients include gingival hyperplasia, minor oral injuries, tooth trauma, and prosthodontic problems, which require the dental treatment. Stress and fear are the most common triggering factors for the epilepsy in dental chair. Therefore, a more appropriate method of treating such epileptic patients may be warranted. Conscious sedation is a technique of providing good anesthesia and analgesia to patients, the main advantage of which is the patient's rapid return to presentation levels. Midazolam used as a sedative agent has anticonvulsant properties. This case report highlights a case requiring multiple dental procedures carried out in a high risk epileptic patient under conscious sedation. PMID:27041847

  20. Energy-efficient MAC Protocol for Patient Personal Area Networks.

    Science.gov (United States)

    Lamprinos, I; Prentza, A; Sakka, E; Koutsouris, D

    2005-01-01

    The formulation of a Personal Area Network (PAN), consisting of a wireless infrastructure of medical sensors, attached to patient's body, and a supervising device carried by them, lays the path for continuous and real-time monitoring of vital signs without discomforting the person in question. This infrastructure enhances the context of remote healthcare services by supporting flexible acquisition of crucial vital signs, while at the same time it provides more convenience to the patient. Aiming at the exploitation of the inherent features and requirements of wireless medical sensor networks, in this paper we focus on the main design guidelines of a low power Medium Access Control (MAC) protocol, designated to support a patient PAN. The proposed protocol intends to improve energy efficiency in such applications and thus is oriented towards the prevention of main energy wastage sources, such as collision, idle listening and power outspending. PMID:17281057