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Abstract Background Information on hemostasis and platelet function in brown bear (Ursus arctos) is of importance for understanding the physiological, protective changes during hibernation. Objective The study objective was to document platelet activity values in brown bears shortly after leaving the den and compare them to platelet function in healthy humans. Methods Blood was drawn from immobilized wild brown bears 7-10 days after leaving the den in mid April. Blood samples from healthy human adults before and after clopidogrel and acetylsalicylic acid administration served as control. We analyzed blood samples by standard blood testing and platelet aggregation was quantified after stimulation with various agonists using multiple electrode aggregometry within 3 hours of sampling. Results Blood samples were collected from 6 bears (3 females) between 1 and 16 years old and from 10 healthy humans. Results of adenosine diphosphate, aspirin, and thrombin receptor activating peptide tests in bears were all half or less of those in humans. Platelet and white blood cell counts did not differ between species but brown bears had more and smaller red blood cells compared with humans. Conclusion Using three different tests, we conclude that platelet function is lower in brown bears compared to humans. Our findings represent the first descriptive study on platelet function in brown bears and may contribute to explain how bears can endure denning without obvious thrombus building. However, the possibility that our findings reflect test-dependent and not true biological variations in platelet reactivity needs further studies.

Acute diarrhea is a common condition in dogs. Most cases are mild and self-limiting and according to guidelines, antimicrobial treatment is only indicated in dogs with severe systemic disease. However, antimicrobials are still prescribed in 50-65 % of mild cases. Multiple factors have been shown to influence the antimicrobial prescription decision, including perceived pressure from pet owners. This study aimed to investigate dog owners' expectations regarding antimicrobial prescription for dogs with acute diarrhea and the attending veterinarians' perceived owner expectation. To investigate this, a structured telephone interview with owners and a post-consultation questionnaire for the attending veterinarians were conducted. Ninety-nine unique dog-consultations were included with a 91 % owner response rate (n = 90), in these cases 63 % of veterinarians responded (n = 57). Only 6/90 (7 %) owners expressed an expectation of antimicrobial prescription. Of these, two expressed dissatisfaction that antimicrobials were withheld. In 5/57 cases, the attending veterinarian perceived an expectation to prescribe antimicrobials. Three cases aligned with an actual owner expectation, the latter two were pure perception. Eighty percent of owners expressed satisfaction with the consultation in general (n = 72/90), while 16 % (14/90) and 4 % (4/90) expressed minor or major dissatisfaction with non-treatment related issues, respectively. In this study, very few dog owners expressed an expectation of antimicrobials for treatment of acute diarrhea. Likewise, the veterinarians perceived an expectation in only a minority of cases, however, the actual and perceived expectation did not always align. In conclusion, this study suggests that an overall high owner satisfaction is feasible despite a non-antimicrobial approach., Competing Interests: Conflict of Interest statement None of the authors have any financial or personal relationships that could inappropriately influence or bias the content of the paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Onset of febrile seizures varies with calendar season. However, it has not previously been assessed, how season of birth interacts with age and peak risk of febrile seizures, and whether season of birth correlates with the cumulative risk of febrile seizures at 5 years of age (i.e., when children are no longer of risk of febrile seizures)., Methods: We identified all singleton children born in Denmark between 1977 and 2011 who were alive at 3 months of age (N = 2,103,232). We used the Danish Civil Registration System to identify age and sex of the children and the Danish National Patient Register to identify children hospitalized with febrile seizures from 3 months to 5 years of age. Follow-up ended on December 31, 2016, when all children had reached 5 years of age., Results: The relative risk of admission with a first febrile seizure varied with calendar month; in February (a winter month in Denmark), the risk was more than doubled (hazard ratio: 2.10 [95% confidence interval [CI]: 2.03-2.18]) compared with August (a summer month in Denmark). The age-specific incidence of a first febrile seizure by birth month identified the highest peak incidence of a first febrile seizure among children born in November (reaching a peak incidence of 350 first admissions with a febrile seizure per 100,000 person months at age 16 months) as compared to children born in July (reaching a peak incidence of 200 first admissions with a febrile seizure per 100,000 person months at age 16 months). However, the cumulative incidence of any admission with febrile seizures before 5 years was not correlated with season of birth (3.69% [95% CI: 3.64-3.74%] for winter births, 3.57% [95% CI: 3.52-3.62%] for spring births, 3.55% [95% CI: 3.50-3.59%] for summer births, and 3.64% [95% CI: 3.59-3.69%] for fall births)., Discussion/conclusion: The study found a significant seasonal variation in onset of the first febrile seizure and in the age-specific peak incidence of febrile seizures. However, there was no correlation between season of birth and cumulative incidence of febrile seizures at 5 years of age suggesting that children who are predisposed to febrile seizures will eventually go on to experience a febrile seizure regardless of season of birth., (© 2022 S. Karger AG, Basel.)

Objective: Febrile seizure is a common childhood disorder that affects 2-5% of all children, and is associated with later development of epilepsy and psychiatric disorders. This study determines how the incidence of febrile seizures correlates with birth characteristics, age, sex and brain development., Methods: This is a cohort study of all children born Denmark between 1977 and 2011 who were alive at 3 months of age (N = 2,103,232). The Danish National Patient Register was used to identify children with febrile seizures up to 5 years of age. Follow-up ended on 31 December 2016 when all cohort members had potentially reached 5 years of age., Results: In total, 75,593 (3.59%, 95% CI: 3.57-3.62%) were diagnosed with febrile seizures. Incidence peaked at 16.7 months of age (median: 16.7 months, interquartile range: 12.5-24.0). The 5-year cumulative incidence of febrile seizures increased with decreasing birth weight (<1500 g; 5.42% (95% CI: 4.98-5.88% vs. 3,000-4,000 g; 3.53% (95% CI: 3.50-3.56%)) and with decreasing gestational age at birth (31-32 weeks; 5.90% (95% CI: 5.40-6.44%) vs. 39-40 weeks; 3.56% (95% CI: 3.53-3.60)). Lower gestational age at birth was associated with higher age at onset of a first febrile seizure; an association that essentially disappeared when correcting for age from conception., Conclusions: The risk of febrile seizures increased with decreasing birth weight and gestational age at birth. The association between low gestational age at birth and age at first febrile seizure suggests that onset of febrile seizures is associated with the stage of brain development., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

OBJECTIVE: To describe the case of an 88-yearold male with rheumatoid arthritis who developed pulmonary manifestations. Treatment for his RA previously included various biologics, while at the time of pulmonary consultation included meloxicam, methotrexate, and abatacept. Following chest scans, bronchoscopy, needle biopsy, pulmonary function testing, and a thoracentesis, the diagnosis of pleural effusion and nodules associated with rheumatoid arthritis was determined. The patient was recommended to follow-up with the pulmonologist but was lost to follow-up because of nonpulmonary and nonrheumatoid arthritis complications.
SETTINGS: Ambulatory clinic pharmacy practice, Community pharmacy, Consultant pharmacy practice.
PRACTICE CONSIDERATIONS: Drugs used to treat rheumatoid arthritis may produce pulmonary toxicity similar to what is seen with the disease itself. Drug therapy may require modification if identified as an offending agent causing pulmonary manifestations. If fibrosing interstitial lung disease develops, the addition of nintedanib may need to be considered.
CONCLUSION: In order for pharmacists to better assist providers and patients and improve therapeutic outcomes, it is important for pharmacists to understand that pulmonary manifestations are common in patients having rheumatoid arthritis as well as with drugs used to treat rheumatoid arthritis.

Background: Olanzapine is commonly utilized in palliative care for the treatment of nausea, and a known side effect of olanzapine is increased appetite. Olanzapine is also known to cause re-emergence of eating disorders (EDs) in patients utilizing olanzapine for its antipsychotic effects. It is unclear to what extent this may also occur in patients with serious/life-limiting illness., Methods and Results: We present a case of a 70-year-old female with recurrent ovarian cancer and a history of bulimia nervosa (BN) that developed resurgence of her BN after initiation of olanzapine for cancer-associated nausea. Her BN resolved with reducing the dose of olanzapine., Conclusion: It is important to recognize that recurrence of EDs can occur when using olanzapine in the palliative care setting.

Objective. To compare pharmacy, osteopathic medicine, dental medicine, and physician assistant (PA) students' perceptions of e-professionalism. Methods. A 20-item questionnaire was developed and administered to four cohorts of health care professions students early in their first professional year. The questionnaire contained 16 scenarios in which a hypothetical health care student or professional shared information or content electronically and students were asked to indicate how much they agreed that the scenario represented professional behavior. Results. Ninety-four percent of students completed the questionnaire. More female students were in the pharmacy and PA cohorts. There were statistical differences in students' perceptions of e-professionalism in five of 16 scenarios. Specific differences were most often between the osteopathic medicine students and the other cohorts. Conclusions. The health care professions students surveyed had similar perceptions of e-professionalism. Of the four cohorts, osteopathic medicine students appeared less conservative in their approach to e-professionalism than the other cohorts.

The changing nature of the transition to adulthood in western societies, such as the United States, may be extending the length of time parents are engaged in "parenting" activities. However, little is known about different approaches parents take in their interactions with their emerging-adult children. Hence, this study attempted to identify different clusters of parents based on the extent to which they exhibited both extremes of control (psychological control, punishment, verbal hostility, indulgence) and responsiveness (knowledge, warmth, induction, autonomy granting), and to examine how combinations of parenting were related to emerging adult children's relational and individual outcomes (e.g. parent-child relationship quality, drinking, self-worth, depression). The data were collected from 403 emerging adults (M age = 19.89, SD = 1.78, range = 18-26, 62% female) and at least one of their parents (287 fathers and 317 mothers). Eighty-four percent of participants reported being European American, 6% Asian American, 4% African American, 3% Latino, and 4% reported being of other ethnicities. Data were analyzed using hierarchical cluster analysis, separately for mothers and fathers, and identified three similar clusters of parents which we labeled as uninvolved (low on all aspects of parenting), controlling-indulgent (high on both extremes of control and low on all aspects of responsiveness), and authoritative (high on responsiveness and low on control). A fourth cluster was identified for both mothers and fathers and was labeled as inconsistent for mothers (mothers were above the mean on both extremes of control and on responsiveness) and average for fathers (fathers were at the mean on all eight aspects of parenting). The discussion focuses on how each of these clusters effectively distinguished between child outcomes.

The purpose of the current study was to explore clusters of proactive parenting practices, and how they might vary as a function of parental demographics, the quality of the parent-child relationship, and the traits and behaviors of the adolescent child. Data were taken from the Flourishing Families Project, which includes 500 families with an early adolescent child (M age = 11.49). Findings suggested that there were four clusters of parents, and patterns were similar for mothers and fathers. Findings also suggested that proactive clusters varied primarily as a function of demographics of the parent (e.g., religiosity, ethnicity, education) and the traits and behaviors of the adolescent child (e.g., empathy, internalizing and externalizing behaviors). Discussion highlights the importance of using a typological approach to study parenting, and places particular emphasis on parents' use of pre-arming (alone, or in conjunction with other practices) in an attempt to avoid misbehavior before it occurs., (Copyright © 2010 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals., Objectives: To evaluate the efficiency of protocols for tight glycemic control used in intensive care units., Methods: Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses., Results: Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason., Conclusions: Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

The Facial Recognition Test (Benton, Hamsher, Varney, & Spreen, 1983; Benton, Sivan, Hamsher, Varney, & Spreen, 1994) was examined in an age-, education- and gender-stratified sample of 346 healthy older adults. Internal consistency reliability estimates were.72 for the Long Form (FRLF),.53 for the Short Form, and.69 for a new short form. Mean FRLF scores did not change over a 1-year interval (p >.5), and the stability estimate was.71 (n = 100). The first of the methods below yielded the highest correlation between estimated and obtained FRLF scores in cross-validation (n = 67): (1) multiple regression based on oral reading and demographics, (2) multiple regression based on age, education and gender, and (3) mean scores by age group.

This report describes the methods and sample characteristics of a neuropsychological study of the elderly conducted by the Geriatric Research, Education and Clinical Center of the Department of Veterans Affairs Medical Center in Minneapolis, Minnesota. The goal of the study was to provide normative data, internal consistency and 1-year reliability estimates, and validated methods of estimating expected performance level. Thirty-one cognitive measures and a demographic questionnaire were administered to an age-, education-, and gender-stratified sample ( N = 349) and a validation sample (N = 70). After 1 year, 104 of the participants were retested. Relative to published, nationally based normative data, the stratified sample showed performance levels that ranged from average to high average across the five tests examined.

The bioavailability of itraconazole from an extemporaneously prepared suspension was compared with its bioavailability from the commercially available capsules. Ten healthy volunteers were fed breakfast and were then randomly assigned to receive either 400 mg of itraconazole 40-mg/mL oral suspension or four 100-mg itraconazole capsules with 240 mL of water. They were not allowed to rest in a supine position for six hours, eat for four hours, or take any beverages for two hours post-dose. Blood samples were taken immediately after the subjects had eaten and at intervals up to 72 hours post-dose. Serum was separated and stored at -70 degrees C. Serum itraconazole and hydroxyitraconazole concentrations were measured by high-performance liquid chromatography. After 14 days, each subject was given the dosage form that he or she did not previously receive, and testing was repeated. Maximum concentration (Cmax) and time to reach maximum concentration (tmax) were determined, and the area under the serum concentration-versus-time curve from 0 to 72 hours (AUC0-72) was estimated. The suspension:capsule ratios of least-squares means for Cmax, tmax, and AUC0-72 for itraconazole were 0.15 (90% confidence interval [CI], 0.11-0.21), 0.95 (90% CI, 0.75-1.20), and 0.12 (9% CI, 0.06-0.23), respectively. The results for hydroxyitraconazole were similar: 0.19 (0.13-0.28), 0.95 (0.81-1.12), and 0.13 (0.07-0.23), respectively. The bioavailability of itraconazole from the extemporaneously prepared suspension is much lower than that from capsules.

The reports of vancomycin resistance, though sparse, cannot be ignored. They document evidence of emerging vancomycin resistance. Because of the absence of suitable alternatives and a poor current understanding of the mechanisms involved, much work is needed to prevent such resistance from becoming widespread. Only by understanding the mechanism(s) of resistance involved can we develop strategies to combat resistant strains.

The authors identified neuropsychological tests appropriate for use in monitoring delirium severity in elderly patients. Ten elderly patients were administered a battery of tests while they were delirious and later during their recovery. All of the measures showed significant improvement across the two occasions (P < 0.05). Examination of components of variance suggests that modified versions of the Forward Digit Span, Similarities, or Oral Sentence Spelling tests or a combination of Forward Digit Span and Similarities or Oral Sentence Spelling are likely to be most effective in monitoring delirium severity., (Copyright © 1996 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Electroencephalograms (EEGs) were recorded from 13 unmedicated and nondepressed patients with DSM-III-R obsessive-compulsive disorder (OCD) and from 10 age-matched controls. All subjects were also administered the Wechsler Memory Scale Delayed Logical Memory and Delayed Visual Reproduction tests. Quantitative analysis of the EEG revealed lower log absolute power in the delta, beta 1, and beta 2 bandwidths for OCD patients at frontal and right-hemisphere locations. OCD patients displayed greater hemispheric asymmetries in EEG activity based on difference measures of EEG power from homologous electrode pairs, indicative of severe right hemisphere EEG hypoactivity. Standardized measures of hemispheric asymmetry for the beta 2 bandwidth accurately predicted group membership and were correlated both with poorer patient performance on the visual-spatial memory task and better performance on the verbal memory task. OCD patients were significantly impaired on the visual-spatial task, but not on the verbal memory test, relative to controls.

A survey of 197 cognitive aging studies revealed infrequent use of structured health assessments and random recruitment. In this study, a health screening questionnarie developed to identify subjects with medical problems that might impair cognition was administered to 315 adults aged 60 and older who were recruited by random digit dialing. On the basis of self-reported medical problems, 35% of the subjects were excluded. Those excluded were older (p less than .001) and tended to be male but did not differ in education from those who passed the screening. Subjects who passed the screening and decided to participate in a neuropsychological research project were younger (p less than .001), better educated (p less than .001), and more likely to be male (p less than .001) than nonparticipants. These findings suggest that careful assessment, selection, and description of subjects is needed to aid interpretation of cognitive aging research. Further attention to health status is needed to aid interpretation of cognitive aging research. Although random recruitment of the elderly is feasible, obtaining representative samples may require stratification on demographic variables.

Neuropsychological functioning was examined in a group of 18 nondepressed patients with obsessive-compulsive disorder (OCD) and 18 age-, education-, and gender-matched normal controls. A recent nonverbal memory deficit was identified in the patients with OCD. From performance on timed and untimed measures of the same constructs, it appears that OCD patients score more poorly than controls when speed is a factor. Although performance on a timed tactual-spatial motor test was also impaired, it is unclear whether this deficit is attributable to the nonverbal memory and/or speed deficits. Deficits in verbal abilities, including recent verbal memory, were not identified. Results were equivocal for executive function and visual-spatial abilities. The previously established association of recent nonverbal memory abilities with functioning of the right mesial temporal area is discussed in the context of current hypotheses about the neuroanatomic substrate of OCD.

Two measures of profile similarity have been derived that offer complementary information about the classification of patients with diagnoses of probable dementia of the Alzheimer type (DAT). These measures were obtained for 31 probable DAT patients and 31 age- and education-matched controls using a set of six newly constructed cognitive scales designed to provide reliable measurement in both patient and control groups. A measure assessing similarity to the average performance of the controls provided perfect separation of the patient and control groups. A measure assessing similarity to the average performance of the probable DAT patients identified up to four atypical cases of probable DAT. One of these four cases has come to autopsy and was found to have Pick disease. The cognitive profiles of this Pick patient and an autopsy-confirmed DAT patient are compared to illustrate the potential advantages of using DAT patients as the reference group for profile analysis.

Alcoholism in the elderly is often underidentified because of the differences in the presentation and symptom patterns compared to younger individuals. One way to address this problem is through routine use of screening instruments, but up to this time, none of the instruments used to identify alcoholism in younger populations have been shown to be valid in the elderly. We studied the validity of the Michigan Alcoholism Screening Test, scored both with weighted (MAST) and unit scoring (UMAST), and two short versions: the Brief MAST (BMAST) and Short MAST (SMAST) in 52 hospitalized elderly male alcoholics and 33 nonalcoholic controls. The MAST and UMAST showed excellent sensitivity and specificity, while the SMAST was less specific, and the BMAST less sensitive and less specific. Factor structure of the two brief versions was similar to that found in younger alcoholics, suggesting that symptom constellation is not necessarily different in the elderly. We recommend the use of the MAST or UMAST for screening for alcoholism in the elderly.

In 10 patients subjected to craniotomy for supratentorial cerebral tumours in neurolept anaesthesia, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured twice peroperatively by a modification of the Kety & Schmidt technique, using 133Xe. The relative CO2 reactivity was assessed indirectly as the % change of the arteriovenous oxygen difference (AVDO2) per mm change in PaCO2. The patients were premedicated with diazepam 10-15 mg perorally. For induction, thiopentone 4-6 mg/kg, droperidol 0.2 mg/kg and fentanyl 5 micrograms/kg were used, and for maintenance N2O 67% and fentanyl 4 micrograms/kg/h. During the first flow measurement the median and range of CBF was 30 ml/100 g/min (range 17-45), of AVDO2 8.0 vol % (range 4.1-9.5), and of CMRO2 2.28 ml O2/100 g/min (range 1.57-2.84). During the second CBF study, AVDO2 increased to 9.3 vol % (range 3.4-11) (P less than 0.05), and CMRO2 increased to 2.51 ml O2/100 g/min (range 1.88-3.00) P less than 0.05, while CBF was unchanged. The CO2 reactivity was present in all studies, median 1.8%/mmHg (range 0.5-15.1). The correlation coefficients between jugular venous oxygen tension/saturation, respectively, and CBF were high at tensions/saturations exceeding 4.0 kPa and 55%, indicating that hyperperfusion is easily unveiled by venous samples from the jugular vein during this anaesthesia.

The present study investigated differences between normal elderly subjects matched for age and education and patients with dementia of the Alzheimer's type (DAT) on two measures of reaction time (RT). Statistically significant group differences clearly demonstrate that normal elderly subjects have faster RT than subjects with senile dementia on all RT tasks. The DAT patients were most clearly differentiated in terms of overall group means and clinical classification from their age-matched counterparts on the choice of RT task. Eleven of 12 (92%) DAT patients displayed choice RT's 2 or more standard deviations above those of age-matched normals. While both RT measures were discriminative between patients and normals, the overall results argue for increased sensitivity when choice is required in RT in accessing the cognitive deficits in DAT.

To seek improved methods for the diagnosis of Pick's disease, we reviewed imaging studies of four women and two men (ages 48 to 65 years at onset) and psychometric testing of three of them with autopsy or biopsy-proved Pick's. The presence of Pick bodies was required for the diagnosis. Seven patients with biopsy-proved Alzheimer's disease served as a comparison group. In the Pick's patients, CT in five of six showed marked frontal pole or temporal pole atrophy, which clearly differed from the pattern of cerebral atrophy seen in the Alzheimer's patients. Psychometric testing showed performance patterns that tended to differ from those of the Alzheimer's patients in that recent memory was relatively preserved despite marked impairment of executive functions. The distinctive psychometric pattern in the Pick's patients was evanescent, however. Thus, there were imaging and psychometric findings of potential diagnostic value for Pick's disease, but, for different reasons, they were imperfect.

The CO2-production and degree of relaxation after increasing doses of suxamethonium were measured in seven patients undergoing alloplastic surgery of the hip. The study indicates that the CO2-production rises following the injection of increasing doses of suxamethonium. Another group of patients received diazepam 0.1 mg kg-1 before the injection of suxamethonium 1 mg kg-1. CO2-production was significantly reduced compared to CO2 production when suxamethonium was not preceded by diazepam. It is suggested that diazepam in doses larger than 0.1 mg kg-1 might be effective in preventing fasciculations and postoperative muscle pains before the injection of suxamethonium in a dose of 0.5 mg kg-1.

Eighteen patients undergoing alloplastic surgery of the hip were divided into three groups, each consisting of six patients. All operations were performed under endotracheal intubation using halothane N2O-O2 anaesthesia. After a steady state as to CO2-production had been obtained, suxamethonium 1 mg kg-1 was given intravenously to the patients in Group I. A maximum rise in CO2-production of 14.8% (range: 12.9-16.8) was observed after 5 min. In Group II, patients were pretreated with pancuronium 0.01 mg kg-1: no increase in CO2-production was observed. The third group received a continuous infusion of suxamethonium. In this group there was an increase in CO2-production of 17.6% (range: 6.7-22.0) 5 min after start of infusion. The CO2-production then fell to the preinfusion level over the next 10 min.

The Venturi circuit was studied with regard to CO2 elimination in a model experiment. A mean concentration of 0.6% CO2 in the fresh gas supply to the patient was accepted. The experiments demonstrated that a soda-lime charge of 200 g will cover the elimination requirements of CO2 in a Venturi circuit for any patient below 100 kg b.w. for a period of 3 h, while a soda-lime charge of 300 g will suffice for 5 h. The utilization of the soda lime charge is of the same order of magnitude as that of the much larger canisters used in circle circuits. In the Venturi circuit, the size of the soda-lime charge can be adjusted to suit the body weight of the patient and the expected length of the anaesthetic procedure. One soda-lime charge for each anaesthetic procedure is preferable from the point of view of hygiene. The charge should not be less than 200 g.

Although scales developed for use with the general population and those developed for use with patients with dementia provide important assessment tools, there are certain questions that might best be answered by cognitive scales that span the range of difficulty from that of the healthy older adult through that of the patient with mild to moderate dementia. To address this need, six cognitive scales are being constructed by using data from both healthy older adult and probable Alzheimer populations in item development and analysis. It is anticipated that these scales will be useful in addressing questions about patterns of deficits in dementias of different etiologies, progression or improvement of function in demented patients, and relationships between cognition and other variables in cognitively impaired patients.

Carbon dioxide production was measured in 20 adult patients undergoing alloplastic operation of the hip. Body weight ranged from 40 to 81 kg. Anaesthesia consisted of lumbar plexus block, i.v. diazepam, pethidine, pavulon and N2O/O2 under controlled ventilation. CO2 production was 2.13 ml kg-1 min-1 (interquartile range 2.09-2.23). A fresh gas flow rate of about 30 ml kg-1 min-1 was required for the elimination of CO2 produced when using the Venturi system for inhalation anaesthesia.

Measurements of carbon dioxide production were carried out on 20 patients undergoing arthroplastic operation of the hip joint, under halothane anaesthesia supplemented with lumbar plexus block. Compared to spontaneous respiration, the carbon dioxide production during controlled ventilation, with and without muscular relaxation, showed a decrease of 19% and 12%, respectively.