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Summary NHS England recently mandated that the National Early Warning Score of vital signs be used in all acute hospital trusts in the UK despite limited validation in the postoperative setting. We undertook a multicentre UK study of 13,631 patients discharged from intensive care after risk-stratified cardiac surgery in four centres, all of which used VitalPAC™ to electronically collect postoperative National Early Warning Score vital signs. We analysed 540,127 sets of vital signs to generate a logistic score, the discrimination of which we compared with the national additive score for the composite outcome of: in-hospital death; cardiac arrest; or unplanned intensive care admission. There were 578 patients (4.2%) with an outcome that followed 4300 sets of observations (0.8%) in the preceding 24 h: 499 out of 578 (86%) patients had unplanned re-admissions to intensive care. Discrimination by the logistic score was significantly better than the additive score. Respective areas (95%CI) under the receiver-operating characteristic curve with 24-h and 6-h vital signs were: 0.779 (0.771–0.786) vs. 0.754 (0.746–0.761), p < 0.001; and 0.841 (0.829–0.853) vs. 0.813 (0.800–0.825), p < 0.001, respectively. Our proposed logistic Early Warning Score was better than the current National Early Warning Score at discriminating patients who had an event after cardiac surgery from those who did not.

Accidental awareness during general anaesthesia with recall is a potentially distressing complication of general anaesthesia that can lead to psychological harm. The 5th National Audit Project was designed to investigate the reported incidence, predisposing factors, causality and impact of accidental awareness. A nationwide network of local co-ordinators across all UK and Irish public hospitals reported all new patient reports of accidental awareness to a central database, using a system of monthly anonymised reporting over a calendar year. The database collected the details of the reported event, anaesthetic and surgical technique, and any sequelae. These reports were categorised into main types by a multidisciplinary panel, using a formalised process of analysis. The main categories of accidental awareness were: certain or probable; possible; during sedation; on or from the intensive care unit; could not be determined; unlikely; drug errors; and statement only. The degree of evidence to support the categorisation was also defined for each report. Patient experience and sequelae were categorised using current tools or modifications of such. The 5th National Audit Project methodology may be used to assess new reports of accidental awareness during general anaesthesia in a standardised manner, especially for the development of an ongoing database of case reporting. This paper is a shortened version describing the protocols, methods and data analysis from 5th National Audit Project - the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

The 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland into accidental awareness during general anaesthesia yielded data related to psychological aspects from the patient, and the anaesthetist, perspectives; patients' experiences ranged from isolated auditory or tactile sensations to complete awareness. A striking finding was that 75% of experiences were for 5 min, yet 51% of patients (95% CI 43-60%) experienced distress and 41% (95% CI 33-50%) suffered longer-term adverse effect. Distress and longer-term harm occurred across the full range of experiences but were particularly likely when the patient experienced paralysis (with or without pain). The patient's interpretation of what is happening at the time of the awareness seemed central to later impact; explanation and reassurance during suspected accidental awareness during general anaesthesia or at the time of report seemed beneficial. Quality of care before the event was judged good in 26%, poor in 39% and mixed in 31%. Three quarters of cases of accidental awareness during general anaesthesia (75%) were judged preventable. In 12% of cases of accidental awareness during general anaesthesia, care was judged good and the episode not preventable. The contributory and human factors in the genesis of the majority of cases of accidental awareness during general anaesthesia included medication, patient and education/training. The findings have implications for national guidance, institutional organisation and individual practice. The incidence of 'accidental awareness' during sedation (~1:15 000) was similar to that during general anaesthesia (~1:19 000). The project raises significant issues about information giving and consent for both sedation and anaesthesia. We propose a novel approach to describing sedation from the patient's perspective which could be used in communication and consent. Eight (6%) of the patients had resorted to legal action (12, 11%, to formal complaint) at the time of reporting. The 5th National Audit Project methodology provides a standardised template that might usefully inform the investigation of claims or serious incidents related to accidental awareness during general anaesthesia.

To explain the observed intermingling of polarities in the magnetic field distributions of rapidly rotating stars, surface magnetic flux transport models demand the presence of fast meridional flows.We combine simulations of the pre-eruptive and post-eruptive magnetic flux transport in cool stars to investigate the influence of a fast meridional circulation on the latitudinal eruption pattern of magnetic flux tubes and on the polar magnetic field properties. Magnetic flux tubes rising through the convection zone experience an enhanced latitude-dependent poleward deflection through meridional flows, which renders the wings of stellar butterfly diagrams convex. The larger amount of magnetic flux emerging at higher latitudes supports the intermingling of opposite polarities of polar magnetic fields and yields magnetic flux densities in the polar regions about 20% higher than in the case disregarding the pre-eruptive deflection. Taking the pre-eruptive evolution of magnetic flux into account therefore eases the need for the fast meridional flows predicted by previous investigations. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

This is an era of technological marvels. Consider the microfiche and the silicon chip. In fact, the 1980s may become known as the “fiche and chip” decade.

Transvenous right ventricular endomyocardial biopsy in an 11-yr-old boy with a proximal skeletal myopathy and a cardiomyopathy, has shown a major increase in mitochondrial size and numbers on electron-microscopic morphometry, with formation of unique ring-shaped mitochondria in cardiac muscle cells. The significance of this finding and the use of cardiac biopsy in children are discussed.

Using a torsion pendulum, measurements have been made of the dynamic modulus of rigidity of wool fibers during the process of sorbing or desorbing water (from the vapor phase). Anomalous behavior is observed, with low values of rigidity which cannot be accounted for in terms of equilibrium data. It appears that transient stresses occurring during sorption and desorption cause a temporary lowering of the rigidity modulus.

Little Thessalon River is an important spawning ground for the sea lamprey, as compared with Desbarats, MacBess, Livingstone, and Lauzon Creeks. More research is necessary to determine the reasons for this difference. The selection of areas by the sea lamprey for spawning confirms the observation of Coventry (1922). Furthermore, the sea lampreys entered the weirs at night, the majority 1 or 2 hours past midnight. Sea lampreys were taken during the earlier period of the sucker run. The majority of the sea lampreys averaged 24 inches in total length. Seventy-five percent of the suckers were scarred, presumably by lampreys. As the numbers of sea lampreys increased the numbers of suckers decreased. Hoop nets are not effective for trapping sea lampreys. Metal weirs are essential, and the wings should be 5 feet deep, measured vertically from the bed of the stream, in order to avoid an overflow during periods of heavy rainfall. To avoid the escape of lampreys the floor of the trap must be screened, and ...

La nephrostomie percutanee, transformee ensuite en attelle ureterale a donne le temps au traitement combine (bethamicol, acide ascorbique, trimethoprim) d'agir