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Background The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. Methods A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epidural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Results Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor characteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). Conclusions The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl.

In certain high-power RF devices, such as isolators and circulators, a static magnetic field is present in parallel with the oscillating RF electric field. This parallel magnetic field imposes electron Larmor motion, which restricts the trajectories of electrons accelerated by the RF field. In open geometries, magnetic confinement reduces electron losses in the multipactor region and can reduce the breakdown threshold. In this paper, the effect of magnetic confinement on multipactor breakdown threshold was measured experimentally using a stripline fixture with an externally applied uniform magnetic field. Multipactor threshold power was reduced from the unmagnetized case by as much as 3 dB at magnetic fields of about 0.5 kG. Multipactor gap aspect ratio has a significant impact on the degree of threshold reduction.

BACKGROUND:Women and minorities are underrepresented in US academic medicine. The Sullivan Commission on Diversity in the Healthcare Workforce emphasized the importance of diverse leadership for reducing health care disparities. The objective of this study was to evaluate the demographics of the Ame

Background:The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacain

Electron impact studies of multiple ionization processes in helium, neon, argon, and xenon appear to support theoretical conclusions that the threshold probability for n-fold ionization is proportional to the nth power of the electron energy in excess of the threshold energy. The probability law applies, for the cases studied, over a considerable energy range that, for all but He2+, includes the possible onset of more than one mode of ionization. The presence of a Boltzmann spread in the energy of the electron beam or specific focusing effects due to ion source geometry are found to affect only the foot of the probability curve. By the use of certain assumptions, an estimate is also made of the departure from a 3P ionization probability curve resulting from onset of ionization to the 1D and 1S states.

Gerada is right that doctors need to develop healthy psychological defence mechanisms.1 But this should be seen in a societal context and in company with other workers. Society today encourages the open disclosure of emotional distress. But the work of the emergency services and clinicians can continue effectively only if this …

The first rule of covering a hurricane? Get footage of palm trees bending to the storm. They sway, arch, bow through 50 degrees, then rebound like elastic to recover their form and position. Cars and pylons cartwheel and buckle in the tempest. But with its heavy root network, its trunk a cable of bundled fibre and fronded leaves that fold up, the canny, durable palm has worked out how to ride a storm by flexing, without falling over. Resilience has attained treasured status in general practice’s belief system since our specialty’s popularity, resourcing, and recruitment began to head south, along with the banks, after 2008. Like an advanced stage of enlightenment, it has become the key attribute for anyone wanting to survive and thrive as a GP in today’s harsh NHS environment.1 That GPs work hard and long, in tough conditions, mostly alone with their patients; that they are exposed to distress and tragedy through their working lives; that they carry formidable responsibilities, and hold unbearable secrets, is not news. Being resolute, courageous, of a calm temperament, committed, able to go without sleep, face abuse and the threat of violence, yet remain open minded and kind — all these are taken as read in a good GP; and that’s before you get on to being up to date, a patient listener, and a smart decision maker. Bags of emotional intelligence and great interpersonal skills make up the full kit list. We embrace the description ‘resilient’ as a sex- and judgement-free upgrade from some of its heroic predecessors: robust, …