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1. Energy dataset of Frontier supercomputer for waste heat recovery

Author: Jian Sun, Zhiming Gao, David Grant, Kashif Nawaz, Pengtao Wang, Cheng-Min Yang, Philip Boudreaux, Stephen Kowalski, and Shean Huff
Subjects: Science
Abstract: Abstract The Hewlett Packard Enterprise–Cray EX Frontier is the world’s first and fastest exascale supercomputer, hosted at the Oak Ridge Leadership Computing Facility in Tennessee, United States. Frontier is a significant electricity consumer, drawing 8–30 MW; this massive energy demand produces significant waste heat, requiring extensive cooling measures. Although harnessing this waste heat for campus heating is a sustainability goal at Oak Ridge National Laboratory (ORNL), the 30 °C–38 °C waste heat temperature poses compatibility issues with standard HVAC systems. Heat pump systems, prevalent in residential settings and some industries, can efficiently upgrade low-quality heat to usable energy for buildings. Thus, heat pump technology powered by renewable electricity offers an efficient, cost-effective solution for substantial waste heat recovery. However, a major challenge is the absence of benchmark data on high-performance computing (HPC) heat generation and waste heat profiles. This paper reports power demand and waste heat measurements from an ORNL HPC data centre, aiming to guide future research on optimizing waste heat recovery in large-scale data centres, especially those of HPC calibre.
Published: 2024
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2. Modeling and Analysis of a Thermophotovoltaic Integrated Self-Powered Furnace

Author: Praveen Cheekatamarla, Stephen Kowalski, Ahmad Abu-Heiba, Timothy LaClair, and Kyle Gluesenkamp
Subjects: thermophotovoltaics, self-powered furnace, primary energy efficiency, carbon footprint, Technology
Abstract: This work investigates the energy efficiency and carbon reduction potential of self-powered residential building heating equipment using a thermodynamic modeling approach. An integrated thermophotovoltaic power module and residential scale furnace system (40,000 Btu/h) were modeled and studied in detail to assess the influence of different design configurations on primary energy efficiency. Operational characteristics such as total power generation, electrical efficiency, and heat recovery were examined in a self-powered system configuration. A sensitivity analysis was conducted to determine the influence of the electric grid’s carbon dioxide footprint (carbon intensity) and the cost of electricity on the environmental, as well as the economic, benefit associated with the self-powered configuration. Compared with a traditional furnace powered by an electric grid at a carbon intensity of 0.5 kg CO2eq/kWhEL, the self-powered furnace was shown to decrease the annual carbon dioxide emissions by approximately 550 kg (~75% reduction), while also saving more than USD 200 in utility expenses, annually. Additionally, the carbon emission reduction potential of blending different concentrations of hydrogen in natural gas fuel was also studied.
Published: 2022
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3. Hemodynamic effects of low-dose bupivacaine spinal anesthesia for cesarean section: A randomized controlled trial

Author: Marta J Cenkowski, Doug Maguire, Stephen Kowalski, Fahd A Al Gurashi, and Duane Funk
Subjects: Cardiac output, cesarean section, hemodynamics, obstetric anesthesia, spinal anesthesia, Anesthesiology, RD78.3-87.3
Abstract: Background: Spinal anesthesia is the most common technique for cesarean section. The conventional local anesthetic dose has been decreasing over time to 8–12.5 mg of bupivacaine. Lower doses of bupivacaine may be associated with reduced incidence of hypotension and other complications. This low dose also may be associated with improved maternal cardiac index (CI). We hypothesized that low dose spinal anesthesia using 4.5 mg bupivacaine would result in improved maternal CI when compared with conventional dose (9 mg) intrathecal bupivacaine. Methods: This randomized controlled trial included all healthy parturients presenting for elective cesarean section. In addition to standard monitors, an arterial line was placed for pulse contour cardiac output measurement. Due to limited data on maternal cardiac output during cesarean section, we had to power our study on recovery room length of stay. Secondary outcomes included the change in maternal CI, fluid administration, vasopressor usage, maternal satisfaction, and adequacy of surgical blockade and recovery time from motor and sensory blockade. Results: The low dose group had significantly faster motor recovery times (132 [122–144] versus. 54 [48–66] min conventional versus. low-dose, respectively, P < 0.01), and a shorter recovery room stay (92 ± 21 vs 70 ± 11 min, conventional vs. low-dose, respectively, P < 0.01, 95% CI -35 to -10 min). There was no difference in CI between the conventional dose and low dose spinal groups. Both groups had a drop in CI with spinal anesthesia. The low-dose group demonstrated equivalent surgical anesthesia and block onset times compared to the conventional group. Conclusions: Low-dose spinal anesthesia provides adequate surgical anesthesia, improved recovery time, but no difference in maternal cardiac index when compared to conventional dose spinal anesthesia. NCT02046697
Published: 2019
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4. Pre-hospital and initial management of head injury patients: An update

Author: Tumul Chowdhury, Stephen Kowalski, Yaseen Arabi, and Hari Hara Dash
Subjects: Evidence, pre-hospital management, secondary brain injury, traumatic brain injury, Anesthesiology, RD78.3-87.3
Abstract: Background: Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. Methods: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic, was conducted. Results: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. Conclusion: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.
Published: 2014
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5. General intensive care for patients with traumatic brain injury: An update

Author: Tumul Chowdhury, Stephen Kowalski, Yaseen Arabi, and Hari Hara Dash
Subjects: Evidence, secondary brain injury, supportive care, traumatic brain injury, Anesthesiology, RD78.3-87.3
Abstract: Background: Traumatic brain injury (TBI) is a growing epidemic throughout the world and may present as major global burden in 2020. Some intensive care units throughout the world still have no access to specialized monitoring methods, equipments and other technologies related to intensive care management of these patients; therefore, this review is meant for providing generalized supportive measurement to this subgroup of patients so that evidence based management could minimize or prevent the secondary brain injury. Methods: Therefore, we have included the PubMed search for the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic. Results: General supportive measures are equally important to prevent and minimize the effects of secondary brain injury and therefore, have a substantial impact on the outcome in patients with TBI. The important considerations for general supportive intensive care unit care remain the prompt reorganization and treatment of hypoxemia, hypotension and hypercarbia. Evidences are found to be either against or weak regarding the use of routine hyperventilation therapy, tight control blood sugar regime, use of colloids and late as well as parenteral nutrition therapy in patients with severe TBI. Conclusion: There is also a need to develop some evidence based protocols for the health-care sectors, in which there is still lack of specific management related to monitoring methods, equipments and other technical resources. Optimization of physiological parameters, understanding of basic neurocritical care knowledge as well as incorporation of newer guidelines would certainly improve the outcome of the TBI patients.
Published: 2014
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6. Specific intensive care management of patients with traumatic brain injury: Present and future

Author: Tumul Chowdhury, Stephen Kowalski, Yaseen Arabi, and Hari Hara Dash
Subjects: Clinical trials, head injury, intensive care management, traumatic brain injury, Anesthesiology, RD78.3-87.3
Abstract: Traumatic brain injury (TBI) is a major global problem and affects approximately 10 million peoples annually; therefore has a substantial impact on the health-care system throughout the world. In this article, we have summarized various aspects of specific intensive care management in patients with TBI including the emerging evidence mainly after the Brain Trauma Foundation (BTF) 2007 and also highlighted the scope of the future therapies. This review has involved the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic. Though, BTF guideline based management strategies could provide standardized protocols for the management of patients with TBI and have some promising effects on mortality and morbidity; there is still need of inclusion of many suggestions based on various published after 2007. The main focus of majority of these trials remained to prevent or to treat the secondary brain injury. The future therapy will be directed to treat injured neurons and may benefit the outcome. There is also urgent need to develop some good prognostic indicators as well.
Published: 2014
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7. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study.

Author: Trevor W R Lee, Stephen Kowalski, Kelsey Falk, Doug Maguire, Darren H Freed, and Kent T HayGlass
Subjects: Medicine, Science
Abstract: Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery.This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein (CRP, PTX3) and cardiovascular risk (sST2) biomarkers.The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005).This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia.ClinicalTrials.gov NCT00348920.
Published: 2016
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8. Prise en charge d’urgence des voies aériennes dans un centre tertiaire de traumatologie (AIRMAN) : une étude prospective longitudinale sur un an

Author: Thomas Hall, Murdoch Leeies, Duane Funk, Carmen Hrymak, Faisal Siddiqui, Holly Black, Kim Webster, Jenn Tkach, Matt Waskin, Brenden Dufault, and Stephen Kowalski
Subjects: Anesthesiology and Pain Medicine, General Medicine
Published: 2023

9. A prospective observational study comparing outcomes before and after the introduction of an intubation protocol during the COVID-19 pandemic

Author: Holly Black, Thomas Hall, Carmen Hrymak, Duane Funk, Faisal Siddiqui, John Sokal, Jaime Satoudian, Kendra Foster, Stephen Kowalski, Brenden Dufault, and Murdoch Leeies
Subjects: Emergency Medicine
Abstract: Orotracheal intubation is a life-saving procedure commonly performed in the Intensive Care unit and Emergency Department as a part of emergency airway management. Prior to the COVID-19 pandemic, our center undertook a prospective observational study to characterize emergency intubation performed in the emergency department and critical care settings at Manitoba's largest tertiary hospital. During this study, a natural experiment emerged when a standardized "COVID-Protected Rapid Sequence Intubation Protocol" was implemented in response to the pandemic. The resultant study aimed to answer the question; in adult ED patients undergoing emergent intubation by EM and CCM teams, does the use of a "COVID-Protected Rapid Sequence Intubation Protocol" impact first-pass success or other intubation-related outcomes?A single-center prospective quasi-experimental before and after study was conducted. Data were prospectively collected on consecutive emergent intubations. The primary outcome was the difference in first-pass success rates. Secondary outcomes included best Modified Cormack-Lehane view, hypoxemia, hypotension, esophageal intubation, cannot intubate cannot oxygenate scenarios, CPR post intubation, vasopressors required post intubation, Intensive Care Unit (ICU) mortality, ICU length of stay (LOS), and mechanical ventilation days.Data were collected on 630 patients, 416 in the pre-protocol period and 214 in the post-protocol period. First-pass success rates in the pre-protocol period were found to be 73.1% (n = 304). Following the introduction of the protocol, first-pass success rates increased to 82.2% (n = 176, p = 0.0105). There was a statistically significant difference in Modified Cormack-Lehane view favoring the protocol (p = 0.0191). Esophageal intubation rates were found to be 5.1% pre-protocol introduction versus 0.5% following the introduction of the protocol (p = 0.0172).A "COVID-Protected Protocol" implemented by Emergency Medicine and Critical Care teams in response to the COVID-19 pandemic was associated with increased first-pass success rates and decreases in adverse events.RéSUMé: OBJECTIFS: L'intubation orotrachéale est une procédure de sauvetage couramment réalisée dans l'unité de soins intensifs et le service des urgences dans le cadre de la gestion des voies aériennes d'urgence. Avant la pandémie de COVID-19, notre centre a entrepris une étude prospective d'observation pour caractériser l'intubation d'urgence effectuée dans le service des urgences et les établissements de soins intensifs du plus grand hôpital tertiaire du Manitoba. Au cours de cette étude, une expérience naturelle est apparue lorsqu'un " protocole d'intubation à séquence rapide protégé contre le COVID " standardisé a été mis en œuvre en réponse à la pandémie. L'étude qui en a résulté visait à répondre à la question suivante : chez les patients adultes des urgences soumis à une intubation urgente par les équipes de médecine d'urgence et de médecine de soins critiques, l'utilisation d'un " protocole d'intubation à séquence rapide protégé par COVID " a-t-elle un impact sur la réussite du premier passage ou sur d'autres résultats liés à l'intubation ? MéTHODE: Une étude prospective quasi-expérimentale avant et après a été menée dans un seul centre. Les données ont été recueillies prospectivement sur des intubations émergentes consécutives. Le résultat principal était la différence entre les taux de réussite au premier passage. Les résultats secondaires comprenaient la meilleure vue de Cormack–Lehane modifiée, l'hypoxémie, l'hypotension, l'intubation œsophagienne, les scénarios d'impossibilité d'intubation et d'oxygénation, la réanimation cardio-pulmonaire après l'intubation, les vasopresseurs nécessaires après l'intubation, la mortalité en unité de soins intensifs (USI), la durée de séjour en USI et les jours de ventilation mécanique. RéSULTATS: Des données ont été recueillies sur 630 patients, 416 dans la période pré-protocole et 214 dans la période post-protocole. Les taux de réussite au premier passage dans la période pré-protocole se sont avérés être de 73,1 % (n = 304). Suite à l'introduction du protocole, les taux de réussite au premier passage ont augmenté à 82,2 % (n = 176, p = 0,0105). Il y avait une différence statistiquement significative dans la vue Cormack–Lehane modifiée en faveur du protocole (p = 0,0191). Les taux d'intubation œsophagienne se sont avérés être de 5,1 % avant l'introduction du protocole contre 0,5 % après l'introduction du protocole (p = 0,0172). CONCLUSION: Un « protocole protégé contre la COVID » mis en œuvre par les équipes de médecine d'urgence et de médecine de soins critiques en réponse à la pandémie de COVID-19 a été associé à une augmentation des taux de réussite du premier passage et à une diminution des événements indésirables.
Published: 2022

10. Soil respiration in a traditional olive grove in the southeast of Spain

Author: Sergio Aranda-Barranco, Penelope Serrano-Ortiz, Andrew Stephen Kowalski, and Enrique P Sánchez-Cañete
Abstract: Olive groves occupy a large area in the Mediterranean and their management has repercussions on the carbon cycle in this region. Weed suppression is the most common management in this crop, but its implications for soil respiration (Rsoil) are not well estimated due to the lack in continuous Rsoil measurements. In this research we present a full year of Rsoil in an irrigated olive grove in which a glyphosate-based herbicide was applied to prevent spontaneous weeds (conventional management). For that, an automatic multi-chamber Rsoil system was used (LI-8100 + LI-8150 with 6 chambers, Li-Cor). In addition, soil temperature (Tsoil) and soil water content (SWC) were measured next to each chamber. To study the influence of olive trees on Rsoil, 3 chambers were placed near the olive trunk and another 3 in the middle of the alleys. Results show seasonal and spatial variability, with higher Rsoil in warm months and lower Rsoil in cold months. Also, Rsoil near the trunk was always larger than in the alleys. The spatial difference increased in the cold months. Diurnal variability was observed with higher Rsoil as the soil temperature increased in the alleys, but this was not observed near the trunks. Under the canopy, a decrease in the Rsoil is observed as the VPD increases, suggesting a major contribution of autotrophic respiration under the canopy. In addition, there is no positive and negative relationship with temperature and SWC under the canopy, while in the alleys, a strong hysteresis occurs in some periods. Finally, rain events were followed by Rsoil peaks. However, low intensity and short duration rain pulses did not manifest on the ground under the olive canopy, so interception is inhibiting this process in part of the agrosystem. This work was supported by the projects PID2020-117825GB-C21 & PID2020-117825GB-C22 (INTEGRATYON3), B-RNM-60-UGR20 (OLEAGEIs), P18-RT-3629 (ICAERSA) and PPJIB2022-08 funded by University of Granada.
Published: 2023

11. Thermodynamic Analysis of a Two-Stage Binary-Fluid Ejector Heat Pump Water Heater

Author: Pengtao Wang, Ahmad AbuHeiba, Jeremy Spitzenberger, Stephen Kowalski, Hongbin Ma, and Kashif Nawaz
Subjects: History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published: 2023

12. Experimental performance of ejector heat pump operating in the sub-critical mode

Author: Jeremy Spitzenberger, Ramy H. Mohammed, Laith Ismael, Pengtao Wang, Hongbin Ma, Ahmad Abu-Heiba, Stephen Kowalski, and Kashif Nawaz
Subjects: Fuel Technology, Nuclear Energy and Engineering, Renewable Energy, Sustainability and the Environment, Energy Engineering and Power Technology
Published: 2023

13. Spatial and temporal variability of soil respiration in an irrigated olive grove in southeastern Spain

Author: Sergio Aranda-Barranco, Penelope Serrano-Ortiz, Andrew Stephen Kowalski, and Enrique Sanchez-Cañete
Abstract: Olive grove management entails environmental and socio-economic repercussions for the Mediterranean region. Maintaining bare soil in alleys is the most common management in this crop, but its implications for soil respiration (Rsoil) are not well understood. Although previous studies have quantified Rsoil at specific moments, soil respiration has not yet been continuously measured in olive groves. In this study a complete year of Rsoil measurements was taken in an irrigated olive grove in southeast of Spain. To avoid spontaneous weed growth a glyphosate-based herbicide was periodically applied. Six automated soil CO2 efflux chambers with additional sensors of soil temperature (T) and soil water content (SWC) were controled by a multichamber monitoring system (Li-8100A, Li-cor). With the aim of know the spatial variability in Rsoil and facilitate scaling up to estimate ecosystem soil respiration, 3 chambers were installed under the olive tree canopy and 3 chambers in the alleys.Preliminary results show that Rsoil increased in the warmer months and decreased in the colder months as expected. Also, daily Rsoil values under the trees are normally several times higher than in the alleys but this ratio changed with the seasons. In warm months, daily Rsoil under the tree was 2-3 times higher than daily Rsoil in the alley, while in cold months (like January) it was 6 times higher. In the alleys, diurnal variability was detected in Rsoil except in winter. While Rsoil under the trees was practically constant throughout the day during the year except in summer when there appears to be a relationship with the decrease in the flux of photosynthates in environments with high VPD. In spring Rsoil-alleys was double at midday versus night-time. Additionally, a positive and a negative relationship was established with temperature and SWC respectively. On the other hand, we found no clear relationship for Rsoil under the tree with respect to T or SWC. These preliminary results suggest a considerable Rsoil component of total ecosystem respiration influenced by the tree which does not depend on changes in T and SWC and that should be included in the partition models.
Published: 2022

14. Searching for Suitable Binary Fluid for an Ejector-Assisted Heat Pump for Domestic Water Heating

Author: Pengtao Wang, Ahmad AbuHeiba, Ramy H. Mohammed, Jeremy Spitzenberger, Stephen Kowalski, Laith Ismael, Hongbin Ma, and Kashif Nawaz
Subjects: History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published: 2022

15. The Role of Fuels in Transforming Energy End-Use in Buildings and Industrial Processes

Author: Praveen Cheekatamarla, Kyle Gluesenkamp, Stephen Kowalski, Zhenning Li, Saad Jajja, Praveen Cheekatamarla, Kyle Gluesenkamp, Stephen Kowalski, Zhenning Li, and Saad Jajja
Subjects: Buildings--Energy conservation, Sustainable buildings
Abstract: Energy-efficient technologies are necessary to lower the carbon footprint for a transition towards clean energy in a sustainable manner. This book examines what role fuels have in the transformation of end-use in buildings and industrial processes. Energy-efficient technologies are necessary to lower the carbon footprint for a transition towards clean energy in a sustainable manner. Efficient utilization of primary energy resources, including renewables, to support the current and future energy needs while targeting grid resiliency, energy, and environmental security at an affordable cost is of significant value. The author analyzes heat pumps, fuel-driven thermal providers, and power systems configurations and looks at the sensitivity of the electrical grid's carbon intensity and tariff towards carbon footprint and energy costs compared with fuel-driven technologies. The role of low-carbon, zero-carbon, and carbon-negative fuels, such as power-to-gas (P2G), power-to-liquid (PtL), hydrogen, and biogas, in conjunction with polygeneration technologies, are discussed. This book also examines two different scenarios focused on the sensitivity of the pace of decarbonization of the electrical grid and fuel supply on operational energy-related carbon emissions.Compares electricity versus fuel as a primary energy sourceExplores the role of fuels in the decarbonization journey Examines the value proposition of currently available energy solutions
Published: 2024

16. Critical care admission following elective surgery was not associated with survival benefit

Author: Kahan, Brennan C., Desponia, Koulenti, Kostoula, Arvaniti, Vanessa, Beavis, Douglas, Campbell, Matthew, Chan, Rui, Moreno, Pearse, Rupert M., Scott, Beattie, Pierre-Alain, Clavien, Nicolas, Demartines, Lee, A Fleisher, Mike, Grocott, James, Haddow, Andreas, Hoeft, Peter, Holt, Naomi, Pritchard, Andrew, Rhodes, Duminda, Wijeysundera, Matt, Wilson, Tahania, Ahmed, Kirsty, Everingham, Russell, Hewson, Marta, Januszewska, Rupert, M Pearse, Mandeep-Kaur, Phull, Richard, Halliwell, Mark, Shulman, Paul, Myles, Werner, Schmid, Michael, Hiesmayr, Patrick, Wouters, Stefan de Hert, Suzana, Lobo, Xiangming, Fang, Lars, Rasmussen, Emmanuel, Futier, Matthieu, Biais, Aurélien, Venara, Karem, Slim, Michael, Sander, Despoina, Koulenti, Mathew, Chan, Atul, Kulkarni, Susilo, Chandra, Aida, Tantri, Emad, Geddoa, Muntadhar, Abbas, Giorgio Della Rocca, Datin, Sivasakthi, Marzida, Mansor, Pastor, Luna, Arthur, Bouwman, Wolfgang, Buhre, Tim, Short, Tunde, Osinaike, Ricardo, Matos, Ioana, Grigoras, Mikhail, Kirov, Denis, Protsenko, Bruce, Biccard, Cesar, Aldecoa, Michelle, Chew, Christoph, Hofer, Martin, Hubner, James, Ditai, Tamas, Szakmany, Lee, Fleisher, Marissa, Ferguson, Michael, Macmahon, Ritchie, Cherian, Helen, Currow, Kathirgamanathan, Kanathiban, David, Gillespie, Edward, Pathmanathan, Katherine, Phillips, Jenifer, Reynolds, Joanne, Rowley, Jeanene, Douglas, Ross, Kerridge, Sameer, Garg, Michael, Bennett, Megha, Jain, David, Alcock, Nico, Terblanche, Rochelle, Cotter, Kate, Leslie, Marcelle, Stewart, Nicolette, Zingerle, Antony, Clyde, Oliver, Hambidge, Adam, Rehak, Sharon, Cotterell, Wilson Binh Quan Huynh, Timothy, Mcculloch, Erez, Ben-Menachem, Thomas, Egan, Jennifer, Cope, Paul, Fellinger, Simone, Haselberger, Caroline, Holaubek, Paul, Lichtenegger, Florian, Scherz, Franz, Hoffer, Veronika, Cakova, Andreas, Eichwalder, Norbert, Fischbach, Reinhold, Klug, Elisabeth, Schneider, Martin, Vesely, Reinhart, Wickenhauser, Karl Gernot Grubmueller, Marion, Leitgeb, Friedrich, Lang, Nancy, Toro, Marlene, Bauer, Friedrich, Laengle, Thomas, Mayrhofer, Christian, Buerkle, Karin, Forstner, Reinhard, Germann, Harald, Rinoesl, Elke, Schindler, Ernst, Trampitsch, Gerhard, Fritsch, Christian, Szabo, Jawad, Bidgoli, Hans, Verdoodt, Patrice, Forget, David, Kahn, Fernande, Lois, Mona, Momeni, Caroline, Prégardien, Audrey, Pospiech, Arnaud, Steyaert, Laurent, Veevaete, Dirk De Kegel, Karen De Jongh, Luc, Foubert, Carine, Smitz, Marcel, Vercauteren, Jan, Poelaert, Veerle Van Mossevelde, Jacques, Abeloos, Stefaan, Bouchez, Marc, Coppens, Luc De Baerdemaeker, Isabel, Deblaere, Ann De Bruyne, Stefan De Hert, Kristine, Fonck, Bjorn, Heyse, Tom, Jacobs, Koen, Lapage, Anneliese, Moerman, Martine, Neckebroek, Aliaksandra, Parashchanka, Nathalie, Roels, Nancy Van Den Eynde, Michael, Vandenheuvel, Jurgen Van Limmen, Ann, Vanluchene, Caroline, Vanpeteghem, Piet, Wyffels, Christel, Huygens, Punitha, Vandenbempt, Marc Van de Velde, Dimitri, Dylst, Bruno, Janssen, Evelien, Schreurs, Fábia Berganton Aleixo, Keulle, Candido, Hugo Dias Batista, Mario, Guimarães, Jaqueline, Guizeline, João, Hoffmann, Suzana, M Lobo, Francisco Ricardo Lobo, Vinícius, Nascimento, Katia, Nishiyama, Lucas, Pazetto, Daniela, Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela Dos Santos, Jaquelline, Jardim, Joao, Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg, Cardoso, Daniela, Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro, Réa-Neto, Fernando, Dias, Pedro, Azambuja, Marcos Freitas Knibel, Antonio, Martins, William, Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana, Caser, Marcio, Machado, Crisitiano, Aguzzoli, Sérgio, Baldisserotto, Fernanda Beck Tabajara, Fernanda, Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais, Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina, Hartmann, Marta, Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline, Azevedo, Juliana, Garcia, Marcel, Lopes, Bernardo, Maia, Paula, Maselli, Ralph, Melo, Weslley, Mendes, Matheus, Neves, Jacqueline, Ney, Claudio, Piras, Christopher, Applewhaite, Adrienne, Carr, Lorraine, Chow, Kaylene, Duttchen, Julena, Foglia, Michael, Greene, Ashley, Hinther, Kendra, Houston, Thomas Jared McCormick, Jennifer, Mikhayel, Sam, Montasser, Alex, Ragan, Andrew, Suen, Adrianna, Woolsey, Hai Chuan Yu, Duane, Funk, Stephen, Kowalski, Regina, Legaspi, Heather, Mcdonald, Faisal, Siddiqui, Jeremy, Pridham, Bernadette, Rowe, Sonia, Sampson, Barton, Thiessen, Geoff, Zbitnew, Andre, Bernard, Ronald, George, Philip, Jones, Rita, Moor, Naveed, Siddiqui, Alexandra, Wolfer, Diem, Tran, Denyse, Winch, Gary, Dobson, Thomas, Mccormick, Osama, Montasser, Richard, Hall, Leyla, Baghirzada, Si Yuan Dai, Gregory, Hare, Esther, Lee, Uma, Shastri, Albert, 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Bhavika, Daya, Leanne, Drummond, Ali, Elabib, Ehab Helmy Abdel Goad, Ismail, E Goga, Riaz, Goga, Harrichandparsad, R, Richard, E Hodgson, Jordaan, J, Nicky, Kalafatis, Christian, Kampik, T Landers, A, Emil, Loots, Rajhmum, Madansein, Anil, Madaree, Thandinkosi, E Madiba, Vukani, T Manzini, Mbali, Mbuyisa, Rajan, Moodley, Mduduzi, Msomi, Innocent, Mukama, Desigan, Naidoo, Rubeshan, Naidoo, Tesuven, K Naidu, Sindiswa, Ntloko, Eneshia, Padayachee, Lucelle, Padayachee, Martijn, Phaff, Bala, Pillay, Desigan, Pillay, Lutchmee, Pillay, Anupa, Ramnarain, Suren, R Ramphal, Paul, Ryan, Ahmed, Saloojee, Motshedisi, Sebitloane, Noluyolo, Sigcu, Jenna, L Taylor, Alexandra, Torborg, Linda, Visser, Philip, Anderson, Alae, Conradie, Mathew de Swardt, Martin de Villiers, Johan, Eikman, Riaan, Liebenberg, Johan, Mouton, Abbey, Paton, Louwrence van der Merwe, Candice, Wilscott-Davids, Wendy Joan Barrett, Marlet, Bester, Johan de Beer, Jacques, Geldenhuys, Hanni, Gouws, Jan-Hendrik, Potgieter, Magdel, Strydom, Edwin, Wilberforce-Turton, Rubendraj, R Chetty, Subash, Chirkut, Larissa, Cronje, Kim de Vasconcellos, Nokukhanya, Z Dube, N Sibusiso Gama, Garyth, M Green, Randolph, Green-Thompson, Suman Mewa Kinoo, Prenolin, Kistnasami, Kapil, Maharaj, Manogaran, S Moodley, Sibongile, J Mothae, Ruvashni, Naidoo, Aslam, M, Noorbhai, F, Vivesh, Rughubar, Jenendhiran, Reddy, Avesh, Singh, David, L Skinner, Murray, J Smith, Bhagwan, Singh, Ravi, Misra, Maheshwar, Naidoo, Pireshin, Ramdharee, Yvonne, Selibea, Selina, Sewpersad, Shailendra, Sham, Joseph, D Wessels, Cucu, Africander, Tarek, Bejia, Stephen, P Blakemore, Marisa, Botes, Bimalshakth, Bunwarie, Carlos, B Hernandez, Mohammud, A Jeeraz, Dagmara, A Legutko, Acela, G Lopez, Jenine, N De Meyer, Tanaka, Muzenda, Noel, Naidoo, Maryam, Patel, Rao, Pentela, Marina, Junge, Naj, Mansoor, Lana, Rademan, Pawel, Scislowski, Ismail, Seedat, Bianca van den Berg, Doreen van der Merwe, Steyn van Wyk, Komalan, Govender, Darshan, Naicker, Rajesh, Ramjee, 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Woon, Yuan Liang, Abd Hadi, Husni Zaeem, Ahmad Azam, Ummi Azmira, Alias, Abdul Hafiz, Kesut, Saiful Aizar, Lee, Jun May, Ooi, Dar Vin, Sulaiman, Hetty Ayuni, Tengku Lih, Tengku Alini, Veerakumaran, Jeyaganesh, Rojas, Eder, Resendiz, Gerardo Esteban Alvarez, Zapata, Darcy Danitza Mari, Aguilar López, Julio Cesar Jesú, Flores, Armando Adolfo Alvarez, Amador, Juan Carlosc Bravo, Avila, Erendira Jocelin Dominguez, Aquino, Laura Patricia González, Rodriguez, Ricardo Lopez, Landa, Mariana Torre, Urias, Emma, Hollmann, Marku, Hulst, Abraham, Kirzner, Osne, Preckel, Benedikt, Koopman-van Gemert, Ankie, Buise, Marc, Tolenaar, Noortje, Weber, Eric, de Fretes, Jennifer, Houweling, Peter, Ormskerk, Patricia, Van Bommel, Jasper, Lance, Marcu, Smit-Fun, Valerie, van Zundert, Tom, Baas, Peter, de Boer, Hans Donald, Sprakel, Joost, Elferink-Vonk, Renske, Noordzij, Peter, van Zeggeren, Laura, Brand, Bastiaan, spanjersberg, Rob, ten Bokkel-Andela, Janneke, Numan, Janneke, van Klei, Wilton, van Zaane, 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Kwok, Andy, Mohr, Otto, Oyeniyi, Peter, Patnaik, Lisa, Post, Benjamin, Ali, Sarah, Arshad, Homa, Baker, Gerard, Brenner, Laura, Brincat, Maximilian, Brunswicker, Annemarie, Cox, Hannah, Cozar, Octavian Ionut, Durst, Alexander, Fengas, Lior, Flatt, Jim, Glister, Georgina, Narwani, Vishal, Photi, Evangelo, Rankin, Adeline, Rosbergen, Melissa, Tan, Mark, Beaton, Ceri, Horn, Rachel, Hunt, Jane, Rousseau, Guy, Stancombe, Lucia, Absar, Mohammed, Allsop, Joanne, Drinkwater, Zoe, Hodgkiss, Tracey, Smith, Kirsty, Brown, Jamie, Alexander-Sefre, Farhad, Campey, Lorraine, Dudgeon, Lucy, Hall, Kathryn, Hitchcock, Rachael, James, Lynne, Smith, Kate, Winstone, Ulrika, Ahmad, Norfaizan, Bauchmuller, Kri, Harrison, Jonathan, Jeffery, Holly, Miller, Duncan, Pinder, Angela, Pothuneedi, Sailaja, Rosser, Jonathan, Sanghera, Sumayer, Swift, Diane, Walker, Rachel, Bester, Delia, Cavanagh, Sarah, Cripps, Heather, Daniel, Harvey, Lynch, Julie, Paton, Alison, Pyke, Shirley, Scholefield, John, Whitworth, Helen, Bottrill, Fiona, Ramalingam, Ganesh, Webb, Stephen, Akerman, Nik, Antill, Philip, Bourner, Lynsey, Buckley, Sarah, Castle, Gail, Charles, Rob, Eggleston, Christopher, Foster, Rebecca, Gill, Satwant, Lindley, Kate, Lklouk, Mohamed, Lowery, Tracey, Martin, Oliver, Milne, David, O’Connor, Patrick, Ratcliffe, Andrew, Rose, Alastair, Smith, Annie, Varma, Sandeep, Ward, Jackie, Barcraft-Barnes, Helena, Camsooksai, Julie, Colvin, Carolyn, Reschreiter, Henrik, Tbaily, Lee, Venner, Nicola, Hamilton, Caroline, Kelly, Lewi, Toth-Tarsoly, Piroska, Dodsworth, Kerry, Foord, Denise, Gordon, Paul, Hawes, Elizabeth, Lamb, Nikki, Mouland, Johanna, Nightingale, Jeremy, Rose, Steve, Schrieber, Joe, Al ‘Amri, Khalid, Aladin, Hafiz, Arshad, Mohammed Asif, Barraclough, Jame, Bentley, Conor, Bergin, Colin, Carrera, Ronald, Clarkson, Aisling, Collins, Michelle, Cooper, Lauren, Denham, Samuel, Griffiths, Ewen, Ip, Peter, Jeyanthan, Somasundaram, Joory, Kavita, Kaur, Satwant, Marriott, Paul, Mitchell, Natalie, Nagaiah, Sukumar, Nilsson, Annette, Parekh, Nilesh, Pope, Martin, Seager, Joseph, Serag, Hosam, Tameem, Alifia, Thomas, Anna, Thunder, Joanne, Torrance, Andrew, Vohra, Ravinder, whitehouse, Arlo, Wong, Tony, Blunt, Mark, Wong, Kate, Giles, Julian, Reed, Isabelle, Weller, Debbie, Bell, Gillian, Birch, Julie, Damant, Rose, Maiden, Jane, Mewies, Clare, Prince, Claire, Radford, Jane, Balain, Birender, Banerjee, Robin, Barnett, Andrew, Burston, Ben, Davies, Kirsty, Edwards, Jayne, Evans, Chri, Ford, David, Gallacher, Pete, Hill, Simon, Jaffray, David, Karlakki, Sudheer, Kelly, Cormac, Kennedy, Julia, Kiely, Nigel, Lewthwaite, Simon, Marquis, Chri, Ockendon, Matthew, Phillips, Stephen, Pickard, Simon, Richardson, Jame, Roach, Richard, Smith, Tony, Spencer-Jones, Richard, Steele, Niall, Steen, Julie, Van Liefland, Marck, White, Steve, Faulds, Matthew, Harris, Meredyth, Kelly, Carrie, Nicol, Scott, Pearson, Sally Anne, Chukkambotla, Srikanth, Andrew, Alyson, Attrill, Elizabeth, Campbell, Graham, Datson, Amanda, Fouracres, Anna, Graterol, Juan, Graves, Lynne, Hong, Bosun, Ishimaru, Alexander, Karthikeyan, Arvind, King, Helen, Lawson, Tom, Lee, Gregory, Lyons, Saoirse, Macalister Hall, Andrew, Mathoulin, Sophie, Mcintyre, Eilidh, Mclaughlin, Danny, Mulcahy, Kathleen, Ratcliffe, Anna, Robbins, Jame, Sung, Weilin, Tayo, Adeoluwa, Trembath, Lisa, Venugopal, Suneetha, Walker, Robert, Wigmore, Geoffrey, Boereboom, Catherine, Downes, Charlotte, Humphries, Ryan, Melbourne, Susan, Smith, Coral, Tou, Samson, Ullah, Shafa, Batchelor, Nick, Boxall, Leigh, Broomby, Rupert, Deen, Tariq, Hellewell, Alistair, Helliwell, Laurence, Hutchings, Melanie, Hutchins, David, Keenan, Samantha, Mackie, Donna, Donna, Alison, Smith, France, Stone, Lucy, Thorpe, Kevin, Wassall, Richard, Woodgate, Andrew, Baillie, Shelley, Campbell, Tara, James, Sarah, King, Chri, Marques de Araujo, Daniela, Martin, Daniel, Morkane, Clare, Neely, Julia, Rajendram, Rajkumar, Burton, Megan, James, Kathryn, Keevil, Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Wrey Brown, Caroline, Docherty, Philip, Gillies, Michael, McGregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Fowler, Alexander, Hewson, Ru, Ijuo, Eke, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, McLean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, White, Stuart, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, 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Knaggs, Alison, Markar, Sheraz, Perera, Anisha, Scott, Alasdair, Shida, Asako, Sirha, Ravneet, Wright, Sally, Frost, Victoria, Gray, Catherine, MacGregor, Mark, Andrews, Emma, Arrandale, Lindsay, Barrett, Stephen, Cifra, Elna, Cooper, Mariese, Dragnea, Drago, Elna, Cifra, Maclean, Jennifer, Meier, Sonja, Milliken, Donald, Munns, Christopher, Ratanshi, Nadir, Salvana, Abegail, Watson, Anthony, Ali, Hani, Campbell, Gill, Critchley, Rebecca, Hicks, Catherine, Liddle, Alison, Pass, Marc, Ritchie, Charlotte, Thomas, Charlotte, Too, Lingxi, Welsh, Sarah, Gill, Talvinder, Johnson, Joanne, Reed, Joanne, Davis, Edward, Papadopoullos, Sam, Attwood, Clare, Biffen, Andrew, Boulton, Kerenza, Gray, Sophie, Hay, David, Mills, Sarah, Montgomery, Jane, Riddell, Rory, Simpson, Jame, Bhardwaj, Neeraj, Paul, Elaine, Uwubamwen, Nosakhare, Alexander, Maini, Arrich, Jame, Arumugam, Swarna, Blackwood, Dougla, Boggiano, Victoria, Brown, Robyn, Lam Chan, Yik, Chatterjee, Devnandan, Chhabra, Ashok, Christian, Rachel, Costelloe, Hannah, Coxwell Matthewman, Madeline, Dalton, Emma, Darko, Julia, Davari, Maria, Dave, Tejal, Deacon, Matthew, Deepak, Shantal, Edmond, Holly, Ellis, Jessica, El-Sayed, Ahmed, Eneje, Philip, English, Rose, Ewe, Renee, Foers, William, Franklin, John, Gallego, Laura, Garrett, Emily, Goldberg, Olivia, Goss, Harry, Greaves, Rosanna, Harris, Rudy, Hennings, Charle, Jones, Eleanor, Kamali, Nelson, Kokkinos, Naomi, Lewis, Cary, Lignos, Leda, Malgapo, Evaleen Victoria, Malik, Rizwana, Milne, Andrew, Mulligan, John-Patrick, Nicklin, Philippa, Palipane, Natasha, Parsons, Thoma, Piper, Rebecca, Prakash, Rohan, Ramesh, Byron, Rasip, Sarah, Reading, Jacob, Rela, Mariam, Reyes, Anna, Robert, Stephen, Rooms, Martin, Shah, Karishma, Simons, Henry, Solanki, Shalil, Spowart, Emma, Stevens, Amy, Thomas, Christopher, Waggett, Helena, Yassaee, Arrash, Kennedy, Anthony, Scott, Sara, Somanath, Sameer, Berg, Andrew, Hernandez, Miguel, Nanda, Rajesh, Tank, Ghanshyambhai, Wilson, Natalie, 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R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al 'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Macalister Hall, A., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Donna, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Wrey Brown, C., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Onie Hove, M., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., MacGregor, M., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Salvana, A., Watson, A., Ali, H., Critchley, R., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Lam Chan, Y., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Coxwell Matthewman, M., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Robert, S., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Skinner, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Zhu, X., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Perioperative Care/methods, 0302 clinical medicine, Surgical procedures, 030202 anesthesiology, law, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, statistics and numerical data, Prospective Studies, Postoperative Period, Postoperative care/methods, education.field_of_study, Postoperative care/method, Elective Surgical Procedures/mortality, fluid output, Middle Aged, fluid administration, Intensive care unit, Hospitalization, Length of Stay/statistics & numerical data, operative/mortality, Intensive Care Units/statistics & numerical data, outcome, Female, Elective Surgical Procedure, Human, Adult, medicine.medical_specialty, Logistic Model, Postoperative care/statistics and numerical data, Critical care/utilisation, Population, Intensive Care Unit, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, Humans, Logistic Models, Surgical procedures, operative/mortality, Postoperative care, methods, Perioperative Care, NO, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Elective surgery, Intensive care medicine, education, business.industry, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Clinical trial, Prospective Studie, septic shock, business
Abstract: PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. CONCLUSIONS: We did not identify any survival benefit from critical care admission following surgery. info:eu-repo/semantics/publishedVersion
Published: 2017

17. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant

Author: Shannon M. Bates, Geneviève Le Templier, Cynthia Wu, Alfonso Tafur, Vinay Shah, Frederick A. Spencer, Peter L. Gross, Nathan P. Clark, Erik Yeo, Elizabeth MacKay, Mark Blostein, Na Li, Alex C. Spyropoulos, Thomas Vanassche, Marc Carrier, Agnes Y.Y. Lee, Sam Schulman, Summer Syed, Joseph A. Caprini, Karen A. Moffat, Jeannine Kassis, Peter Verhamme, Grégoire Le Gal, Sudeep Shivakumar, Susan Solymoss, Donald M. Arnold, Michiel Coppens, James D. Douketis, Joanne Duncan, Stephen Kowalski, Eleni Arnaoutoglou, ACS - Pulmonary hypertension & thrombosis, Vascular Medicine, and Graduate School
Subjects: Rivaroxaban, medicine.medical_specialty, business.industry, medicine.drug_class, 010102 general mathematics, Anticoagulant, Perioperative, 01 natural sciences, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Cohort, Internal Medicine, medicine, Apixaban, 030212 general & internal medicine, 0101 mathematics, Elective surgery, business, medicine.drug, Cohort study
Abstract: Importance: Patients with atrial fibrillation (AF) who use a direct oral anticoagulant (DOAC) and request elective surgery or procedure present a common clinical situation yet perioperative management is uncertain. Objective: To investigate the safety of a standardized perioperative DOAC management strategy. Design, Setting, and Participants: The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) cohort study conducted at 23 clinical centers in Canada, the United States, and Europe enrolled and screened patients from August 1, 2014, through July 31, 2018. Participants (n = 3007) had AF; were 18 years of age or older; were long-term users of apixaban, dabigatran etexilate, or rivaroxaban; were scheduled for an elective surgery or procedure; and could adhere to the DOAC therapy interruption protocol. Interventions: A simple standardized perioperative DOAC therapy interruption and resumption strategy based on DOAC pharmacokinetic properties, procedure-associated bleeding risk, and creatinine clearance levels. The DOAC regimens were omitted for 1 day before a low-bleeding-risk procedure and 2 days before a high-bleeding-risk procedure. The DOAC regimens were resumed 1 day after a low-bleeding-risk procedure and 2 to 3 days after a high-bleeding-risk procedure. Follow-up of patients occurred for 30 days after the operation. Main Outcomes and Measures: Major bleeding and arterial thromboembolism (ischemic stroke, systemic embolism, and transient ischemic attack) and the proportion of patients with an undetectable or minimal residual anticoagulant level (
Published: 2019

18. Association of earlier extubation and postoperative delirium after coronary artery bypass grafting

Author: Stephen Kowalski, Scott Mackenzie, Eric Jacobsohn, Hellmuth R. Muller Moran, Doug Maguire, Rakesh C. Arora, Duncan Maguire, and Hilary P. Grocott
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, mental disorders, medicine, Mechanical ventilation, business.industry, Odds ratio, Intensive care unit, Confidence interval, Cardiac surgery, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Delirium, Surgery, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Complication, Artery
Abstract: Earlier extubation after cardiac surgery is reported to have benefits on length of stay and complication rates, but the influence on postoperative delirium remains unclear. We sought to determine the effect of earlier extubation on delirium after coronary artery bypass grafting.A single-center retrospective review of consecutive isolated coronary artery bypass grafting patients from January 1, 2010, to December 31, 2015, was conducted. Baseline demographic characteristics, preoperative comorbidities, intraoperative data, and postoperative data were collected. A multivariable logistic regression was performed with analysis limited to extubation within the first 24 hours postoperatively.We identified 2561 eligible patients. Delirium occurred in 13.9% (n = 357). Duration of postoperative mechanical ventilation was associated with higher delirium rates following adjustment, particularly after 12 to 24 hours (hourly odds ratio, 1.12; 95% confidence interval, 1.05-1.19; P .001). No association was observed during the time period from 0 to 12 hours (hourly odds ratio, 1.02; 95% confidence interval, 0.99-1.06; P = .218). Major adverse events were associated with duration of ventilation after 0 to 12 hours (hourly odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P .002) but not after 12 to 24 hours (hourly odds ratio, 1.04; 95% CI, 0.96-1.14; P = .316). The overall rate of reintubation was 2.9% (n = 73).Our findings suggest that delirium rates increase with lengthier postoperative ventilation times. This study provides the basis for consideration of the appropriate selection of earlier extubation to minimize delirium in patients undergoing cardiac surgery.
Published: 2020

19. The surgical safety checklist and patient outcomes after surgery

Author: T.E.F. Abbott, T. Ahmad, M.K. Phull, A.J. Fowler, R. Hewson, B.M. Biccard, M.S. Chew, M. Gillies, R.M. Pearse, Rupert M. Pearse, Scott Beattie, Pierre-Alain Clavien, Nicolas Demartines, Lee A. Fleisher, Mike Grocott, James Haddow, Andreas Hoeft, Peter Holt, Rui Moreno, Naomi Pritchard, Andrew Rhodes, Duminda Wijeysundera, Matt Wilson, Tahania Ahmed, Kirsty Everingham, Russell Hewson, Marta Januszewska, Mandeep-Kaur Phull, Richard Halliwell, Mark Shulman, Paul Myles, Werner Schmid, Michael Hiesmayr, Patrick Wouters, Stefan de Hert, Suzana Lobo, Xiangming Fang, Lars Rasmussen, Emmanuel Futier, Matthieu Biais, Aurélien Venara, Karem Slim, Michael Sander, Despoina Koulenti, Kostoula Arvaniti, Mathew Chan, Atul Kulkarni, Susilo Chandra, Aida Tantri, Emad Geddoa, Muntadhar Abbas, Giorgio Della Rocca, Datin Sivasakthi, Marzida Mansor, Pastor Luna, Arthur Bouwman, Wolfgang Buhre, Vanessa Beavis, Douglas Campbell, Tim Short, Tunde Osinaike, Ricardo Matos, Ioana Grigoras, Mikhail Kirov, Denis Protsenko, Bruce Biccard, Cesar Aldecoa, Michelle Chew, Christoph Hofer, Martin Hubner, James Ditai, Tamas Szakmany, Lee Fleisher, Marissa Ferguson, Michael MacMahon, Ritchie Cherian, Helen Currow, Kathirgamanathan Kanathiban, David Gillespie, Edward Pathmanathan, Katherine Phillips, Jenifer Reynolds, Joanne Rowley, Jeanene Douglas, Ross Kerridge, Sameer Garg, Michael Bennett, Megha Jain, David Alcock, Nico Terblanche, Rochelle Cotter, Kate Leslie, Marcelle Stewart, Nicolette Zingerle, Antony Clyde, Oliver Hambidge, Adam Rehak, Sharon Cotterell, Wilson Binh Quan Huynh, Timothy McCulloch, Erez Ben-Menachem, Thomas Egan, Jennifer Cope, Paul Fellinger, Markus Haisjackl, Simone Haselberger, Caroline Holaubek, Paul Lichtenegger, Florian Scherz, Franz Hoffer, Veronika Cakova, Andreas Eichwalder, Norbert Fischbach, Reinhold Klug, Elisabeth Schneider, Martin Vesely, Reinhart Wickenhauser, Karl Gernot Grubmueller, Marion Leitgeb, Friedrich Lang, Nancy Toro, Marlene Bauer, Friedrich Laengle, Claudia Haberl, Thomas Mayrhofer, Christoph Trybus, Christian Buerkle, Karin Forstner, Reinhard Germann, Harald Rinoesl, Elke Schindler, Ernst Trampitsch, Gerhard Bogner, Daniel Dankl, Martin Duenser, Gerhard Fritsch, Ilse Gradwohl-Matis, Andreas Hartmann, Thomas Hoelzenbein, Tarkan Jaeger, Franz Landauer, Gregor Lindl, Michael Lux, Johannes Steindl, Ottokar Stundner, Christian Szabo, Jawad Bidgoli, Hans Verdoodt, Patrice Forget, David Kahn, Fernande Lois, Mona Momeni, Caroline Prégardien, Audrey Pospiech, Arnaud Steyaert, Laurent Veevaete, Dirk De Kegel, Karen De Jongh, Luc Foubert, Carine Smitz, Marcel Vercauteren, Jan Poelaert, Veerle Van Mossevelde, Jacques Abeloos, Stefaan Bouchez, Marc Coppens, Luc De Baerdemaeker, Isabel Deblaere, Ann De Bruyne, Kristine Fonck, Bjorn Heyse, Tom Jacobs, Koen Lapage, Anneliese Moerman, Martine Neckebroek, Aliaksandra Parashchanka, Nathalie Roels, Nancy Van Den Eynde, Michael Vandenheuvel, JurgenVan Limmen, Ann Vanluchene, Caroline Vanpeteghem, Piet Wyffels, Christel Huygens, Punitha Vandenbempt, Marc Van de Velde, Dimitri Dylst, Bruno Janssen, Evelien Schreurs, Fábia Berganton Aleixo, Keulle Candido, Hugo Dias Batista, Mario Guimarães, Jaqueline Guizeline, João Hoffmann, Francisco Ricardo Marques Lobo, Vinícius Nascimento, Katia Nishiyama, Lucas Pazetto, Daniela Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela dos Santos, Jaquelline Jardim, Luiz Marcelo Sá Malbouisson, Joao Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg Cardoso, Daniela Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro Réa-Neto, Fernando Dias, Maria Eduarda Travi, Luiza Zerman, Pedro Azambuja, Marcos Freitas Knibel, Antonio Martins, William Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana Caser, Marcio Machado, Crisitiano Aguzzoli, Sérgio Baldisserotto, Fernanda Beck Tabajara, Fernanda Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina Hartmann, Marta Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline Azevedo, Juliana Garcia, Marcel Lopes, Bernardo Maia, Paula Maselli, Ralph Melo, Weslley Mendes, Matheus Neves, Jacqueline Ney, Claudio Piras, Christopher Applewhaite, Adrienne Carr, Lorraine Chow, Kaylene Duttchen, Julena Foglia, Michael Greene, Ashley Hinther, Kendra Houston, Thomas Jared McCormick, Jennifer Mikhayel, Sam Montasser, Alex Ragan, Andrew Suen, Adrianna Woolsey, Hai Chuan Yu, Duane Funk, Stephen Kowalski, Regina Legaspi, Heather McDonald, Faisal Siddiqui, Jeremy Pridham, Bernadette Rowe, Sonia Sampson, Barton Thiessen, Geoff Zbitnew, Andre Bernard, Ronald George, Philip Jones, Rita Moor, Naveed Siddiqui, Alexandra Wolfer, Diem Tran, Denyse Winch, Gary Dobson, Thomas McCormick, Osama Montasser, Richard Hall, Leyla Baghirzada, Gerard Curley, Si Yuan Dai, Gregory Hare, Esther Lee, Uma Shastri, Albert Tsui, Anmol Yagnik, Danielle Alvares, Stephen Choi, Heather Dwyer, Kathrina Flores, Colin McCartney, Priya Somascanthan, Jo Carroll, Janneth Pazmino-Canizares, Noam Ami, Vincent Chan, Anahi Perlas, Ruth Argue, Yang Huang, Katie Lavis, Kelly Mayson, Ying Cao, Hong Gao, Tingju Hu, Jie Lv, Jian Yang, Yang Yang, Yi Zhong, Jing Zhou, Xiaohua Zou, Miao He, Xiaoying Li, Dihuan Luo, Haiying Wang, Tian Yu, Liyong Chen, Lijun Wang, Yunfei Cai, Zhongming Cao, Yanling Li, Jiaxin Lian, Haiyun Sun, Sheng Wang, Zhipeng Wang, Kenru Wang, Yi Zhu, Xindan Du, Hao Fan, Yunbin Fu, Lixia Huang, Yanming Huang, Haifang Hwan, Hong Luo, Pi-Sheng Qu, Fan Tao, Zhen Wang, Guoxiang Wang, Shun Wang, Yan Zhang, Xiaolin Zhang, Chao Chen, Weixing Wang, Zhengyuan Liu, Lihua Fan, Jing Tang, Yijun Chen, Yongjie Chen, Yangyang Han, Changshun Huang, Guojin Liang, Jing Shen, Jun Wang, Qiuhong Yang, Jungang Zhen, Haidong Zhou, Junping Chen, Zhang Chen, Xiaoyu Li, Bo Meng, Haiwang Ye, Xiaoyan Zhang, Yanbing Bi, Jianqiao Cao, Fengying Guo, Hong Lin, Yang Liu, Meng Lv, Pengcai Shi, Xiumei Song, Chuanyu Sun, Yongtao Sun, Yuelan Wang, Shenhui Wang, Min Zhang, Rong Chen, Jiabao Hou, Yan Leng, Qing-tao Meng, Li Qian, Zi-ying Shen, Zhong-yuan Xia, Rui Xue, Yuan Zhang, Bo Zhao, Xian-jin Zhou, Qiang Chen, Huinan Guo, Yongqing Guo, Yuehong Qi, Zhi Wang, Jianfeng Wei, Weiwei Zhang, Lina Zheng, Qi Bao, Yaqiu Chen, Yijiao Chen, Yue Fei, Nianqiang Hu, Xuming Hu, Min Lei, Xiaoqin Li, Xiaocui Lv, Fangfang Miao, Lingling Ouyang, Lu Qian, Conyu Shen, Yu Sun, Yuting Wang, Dong Wang, Chao Wu, Liyuan Xu, Jiaqi Yuan, Lina Zhang, Huan Zhang, Yapping Zhang, Jinning Zhao, Chong Zhao, Lei Zhao, Tianzhao Zheng, Dachun Zhou, Haiyan Zhou, Ce Zhou, Kaizhi Lu, Ting Zhao, Changlin He, Hong Chen, Shasha Chen, Baoli Cheng, Jie He, Lin Jin, Caixia Li, Hui Li, Yuanming Pan, Yugang Shi, Xiao Hong Wen, Shuijing Wu, Guohao Xie, Kai Zhang, Bing Zhao, Xianfu Lu, Feifei Chen, Qisheng Liang, Xuewu Lin, Yunzhi Ling, Gang Liu, Jing Tao, Lu Yang, Jialong Zhou, Fumei Chen, Zhonggui Cheng, Hanying Dai, Yunlin Feng, Benchao Hou, 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De Meyer, Tanaka Muzenda, Noel Naidoo, Maryam Patel, Rao Pentela, Marina Junge, Naj Mansoor, Lana Rademan, Pawel Scislowski, Ismail Seedat, Bianca van den Berg, Doreen van der Merwe, Steyn van Wyk, Komalan Govender, Darshan Naicker, Rajesh Ramjee, Mueen Saley, Warren Paul Kuhn, Roel Matos-Puig, Zaheer Moolla Alberto Lisi, Gisela Perez, Anna Valle Beltran, Angels Lozano, Carlos Delgado Navarro, Alejandro Duca, Ernesto Pastor Martinez Ernesto, Carlos Ferrando, Isabel Fuentes, Maria Luisa García-Pérez, Estefania Gracia, Ana Izquierdo Palomares, Antonio Katime, Amanda Miñana, Raul Raul Incertis, Esther Romero, Carolina Soledad Romero Garcia, Concepcion Rubio, Tania Socorro Artiles, Marina Soro, Paola Valls, Gisela Alaman Laguarda, Pau Benavent, Vicente Chisbert Cuenca, Andreu Cueva, Matilde Lafuente, Asuncion Marques Parra, Alejandra Romero Rodrigo, Silvia Sanchez-Morcillo, Sergi Tormo, Francisco Javier Redondo, José Antonio De Andrés Ibanez, Lorena Gómez Diago, Maria José Hernández Cádiz, Granell Gil Manuel, Raquel Peris, Cristina Saiz, Jose Tatay Vivo, Maria Teresa Tebar Soto, Tamara Brunete, David Cancho, David R. Delgado García, Diana Zamudio, Santiago Garcia Del Valle, M. Luz Serrano, Eduardo Alonso, Victor Anillo, Emilio Maseda, Patricia Salgado, Luis Suarez, Alejandro Suarez-de-la-Rica, María José Villagrán, José Ignacio Alonso, Estefania Cabezuelo, Irene Garcia-Saiz, Olga Lopez del Moral, Silvia Martín, Alba Perez Gonzalez, Ma Sherezade Tovar Doncel, Martin Agüero Vera, Francisco José Ávila Sánchez, Beatriz Castaño, Beatriz Castaño Moreira, Sahely Flores Risco, Daniel Paz Martín, Fernando Pérez Martín, Paloma Poza, Adela Ruiz, Wilson Fabio Serna Martínez, Bárbara Vázquez Vicente, Saul Velaz Dominguez, Salvador Fernández, Alfonso Munoz-López, Maria Jose Bernat, Arantxa Mas, Kenneth Planas, Monir Jawad, Yousif Saeed, Annika Hedin, Helena Levander, Sandra Holmström, David Lönn, Frank Zoerner, Irene Åkring, Carl Widmark, Jan Zettergren, Victor Aspelund Liljequist, Lena Nystrom, Suzanne Odeberg-Wernerman, Anders Oldner, Malin Jonsson Fagerlund, Patrik Reje, Sara Lyckner, Jesper Sperber, Anne Adolfsson, Bengt Klarin, Katrin Ögren, Jean-Pierre Barras, Thomas Bührer, Vasileios Despotidis, Naeder Helmy, Stephan Holliger, Dimitri Aristotle Raptis, Roger Schmid, Antoine Meyer, Yves Jaquet, Ulf Kessler, Mirza Muradbegovic, Solange R. 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Ganter, Martin Geisen, Christopher Soll, Michelle Korkmaz, Iris Lubach, Michael Schmitz, Moritz Meyer zu Schwabedissen, Meyer zu Schwabedissen Moritz, Urs Zingg, Thomas Hillermann, Stefan Wildi, Bernardo Bollen Pinto, Bernhard Walder, Giustina Mariotti, Ksenija Slankamenac, Mirioce Namuyuga, Edward Kyomugisha, Olivia Kituuka, Anne Wesonga Shikanda, Nasser Kakembo, Charles Otim Tom, Webombesa Antonina, Emmanuel Bua, Eden Michael Ssettabi, Joseph Epodoi, Fiona Kabagenyi, Fred Kirya, Ged Dempsey, Colette Seasman, Raja Basit Nawaz Khan, Claire Kurasz, Mark Macgregor, Burhan Shawki, Daren Francis, Vimal Hariharan, Simon Chau, Kate Ellis, Georgina Butt, Dennis-Wayne Chicken, Natasha Christmas, Samantha Allen, Gayatri Daniel Daniel, Angie Dempster, Juliette Kemp, Lewis Matthews, Philip Mcglone, Joanne Tambellini, Dawn Trodd, Katie Freitas, Atul Garg, Janesh Kumar Gupta, Shilpaja Karpate, Aditi Kulkarni, Chloe O'Hara, Jtroko Troko, Kirsty Angus, Jacqueline Bradley, Emma Brennan, Carolyn Brooks, Janette Brown, Gemma Brown, Amanda Finch, Karen Gratrix, Sue Hesketh, Gillian Hill, Carol Jeffs, Maureen Morgan, Chris Pemberton, Nicola Slawson, Helen Spickett, Gemma Swarbrick, Megan Thomas, Greta Van Duyvenvoorde, Andrew Brennan, Richard Briscoe, Sarah Cooper, Tom Lawton, Martin Northey, Rashmi Senaratne, Helen Stanworth, Lorna Burrows, Helen Cain, Rachael Craven, Keith Davies, Attila Jonas, Marcin Pachucki, Graham Walkden, Helen Davies, Mariethel Gudaca, Maria Hobrok, Dilshan Arawwawala, Lauren Fergey, Matthew Gardiner, Jacqueline Gunn, Lyndsay Johnson, Amanda Lofting, Amanda Lyle, Fiona Mc Neela, Susan Smolen, Joanne Topliffe, Sarah Williams, Martin Bland, Packianathaswamy Balaji, Vikas Kaura, Prasad Lanka, Neil Smith, Ahmed Ahmed, John Myatt, Ravikiran Shenoy, Wai Cheong Soon, Jessica Tan, Sunny Karadia, James Self, Emma Durant, Shiva Tripathi, Clare Bullock, Debbie Campbell, Alison Ghosh, Thomas Hughes, Lajos Zsisku, Sheshagiri Bengeri, Amanda Cowton, Mohammed Shazad Khalid, James Limb, Colin McAdam, Mandy Porritt, M. Amir Rafi, Priya Shekar, David Adams, Catherine Harden, Heidi Hollands, Angela King, Linda March, Gary Minto, Abigail Patrick, Rosalyn Squire, Darren Waugh, Paramesh Kumara, Karen Simeson, Jamie Yarwood, Julie Browning, Jonathan Hatton, Howes Julian, Atideb Mitra, Maria Newton, Pawan Kootelu Pernu, Alison Wilson, Thelma Commey, Helen Foot, Lyn Glover, Ajay Gupta, Nicola Lancaster, Jill Levin, Felicity Mackenzie, Claire Mestanza, Emma Nofal, Lauren Pout, Rosanna Varden, Jonathan Wild, Stephanie Jones, Sarah Moreton, Mark Pulletz, Charlotte Davies, Matthew Martin, Sian Thomas, Karen Burns, Carol McArthur, Panna Patel, Gary Lau, Natalie Rich, Fiona Davis, Rachel Lyons, Beth Port, Rachel Prout, Christopher Smith, Yemi Adelaja, Victoria Bennett, Heena Bidd, Alexandra Dumitrescu, Jacqui Fox Murphy, Abigail Keen, Nhlanhla Mguni, Cheng Ong, George Adams, Piers Boshier, Richard Brown, Izabella Butryn, Jayanta Chatterjee, Alexander Freethy, Geoffrey Lockwood, Maria Tsakok, Sophia Tsiligiannis, William Peat, Lorraine Stephenson, Mike Bradburn, Sara Pick, Pedro Cunha, Olufemi Olagbaiye, Salim Tayeh, Balaji Packianathaswamy, Caroline Abernethy, Madhu Balasubramaniam, Rachael Bennett, David Bolton, Victoria Martinson, Charde Naylor, Stephanie Bell, Blaylock Heather, Vlad Kushakovsky, Liam Alcock, Hazel Alexander, Colette Anderson, Paul Baker, Morag Brookes, Louise Cawthorn, Emanuel Cirstea, Rachel Clarkson, Kerry Colling, Ian Coulter, Suparna Das, Kathryn Haigh, Alhafidz Hamdan, Keith Hugill, Lucksy Kottam, Emily Lisseter, Matthew Mawdsley, Julie McGivern, Krishnaveni Padala, Victoria Phelps, Vineshykaa Ramesh kumar, Kirsten Stewart, Kayley Towse, Julie Tregonning, Ali Vahedi, Alycon Walker, Duncan Baines, Anjali Bilolikar, Shiv Chande, Edward Copley, Nigel Dunk, Raghavendra Kulkarni, Pawan Kumar, Yavor Metodiev, Dumisani Ncomanzi, Bhavesh Raithatha, Parizade Raymode, Jan Szafranski, Linda Twohey, Philip Watt, Lucie Weatherall, J. 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A., Panagiotakis, C., Sfyras, D., Tsimpoukas, F., Tsirogianni, A., Axioti, E., Filippopoulos, A., Kalliafa, E., Kassavetis, G., Katralis, P., Komnos, I., Pilichos, G., Ravani, I., Totis, A., Apagaki, E., Efthymiadi, A., Kampagiannis, N., Paraforou, T., Tsioka, A., Georgiou, G., Vakalos, A., Bairaktari, A., Charitos, E., Markou, G., Niforopoulou, P., Papakonstantinou, N., Tsigou, E., Xifara, A., Zoulamoglou, M., Gkioni, P., Karatzas, S., Kyparissi, A., Mainas, E., Papapanagiotou, I., Papavasilopoulou, T., Fragandreas, G., Georgopoulou, E., Katsika, E., Psarras, K., Synekidou, E., Verroiotou, M., Vetsiou, E., Zaimi, D., Anagnou, A., Apostolou, K., Melissopoulou, T., Rozenberg, T., Tsigris, C., Boutsikos, G., Kalles, V., Kotsalas, N., Lavdaiou, C., Paikou, F., Panagou, G.L., Spring, A., Botis, I., Drimala, M., Georgakakis, G., Kiourtzieva, E., Ntouma, P., Prionas, A., Xouplidis, K., Dalampini, E., Giannaki, C., Iasonidou, C., Ioannidis, O., Lavrentieva, A., Papageorgiou, G., Kokkinoy, M., Stafylaraki, M., Gaitanakis, S., Karydakis, P., Paltoglou, J., Ponireas, P., Chaloulis, P., Provatidis, A., Sousana, A., Gardikou, V.V., Konstantivelli, M., Lataniotou, O., Lisari, E., Margaroni, M., Stamatiou, K., Nikolaidis, E., Pnevmatikos, I., Sertaridou, E., Andreou, A., Arkalaki, E., Athanasakis, E., Chaniotaki, F., Chatzimichali, C.A., Christofaki, M., Dermitzaki, D., Fiorentza, K., Frantzeskos, G., Geromarkaki, E., Kafkalaki, K., Kalogridaki, M., Karydi, K., Kokkini, S., Kougentakis, G., Lefaki, T., Lilitsis, E., Makatounaki, A., Malliotakis, P., Michelakis, D., Neonaki, M., Nyktari, V., Palikyra, I., Papadakis, E., Papaioannou, A., Sfakianakis, K., Sgouraki, M., Souvatzis, X., Spartinou, A., Stefanidou, N., Syrogianni, P., Tsagkaraki, G., Arnaoutoglou, E., Arnaoutoglou, C., Bali, C., Bouris, V., Doumos, R., Gkini, K.P., Kapaktsi, C., Koulouras, V., Lena, A., Lepida, D., Michos, E., Papadopoulos, D., Paschopoulos, M., Rompou, V.A., Siouti, I., Tsampalas, S., Ververidou, O., Zilis, G., Charlalampidoy, A., Christodoulidis, G., Flossos, A., Stamoulis, K., Tsang, MSC, Tsang, M.S., Lai, M.L., Yip, C.P., Heymans Chan, H.M., Law, B., Li, W.S., Chu, H.M., Koo, EGY, Lam, CCJ, Cheng, K.H., Lam, T., Chu, S., Lam, W.Y., Wong, KWK, Kwok, D., Hung, CYJ, Chan, WKJ, Wong, W.L., Chung, CKE, Ma, S.K., Kaushik, S., Shah, B., Shah, D., Shah, S., Ar, P., Muthuchellappan, R., Agarwal, V., Divatia, J., Mishra, S., Nimje, G., Pande, S., Savarkar, S., Shrivastava, A., Thomas, M., Yegnaram, S., Hidayatullah, R., Puar, N., Niman, S., Indra, I., Hamzah, Z., Yuliana, A., Abidin, U.N., Dursin, A.N., Kurnia, A., Susanti, A., Handayani, D., Alit, M.A., Arya, A., Senapathi, TGA, Utara, U.H., Wid, W.M., Wima, S., Wir, W.M., Jehosua, B., Kaunang, J., Lantang, E.Y., Najoan, R., Waworuntu, N., Awad, H., Fuad, A., Geddoa, B., Khalaf, A.R., Al Hussaini, S., Albaj, S., Kenber, M., Bettinelli, A., Spadaro, S., AlbertoVolta, C., Giancarlo, L., Sottosanti, V., Copetti, E., Spagnesi, L., Toretti, I., Alloj, C., Cardellino, S., Carmino, L., Costanzo, E., Fanfani, L.C., Novelli, M.T., Roasio, A., Bellandi, M., Bignami, E., Bocchino, S., Cabrini, L., Corti, D., Landoni, G., Meroni, R., Moizo, E., Monti, G., Pintaudi, M., Plumari, V.P., Taddeo, D., Testa, V., Winterton, D., Zangrillo, A., Cloro, L.M., Colangelo, C., Colangelo, A., Rotunno, G., Paludi, M.A., Maria, C.P., Pata, A., Parrini, V., Gatta, A., Nastasi, M., Tinti, C., Baroselli, A., Arrigo, M., Benevento, A., Bottini, C., Cannavo', M., Gastaldi, C., Marchesi, A., Pascazio, A., Pata, F., Pozzi, E., Premoli, A., Tessera, G., Boschi, L., D'Andrea, R., Ghignone, F., Poggioli, G., Sibilio, A., Taffurelli, M., Ugolini, G., Ab Majid, M.A., Ab Rahman, R., Joseph, J., Pathan, F., Sybil Shah, M.H., Yap, H.L., Cheah, S., Chin, I.I., Looi, J.K., Tan, S.C., Visvalingam, S., Kwok, F.Y., Lee, C.K., Tan, T.S., Wong, S.M., Abdullah, N.H., Liew, C.F., Luxuman, L., Mohd Zin, N.H., Norddin, M.F., Raja Alias, R.L., Wong, J.Y., Yong, J., Bin Mustapha, M.T., Chan, W.K., Dzulkipli, N., Kuan, P.X., Lee, Y.C., Alias, A., Guok, E.C., Jee, C.C., Ramon, B.R., Wong, C.W., Abd Ghafar, FNI, Aziz, F.Z., Hussain, N., Lee, H.S., Sukawi, I., Woon, Y.L., Abd Hadi, H.Z., Ahmad Azam, U.A., Alias, A.H., Kesut, S.A., Lee, J.M., Ooi, D.V., Sulaiman, H.A., Lih, TAT, Veerakumaran, J., Rojas, E., Resendiz, GEA, Zapata, DDM, López, JCJA, Flores, AAA, Amador, JCB, Avila, EJD, Aquino, LPG, Rodriguez, R.L., Landa, M.T., Urias, E., Hollmann, M., Hulst, A., Benedikt Preckel, O.K., Gemert, A.K., Buise, M., Tolenaar, N., Weber, E., de Fretes, J., Houweling, P., Ormskerk, P., Van Bommel, J., Lance, M., Smit-Fun, V., van Zundert, T., Baas, P., de Boer, H.D., Sprakel, J., Elferink-Vonk, R., Noordzij, P., van Zeggeren, L., Brand, B., Spanjersberg, R., Bokkel-Andela, J.T., Numan, S., van Klei, W., van Zaane, B., Boer, C., van Duivenvoorde, Y., Hering, J.P., van Rossum, S., Zonneveldt, H., Hoare, S., Santa, S., Ali, M., Allen, S.J., Bell, R., Choi, H.D., Drake, M., Farrell, H., Hayes, K., Higgie, K., Holmes, K., Jenkins, N., Kim, C.J., Kim, S., Law, K.C., McAllister, D., Park, K., Pedersen, K., Pfeifer, L., Pozaroszczyk, A., Salmond, T., Steynor, M., Tan, M., Waymouth, E., Ab Rahman, A.S., Armstrong, J., Dudson, R., Nilakant, J., Richard, S., Virdi, P., Dixon, L., Donohue, R., Farrow, M., Kennedy, R., Marissa, H., McKellow, M., Nicola, D., Pascoe, R., Roberts, S.J., Rowell, G., Sumner, M., Templer, P., Chandrasekharan, S., Fulton, G., Jammer, I., More, R., Wilson, L., Chang, Y.H., Foley, J., Fowler, C., Panckhurst, J., Sara, R., Stapelberg, F., Cherrett, V., Ganter, D.L., McCann, L., Gilmour, F., Lumsden, R., Moores, M., Olliff, S., Sardareva, E., Tai, J., Wikner, M., Wong, C., Chaddock, M., Czepanski, C., McKendry, P., Polakovic, D., Polakovich, D., Robert, A., Belda, M.T., Norton, T., Alherz, F., Barneto, L., Ramirez, A., Sayeed, A., Smith, N., Bennett, C., McQuoid, S., Jansen, T.L., Nico, Z., Scott, J., Freschini, D., Freschini, A., Hopkins, B., Manson, L., Stoltz, D., Bates, A., Davis, S., Freeman, V., McGaughran, L., Williams, M., Sharma, S.B., Burrows, T., Byrne, K., English, D., Johnson, R., Manikkam, B., Naidoo, S., Rumball, M., Whittle, N., Franks, R., Gibson-Lapsley, H., Salter, R., Walsh, D., Cooper, R., Perry, K., Obobolo, A., Sule, U.M., Ahmad, A., Atiku, M., Mohammed, A.D., Sarki, A.M., Adekola, O., Akanmu, O., Durodola, A., Olukoju, O., Raji, V., Olajumoke, T., Oyebamiji, E., Adenekan, A., Adetoye, A., Faponle, F., Olateju, S., Owojuyigbe, A., Talabi, A., Adenike, O., Adewale, B., Collins, N., Ezekiel, E., Fatungase, O.M., Grace, A., Sola, S., Stella, O., Ademola, A., Adeolu, A.A., Adigun, T., Akinwale, M., Fasina, O., Gbolahan, O., Idowu, O., Olonisakin, R.P., Osinaike, B.B., Asudo, F., Mshelia, D., Abdur-Rahman, L., Agodirin, O., Bello, J., Bolaji, B., Oyedepo, O.O., Ezike, H., Iloabachie, I., Okonkwo, I., Onuora, E., Onyeka, T., Ugwu, I., Umeh, F., Alagbe-Briggs, O., Dodiyi-Manuel, A., Echem, R., Obasuyi, B., Onajin-Obembe, B., Bandeira, M.E., Tomé, M., Costa, ACMM, Krystopchuk, A., Branco, T., Esteves, S., Melo, M.A., Monte, J., Rua, F., Martins, I., Pinho-Oliveira, V.M., Rodrigues, C.M., Cabral, R., Marques, S., Rêgo, S., Jesus, JST, Marques, M.C., Romao, C., Dias, S., Santos, A.M., Alves, M.J., Salta, C., Cruz, S., Duarte, C., Paiva, AAF, Cabral, TDN, Faria E Maia, D., Correia da Silva, RFM, Langner, A., Resendes, H.O., Soares, MDC, Abrunhosa, A., Faria, F., Miranda, L., Pereira, H., Serra, S., Ionescu, D., Margarit, S., Mitre, C., Vasian, H., Manga, G., Stefan, A., Tomescu, D., Filipescu, D., Paunescu, M.A., Stefan, M., Stoica, R., Gavril, L., Pătrășcanu, E., Ristescu, I., Rusu, D., Diaconescu, C., Iosep, G.F., Pulbere, D., Ursu, I., Balanescu, A., Grintescu, I., Mirea, L., Rentea, I., Vartic, M., Lupu, M.N., Stanescu, D., Streanga, L., Antal, O., Hagau, N., Patras, D., Petrisor, C., Tosa, F., Tranca, S., Copotoiu, S.M., Ungureanu, L.L., Harsan, C.R., Papurica, M., Cernea, D.D., Dragoescu, N.A., CarmenVaida, L.A., Ciobotaru, O.R., Aignatoaie, M., Carp, C.P., Cobzaru, I., Mardare, O., Purcarin, B., Tutunaru, V., Ionita, V., Arustei, M., Codita, A., Busuioc, M., Chilinciuc, I., Ciobanu, C., Belciu, I., Tincu, E., Blaj, M., Grosu, R.M., Sandu, G., Bruma, D., Corneci, D., Dutu, M., Krepil, A., Copaciu, E., Dumitrascu, C.O., Jemna, R., Mihaescu, F., Petre, R., Tudor, C., Ursache, E., Kulikov, A., Lubnin, A., Grigoryev, E., Pugachev, S., Tolmasov, A., Hussain, A., Ilyina, Y., Roshchina, A., Iurin, A., Chazova, E., Dunay, A., Karelov, A., Khvedelidze, I., Voldaeva, O., Belskiy, V., Dzhamullaev, P., Grishkowez, E., Kretov, V., Levin, V., Molkov, A., Puzanov, S., Samoilenko, A., Tchekulaev, A., Tulupova, V., Utkin, I., Allorto, N.L., Bishop, D.G., Builu, P.M., Cairns, C., Dasrath, A., de Wet, J., Hoedt, M.D., Grey, B., Hayes, M.P., Küsel, B.S., Shangase, N., Wise, R., Cacala, S., Farina, Z., Govindasamy, V., Kruse, C.H., Lee, C., Marais, L., Naidoo, T.D., Rajah, C., Rodseth, R.N., Ryan, L., von Rhaden, R., Adam, S., Alphonsus, C., Ameer, Y., Anderson, F., Basanth, S., Bechan, S., Bhula, C., Biccard, B.M., Biyase, T., Buccimazza, I., Cardosa, J., Daya, B., Drummond, L., Elabib, A., Abdel Goad, E.H., Goga, I.E., Goga, R., Harrichandparsad, R., Hodgson, R.E., Jordaan, J., Kalafatis, N., Kampik, C., Landers, A.T., Loots, E., Madansein, R., Madaree, A., Madiba, T.E., Manzini, V.T., Mbuyisa, M., Moodley, R., Msomi, M., Mukama, I., Naidoo, D., Naidoo, R., Naidu, T.K., Ntloko, S., Padayachee, E., Padayachee, L., Phaff, M., Pillay, B., Pillay, D., Pillay, L., Ramnarain, A., Ramphal, S.R., Ryan, P., Saloojee, A., Sebitloane, M., Sigcu, N., Taylor, J.L., Torborg, A., Visser, L., Anderson, P., Conradie, A., de Swardt, M., de Villiers, M., Eikman, J., Liebenberg, R., Mouton, J., Paton, A., van der Merwe, L., Wilscott-Davids, C., Barrett, W.J., Bester, M., de Beer, J., Geldenhuys, J., Gouws, H., Potgieter, J.H., Strydom, M., WilberforceTurton, E., Chetty, R.R., Chirkut, S., Cronje, L., de Vasconcellos, K., Dube, N.Z., Gama, N.S., Green, G.M., Green-Thompson, R., Kinoo, S.M., Kistnasami, P., Maharaj, K., Moodley, M.S., Mothae, S.J., Aslam F Noorbhai, M., Rughubar, V., Reddy, J., Singh, A., Skinner, D.L., Smith, M.J., Singh, B., Misra, R., Naidoo, M., Ramdharee, P., Selibea, Y., Sewpersad, S., Sham, S., Wessels, J.D., Africander, C., Bejia, T., Blakemore, S.P., Botes, M., Bunwarie, B., Hernandez, C.B., Jeeraz, M.A., Legutko, D.A., Lopez, A.G., De Meyer, J.N., Muzenda, T., Naidoo, N., Patel, M., Pentela, R., Junge, M., Mansoor, N., Rademan, L., Scislowski, P., Seedat, I., van den Berg, B., van der Merwe, D., van Wyk, S., Govender, K., Naicker, D., Ramjee, R., Saley, M., Kuhn, W.P., Matos-Puig, R., Alberto Lisi, Z.M., Perez, G., Beltran, A.V., Lozano, A., Navarro, C.D., Duca, A., Ernesto, EPM, Ferrando, C., Fuentes, I., García-Pérez, M.L., Gracia, E., Palomares, A.I., Katime, A., Miñana, A., Incertis, R.R., Romero, E., Romero Garcia, C.S., Rubio, C., Artiles, T.S., Soro, M., Valls, P., Laguarda, G.A., Benavent, P., Cuenca, V.C., Cueva, A., Lafuente, M., Parra, A.M., Rodrigo, A.R., Sanchez-Morcillo, S., Tormo, S., Redondo, F.J., De Andrés Ibanez, J.A., Diago, L.G., José Hernández Cádiz, M., Manuel, G.G., Peris, R., Saiz, C., Vivo, J.T., Soto, MTT, Brunete, T., Cancho, D., Delgado García, D.R., Zamudio, D., Del Valle, S.G., Serrano, M.L., Alonso, E., Anillo, V., Maseda, E., Salgado, P., Suarez, L., Suarez-de-la-Rica, A., Villagrán, M.J., Alonso, J.I., Cabezuelo, E., Garcia-Saiz, I., Lopez Del Moral, O., Martín, S., Gonzalez, A.P., Doncel, MST, Vera, M.A., José Ávila Sánchez, F., Castaño, B., Moreira, B.C., Risco, S.F., Martín, D.P., Martín, F.P., Poza, P., Ruiz, A., Serna Martínez, W.F., Vicente, B.V., Dominguez, S.V., Fernández, S., Munoz-López, A., Bernat, M.J., Mas, A., Planas, K., Jawad, M., Saeed, Y., Hedin, A., Levander, H., Holmström, S., Lönn, D., Zoerner, F., Åkring, I., Widmark, C., Zettergren, J., Liljequist, 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V., Naylor, C., Bell, S., Heather, B., Kushakovsky, V., Alcock, L., Alexander, H., Anderson, C., Baker, P., Brookes, M., Cawthorn, L., Cirstea, E., Clarkson, R., Colling, K., Coulter, I., Das, S., Haigh, K., Hamdan, A., Hugill, K., Kottam, L., Lisseter, E., Mawdsley, M., McGivern, J., Padala, K., Phelps, V., Ramesh Kumar, V., Stewart, K., Towse, K., Tregonning, J., Vahedi, A., Walker, A., Baines, D., Bilolikar, A., Chande, S., Copley, E., Dunk, N., Kulkarni, R., Kumar, P., Metodiev, Y., Ncomanzi, D., Raithatha, B., Raymode, P., Szafranski, J., Twohey, L., Watt, P., Weatherall, L., Weatherill, J., Whitman, Z., Wighton, E., Abayasinghe, C., Chan, A., Darwish, S., Gill, J., Glasgow, E., Hadfield, D., Harris, C., Hopkins, P., Kochhar, A., Kunst, G., Mellis, C., Pool, A., Riozzi, P., Selman, A., Smith, E.J., Vele, L., Gercek, Y., Guy, K., Holden, D., Watson, N., Whysall, K., Andreou, P., Hales, D., Thompson, J., Bowrey, S., McDonald, S., Gilmore, J., Hills, V., Kelly, C., Kelly, S., Lloyd, G., Abbott, T., Gall, L., Torrance, H., Vivian, M., Berntsen, E., Nolan, T., Turner, A., Vohra, A., Brown, A., Clark, R., Coughlan, E., Daniel, C., Patvardhan, C., Pearson, R., Predeep, S., Saad, H., Shanmugam, M., Varley, S., Wylie, K., Cooper, L., Makowski, A., Misztal, B., Moldovan, E., Pegg, C., Donovan, A., Foot, J., Large, S., Claxton, A., Netke, B., Armstrong, R., Calderwood, C., Kwok, A., Mohr, O., Oyeniyi, P., Patnaik, L., Post, B., Ali, S., Arshad, H., Baker, G., Brenner, L., Brincat, M., Brunswicker, A., Cox, H., Cozar, O.I., Cheong, E., Durst, A., Fengas, L., Flatt, J., Glister, G., Narwani, V., Photi, E., Rankin, A., Rosbergen, M., Beaton, C., Horn, R., Hunt, J., Rousseau, G., Stancombe, L., Absar, M., Allsop, J., Drinkwater, Z., Hodgkiss, T., Smith, K., Alexander-Sefre, F., Campey, L., Dudgeon, L., Hall, K., Hitchcock, R., James, L., Winstone, U., Ahmad, N., Bauchmuller, K., Harrison, J., Jeffery, H., Miller, D., Pinder, A., Pothuneedi, S., Rosser, J., Sanghera, S., Swift, D., Walker, R., Bester, D., Cavanagh, S., Cripps, H., Daniel, H., Lynch, J., Pyke, S., Scholefield, J., Whitworth, H., Bottrill, F., Ramalingam, G., Webb, S., Akerman, N., Antill, P., Bourner, L., Buckley, S., Castle, G., Charles, R., Eggleston, C., Foster, R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Reynolds, T., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Hall, A.M., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Paddle, J., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Potter, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Brown, C.W., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Harper, M., Jack, J., Ridley, C., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Hove, M.O., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Hanna, G., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Ramessur, S., Salvana, A., Watson, A., Ali, H., Critchley, R., Endersby, S., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Chan, Y.L., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Matthewman, M.C., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Stephens, R., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Collins, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Salmon, K., Seaward, L., Skinner, B., Tyrell, B., Wadams, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Oshowo, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Elgasim, M., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., O'Connor, J., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, Postoperative Complications/epidemiology, Hospital mortality, [SDV]Life Sciences [q-bio], surgery, Postoperative Complications, 0302 clinical medicine, cohort studies, 030202 anesthesiology, patient safety, 030212 general & internal medicine, Postoperative Period, Medicine(all), Middle Aged, Checklist, 3. Good health, Treatment Outcome, operative/mortality, Elective Surgical Procedures, Surgical Procedures, Operative, Meta-analysis, Cohort, Cohort studies, Female, Elective Surgical Procedure, postoperative care/methods, postoperative care/statistics and numerical data, surgical procedures, Anesthesiology and Pain Medicine, Cohort study, Adult, medicine.medical_specialty, Evidence-based medicine, NO, 03 medical and health sciences, Patient safety, medicine, postoperative care/method, Humans, Elective Surgical Procedures/standards, Aged, Cohort Studies, Evidence-Based Medicine, Hospital Mortality, Patient Safety, Postoperative Complications/mortality, Postoperative Complications/prevention & control, Surgical Procedures, Operative/methods, business.industry, Odds ratio, Surgery, Observational study, business, cohort studie
Abstract: BACKGROUND: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.METHODS: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.RESULTS: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); PCONCLUSIONS: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
Published: 2018

20. The Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study for Patients on a Direct Oral Anticoagulant Who Need an Elective Surgery or Procedure: Design and Rationale

Author: Jeannine Kassis, Frederick A. Spencer, Michiel Coppens, Donald M. Arnold, Mark Blostein, Julia A. M. Anderson, Nathan P. Clark, Summer Syed, Joanne Duncan, Grégoire Le Gal, Peter L. Gross, Sudeep Shivakumar, Shannon M. Bates, Geneviève Le Templier, Francesco Dentali, Na Li, Sam Schulman, Thomas Thiele, Alfonso Tafur, Stephen Kowalski, Marc Carrier, Agnes Y.Y. Lee, James D. Douketis, Elizabeth MacKay, Vinay Shah, Alex C. Spyropoulos, Susan Solymoss, Thomas Vanassche, Joseph A. Caprini, Erik Yeo, Cynthia Wu, Department of Medicine (DM - McMaster), McMaster University [Hamilton, Ontario], Thrombosis Program, University of Ottawa [Ottawa], Department ofComputationaland Systems Biology, University of Pittsburgh (PITT), Pennsylvania Commonwealth System of Higher Education (PCSHE)-Pennsylvania Commonwealth System of Higher Education (PCSHE), Department of Clinical and Experimental Medicine (VARESE - Thrombosis Center), Universitá degli Studi dell’Insubria = University of Insubria [Varese] (Uninsubria), Columbia University [New York], Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Department of Medicine (Dep Med - HALIFAX), Dalhousie University [Halifax], Department of Medecine [Montréal], McGill University = Université McGill [Montréal, Canada], Division of Hematology (Div Hemato - TORONTO), University Health Network, Universitá degli Studi dell’Insubria, Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, and ACS - Pulmonary hypertension & thrombosis
Subjects: Adult, Male, Canada, medicine.medical_specialty, Pyridones, [SDV]Life Sciences [q-bio], Administration, Oral, Hemorrhage, 030204 cardiovascular system & hematology, Dabigatran, Cohort Studies, surgery, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Rivaroxaban, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Atrial Fibrillation, medicine, Humans, Prospective Studies, oral anticoagulants, 030212 general & internal medicine, Cardiac Surgical Procedures, Precision Medicine, Elective surgery, Perioperative Period, Prospective cohort study, thrombosis, ComputingMilieux_MISCELLANEOUS, clinical trials, business.industry, Anticoagulants, Atrial fibrillation, Hematology, Perioperative, medicine.disease, 3. Good health, Surgery, Clinical trial, Pyrazoles, Female, Apixaban, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract: Background The perioperative management of patients who take a direct oral anticoagulant (DOAC) for atrial fibrillation and require treatment interruption for an elective surgery/procedure is a common clinical scenario for which best practices are uncertain. The Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) study is designed to address this unmet clinical need. We discuss the rationale for the PAUSE design and analysis plan as well as the rationale supporting the perioperative DOAC protocol. Methods PAUSE is a prospective study with three parallel cohorts, one for each DOAC, to assess a standardized but patient-specific perioperative management protocol for DOAC-treated patients with atrial fibrillation. The perioperative protocol accounts for DOAC type, patient's renal function and surgery/procedure-related bleeding risk. The primary study aim is to demonstrate the safety of the PAUSE protocol for the perioperative management of each DOAC. The secondary aim is to determine the effect of the pre-procedure interruption on residual anticoagulation when measured by the dilute thrombin time for dabigatran and anti-factor Xa levels for rivaroxaban and apixaban. The study hypothesis is that the perioperative management protocol for each DOAC is safe for patient care, defined by expected risks for major bleeding of 1% (80% power to exclude 2%), and for arterial thromboembolism of 0.5% (80% power to exclude 1.5%) in each DOAC group. Conclusion The PAUSE study has the potential to establish a standard-of-care approach for the perioperative management of DOAC-treated patients. The PAUSE management protocol is designed to be easily applied in clinical practice, as it is standardized and also patient specific.
Published: 2017

21. Weaning from mechanical ventilation using tracheostomy cuff deflation and a one-way speaking valve: a historical-cohort series

Author: Zoheir Bshouty, Linda G. Girling, Rhonda Thorkelsson, Renée El-Gabalawy, Kandy Macaulay, Stephen Kowalski, and Adrian Robertson
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Tracheostomy, medicine, Weaning, Humans, Speech, 030212 general & internal medicine, Aged, Mechanical ventilation, 030504 nursing, business.industry, General Medicine, Equipment Design, Middle Aged, Deflation, Respiration, Artificial, Surgery, Anesthesiology and Pain Medicine, Anesthesia, Cuff, Female, 0305 other medical science, business, Ventilator Weaning, Historical Cohort
Published: 2017

22. Perioperative implications of thoracic decortications: a retrospective cohort study

Author: Linda G. Girling, Stephen Kowalski, Sadeesh Srinathan, Duane J. Funk, John M. Embil, and Jay Gorman
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Treatment outcome, 030204 cardiovascular system & hematology, Perioperative Care, Reports of Original Investigations, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Thoracic Diseases, Anesthesiology, Epidemiology, Medicine, Humans, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Manitoba, General Medicine, Perioperative, Decortication, Middle Aged, Thoracic Surgical Procedures, Surgery, Anesthesiology and Pain Medicine, Treatment Outcome, 030228 respiratory system, Etiology, Female, business, Cohort study
Abstract: Purpose An increasing number of thoracic decortications have been performed in Manitoba, from five in 2007 to 45 in 2014. The primary objective of this study was to define the epidemiology of decortications in Manitoba. The secondary objective was to compare patients who underwent decortication due to primary infectious vs non-infectious etiology with respect to their perioperative outcomes. Methods Data for this cohort study were extracted from consecutive charts of all adult patients who underwent a decortication in Manitoba from 2007-2014 inclusive. Results One hundred ninety-two patients underwent a decortication. The most frequent disease processes resulting in a decortication were pneumonia (60%), trauma (13%), malignancy (8%), and procedural complications (5%). The number of decortications due to complications of pneumonia rose at the greatest rate, from three cases in 2007 to 29 cases in 2014. Performing a decortication for an infectious vs a non-infectious etiology was associated with a higher rate of the composite postoperative outcome of myocardial infarction, acute kidney injury, need of vasopressors for > 12 hr, and mechanical ventilation for > 48 hr (44.4% vs 24.2%, respectively; relative risk, 1.83; 95% confidence interval, 1.1 to 2.9; P = 0.01). Conclusion There has been a ninefold increase in decortications over an eight-year period. Potential causes include an increase in the incidence of pneumonia, increased organism virulence, host changes, and changes in practice patterns. Patients undergoing decortication for infectious causes had an increased risk for adverse perioperative outcomes. Anesthesiologists need to be aware of the high perioperative morbidity of these patients and the potential need for postoperative admission to an intensive care unit.
Published: 2016

23. Erratum to: The Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study for Patients on a Direct Oral Anticoagulant who Need an Elective Surgery or Procedure: Design and Rationale

Author: Alex C. Spyropoulos, Na Li, Joseph A. Caprini, Donald M. Arnold, Stephen Kowalski, Shannon M. Bates, Thomas Vanassche, Summer Syed, Vinay Shah, Geneviève Le Templier, Alfonso Tafur, Peter L. Gross, Agnes Y.Y. Lee, Sudeep Shivakumar, Jeannine Kassis, Mark Blostein, Marc Carrier, Joanne Duncan, Julia A. M. Anderson, Nathan P. Clark, Sam Schulman, Susan Solymoss, Thomas Thiele, Grégoire Le Gal, Elizabeth MacKay, Francesco Dentali, Erik Yeo, Cynthia Wu, James D. Douketis, Michiel Coppens, and Frederick A. Spencer
Subjects: 0301 basic medicine, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Infarction, Magnetic resonance imaging, Hematology, Perioperative, medicine.disease, Surgery, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Embolism, 030220 oncology & carcinogenesis, Angiography, medicine, Elective surgery, business, Off Treatment, Stroke
Abstract: In the Original Article by Douketis et al. "The Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study for Patients on a Direct Oral Anticoagulant who Need an Elective Surgery or Procedure: Design and Rationale (Thromb Haemost 2017;117:2415-2424; DOI: 10.1160/TH17-08-0553), the authors have identified two errors that they wish to correct: First, on page 2419, second paragraph, Clinical Outcomes subheading, the authors state that, "The primary clinical outcomes are arterial thromboembolism, comprising stroke (ischemic or haemorrhagic), systemic embolism or transient ischemic attack and major bleeding. The inclusion of "haemorrhagic stroke is incorrect as only ischemic strokes are included in their definition of an arterial thromboembolism outcome. The definitions of study outcomes are correctly indicated in Appendix A (pg. 2424) of the paper, where the authors state: "The second primary outcome is arterial thromboembolism, comprising (1) ischemic stroke, defined as any new focal neurologic deficit that persists for 24 hours or any new focal neurologic deficit of any duration that occurs with evidence of acute infarction on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain; (2) systemic embolism, defined as symptomatic embolism to upper or lower extremity or abdominal organ, confirmed intraoperatively or by objective imaging studies (e.g. CT angiography) and (3) transient ischemic attack, defined as symptomatic focal neurologic deficit (lasting typically 1 hour) that occurs with no evidence of acute infarction on CT/MRI of the brain. Second, the depiction of the pre-procedure interruption interval for dabigatran-treated patientswith a CrCl 50 mL/min is incorrect in Figure 1 (pg. 2418) of the paper, as the arrow should extend so it reflects 2 days off treatment (i.e., day -2 and day -1). The incorrect (currently published) version is shown below, with incorrect area shaded in red: (Figure Presented).
Published: 2018

24. Hemodynamic effects of low-dose bupivacaine spinal anesthesia for cesarean section: A randomized controlled trial

Author: Stephen Kowalski, Fahd A Al Gurashi, Marta J Cenkowski, Doug Maguire, and Duane J. Funk
Subjects: Cardiac output, medicine.drug_class, Cardiac index, Hemodynamics, Obstetric anesthesia, hemodynamics, law.invention, lcsh:RD78.3-87.3, Randomized controlled trial, law, cesarean section, obstetric anesthesia, spinal anesthesia, Medicine, Bupivacaine, business.industry, Local anesthetic, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, Anesthesia, Arterial line, Original Article, business, medicine.drug
Abstract: Background: Spinal anesthesia is the most common technique for cesarean section. The conventional local anesthetic dose has been decreasing over time to 8–12.5 mg of bupivacaine. Lower doses of bupivacaine may be associated with reduced incidence of hypotension and other complications. This low dose also may be associated with improved maternal cardiac index (CI). We hypothesized that low dose spinal anesthesia using 4.5 mg bupivacaine would result in improved maternal CI when compared with conventional dose (9 mg) intrathecal bupivacaine. Methods: This randomized controlled trial included all healthy parturients presenting for elective cesarean section. In addition to standard monitors, an arterial line was placed for pulse contour cardiac output measurement. Due to limited data on maternal cardiac output during cesarean section, we had to power our study on recovery room length of stay. Secondary outcomes included the change in maternal CI, fluid administration, vasopressor usage, maternal satisfaction, and adequacy of surgical blockade and recovery time from motor and sensory blockade. Results: The low dose group had significantly faster motor recovery times (132 [122–144] versus. 54 [48–66] min conventional versus. low-dose, respectively, P < 0.01), and a shorter recovery room stay (92 ± 21 vs 70 ± 11 min, conventional vs. low-dose, respectively, P < 0.01, 95% CI -35 to -10 min). There was no difference in CI between the conventional dose and low dose spinal groups. Both groups had a drop in CI with spinal anesthesia. The low-dose group demonstrated equivalent surgical anesthesia and block onset times compared to the conventional group. Conclusions: Low-dose spinal anesthesia provides adequate surgical anesthesia, improved recovery time, but no difference in maternal cardiac index when compared to conventional dose spinal anesthesia. NCT02046697
Published: 2019

25. Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study: A Perioperative Management Plan for Patients with Atrial Fibrillation Who Are Receiving a Direct Oral Anticoagulant

Author: Alfonso Tafur, Vinay Shah, Marc Carrier, Agnes Yuet Ying Lee, Sam Schulman, Karen A. Moffat, Shannon M. Bates, Geneviève Le Templier, Nathan P. Clark, Peter L. Gross, Joanne Duncan, Sudeep Shivakumar, Joseph A. Caprini, Grégoire Le Gal, Na Li, Jeannine Kassis, Peter Verhamme, Erik Yeo, Cynthia Wu, Thomas Vanassche, Frederick A. Spencer, Michiel Coppens, Mark Blostein, Alex C. Spyropoulos, James D. Douketis, Elizabeth MacKay, Donald M. Arnold, Stephen Kowalski, Eleni Arnaoutoglou, Syed Summer, and Susan Solymoss
Subjects: medicine.medical_specialty, Rivaroxaban, business.industry, Immunology, Atrial fibrillation, Cell Biology, Hematology, Perioperative, medicine.disease, Biochemistry, Surgery, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Cohort, medicine, Apixaban, Anticoagulant use, Elective surgery, business, 030215 immunology, medicine.drug
Abstract: Introduction: The perioperative management of patients who are taking a direct oral anticoagulant (DOAC) for atrial fibrillation (AF) and require an elective surgery/procedure is uncertain. No studies have addressed the timing of perioperative DOAC interruption and resumption, and if perioperative heparin bridging and coagulation function testing are needed. The Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study hypothesized that a simple, standardized perioperative management strategy, based on DOAC-specific interruption and resumption intervals, that foregoes perioperative heparin bridging and coagulation function testing, is safe for patient care, with associated low rates of major bleeding (1%) and arterial thromboembolism (0.5%). We postulated that this management yields a high proportion of patients (>90%) with a minimal to no DOAC level at surgery/procedure. Methods: PAUSE is a prospective study with 3 parallel DOAC cohorts of patients with AF taking apixaban, dabigatran or rivaroxaban and requiring anticoagulant interruption for an elective surgery/procedure. Patients were managed using a standardized protocol based on DOAC pharmacokinetic properties, procedure-associated bleeding risk (Appendix 1) and creatinine clearance (CrCl). DOACs were interrupted for 1 day before and after surgery for a low bleed risk surgery and 2 days before and after a high bleed surgery; longer interruption was done in patients on dabigatran with a CrCl Results: We enrolled 3007 patients from 23 sites in Canada, the U.S. and Europe (Appendix 4). The patient characteristics were (Figure 2): mean age 72.5 years; 66.1% male; 33.5% high bleeding risk surgery/procedure, with 1257 patients in the apixaban cohort, 668 in the dabigatran cohort and 1082 in the rivaroxaban cohort (Table 1). DOAC interruption and resumption intervals are shown in Table 2. The 30-day postoperative rate (95% CI) of major bleeding was 1.35% (0-2.00) in the apixaban cohort, 0.90% (0-1.73) in the dabigatran cohort and 1.85% (0-2.65) in the rivaroxaban cohort; the rate (95% CI) of arterial thromboembolism was 0.16% (0-0.48) in the apixaban cohort, 0.6% (0-1.33) in the dabigatran cohort and 0.37% (0-0.82) in the rivaroxaban cohort (Table 3). There were 2541 (84.5%) patients with preoperative DOAC levels measured: a level Conclusions: In patients with AF who were taking a DOAC (apixaban, dabigatran, rivaroxaban) and required anticoagulant interruption for an elective surgery/procedure, using a standardized DOAC-specific perioperative management strategy was safe for patient care, with associated low rates of perioperative MB (90% overall; 98.8% at high bleeding risk) had a minimal or no residual DOAC level at the time of the surgery/procedure. PAUSE is the largest study, to date, that addresses how to manage the common problem of perioperative DOAC management. It is likely to have a practice-changing impact and will inform future practice guidelines in perioperative care. Study Funding: CIHR (313156) and the H&S Foundation of Canada (G-14-0006136). Aniara-Hyphen Biomed (assays). Acknowledgments: We thank Drs. Walter Ageno, David Garcia, Lehana Thabane, Wendt Lim, Lori Linkins, William Ristevski, and Demetrios J. Sahlas. Also, Kayla Lucier, Grace Wang, Tara McDougall, and HRLMP and CRLB. Supported by CanVector and REDCap. Disclosures Douketis: Bayer: Other: Advisory Board; Janssen: Consultancy; BMS: Other: Advisory Board; Biotie: Other: Advisory Board; Daiichi-Sankyo: Other: Advisory Board; Boehringer-Ingelheim: Consultancy, Other: Advisory Board, Research Funding; The Medicines Company: Other: Advisory Board; Sanofi: Consultancy, Other: Advisory Board; Astra-Zeneca: Other: Advisory Board; Portola: Other: Advisory Board; Pfizer: Other: Advisory Board. Spyropoulos:Janssen Scientific Affairs, LLC: Consultancy. Carrier:Bayer: Honoraria; Leo Pharma: Research Funding; Pfizer: Honoraria; BMS: Honoraria, Research Funding. Vanassche:Bayer: Consultancy; Boehringer Ingelheim: Consultancy; BMS/Pfizer: Consultancy. Verhamme:Bayer: Honoraria, Research Funding; Medtronic: Honoraria; Portola: Honoraria; Boehringer Ingelheim: Honoraria; Leo Pharma: Honoraria, Research Funding; BMS: Honoraria, Research Funding; Daiichi-Sankyo: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding. Shivakumar:Pfizer: Honoraria; Servier: Honoraria; Bayer: Honoraria; LEO Pharma: Honoraria. Gross:Pfizer: Honoraria; Bayer: Honoraria; LEO Pharma: Honoraria; Servier: Honoraria. Lee:Pfizer: Consultancy, Research Funding; BMS: Research Funding; Servier: Honoraria; LEO Pharma: Consultancy, Research Funding; Bayer: Consultancy, Honoraria. Le Templier:BMS-pfizer: Honoraria. Wu:Leo Pharma: Honoraria; Pfizer: Honoraria; BMS-Pfizer: Honoraria. Coppens:Bayer: Honoraria, Other: Non-financial support, Research Funding; CSL Behring: Honoraria, Other: non-financial support, Research Funding; Uniqure BV: Research Funding. Arnold:Bristol Myers Squibb: Research Funding; UCB: Consultancy; Amgen: Consultancy, Research Funding; UCB: Consultancy; Amgen: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Bristol Myers Squibb: Research Funding; Novartis: Consultancy, Research Funding. Caprini:Alexion Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Recovery Force: Consultancy; BMS: Membership on an entity's Board of Directors or advisory committees; Pfizor: Membership on an entity's Board of Directors or advisory committees; Janssen R&D: Membership on an entity's Board of Directors or advisory committees. Summer:Octapharma: Honoraria. Schulman:Daiichi-Sankyo: Honoraria; Bayer: Honoraria; Sanofi: Honoraria; Boehringer-Ingelheim: Honoraria, Research Funding.
Published: 2018

26. Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation during High-risk Cardiac Surgery: A Randomized Controlled Feasibility Trial

Author: Alain, Deschamps, Richard, Hall, Hilary, Grocott, C David, Mazer, Peter T, Choi, Alexis F, Turgeon, Etienne, de Medicis, Jean S, Bussières, Christopher, Hudson, Summer, Syed, Doug, Seal, Stuart, Herd, Jean, Lambert, André, Denault, Alan, Mutch, Alexis, Turgeon, Andre, Denault, Andrea, Todd, Angela, Jerath, Ashraf, Fayad, Barry, Finnegan, Blaine, Kent, Brent, Kennedy, Brian H, Cuthbertson, Brian, Kavanagh, Brian, Warriner, Charles, MacAdams, Christian, Lehmann, Christine, Fudorow, Colin, McCartney, Dan, McIsaac, Daniel, Dubois, David, Campbell, David, Mazer, David, Neilpovitz, David, Rosen, Davy, Cheng, Dennis, Drapeau, Derek, Dillane, Diem, Tran, Dolores, Mckeen, Duminda, Wijeysundera, Eric, Jacobsohn, Etienne, Couture, Fahad, Alam, Faraj, Abdallah, Fiona E, Ralley, Frances, Chung, Francois, Lellouche, Gary, Dobson, Genevieve, Germain, George, Djaiani, Ian, Gilron, Gregory, Hare, Gregory, Bryson, Hance, Clarke, Heather, McDonald, Helen, Roman-Smith, Homer, Yang, James, Douketis, James, Paul, Jean, Beaubien, Jean, Bussières, Jeremy, Pridham, J N, Armstrong, Joel, Parlow, John, Murkin, Jonathan, Gamble, Kaylene, Duttchen, Keyvan, Karkouti, Kim, Turner, Leyla, Baghirzada, Linda, Szabo, Manoj, Lalu, Marcin, Wasowicz, Michael, Bautista, Michael, Jacka, Michael, Murphy, Michael, Schmidt, Michaël, Verret, Michel-Antoine, Perrault, Nicolas, Beaudet, Norman, Buckley, Peter, Choi, Peter, MacDougall, Philip, Jones, Pierre, Drolet, Pierre, Beaulieu, Ravi, Taneja, Rene, Martin, Ronald, George, Rosa, Chun, Sarah, McMullen, Scott, Beattie, Sonia, Sampson, Stephen, Choi, Stephen, Kowalski, Stuart, McCluskey, Sylvain, Boet, Tim, Ramsay, Tarit, Saha, Thomas, Mutter, Tumul, Chowdhury, Vishal, Uppal, and William, Mckay
Subjects: Male, Risk, Oxygen, Oxygen Consumption, Cerebrovascular Circulation, Monitoring, Intraoperative, Feasibility Studies, Humans, Female, Oximetry, Prospective Studies, Cardiac Surgical Procedures, Algorithms, Aged, Follow-Up Studies
Abstract: Cerebral oxygen desaturation during cardiac surgery has been associated with adverse perioperative outcomes. Before a large multicenter randomized controlled trial (RCT) on the impact of preventing desaturations on perioperative outcomes, the authors undertook a randomized prospective, parallel-arm, multicenter feasibility RCT to determine whether an intervention algorithm could prevent desaturations.Eight Canadian sites randomized 201 patients between April 2012 and October 2013. The primary outcome was the success rate of reversing cerebral desaturations below 10% relative to baseline in the intervention group. Anesthesiologists were blinded to the cerebral saturation values in the control group. Intensive care unit personnel were blinded to cerebral saturation values for both groups. Secondary outcomes included the area under the curve of cerebral desaturation load, enrolment rates, and a 30-day follow-up for adverse events.Cerebral desaturations occurred in 71 (70%) of the 102 intervention group patients and 56 (57%) of the 99 control group patients (P = 0.04). Reversal was successful in 69 (97%) of the intervention group patients. The mean cerebral desaturation load (SD) in the operating room was smaller for intervention group patients compared with control group patients (104 [217] %.min vs. 398 [869] %.min, mean difference, -294; 95% CI, -562 to -26; P = 0.03). This was also true in the intensive care unit (P = 0.02). There were no differences in adverse events between the groups.Study sites were successful in reversal of desaturation, patient recruitment, randomization, and follow-up in cardiac surgery, supporting the feasibility of conducting a large multicenter RCT.
Published: 2016

27. Assessment of cough strength in patients with a tracheostomy

Author: Rhonda Thorkelsson, Zoheir Bshouty, Kandy Macaulay, Linda G. Girling, and Stephen Kowalski
Subjects: medicine.medical_specialty, Cross-Over Studies, business.industry, Pain medicine, 030208 emergency & critical care medicine, General Medicine, Middle Aged, Respiration, Artificial, 03 medical and health sciences, Tracheostomy, 0302 clinical medicine, Anesthesiology and Pain Medicine, Cough, 030228 respiratory system, Anesthesia, Anesthesiology, medicine, Humans, In patient, business, Aged
Published: 2017

28. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study

Author: Darren H. Freed, Stephen Kowalski, Kelsey Falk, Doug Maguire, T.W. Lee, and Kent T. HayGlass
Subjects: Aortic valve, Male, Sympathetic nervous system, Cardiovascular Procedures, Interleukin-1beta, lcsh:Medicine, Pilot Projects, 030204 cardiovascular system & hematology, Pathology and Laboratory Medicine, Biochemistry, law.invention, 0302 clinical medicine, Aortic valve replacement, 030202 anesthesiology, law, Anesthesiology, Medicine and Health Sciences, Medicine, General anaesthesia, Anesthesia, Prospective Studies, Coronary Artery Bypass, lcsh:Science, Immune Response, Chemokine CCL2, Heart Valve Prosthesis Implantation, Multidisciplinary, Coronary Artery Bypass Grafting, Cardiopulmonary Bypass, Pharmaceutics, Drugs, Middle Aged, Cardiac surgery, Interleukin-10, medicine.anatomical_structure, Aortic valve stenosis, Aortic Valve, Heart Valve Prosthesis, Cardiology, Female, Artery, Research Article, medicine.medical_specialty, Cardiac Surgery, Immunology, Surgical and Invasive Medical Procedures, Anesthesia, Spinal, 03 medical and health sciences, Signs and Symptoms, Drug Therapy, Internal medicine, Cardiopulmonary bypass, Humans, Receptors, Tumor Necrosis Factor, Type II, Pain Management, Aged, Anesthetics, Inflammation, Pharmacology, business.industry, Interleukin-6, lcsh:R, Biology and Life Sciences, Aortic Valve Stenosis, medicine.disease, Surgery, lcsh:Q, business, Biomarkers
Abstract: Background Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery. Methods This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein (CRP, PTX3) and cardiovascular risk (sST2) biomarkers. Results The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005). Conclusions This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia. Trial Registration ClinicalTrials.gov NCT00348920
Published: 2015

29. From the journal archives: Pulmonary marrow embolism: lessons learned from a canine model simulating dual component cemented arthroplasty

Author: Brad Pilkey, Dean D. Bell, and Stephen Kowalski
Subjects: medicine.medical_specialty, business.industry, General surgery, medicine.medical_treatment, Bone Cements, Embolism, Fat, General Medicine, Marrow embolism, Dog model, Arthroplasty, Surgery, Clinical Practice, Hip arthroplasty, Disease Models, Animal, Anesthesiology and Pain Medicine, Dogs, Bone Marrow, Anesthesia, Medicine, Animals, business, Pulmonary Embolism, Canine model
Abstract: As part of the Journal’s 60 anniversary Diamond Jubilee Celebration, a number of seminal articles from the Journal archives are highlighted in the Journal’s 61 printed volume and online at: www.springer.com/12630. The following article was selected on the basis of its novelty at the time of publication, its scientific merit, and its overall importance to clinical practice: Byrick RJ, Kay JC, Mullen JBM. Pulmonary marrow embolism: a dog model simulating dual component cemented arthroplasty. Can J Anaesth 1987; 34: 336-42. Herein, Dr. Stephen Kowalski and his colleagues provide expert commentary on this key article, one of a series of important studies by this group elucidating the systemic cardiovascular and histologic responses that occur during cemented hip arthroplasty.
Published: 2013

30. Biologically Variable or Naturally Noisy Mechanical Ventilation Recruits Atelectatic Lung

Author: Stephen Kowalski, Gerald R. Lefevre, Linda G. Girling, W. Alan C. Mutch, Stefan Harms, and M. Ruth Graham
Subjects: Pulmonary and Respiratory Medicine, Artificial ventilation, Mechanical ventilation, medicine.medical_specialty, Lung, business.industry, medicine.medical_treatment, Atelectasis, Lung injury, Critical Care and Intensive Care Medicine, medicine.disease, Surgery, Collapsed Lung, medicine.anatomical_structure, Internal medicine, Intensive care, medicine, Breathing, Cardiology, business
Abstract: Biologically variable mechanical ventilation (V˙bv)—using a computer-controller to mimic the normal variability in spontaneous breathing—improves gas exchange in a model of severe lung injury (Lefevre, G. R., S. E. Kowalski, L. G. Girling, D. B. Thiessen, W. A. C. Mutch. Am. J. Respir. Crit. Care Med. 1996;154:1567–1572). Improved oxygenation with V˙bv, in the face of alveolar collapse, is thought to be due to net volume recruitment secondary to the variability or increased noise in the peak inspiratory airway pressures (Ppaw). Biologically variable noise can be modeled as an inverse power law frequency distribution (y ∝ 1/fa) (West, B. J., M. Shlesinger. Am. Sci. 1990;78:40–45). In a porcine model of atelectasis—right lung collapse with one-lung ventilation—we studied if V˙bv (n = 7) better reinflates the collapsed lung compared with conventional monotonously regular control mode ventilation (V˙c; n = 7) over a 5-h period. We also investigated the influence of sigh breaths with V˙c (V˙s; n = 8) with this...
Published: 2000

31. Improved arterial oxygenation after oleic acid lung injury in the pig using a computer-controlled mechanical ventilator

Author: Gerald R. Lefevre, Stephen Kowalski, D. B. Thiessen, W. A. C. Mutch, and Linda G. Girling
Subjects: Pulmonary and Respiratory Medicine, Mechanical ventilation, Artificial ventilation, Respiratory rate, business.industry, medicine.medical_treatment, Lung injury, Critical Care and Intensive Care Medicine, Intensive care, Anesthesia, Breathing, medicine, business, Tidal volume, Respiratory minute volume
Abstract: We compared computer-controlled mechanical ventilation programmed for biologic variability of respiratory rate (RR) and tidal volume (VT) with conventional intermittent positive-pressure ventilation (IPPV) in an oleic acid (OA) lung injury model. Seventeen pigs were ventilated with an Ohio 7000 anesthesia ventilator. Minute ventilation (VE) was adjusted to maintain PaCO2 at 30 to 35 mm Hg at baseline and was not altered further. OA was infused at 0.2 ml/kg/h until PaO2 decreased to < 125 mm Hg (F(I)O2 = 0.5). Animals were randomly assigned to continue with conventional IPPV (control group; n = 8) or had IPPV computer-controlled (computer group; n = 9). Hemodynamic, respiratory gas, airway pressure, and volume data were obtained at baseline (before OA infusion), at Time 30 (after infusion), and at 30-min intervals for 240 min after OA. At experiment completion, the lungs were removed to determine the wet:dry weight ratios. The control group had RR fixed at 20 breaths/min. The computer group had a RR of 20 ...
Published: 1996

32. Epinephrine Decreases Postoperative Requirements for Continuous Thoracic Epidural Fentanyl Infusions

Author: Roy A. Greengrass, Thomas A. Horan, Cynthia M. Baron, Christopher L. Baron, Helmut Unruh, and Stephen Kowalski
Subjects: Male, Spirometry, medicine.medical_specialty, Epinephrine, Visual analogue scale, medicine.medical_treatment, Hemodynamics, Fentanyl, law.invention, Randomized controlled trial, law, Forced Expiratory Volume, medicine, Humans, Prospective Studies, Thoracotomy, Postoperative Care, Dose-Response Relationship, Drug, medicine.diagnostic_test, business.industry, Thoracic Surgery, Middle Aged, Surgery, Analgesia, Epidural, Anesthesiology and Pain Medicine, Cardiothoracic surgery, Anesthesia, Female, business, medicine.drug
Abstract: Epidural thoracic fentanyl infusions provide effective preoperative analgesia after thoracotomy; however, side effects can limit the effectiveness of this technique. This study evaluates epinephrine as an adjunct to continuous thoracic epidural fentanyl infusions after thoracotomy. Thirty-eight patients were studied in a prospective, randomized, double-blind trial comparing fentanyl alone to fentanyl with epinephrine 1:300,000. Epidural infusion rates were titrated to equivalent pain relief using a visual analog scale. With the addition of epinephrine, there was a significant reduction in fentanyl requirements (0.82 +/- 0.07 vs 1.19 +/- 0.11 micrograms.kg-1.h-1, P = 0.005, repeated-measures analysis of variance) and in plasma fentanyl concentrations (steady state: 0.91 +/- 0.13 vs 1.65 +/- 0.23 ng/mL, P = 0.007, repeated-measures analysis of variance). There were no differences in pain scores, side effects, spirometry, patient satisfaction scores, or hemodynamic variables. This study demonstrates that adding epinephrine 1:300,000 to continuous thoracic epidural infusions decreases fentanyl requirements titrated for effective analgesia. The reduction in fentanyl requirements was associated with reduced fentanyl plasma concentrations.
Published: 1996

33. Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

Author: Roland Debrouwere, Paul K. Tenenbein, Michael P. Meyers, Brian Muirhead, James Enns, Peter C. Duke, Kevin Wolfe, Stephen Kowalski, and Doug Maguire
Subjects: medicine.medical_specialty, Thoracic Vertebrae, Pulmonary function testing, law.invention, Randomized controlled trial, law, Anesthesiology, Forced Expiratory Volume, Medicine, Humans, cardiovascular diseases, Prospective Studies, Coronary Artery Bypass, Prospective cohort study, Lung, Pain Measurement, business.industry, Ropivacaine, Analgesia, Patient-Controlled, General Medicine, Surgery, Cardiac surgery, Analgesia, Epidural, surgical procedures, operative, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Thoracic vertebrae, business, Artery, medicine.drug
Abstract: Pulmonary dysfunction commonly occurs following coronary artery bypass graft (CABG) surgery, increasing morbidity and mortality. We hypothesized that thoracic epidural anesthesia (TEA) would improve pulmonary function and would decrease complications in patients undergoing CABG surgery.This prospective, randomized, controlled trial was conducted with Ethics Board approval. Fifty patients, undergoing CABG surgery, were randomized to the epidural group or to the patient-controlled analgesia morphine group. Patients in the epidural group received a high, thoracic epidural, preoperatively. Intraoperatively, 0.75% ropivacaine was infused, followed postoperatively, by 0.2% ropivacaine for 48 hr. Outcome measurements included: visual analogue pain scores; spirometry; atelectasis scores on chest radiographs; and the incidence of atrial fibrillation.Twenty-five patients were enrolled in each group. Patients in the epidural group had significantly less pain on the operative day, and for the subsequent two days. Compared to baseline, the forced expiratory volume in one second was significantly higher in the epidural group, on the first and second postoperative days (43.7 +/- 12.2% vs 36.4 +/- 12.0%, p0.002, and 43.3 +/- 12.5% vs 38.4 +/- 11.0%, p0.05). There was significantly more atelectasis in the control group, four hours postoperatively (p0.04); however, on the third, postoperative day, the groups were similar with regards to this outcome. The incidence of atrial fibrillation was similar in both groups, and there were no complications related to the epidural.High TEA decreases postoperative pain and atelectasis and improves pulmonary function in patients undergoing CABG surgery. Our results support the use of TEA in this group of patients.
Published: 2008

34. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation

Author: Stephen Kowalski, G. Andrew Hamilton, Michael P. Meyers, Carl Serrette, Donna J. Nicholson, and Peter C. Duke
Subjects: Lung Diseases, Male, medicine.medical_specialty, medicine.medical_treatment, Pulmonary function testing, Functional residual capacity, Postoperative Complications, Intubation, Intratracheal, Medicine, Intubation, Humans, Lung volumes, Derivation, Prospective Studies, Coronary Artery Bypass, Device Removal, Mechanical ventilation, Postoperative Care, business.industry, Pulmonary Gas Exchange, Middle Aged, Respiration, Artificial, Cardiac surgery, Surgery, Anesthesiology and Pain Medicine, Anesthesia, Anesthesia Recovery Period, Respiratory Mechanics, Female, Cardiology and Cardiovascular Medicine, business, Complication
Abstract: To evaluate the effect of a short period of mechanical ventilation (3 hours) versus immediate extubation (within 1 hour of surgery) on pulmonary function, gas exchange, and pulmonary complications after coronary artery bypass graft (CABG) surgery.Prospective randomized study.University teaching hospital.Thirty-five patients undergoing CABG surgery.Patients were randomized into 2 groups. Patients in group I were extubated as soon as possible after surgery. Patients in group II were ventilated for a minimum of 3 hours after surgery. Patients in both groups were extubated only after achieving predetermined extubation criteria. Patients who did not meet the criteria for extubation within the predetermined set time limit (90 minutes in group I and 6 hours in group II) were withdrawn from the study. Pulmonary function tests (vital capacity, forced expiratory volume in 1 second, total lung capacity, functional residual capacity), arterial blood gases, and chest radiographs were done preoperatively and postoperatively. Pulmonary complications were recorded.Demographic data were similar between groups. The mean time to extubation in group I was 45.7 plus minus 27.6 minutes and in group II was 201.4 plus minus 21 minutes (p0.01). Two patients in group I and 1 patient in group II did not meet the extubation criteria within the predetermined set time limit and were excluded from the study. In both groups, there was a significant decline in pulmonary function but no differences between groups at 24 or 72 hours after surgery. There were no differences between groups in blood gases, atelectasis scores, or pulmonary complications.The data suggest that extending mechanical ventilation after CABG surgery does not affect pulmonary function. Provided that routine extubation criteria are met, patients can be safely extubated early (within 1 hour) after major cardiac surgery without concerns of further pulmonary derangement.
Published: 2002

35. General intensive care for patients with traumatic brain injury: An update

Author: Yaseen M. Arabi, Tumul Chowdhury, Stephen Kowalski, and Hari Hara Dash
Subjects: medicine.medical_specialty, Evidence-based practice, Traumatic brain injury, business.industry, traumatic brain injury, Evidence-based management, Neurointensive care, medicine.disease, Intensive care unit, law.invention, supportive care, lcsh:RD78.3-87.3, Clinical trial, Anesthesiology and Pain Medicine, Parenteral nutrition, secondary brain injury, lcsh:Anesthesiology, law, Intensive care, medicine, Original Article, Intensive care medicine, business, Evidence
Abstract: Background: Traumatic brain injury (TBI) is a growing epidemic throughout the world and may present as major global burden in 2020. Some intensive care units throughout the world still have no access to specialized monitoring methods, equipments and other technologies related to intensive care management of these patients; therefore, this review is meant for providing generalized supportive measurement to this subgroup of patients so that evidence based management could minimize or prevent the secondary brain injury. Methods: Therefore, we have included the PubMed search for the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic. Results: General supportive measures are equally important to prevent and minimize the effects of secondary brain injury and therefore, have a substantial impact on the outcome in patients with TBI. The important considerations for general supportive intensive care unit care remain the prompt reorganization and treatment of hypoxemia, hypotension and hypercarbia. Evidences are found to be either against or weak regarding the use of routine hyperventilation therapy, tight control blood sugar regime, use of colloids and late as well as parenteral nutrition therapy in patients with severe TBI. Conclusion: There is also a need to develop some evidence based protocols for the health-care sectors, in which there is still lack of specific management related to monitoring methods, equipments and other technical resources. Optimization of physiological parameters, understanding of basic neurocritical care knowledge as well as incorporation of newer guidelines would certainly improve the outcome of the TBI patients.
Published: 2014

36. Specific intensive care management of patients with traumatic brain injury: Present and future

Author: Hari Hara Dash, Stephen Kowalski, Yaseen M. Arabi, and Tumul Chowdhury
Subjects: intensive care management, medicine.medical_specialty, Traumatic brain injury, business.industry, traumatic brain injury, Head injury, Global problem, Intensive care management, Review Article, Guideline, medicine.disease, lcsh:RD78.3-87.3, Clinical trial, Clinical trials, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, medicine, In patient, Intensive care medicine, business, Brain trauma, head injury
Abstract: Traumatic brain injury (TBI) is a major global problem and affects approximately 10 million peoples annually; therefore has a substantial impact on the health-care system throughout the world. In this article, we have summarized various aspects of specific intensive care management in patients with TBI including the emerging evidence mainly after the Brain Trauma Foundation (BTF) 2007 and also highlighted the scope of the future therapies. This review has involved the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic. Though, BTF guideline based management strategies could provide standardized protocols for the management of patients with TBI and have some promising effects on mortality and morbidity; there is still need of inclusion of many suggestions based on various published after 2007. The main focus of majority of these trials remained to prevent or to treat the secondary brain injury. The future therapy will be directed to treat injured neurons and may benefit the outcome. There is also urgent need to develop some good prognostic indicators as well.
Published: 2014

37. Biologically variable ventilation increases arterial oxygenation over that seen with positive end-expiratory pressure alone in a porcine model of acute respiratory distress syndrome

Author: Stefan Harms, Linda G. Girling, M. R. Graham, Gerald R. Lefevre, Stephen Kowalski, and William Alan C. Mutch
Subjects: ARDS, Cardiotonic Agents, Respiratory rate, Swine, Dopamine, Mean airway pressure, Critical Care and Intensive Care Medicine, Positive-Pressure Respiration, medicine, Tidal Volume, Animals, Respiratory system, Tidal volume, Positive end-expiratory pressure, Analysis of Variance, Respiratory Distress Syndrome, business.industry, Pulmonary Gas Exchange, Hemodynamics, Oxygenation, medicine.disease, Respiration, Artificial, Oxygen, Disease Models, Animal, Anesthesia, Breathing, Blood Gas Analysis, business, Oleic Acid
Abstract: Objectives: We compared biologically variable ventilation (BVV) (as previously described) (1) with conventional control mode ventilation (CV) in a model of acute respiratory distress syndrome (ARDS) both at 10 cm H 2 O positive end-expiratory pressure. Design: Randomized, controlled, prospective study. Setting: University research laboratory. Subjects: Farm-raised 3- to 4-month-old swine. Interventions: Oleic acid (OA) was infused at 0.2 mUkg/hr with FIO 2 = 0.5 and 5 cm H 2 O positive end-expiratory pressure until Pao 2 was ≤60 mm Hg; then all animals were placed on an additional 5 cm H 2 O positive end-expiratory pressure for the next 4 hrs. Animals were assigned randomly to continue CV (n = 9) or to have CV computer controlled to deliver BW (variable respiratory rate and tidal volume; n = 8). Hemodynamic, expired gas, airway pressure, and volume data were obtained at baseline (before OA), immediately after OA, and then at 60-min intervals for 4 hrs. Measurements and Main Results: At 4 hrs after OA injury, significantly higher Pao 2 (213 ± 17 vs. 123 ± 47 mm Hg; mean ± so), lower shunt fraction (6% ± 1% vs. 18% ± 14%), and lower Paco 2 (50 ± 8 vs. 65 ± 11 mm Hg) were seen with BW than with CV. Respiratory system compliance was greater by experiment completion with BW (0.37 ± 0.05 vs. 0.31 ± 0.08 mUcm H 2 O/kg). The improvements in oxygenation, CO 2 elimination, and respiratory mechanics occurred without a significant increase in either mean airway pressure (14.3 ± 0.9 vs. 14.9 ± 1.1 cm H 2 O) or mean peak airway pressure (39.3 ± 3.5 vs. 44.5 ± 7.2 cm H 2 O) with BW. The oxygen index increased five-fold with OA injury and decreased to significantly lower levels over time with BW. Conclusions: In this model of ARDS, BW with 10 cm H 2 O positive end-expiratory pressure improved arterial oxygenation over and above that seen with CV with positive end-expiratory pressure alone. Proposed mechanisms for BW efficacy are discussed.
Published: 2000

38. Biologically variable ventilation prevents deterioration of gas exchange during prolonged anaesthesia

Author: Gerald M Eschun, W. A. C. Mutch, Linda G. Girling, Stephen Kowalski, M. R. Graham, and Gerald R. Lefevre
Subjects: Artificial ventilation, Time Factors, Swine, medicine.medical_treatment, Partial Pressure, Pulmonary compliance, Medicine, Animals, Respiratory system, Tidal volume, Mechanical ventilation, Isoflurane, business.industry, Pulmonary Gas Exchange, Hemodynamics, Carbon Dioxide, Respiration, Artificial, Oxygen, Anesthesiology and Pain Medicine, Anesthesia, Anesthetics, Inhalation, Breathing, Respiratory Mechanics, business, Anesthesia, Inhalation, Respiratory minute volume, medicine.drug
Abstract: We have studied the time course of changes in gas exchange and respiratory mechanics using two different modes of ventilation during 7 h of isoflurane anaesthesia in pigs. One group received conventional control mode ventilation (CV). The other group received biologically variable ventilation (BVV) which simulates the breath-to-breath variation in ventilatory frequency (f) that characterizes normal spontaneous ventilation. After baseline measurements with CV, animals were allocated randomly to either CV or BVV (FIO2 1.0 with 1.5% end-tidal isoflurane). With BVV, there were 376 changes in f and tidal volume (VT) over 25.1 min. Ventilation was continued over the next 7 h and blood gases and respiratory mechanics were measured every 60 min. The modulation file used to control the ventilator for BVV used an inverse power law frequency distribution (I/fa with a = 2.3 +/- 0.3). After 7 h, at a similar delivered minute ventilation, significantly greater PaO2 (mean 72.3 (SD 4.0) vs 63.5 (6.5) kPa) and respiratory system compliance (1.08 (0.08) vs 0.92 (0.16) ml cm H2O-1 kg-1) and lower PaCO2 (6.5 (0.7) vs 8.7 (1.5) kPa) and shunt fraction (7.2 (2.7)% vs 12.3 (6.2)%) were seen with BVV, with no significant difference in peak airway pressure (16.3 (1.2) vs 15.3 (3.7) cm H2O). A deterioration in gas exchange and respiratory mechanics was seen with conventional control mode ventilation but not with BVV in this experimental model of prolonged anaesthesia.
Published: 2000

39. Role of Midazolam in Parkinsonian Tremors: To Use or Not to Use

Author: Ronald B. Cappellani, Tumul Chowdhury, and Stephen Kowalski
Subjects: Parkinsonian tremors, Neurology, business.industry, Anesthesia, medicine, Midazolam, Neurology (clinical), General Medicine, business, medicine.drug
Published: 2013

40. Effects of interpleural bupivacaine (0.5%) on canine diaphragmatic function

Author: Stephen Kowalski, Magdy K. Younes, Jeff Freedman, Barry D. Bradley, and Roy A. Greengrass
Subjects: medicine.medical_specialty, Supine position, medicine.drug_class, Diaphragm, Diaphragmatic breathing, Injections, Interpleural Analgesia, Dogs, medicine, Animals, Bupivacaine, Local anesthetic, business.industry, Balloon catheter, Peripheral Nervous System Diseases, musculoskeletal system, Respiratory Paralysis, Diaphragm (structural system), Surgery, Phrenic Nerve, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Abdomen, Pleura, business, medicine.drug
Abstract: Several authors have questioned the potential for phrenic nerve paralysis with interpleural analgesia. This study was designed to examine the potential for phrenic nerve paralysis with the use of interpleural bupivacaine in dogs. Seven dogs were anesthetized, tracheally intubated, and allowed to breathe spontaneously with halothane/oxygen while in the supine position. After a midline laparotomy, two wires were inserted into the costal portion of each hemidiaphragm for measurement of electromyographic (EMG) signals. A balloon catheter was placed in the abdominal cavity to measure abdominal pressure. The abdomen was then closed. Airway pressure was measured through a side port in the endotracheal tube. Bilateral interpleural catheters were inserted with the loss-of-resistance technique. Each dog was used for two experiments, one on each side, except for one animal. To assess the contribution of the ipsilateral diaphragm to total respiratory effort, the airway was occluded at functional residual capacity for three consecutive breaths, and EMG, airway pressure, and abdominal pressure were measured. In five of nine experiments with bupivacaine, there was complete loss of EMG activity on the side of the injection. In two dogs, there was partial loss of diaphragmatic function, and in the remaining two, there was no change in EMG. In the normal saline solution group (n = 4), there was no change in the EMG. Two dogs that received bilateral bupivacaine injections developed paradoxical respiration with negative inspiratory intraabdominal pressures. Phrenic nerve paralysis or paresis can occur with interpleural blockade. The factors affecting the occurrence of this complication remain to be elucidated.
Published: 1992

41. Book Reviews

Author: Igor Brodkin, Stephen Kowalski, Joëlle F. Desparmet, and David A. E. Shephard
Subjects: Anesthesiology and Pain Medicine, General Medicine
Published: 1997

42. Thoracic epidural analgesia improves lung function in CABG patients

Author: Roland Debrouwere, Peter C. Duke, Doug Maguire, Stephen Kowalski, and Paul K. Tenenbein
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, Thoracic epidural, Ropivacaine, business.industry, Pain medicine, Anesthesiology, Anesthesia, medicine, General Medicine, business, Lung function, medicine.drug
Published: 2005

43. Book reviews

Author: Anne Moore, David Malm, M. Graham, Stephen Kowalski, and David P. Archer
Subjects: Anesthesiology and Pain Medicine, General Medicine
Published: 1996

44. ICU ADMISSION IS NOT REQUIRED AFTER UNCOMPLICATED CARDIAC SURGERY

Author: Peter C. Duke, D. S. Maguire, Eric Jacobsohn, R. DeBrouwere, J. P. Enns, Stephen Kowalski, B. D. Muirhead, and S. Kenny
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Internal medicine, Emergency medicine, Cardiology, medicine, business, Icu admission, Cardiac surgery
Published: 1999

45. POST-OPERATIVE PULMONARY FUNCTION IN CABG PATIENTS UNDERGOING EARLY TRACHEAL EXTUBATION

Author: Donna Nicholson, Michael P. Meyers, Peter C. Duke, Stephen Kowalski, G. Andrew Hamilton, and Carl Serrette
Subjects: Anesthesiology and Pain Medicine, Tracheal extubation, business.industry, Anesthesia, Medicine, Post operative, business, Pulmonary function testing
Published: 1999

46. ROUTINE ICU ADMISSION IS NOT REQUIRED AFTER CARDIAC SURGERY

Author: Peter C. Duke, S. Kenny, B. D. Muirhead, G.A. Hamilton, R.L. Goodman, Stephen Kowalski, J. P. Enns, D. Roberts, D. S. Maguire, R. DeBrouwere, and Eric Jacobsohn
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Internal medicine, Emergency medicine, Cardiology, Medicine, business, Icu admission, Cardiac surgery
Published: 1999

47. Critical Thinking for Understanding

Author: Stephen Kowalski
Subjects: Critical thinking, Systematic process, Psychology, Epistemology
Published: 1990

48. Measurement of extra-vascular lung water during abdominal aortic surgery

Author: Stephen Kowalski, Allen R. Downs, L. Oppenheimer, and Charles Lye
Subjects: Adult, Male, Catheterization, Central Venous, medicine.medical_specialty, Indicator Dilution Techniques, Anesthesia, General, Axillary artery, Internal medicine, medicine.artery, medicine, Humans, Aorta, Abdominal, Pulmonary Wedge Pressure, Cardiac Output, Brachial artery, Pulmonary wedge pressure, Lung, Aged, Aorta, Catheter insertion, business.industry, Abdominal aorta, General Medicine, Middle Aged, respiratory system, Constriction, Catheter, Anesthesiology and Pain Medicine, Anesthesia, Pulmonary artery, cardiovascular system, Cardiology, Female, sense organs, Extracellular Space, business
Abstract: Cross-clamping of the abdominal aorta can be associated with significant changes in haemodynamic variables. However, intraoperative changes in extravascular lung water (EVLW) have not been studied. Nine patients undergoing elective surgery, either aortic aneurysm repair or aorto-bifemoral grafting, were monitored invasively with arterial lines, pulmonary artery catheters and Edwards lung water catheters inserted in either the brachial or axillary artery. Determinations of EVLW were made prior to and five minutes after application of the aortic cross-clamp and at 30-minute intervals during the course of the operation. Baseline EVLW was found to be 7− 9ml·kg− 1. There were no significant changes in haemodynamic variables and no changes in EVLW with cross-clamping of the aorta. The EVLW did not change during the course of surgery. The EVLW did not increase in the absence of sustained elevation of pulmonary capillary wedge pressure. One patient developed an axillary artery thrombosis which required thrombectomy at the site of lung water catheter insertion. Two other patients lost their distal pulses without overt ischaemic changes. It was felt that such relatively high incidence of complications precluded further use of the lung water catheter in the axillary or brachial artery.
Published: 1989

49. Mitral valve prolapse

Author: Stephen Kowalski
Subjects: Adult, Male, Risk, medicine.medical_specialty, Pain medicine, 030204 cardiovascular system & hematology, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, 030202 anesthesiology, Mitral valve, Anesthesiology, medicine, Endocarditis, Mitral valve prolapse, Humans, Anesthesia, Aged, Mitral Valve Prolapse, medicine.diagnostic_test, business.industry, General Medicine, Middle Aged, medicine.disease, Prognosis, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Echocardiography, Etiology, Female, business, Complication, Follow-Up Studies
Published: 1985

50. Biologically variable ventilation in patients with acute lung injury: a pilot study

Author: Brendan McCarthy, Stephen Kowalski, Michael McMullen, and Linda G. Girling
Subjects: Mechanical ventilation, ARDS, business.industry, medicine.medical_treatment, General Medicine, respiratory system, Lung injury, Pulmonary compliance, medicine.disease, Anesthesiology and Pain Medicine, Anesthesia, Fraction of inspired oxygen, Correspondence, Breathing, medicine, business, Respiratory minute volume, Tidal volume
Abstract: To the Editor, Biologically variable ventilation (BVV) involves the delivery of a fixed minute ventilation but with a variable respiratory rate and a correspondingly variable tidal volume. This type of ventilation introduces a more physiological breathing pattern than traditional types of mechanical ventilation. It has been shown to improve oxygenation and ventilation in various animal models of lung injury when compared with conventional monotonous assist control ventilation (AC).1-3 We report our preliminary experience with BVV in eight critically ill patients. With BVV, the ventilator is configured so that the product of the respiratory rate and tidal volume is constant. The average coefficient of variation in the size of tidal volume was 30%. The local Research and Ethics Board of the University of Manitoba approved this study in February 2006, and informed consent was obtained from the patients’ legal representatives. The eight patients in this study were intubated and ventilated for at least 72 hr in the medical or surgical intensive care units at the Health Sciences Centre in Winnipeg. Their baseline ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) was 100-300 mmHg. The study was conducted as a crossover trial with patients acting as their own control. The patients were randomized to begin with either BVV or AC, and their lungs were ventilated for a four-hour period in each mode of ventilation. The baseline tidal volume was set at 6 mL·kg−1 to comply with the adult respiratory distress syndrome (ARDS) protocol. The patients were switched to a modified Esprit® ventilator (Respironics, Carlsbad, CA, USA) that could be controlled by computer software. The computer ran a variability file that was recorded from a healthy individual and consisted of 1,489 breaths. Arterial blood gases, static lung compliance, and dead space (VD/VT) were measured every hour. After completion of the study, the patients were returned to their baseline mode of ventilation. Continuous variables were compared using repeated measures one-way analysis of variance with post hoc least squares matrices to enable between group and within group comparisons. For within group comparisons, a Bonferroni correction for multiple comparisons was used. None of the patients required an increase in FiO2 or change in the level of positive end-expiratory pressure during the study. There was improvement in the oxygen index (FiO2 × mean airway pressure × 100 /PaO2) after four hours of BVV compared with AC (7.1 vs 11.5 cm H2O·mmHg−1, respectively; P = 0.034) (Figure). There was no statistically significant change in arterial PaCO2 after four hours of BVV. The VD/VT ratio decreased after four hours of BVV compared with AC (0.64 vs 0.68, respectively; P = 0.017) and lung compliance improved (0.36 vs 0.34 mL·cm H2O−1·kg−1, respectively; P = 0.049). Figure Oxygen index vs time. The oxygen index (FiO2 × mean airway pressure × 100/PaO2, expressed in cm H2O·mmHg−1) in patients ventilated with biologically variable ventilation (BVV) compared with ... A series of mechanisms have been proposed to account for the improved ventilation with BVV in the setting of ARDS. A presumed mechanism is thought to be enhanced alveolar recruitment. Evidence for alveolar recruitment with BVV has been shown by computed tomography scanning in a porcine model of ARDS.3 If alveoli can be recruited and kept open, improved gas exchange and lung compliance would be expected with BVV. By using a variety of tidal volumes and respiratory rates, the probability of selecting the appropriate time constant for a given subpopulation of alveolar units is greatly increased. Recent editorials advocate for the role of “noisy” or physiological variability to aid ventilation of patients.4,5 This pilot project suggests that BVV may warrant further study as a mode of ventilation in patients who require controlled ventilation.
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