Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients

Background and objective

Stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis.

Methods

The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients.Results: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis.

Conclusions

The applicability of SVV in a predominantly medical ICU is only about 25%–35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.

     

French Mass Media Books: 1980-81

TELECOMMUNICATIONS REGULATORY MONITOR by David A. Irwin (Bethesda, Md.: Phillips Publishing, 1984—$297.00 for loose -leaf binder and contents, plus one year's quarterly updates)

COMMUNICATIONS FLOWS: A CENSUS IN THE UNITED STATES AND JAPAN by Ithiel de Sola Pool, et al. (Amsterdam: North-Holland/Tokyo: Tokyo University Press, 1984—$39.00)     

On the necessary co-existence of special and inclusive education

ABSTRACT

While many distinctions between ‘special’ and ‘inclusive’ education have been made and continue to be forcefully debated, the two concepts remain strongly evident in policy and practice in many countries. This paper discusses the interrelated history of these concepts. It explores how conceptualisations of them have changed since Salamanca and reflects on whether inclusive education has, can or should replace special education. It considers the extent to which ‘special’ and ‘inclusive’ education are understood as the same or different today. The paper argues for a clear a distinction to be made between how special educators can work in support of inclusive education and the task of inclusive education which addresses the barriers to participation faced by members of marginalised groups.     

Beyond access: special education in America

ABSTRACT

This paper seeks to examine the parallels between many aspects of conductive education and the conceptual framework of Feuerstein's theory of mediated learning. Conductive education is not a treatment administered to remedy some pathology, as is the case with many therapies, but rather a system of education aimed at developing the whole individual. How this process is achieved may be enlightened by reference to Feuerstein's model of mediated learning experience (MLE). Two key aspects of Feuerstein's theory are examined: first, structural cognitive modifiability (SCM), which maintains that every individual's cognitive structures are capable of modifiability, despite barriers of retardation ‐ very much in line with modern neuroscience and its model of the brain as a plastic and adaptable system; and secondly, mediation (MLE), which is the process whereby a more initiated individual acts as a mediator between culture and child and thereby directs the child into preparing an adequate response. A detailed examination with exemplars is then undertaken into the mediation of many different aspects of development, including the three essential mediation processes of intentionality and reciprocity, transcendence and meaning. Finally, the implications of Feuerstein's theory for models of research and evaluation are considered, particularly the need for more qualitative and interactional approaches which maintain ecological validity.     

Relative Age Effects are a developmental problem in tennis: but not necessarily when you’re left‐handed!

Relative Age Effects (RAEs), describing attainment inequalities as a result of interactions between biological age and age‐grouping procedures, have been demonstrated across many sports contexts. This study examined whether an additional individual characteristic (i.e., handedness) mediated RAEs in tennis. Relative age and handedness distributions of 1027 male professional tennis players ranked in the year‐end ATP Top 500 for 2000–2006 were analyzed. Relatively older players, born in the first two quartiles, were over‐represented for right‐handed players (86.56%), whereas no RAEs were found for left‐handers (13.44%). Findings seem to suggest that left‐handers in tennis gain advantages that circumvent the RAE problem.     

The Health Risks of Doping during the Cold War: A Comparative Analysis of the Two Sides of the Iron Curtain

This article compares East Germany's Cold War-era approach to doping to that of the USA's in terms of their respective impacts on medical risk. Although deserving of criticism on many levels, the GDR doping programme featured a number of safeguards designed to minimise medical dangers. Unlike their East German counterparts, American governmental units were not directly involved in the administration of performance-enhancing substances. The US approach to doping was not ideal in terms of medical risk, however. As a result of the country's regulatory approach to doping, the country's athletes frequently turned to black market sources for doping agents. It was also relatively common for American athletes to use performance-enhancing drugs without the benefit of medical supervision. The US approach to doping was in these ways inferior to that of East Germany's on the subject of medical risk.     

Listening to young people with autism: learning from researcher experiences

This study explores the opportunities and dilemmas that have been encountered by researchers seeking the views of young people with autism. Twelve researchers were interviewed about their experiences in this field. Through exploration of the complex methodological and ethical issues that they encountered, this study aims to better understand how researchers can improve the way they listen to, and engage with, the views of children and young people with autism. This article discusses four themes that emerged from the interviews: power dynamics; building rapport; communication; and meaningful processes and outputs.