To review and revise the 1987 pediatric brain death guidelines.
Relevant literature was reviewed. Recommendations were developed using the Grading of Recommendations Assessment, Development and ...Evaluation (GRADE) system.
1) Determination of brain death in term newborns, infants, and children is a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma. Because of insufficient data in the literature, recommendations for preterm infants <37 wks gestational age are not included in this guideline. 2) Hypotension, hypothermia, and metabolic disturbances should be treated and corrected and medications that can interfere with the neurologic examination and apnea testing should be discontinued allowing for adequate clearance before proceeding with these evaluations. 3) Two examinations, including apnea testing with each examination separated by an observation period, are required. Examinations should be performed by different attending physicians. Apnea testing may be performed by the same physician. An observation period of 24 hrs for term newborns (37 wks gestational age) to 30 days of age and 12 hrs for infants and children (>30 days to 18 yrs) is recommended. The first examination determines the child has met the accepted neurologic examination criteria for brain death. The second examination confirms brain death based on an unchanged and irreversible condition. Assessment of neurologic function after cardiopulmonary resuscitation or other severe acute brain injuries should be deferred for ≥24 hrs if there are concerns or inconsistencies in the examination. 4) Apnea testing to support the diagnosis of brain death must be performed safely and requires documentation of an arterial Paco2 20 mm Hg above the baseline and ≥60 mm Hg with no respiratory effort during the testing period. If the apnea test cannot be safely completed, an ancillary study should be performed. 5) Ancillary studies (electroencephalogram and radionuclide cerebral blood flow) are not required to establish brain death and are not a substitute for the neurologic examination. Ancillary studies may be used to assist the clinician in making the diagnosis of brain death a) when components of the examination or apnea testing cannot be completed safely as a result of the underlying medical condition of the patient; b) if there is uncertainty about the results of the neurologic examination; c) if a medication effect may be present; or d) to reduce the interexamination observation period. When ancillary studies are used, a second clinical examination and apnea test should be performed and components that can be completed must remain consistent with brain death. In this instance, the observation interval may be shortened and the second neurologic examination and apnea test (or all components that are able to be completed safely) can be performed at any time thereafter. 6) Death is declared when these criteria are fulfilled.
TiO₂ photocatalysis with ultraviolet (UV-A) light has proven to be a highly effective process for complete inactivation of airborne microbes. However, the overall efficiency of the technology needs ...to be improved to make it more attractive as a defense against bio-terrorism. The present research investigates the enhancement in the rate of destruction of bacterial spores on metal (aluminum) and fabric (polyester) substrates with metal (silver)-doped titanium dioxide and compares it to conventional photocatalysis (TiO₂ P25/+UV-A) and UV-A photolysis. Bacillus cereus bacterial spores were used as an index to demonstrate the enhanced disinfection efficiency. The results indicate complete inactivation of B. cereus spores with the enhanced photocatalyst. The enhanced spore destruction rate may be attributed to the highly oxidizing radicals generated by the doped TiO₂.
Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general ...practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking to affect workforce outcomes by applying policy levers to influence doctors' choice of speciality.
Summary Necrotizing fasciitis is a rare, life-threatening infection. We report a case of necrotizing oropharyngitis caused by Serratia marcescens in a previously immunocompetent 6-year-old male. This ...necrotizing infection led to a near-total defect of the oropharynx. The wound was managed with daily wound debridement of the patient’s oropharynx with 3% hydrogen peroxide, carotid artery coverage with Kaltostat™, and pharyngeal packing with iodoform ribbon gauze. Our patient’s resultant nasopharyngeal and hypopharyngeal stenoses present challenges for restoration of form and function for voicing and deglutition. We present our experience of managing this child’s hypopharyngeal stenosis with a minimally invasive double-balloon dilatation technique.
Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to ...71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P < 0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.
Photocatalytic oxidation is a process in which a semiconductor upon adsorption of a photon acts as a catalyst in producing reactive radicals, mainly •OH radicals, which in turn can oxidize ...contaminant species. These •OH radicals completely mineralize even the dead microbial species to carbon dioxide and water, thus providing a highly efficient, non-residual disinfecting mechanism. Past research at the University of Florida has proven TiO2 photocatalysis with 350 nm ultraviolet (UVA) light as a highly effective process for complete inactivation of airborne microbes. However, the overall efficiency of the technology needs to be improved to make it commercially viable as an air disinfection process and as a defense against the threat of bio-terrorism. The present research investigates the enhancement in the photocatalytic rate of destruction of microbes with an Ag-TiO2 photocatalyst. The effectiveness of this enhanced photocatalyst has been successfully tested for bacterial spores, gram-positive bacteria, gram-negative bacteria, fungal spores and virus in a still air as well as a recirculating air experimental facility. Bacillus cereus, Staphylococcus aureus, Escherichia coli, Aspergillus niger, and MS2 Bacteriophage have been used as indexes to demonstrate the high disinfection efficiency of the Ag-TiO2/+UVA process. The results indicate complete inactivation of Bacillus cereus bacterial spores in about 10 minutes and Aspergillus niger fungal spores in 30 minutes with the enhanced photocatalytic process. The relative humidity (RH) of air is known to have an effect on the rate of photocatalysis. In this research, the effect of RH on photocatalytic disinfection has been experimentally and theoretically analyzed. An optimum RH range of 35-65% has been determined for photocatalytic destruction of Bacillus cereus spores in indoor air, and possible explanations of these results have been presented. The effect of surface roughness of photocatalytic reactor passages on the process reaction kinetics has also been studied. Two different shapes of roughness elements have been investigated, and their optimum heights and pitch ratios (along and across the flow direction) for maximum enhancement in turbulence quantities, and hence improvement in mass transport, have been determined using FLUENT. An optimum height of 0.1 mm and optimum pitch ratios in the range 8-10 were found.
Thesis (Ph. D.)--University of Florida, 2005.
Title from title page of source document. Document formatted into pages; contains 165 pages. Includes vita. Includes bibliographical references.
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