The role of journalistic voice in communicating climate scepticism.

This brief study investigates the subtle ways that language can be used to subconsciously shape a reader's opinions about climate science within conservative news texts. To do so, our study employed techniques from critical discourse analysis to highlight the role of 'journalistic voice' and consider the granular linguistic techniques these outlets may use to subliminally validate sceptical viewpoints, while casting doubt on those espousing the consensus position. We found that certain semantic structures used in conservative climate reporting can take an otherwise apolitical analysis of climate issues, and potentially guide readers to a reactionary conclusion. Our analysis arrived at this position after undertaking a critical discourse analysis of the ways in which sceptical and non-sceptical climate 'experts' have been framed by Australia's largest conservative broadsheet newspaper, News Corp's The Australian, in the period after it changed its official position on climate to one of accepting the consensus view.

National climate institutions complement targets and policies.

Institutions can affect coordination, consensus, and strategy.

Laryngoscopy in conscious patients with remifentanil: how useful is an "awake look"?

STUDY OBJECTIVE: To determine the sensitivity and specificity of direct laryngoscopy in the conscious patient as a diagnostic test for difficult direct laryngoscopy in the unconscious patient. DESIGN: Prospective case series. SETTING: Various operating rooms in a Canadian tertiary-care hospital. PATIENTS: 81 ASA physical status 1, 2, and 3 subjects undergoing elective surgery. INTERVENTIONS: A bolus of midazolam was given and a continuous infusion of remifentanil was started and adjusted as needed. Direct laryngoscopy was performed in the conscious subject. No topical anesthesia was applied to the upper airway. MEASUREMENTS: The modified Cormack-Lehane grade was recorded with each subject conscious and unconscious. Other data collected before the intervention included age, gender, height, weight, body mass index, Mallampati class, thyromental distance, mouth opening, previous history of failed or difficult intubation, history of hypertension or obstructive sleep apnea, and routine use of beta blockers. The time of intravenous placement, total dose and duration of remifentanil infusion, and time of endotracheal tube placement were recorded. The lowest oxygen saturation, lowest and highest systolic blood pressure and heart rate, and presence or absence of gagging, coughing, or chest wall rigidity were also noted. Subjects were also asked to complete a questionnaire in the recovery room regarding recall and the degree of discomfort experienced. MAIN RESULTS: 43 of 81 subjects were graded 1 or 2a when the laryngoscopy was done in the conscious subject. Six of the 38 subjects who were graded as a difficult laryngoscopy (grade 2b or higher) when they were conscious also remained a difficult laryngoscopy when unconscious and paralyzed. Sensitivity and specificity of direct laryngoscopy in the conscious subject as a diagnostic test for difficult direct laryngoscopy in the unconscious subject were 100% [95% confidence interval (CI) 0.52 to 1] and 57% (95% CI 0.47 to 0.70), respectively. CONCLUSIONS: Using remifentanil as the sole analgesic allows evaluation of the larynx with direct laryngoscopy in a conscious patient. A poor Cormack-Lehane grade in a conscious patient may or may not improve with general anesthesia.

Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery.

BACKGROUND: Maternal hypotension occurs in 60-94% of Cesarean deliveries with 10-15 mg spinal bupivacaine. Reduced doses of bupivacaine may decrease the incidence of hypotension, nausea, and vasopressor use. The primary objective of this study was to compare 4.5 mg and 12 mg doses of intrathecal bupivacaine on maternal hemodynamics. The secondary objective was to determine if anticipated reductions in side effects were reflected in increased patient satisfaction. METHODS: Following Research Ethics Board approval and informed consent 52 term parturients undergoing elective Cesarean delivery were randomly assigned to isobaric bupivacaine 4.5 mg or hyperbaric bupivacaine 12 mg for spinal anesthesia. All patients received fentanyl 50 microg and morphine 200 microg intrathecally. Intravenous fluid and vasopressor administration were standardized. Maternal hemodynamics, and sensorimotor levels were recorded at regular intervals. Side effects and patient satisfaction were documented. RESULTS: Median cepahalad sensory block was C8 in both groups (NS) but the intensity of motor block was significantly less (P < 0.001) and of shorter duration (P < 0.001) with bupivacaine 4.5 mg. The proportion of patients requiring ephedrine (> 70%) and the quantities of ephedrine used were similar in both groups (NS). Use of supplemental analgesia, side effects, and measures of patient satisfaction were comparable in both groups. DISCUSSION: Intrathecal bupivacaine 4.5 and 12 mg yielded similar sensory block and side effects during Cesarean delivery. Patients receiving 4.5 mg did, however, experience significantly less motor blockade of shorter duration.