Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) vs. facemask breathing pre-oxygenation for rapid sequence induction in adults: a prospective randomised non-blinded clinical trial.

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) can prolong apnoea time in adults. Therefore, THRIVE used for pre-oxygenation in rapid sequence induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO2 ) during intubation when pre-oxygenating with either traditional facemask or THRIVE. Eighty adult patients, undergoing rapid sequence induction of anaesthesia for emergency surgery, were randomly allocated to pre-oxygenation with 100% oxygen with facemask or with THRIVE. Median (IQR [range]) lowest SpO2 until 1 min after intubation was 99% (97-100 [70-100]%) for the facemask group vs. 99% (99-100 [96-100]%) for the THRIVE group (p = 0.097). Five patients (12.5%) desaturated below 93% when pre-oxygenated with the facemask vs. none in the THRIVE group (p = 0.019). There were no differences in intubation time or apnoea time between the groups. Median intubation time was 51 (34-66 [22-261]) s in the facemask group vs. 48 (38-63 [10-146]) s in the THRIVE group (p = 0.99). Median apnoea time was 109 (86-142 [37-291]) s and 116 (92-146 [63-249]) s when using facemask and THRIVE, respectively (p = 0.49). No signs of regurgitation of gastric content were detected. The data on desaturation indicate potential benefits of oxygenation with THRIVE for rapid sequence induction compared with facemask pre-oxygenation.

Effect of changes in the health care system on the career outlook of University of Washington, Seattle, medical students.

We describe how market-oriented and governmental reforms were shaping students' career choice and outlook toward future clinical practice during the 1993-1994 academic year. A random sample of a third of University of Washington, Seattle, medical students (n = 212) was surveyed regarding attitudes toward health care reform, specialty choice, and future clinical practice; 171 responded (81%). Most students (90%) thought that the health care system required fundamental change. An equal proportion favored managed competition and single-payer proposals (40% and 39%, respectively). Most (72%) were confident that they would be able to practice medicine in a professionally satisfying environment. More than half the students interested in specialty careers thought that they might not be able to practice in their chosen field, but only 21% of these were more likely to choose a career in primary care in light of anticipated reforms. Most students were optimistic about their future medical careers. Knowledge of market-oriented reforms exerted little influence on the career decisions of students interested in nonprimary care fields. Medical schools should play a more active role at the undergraduate level so that those students who apply to medical school have a better understanding of the changing nature of health care delivery in this country.

Mycobacterium bovis infection in a captive herd of Sika deer.

Infection with Mycobacterium bovis was diagnosed in a small privately owned herd of Sika deer. After postmortem examination of a deer with progressive pulmonary disease, diagnosis of infection with M bovis was confirmed by bacteriologic culture. The 2 remaining deer in this herd were euthanatized, necropsied, and confirmed to be infected with M bovis. Three cats in contact with the deer were also euthanatized and necropsied. One of these cats had lesions suggestive of mycobacterial infection in the colon and mesenteric lymph nodes. Infection of this cat with M bovis was not confirmed by bacterial culture. Mycobacteriosis, infrequently encountered in clinical veterinary practice, may be confused with disease caused by other infective agents or neoplasia. The zoonotic potential of these bacteria and a recent increase in human tuberculosis warrants continued surveillance of companion and food animal populations for mycobacterial infection.

The golden section: the "true" ratio?

Seven rectangles with different ratios of the lengths of their sides but of approximately equal areas were presented to 120 subjects to asses their aesthetic preferences for each rectangle. The method of pair comparisons was used for presentation of the rectangles. Subjects tended to prefer the golden rectangle. Also rectangles in the vicinity of the golden rectangle were preferred to those deviating markedly from it.

The 'golden section': an artifact of stimulus range and demand characteristics.

Rectangles haveing different ratios between the lengths of their sides were presented in three different ranges: with the golden section either (a) the next to most elongated rectangle, (b) the middle rectangle, or (c) the next to shortest rectangle. Each of 90 subjects had to pick the rectangles they liked best from all three ranges. This basic procedure was run under three different conditions: (a) subjects did not know the stimuli before, (b) subjects knew them from a foregoing psychophysical experiment, (c) the same, with reinforcing the golden section. The rectangles at both extremes of each range were chosen first most often under the first two conditions, whereas the golden section was chosen most often under the last condition. The conclusion is that preference for the golden section is an artifact of the stimulus range and of the demand characteristics of the experimental procedure rather than of any intrinsic aesthetic quality.