Biomedical subjects
Publications and source records attributed to D H Scott.
The influence of the Stiles-Crawford effect on visual performance can be investigated by filters based on the apodisation model of the Stiles-Crawford effect. We describe the development of practical filters to achieve neutralisation. We present some results of the Stiles-Crawford function showing that the filters work well for expected errors in aligning filters in front of the eye.
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Using theoretical estimates of the optical-transfer function and line-spread function as image-quality criteria, we predicted the influence of the Stiles-Crawford effect (SCE) on both optical performance of the eye and subjective measurements of transverse aberrations when pupils are decentered. The SCE was modeled as a pupil apodization. The SCE appears to improve image quality by providing compensation for aberrations induced by pupil decentration, but this improvement is usually small. When a criterion of the placement of the image is used as the centroid of the line-spread function, an average SCE reduces the influence of pupil decentration on subjective transverse chromatic aberrations (TCA's) for 5-mm-diameter pupils by 30%. This reduction is much less than that obtained by previous experimental studies of TCA, and possible reasons for this discrepancy are discussed. Decentering the SCE produces an appreciable shift in subjective TCA for 5-mm-diameter pupils of 1.4 arc min per 1-mm decentration (at wavelengths 433 and 622 nm).
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BACKGROUND: Oscillometric non-invasive blood-pressure (NIBP) monitors estimate the arterial pressure using model-specific signal processing and algorithms. Hence each model's accuracy must be clinically evaluated. Simulators may assist the evaluation, but their ability to do so has not been verified. OBJECTIVE: To investigate whether simulators can detect systematic differences between NIBP monitors. METHODS: We tested whether a simulator can distinguish between the two different algorithms available in a particular monitor, detect calibration errors and detect systematic differences between monitors that are observed clinically. RESULTS: Simulator evaluation correctly detected 1.8 and 4.2 mmHg systolic and diastolic differences between the two Nellcor N-3100 algorithms (with specified 2 and 5 mmHg differences) but found no difference between their mean arterial pressures (as expected from the specification). Simulator evaluations detected calibration adjustments at 80/50, 120/80 and 200/150 mmHg. Simulator and clinical comparisons of two devices of the same type recording slightly different blood pressures were in close agreement, but simulator and clinical comparisons of three different models (Propaq, Critikon DINAMAP and Datex Cardiocap) were not consistently in agreement. The simulators generated oscillometric pulse shapes different from physiological recordings. CONCLUSION: The results suggest that, although simulators can reveal systematic differences between devices of the same model, they cannot be used to detect systematic differences between different NIBP models. This could be at least partly because the oscillometric pulses generated by the simulators are dissimilar to physiologically recorded pulses.
We use equations to show pupil photometric efficiency and effective pupil centre when the Stiles-Crawford function is not centred on the pupil of the eye.
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OBJECTIVE: Arterial oxygenation may be impaired in the early period after open-heart surgery, with an associated increase in ventilation time, morbidity and hospital stay. We tested the hypothesis that inhaled nitric oxide could be a useful therapeutic adjunct in this setting. We sought to establish clinical benefits (if any), safety and the appropriate dose range of inhaled nitric oxide therapy in hypoxaemic patients after coronary artery bypass graft surgery. METHODS: Forty patients who satisfied our definition of post-operative impaired oxygenation were prospectively randomised. The treatment group (n = 20) received nitric oxide in addition to ventilatory support. While the control group (n = 20) was managed only by conventional ventilatory support. Cardio-respiratory parameters and clinical outcome measures were compared. RESULTS: We determined the optimum concentration of inhaled nitric oxide as 20 ppm in the majority (60%) of patients. Treatment improved arterial oxygenation (8.4 +/- 1.4 kPa before, 11.8 +/- 1.5 kPa after 4 h, P < 0.001) and this benefit was sustained with lower oxygen fractions required at 24 h (P < 0.001). A significantly shorter period of mechanical ventilation was required in the treatment group (mean ventilation hours 67.0 +/- 5.9 vs. 85.0 +/- 6.5, P < 0.05), although the study did not have the power to distinguish differences in ITU or overall hospital stay. Nitrous oxide and met-haemoglobin levels did not rise appreciably. CONCLUSION: We have established the safety and efficacy of inhaled nitric oxide, at a dose of between 10 and 30 ppm, in this group of patients. We suggest that nitric oxide and a delivery system are useful adjuvants in a cardiac surgical intensive care unit.
The performance of the Intersurgical disposable soda lime canister was compared to British Pharmacopoeia standards for carbon dioxide absorption and to other carbon dioxide absorber systems. This canister system more than adequately fulfilled the equivalent of the British Pharmacopoeia standard for CO2 absorption. It performed efficiently for over 3 h of continuous use, absorbing 200 ml.min-1 at varying combinations of tidal volume and ventilation rate. Efficiency was not dependent on close matching of tidal volume with canister volume and there was no channelling of gases. Heat was generated by the reaction between soda lime and CO2 and the maximum temperature recorded in the system was 42.1 degrees C. Under clinical conditions this should pose no threat of thermal injury to the patient.
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BACKGROUND: Long-term complications of jejunoileal bypass (JIB) have been reported, prompting restoration of intestinal continuity and concomitant performance of vertical banded gastroplasty (VBG) for weight control. The aim of this study was to evaluate the presentation and reversal of JIB complications, late complications, mortality, and long-term weight control in patients who have undergone JIB reversal and concomitant VBG. STUDY DESIGN: From 1981 to 1994, 37 patients were treated for complications from JIB that included diarrhea (73 percent), arthritis (46 percent), malnutrition (22 percent), urolithiasis (19 percent), electrolyte disorders (19 percent), and lack of weight loss (8 percent). Four patients required preoperative parenteral nutrition to correct protein and electrolyte imbalances. Surgical management of all 37 patients included restoration of bowel continuity and VBG during the same operative procedure. RESULTS: Postoperative complications occurred in 11 patients, including prolonged ileus in seven patients, pancreatitis in three patients, and infectious complications in two. There were no deaths. Late morbidity included staple line dehiscence in four patients, incisional hernia in three patients, and reversal of the VBG in one. All patients with diarrhea, malnutrition, electrolyte disorders, and lack of weight loss had resolution of their symptoms, while urolithiasis and arthritis resolved in 86 and 53 percent of patients, respectively. In patients available for five-year follow-up evaluation, weight changes were small, shifting from a preoperative weight of 87 +/- 19 to 90 +/- 19 kg at five years (mean +/- SD). CONCLUSIONS: Restoration of intestinal continuity combined with VBG is a safe and effective operation that will reverse most of the long-term complications of JIB and provide stable weight control for up to five years.
We assessed the resistance to air flow in four commonly used air inlets. The Avon A81 and Codan air inlets provide the least resistance to flow, followed by the Baxter CO413 and lastly the Braun air inlet. The presence of a valve confers an advantage when rapid infusion of fluid is attempted. The valve in the Codan air inlet performed best out of the inlets tested.
Internal jugular vein (IJV) cannulation is a popular approach for central venous access as it has few complications, of which failure to locate the vein and carotid artery puncture are the most common. A variety of manoeuvres and body positioning has been used to maximise IJV size and thereby increase cannulation success rate and decrease complications. Realtime 2D ultrasound can be used to view neck vascular anatomy in vivo and allow IJV size to be measured. Thirty-five volunteers had the lateral diameter of their IJV measured using the SiteRite ultrasound machine to discover the most effective methods of increasing its diameter. No correlation was found between the IJV lateral diameter and subject height, weight, age or neck circumference. Carotid artery palpation and full neck extension reduced its diameter considerably. Increasing Trendelenberg increased diameter. Abdominal binder and the Valsalva manoeuvre were the most efficient methods of increasing its size.
The 'SiteRite' is a portable ultrasound imaging system designed to aid vein location during internal jugular vein cannulation. It was compared to the use of anatomical landmarks for internal jugular vein cannulation. It was easy to use and gave good quality images, increased the speed of cannulation, decreased the number of attempts to locate the internal jugular vein and reduced the failure rate, although it had no effect on the incidence of carotid artery puncture.
Noninvasive blood pressure monitors which use twin- and single-hose cuffs complicate the movement of patients between bed spaces with different cuff-hose systems. We assessed, using a commercially available noninvasive blood pressure monitor function analyser, the use of single-hose cuffs coupled via a Y-piece adaptor to the twin-hose of noninvasive monitors designed for use with twin-hose cuffs. Assessments were made at three simulated pressures (200/150 mmHg, 120/80 mmHg, and 60/30 mmHg) and at normal and weak arterial pulsations. The use of a single-hose cuff attached with the Y-piece adaptor did not adversely affect the performance of the monitors.
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