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Baminiwatta A, Fernando R, Solangaarachchi I, Abayabandara-Herath T, Wickremasinghe AR, Hapangama A. Improving psychological well-being among healthcare workers during the COVID-19 pandemic with an online mindfulness intervention: A randomised waitlist-controlled trial. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2024; 59:410-418. [PMID: 38355927 DOI: 10.1002/ijop.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/06/2024] [Indexed: 02/16/2024]
Abstract
The high prevalence of psychological problems observed among healthcare workers (HCWs) during the COVID-19 pandemic called for interventions to safeguard their mental health. We assessed the effectiveness of a 6-week online mindfulness-based intervention in improving well-being and reducing stress among HCWs in Sri Lanka. Eighty HCWs were recruited and randomised into two groups: waitlist-control (WLC) and intervention groups. In the intervention, 1-hour online sessions were conducted at weekly intervals and participants were encouraged to do daily home practice. Stress and well-being were measured pre- and post-intervention using the Perceived Stress Scale and WHO-5 Well-being Index, respectively. One-way analysis of covariance was used to evaluate the effectiveness, in both intention-to-treat (ITT) and complete-case (CC) analyses. A significantly greater improvement in well-being occurred in the intervention arm compared to WLC on both ITT (p = .002) and CC analyses (p < .001), with medium-to-large effect sizes (partial η2 = .117-.278). However, the reduction in stress following the intervention was not significant compared to the WLC group on both ITT (p = .636) and CC analyses (p = .262). In the intervention arm, the median number of sessions attended by participants was 3. Low adherence to the intervention may have contributed to the apparent non-significant effect on stress.
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Baminiwatta A, Fernando R, Gadambanathan T, Jiyatha F, Sasala R, Kuruppuarachchi L, Wickremasinghe R, Hapangama A. Measuring Resilience Among Sri Lankan Healthcare Workers: Validation of the Brief Resilience Scale in Sinhalese and Tamil Languages. Indian J Psychol Med 2023; 45:542-543. [PMID: 37772141 PMCID: PMC10523521 DOI: 10.1177/02537176231174185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
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Wagstaff DT, Bulamba F, Fernando R. Obstetric anaesthesia over the next 10 years: Africa and Middle East. Int J Obstet Anesth 2023; 55:103877. [PMID: 37076357 DOI: 10.1016/j.ijoa.2023.103877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
Maternal and neonatal health outcomes vary within Africa and the Middle East. Despite substantial improvements over the past 20 years, there are persisting inequities in access to, and the quality of, obstetric anaesthetic care. These are most noticeable in Sub-Saharan Africa which has only 3% of the world's healthcare workforce but approximately two-thirds of global maternal deaths. Improvements are being made by: improving access; increasing numbers of trained staff; delivering accessible training; gathering data; conducting research and quality improvement activities; using innovative technologies; and forming productive collaborations. Further improvements will be needed to cope with increasing demand, the impacts of climate change and potential future pandemics.
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Baminiwatta A, Fernando R, Williams S. Improving medical students' understanding of dementia using a movie ( The Father). EDUCATION FOR PRIMARY CARE 2023; 34:109. [PMID: 36799504 DOI: 10.1080/14739879.2023.2178333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Alhammad MF, Mathias R, Nahid S, Fernando R, Shallik N. No: 7535 Urinary guidewire and Tritube solved the mystery of severe tracheal stenosis management: a case report. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/s2210-8440(23)00087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Korenblik R, van Zon JFJA, Olij B, Heil J, Dewulf MJL, Neumann UP, Olde Damink SWM, Binkert CA, Schadde E, van der Leij C, van Dam RM, van Baardewijk LJ, Barbier L, Binkert CA, Billingsley K, Björnsson B, Andorrà EC, Arslan B, Baclija I, Bemelmans MHA, Bent C, de Boer MT, Bokkers RPH, de Boo DW, Breen D, Breitenstein S, Bruners P, Cappelli A, Carling U, Robert MCI, Chan B, De Cobelli F, Choi J, Crawford M, Croagh D, van Dam RM, Deprez F, Detry O, Dewulf MJL, Díaz-Nieto R, Dili A, Erdmann JI, Font JC, Davis R, Delle M, Fernando R, Fisher O, Fouraschen SMG, Fretland ÅA, Fundora Y, Gelabert A, Gerard L, Gobardhan P, Gómez F, Guiliante F, Grünberger T, Grochola LF, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess G, Hilal MA, Hoffmann M, Iezzi R, Imani F, Inmutto N, James S, Borobia FJG, Jovine E, Kalil J, Kingham P, Kollmar O, Kleeff J, van der Leij C, Lopez-Ben S, Macdonald A, Meijerink M, Korenblik R, Lapisatepun W, Leclercq WKG, Lindsay R, Lucidi V, Madoff DC, Martel G, Mehrzad H, Menon K, Metrakos P, Modi S, Moelker A, Montanari N, Moragues JS, Navinés-López J, Neumann UP, Nguyen J, Peddu P, Primrose JN, Olde Damink SWM, Qu X, Raptis DA, Ratti F, Ryan S, Ridouani F, Rinkes IHMB, Rogan C, Ronellenfitsch U, Serenari M, Salik A, Sallemi C, Sandström P, Martin ES, Sarría L, Schadde E, Serrablo A, Settmacher U, Smits J, Smits MLJ, Snitzbauer A, Soonawalla Z, Sparrelid E, Spuentrup E, Stavrou GA, Sutcliffe R, Tancredi I, Tasse JC, Teichgräber U, Udupa V, Valenti DA, Vass D, Vogl TJ, Wang X, White S, De Wispelaere JF, Wohlgemuth WA, Yu D, Zijlstra IJAJ. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Fernando R, Gan L, Xiao J, Yun Y. Hyperprolactinemia induced by brexpiprazole in patients with schizophrenia: A case report. Psychiatry Res 2021; 305:114215. [PMID: 34563975 DOI: 10.1016/j.psychres.2021.114215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
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Peacock S, Briggs D, Barnardo M, Battle R, Brookes P, Callaghan C, Clark B, Collins C, Day S, Diaz Burlinson N, Dunn P, Fernando R, Fuggle S, Harmer A, Kallon D, Keegan D, Key T, Lawson E, Lloyd S, Martin J, McCaughan J, Middleton D, Partheniou F, Poles A, Rees T, Sage D, Santos-Nunez E, Shaw O, Willicombe M, Worthington J. BSHI/BTS guidance on crossmatching before deceased donor kidney transplantation. Int J Immunogenet 2021; 49:22-29. [PMID: 34555264 PMCID: PMC9292213 DOI: 10.1111/iji.12558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
All UK H&I laboratories and transplant units operate under a single national kidney offering policy, but there have been variations in approach regarding when to undertake the pre‐transplant crossmatch test. In order to minimize cold ischaemia times for deceased donor kidney transplantation we sought to find ways to be able to report a crossmatch result as early as possible in the donation process. A panel of experts in transplant surgery, nephrology, specialist nursing in organ donation and H&I (all relevant UK laboratories represented) assessed evidence and opinion concerning five factors that relate to the effectiveness of the crossmatch process, as follows: when the result should be ready for reporting; what level of donor HLA typing is needed; crossmatch sample type and availability; fairness and equity; risks and patient safety. Guidelines aimed at improving practice based on these issues are presented, and we expect that following these will allow H&I laboratories to contribute to reducing CIT in deceased donor kidney transplantation.
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Ahmed I, Majeed A, Fernando R, Hyare H, Columb M, Setty T. Magnetic resonance imaging of cerebrospinal fluid spread in the epidural space and postdural puncture headache in obstetrics: A proof-of-concept study. Eur J Anaesthesiol 2021; 38:777-784. [PMID: 33470687 DOI: 10.1097/eja.0000000000001445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Currently, performing an epidural blood patch (EBP) for postdural puncture headache (PDPH) remains a subjective clinical decision. An evidence-based protocol may be of value in identifying women at high risk of developing a severe PDPH. OBJECTIVE To investigate a potential correlation between the extent of CSF spread in the epidural space, as noted on Magnetic Resonance Imaging (MRI), and the likelihood of development of severe PDPH in obstetric patients. DESIGN A prospective double-blind quasi-observational study. SETTING Eight tertiary obstetric units, from NHS hospitals. PATIENTS Parturients with accidental dural puncture (ADP) underwent T1 and T2-weighted MRI scans of the brain and lumbar spine within 48 h after delivery. All women were followed up, daily, for 1 week. MAIN OUTCOME MEASURES For each woman, a PDPH severity score was calculated using a four-point Verbal Reporting Scale (none = 0, mild = 1, moderate = 2, severe = 3), with additional points awarded for visual, auditory and emetic symptoms. MRIs were reported by a neuroradiologist, blind to the patient details, using a predefined MRI score. RESULTS Twenty-two parturients were recruited; 86% (n=19) developed PDPH and 10 of these (53%) required an EBP. The median (range) time for the onset of PDPH was 24 (4 to 126) hours. The median (range) cumulative PDPH severity score was 10 (0 to 21), whereas, the median (range) MRI score was 2.5 (0 to 12). Spearman (rs) analysis identified a significant positive correlation (rs = 0.46; P = 0.024) between cumulative PDPH severity and MRI scores. Of all the radiological features identified in an MRI (lumbar dural shift, caudal brain displacement, epidural or intrathecal blood), the presence of intrathecal blood was most strongly correlated with PDPH severity (P = 0.043). CONCLUSION Following an ADP, the extent of CSF spread in the epidural space correlates with the severity of subsequent PDPH. CLINICAL TRIAL NUMBER AND REGISTRY URL ISRCTN14959004, https://www.isrctn.com/.
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Samanta BR, Fernando R, Rösch D, Reisler H, Osborn DL. Primary photodissociation mechanisms of pyruvic acid on S1: observation of methylhydroxycarbene and its chemical reaction in the gas phase. Phys Chem Chem Phys 2021; 23:4107-4119. [DOI: 10.1039/d0cp06424f] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Following S1 ← S0 excitation at 351 nm, pyruvic acid dissociates mainly into methylhydroxycarbene (MHC) and CO2. Some MHC molecules isomerize to more stable acetaldehyde and vinyl alcohol; the remaining MHC is stabilized and reacts bimolecularly.
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Gupta A, von Heymann C, Magnuson A, Alahuhta S, Fernando R, Van de Velde M, Mercier FJ, Schyns-van den Berg AMJV, Bryon B, Soetens F, Dewandre PY, Lambert G, Christiaen J, Schepers R, Van Houwe P, Kalmar A, Vanoverschelde H, Bauters M, Roofthooft E, Devroe S, Van de Velde M, Jadrijevic A, Jokic A, Marin D, Sklebar I, Mihaljević S, Kosinova M, Stourac P, Adamus M, Kufa C, Volfová I, Zaoralová B, Froeslev-Friis C, Mygil B, Krebs Albrechtsen C, Kavasmaa T, Alahuhta S, Mäyrä A, Mennander S, Rautaneva K, Hiekkanen T, Kontinen V, Linden K, Toivakka S, Boselli E, Greil PÉ, Mascle O, Courbon A, Lutz J, Simonet T, Barbier M, Hlioua T, Meniolle d’Hauthville F, Quintin C, Bouattour K, Lecinq A, Soued M, Bonnet MP, Carbonniere M, Fischer C, Picard PC, Bonnin M, Storme B, Bouthors AS, Detente T, Nguyen Troung M, Keita H, Nebout S, Osse L, Delmas A, Vial F, Kaufner L, Hoefing C, Mueller S, Becke K, Blobner M, Lewald H, Schaller SJ, Muggleton E, Bette B, Neumann C, Weber S, Grünewald M, Ohnesorge H, Helf A, Jelting Y, Kranke P, von Heymann C, Welfle S, Staikou C, Stavrianopoulou A, Tsaroucha A, Kalopita K, Loukeri A, Valsamidis D, Matsota P, Thorsteinsson A, Tome R, Eidelman LA, Davis A, Orbach-Zinger S, Ioscovich A, Ramona I, De Simone L, Pesetti B, Brazzi L, Zito A, Camorcia M, Della Rocca G, Aversano M, Frigo MG, Todde C, Morina Q, Macas A, Keraitiene G, Rimaitis K, Borg F, Tua C, Kuijpers-Visser AG, Schyns-van den Berg A, Hollmann MW, Van den Berg T, Koolen E, Dons I, van der Knijff A, van der Marel C, Ruysschaert N, Pelka M, Pluymakers C, Koopman S, Teunissen AJ, Cornelisse D, van Dasselaar N, Verdouw B, Beenakkers I, Dahl V, Hagen R, Vivaldi F, Eriksen JR, Wiszt R, Aslam Tayyaba N, Ringvold EM, Chutkowski R, Skirecki T, Wódarski B, Faria MA, Ferreira A, Sampaio AC, Ferreira I, Matias B, Teixeira J, Araujo R, Cabido H, Fortuna R, Lemos P, Cardoso C, Moura F, Pereira C, Pereira S, Tavares F, Vasconcelos P, Abecasis M, Lança F, Muchacho P, Ormonde L, Guedes-Araujo I, Pinho-Oliveira V, Paredes P, Bentes C, Gouveia F, Milheiro A, Castanheira C, Neves M, Pacheco V, Cortez M, Tranquada R, Tareco G, Furtado I, Pereira E, Marinho L, Seabra M, Bulasevic A, Kendrisic M, Jovanovic L, Pujić B, Kutlesic M, Grochova M, Simonova J, Pavlovic G, Rozman A, Blajic I, Graovac D, Stopar Pintraic T, Chiquito T, Monedero P, Carlos-Errea DJ, Guillén-Casbas R, Veiga-Gil L, Basso M, Garcia Bartolo C, Hernandez C, Ricol L, De Santos MP, Gràcia Solsona JA, López-Baamonde M, Magaldi Mendaña M, Plaza Moral AM, Vendrell M, Trillo L, Perez Garcia AR, Alamillo Salas C, Moret E, Ramió L, Aguilar Sanchez JL, Soler Pedrola M, Valldeperas Hernandez MI, Aldalur G, Bárcena E, Herrera J, Iturri F, Martínez A, Martínez L, Serna R, Gilsanz F, Guasch Arevalo E, Iannuccelli F, Latorre J, Rodriguez Roca C, Pérez Pardo OC, Sierra Biddle N, Suárez Cendaña C, Hernández González L, Remacha González C, Sánchez Nuez R, Anta D, Beleña JM, García-Cuadrado C, Garcia I, Manrique S, Suarez E, Hein A, Arbman E, Hansson H, Tillenius M, Al-Taie R, Ledin-Eriksson S, Lindén-Söndersö A, Rosén O, Austruma E, Gillberg L, Darvish B, Gupta A, Nordstöm JL, Persson J, Rosenberg J, Brühne L, Forshammar J, Ugarph Edfeldt M, Rolfsson H, Hellblom A, Levin K, Rabow S, Thorlacius K, Bansch P, Robertson (Baeriswyl) M, Stamer U, Mathivon S, Savoldelli G, Auf der Maur P, Filipovic M, Dullenkopf A, Brunner M, Girard T, Vonlanthen C, Ozbilgin S, Gunaydin D B, Corman Dincer P, Tas Tuna A. Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study. Br J Anaesth 2020; 125:1045-1055. [PMID: 33039123 DOI: 10.1016/j.bja.2020.07.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/05/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. METHODS Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. RESULTS A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. CONCLUSIONS Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.
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Al-Sulttan S, Bampoe S, Howle R, Setty T, Columb M, Patel A, Fernando R, Husain T, Sultan P. A prospective, up-down sequential allocation study investigating the effectiveness of vital capacity breaths using high-flow nasal oxygenation versus a tight-fitting face mask to pre-oxygenate term pregnant women. Int J Obstet Anesth 2020; 45:28-33. [PMID: 33129656 DOI: 10.1016/j.ijoa.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of high flow nasal oxygenation (HFNO) for pre-oxygenation before obstetric general anaesthesia remains unclear. This study aimed to determine the number of vital capacity breaths using HFNO required to pre-oxygenate 90% of parturients to an end-tidal oxygen concentration fraction (FETO2) of ≥0.90 (termed EN90). METHODS Using up-down, sequential allocation trial design, volunteer term parturients undergoing caesarean delivery were investigated with HFNO with their mouth closed, followed by mouth open, and if FETO2 ≥0.90 was not achieved after a maximum of 20 vital capacity breaths, pre-oxygenation was attempted with a face mask. The primary outcome was the number of vital capacity breaths required using HFNO (mouth open and closed) to achieve EN90. Secondary outcomes included assessment of EN90 using mouth open versus mouth closed and face mask pre-oxygenation, maternal satisfaction and evaluation of fetal cardiotocography. RESULTS Twenty women at term were recruited. Successful pre-oxygenation occurred in 4 (20%), 3 (15%) and 14 (70%) women with HFNO mouth closed, HFNO mouth open, and via face mask respectively. At up to 20 vital capacity breaths, face mask pre-oxygenation was more successful at achieving EN90 compared with both HFNO with a closed (P=0.006) or open (P=0.001) mouth. Closed mouth HFNO did not outperform open mouth pre-oxygenation. CONCLUSION Face mask pre-oxygenation is more effective at achieving EN90 compared with to HFNO within a clinically acceptable number of vital capacity breaths. Further studies are needed to determine the role of HFNO in optimising the time before desaturation and for apnoeic oxygenation in term parturients.
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Samanta BR, Fernando R, Rösch D, Reisler H, Osborn DL. Looking at the bigger picture: Identifying the photoproducts of pyruvic acid at 193 nm. J Chem Phys 2020; 153:074307. [DOI: 10.1063/5.0018582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Swanger AM, Fesmire JE, Fernando R. Oxygen storage module with physisorption technology for closed-circuit respirators. IOP CONFERENCE SERIES. MATERIALS SCIENCE AND ENGINEERING 2020; 755:10.1088/1757-899x/755/1/012106. [PMID: 37206896 PMCID: PMC10193508 DOI: 10.1088/1757-899x/755/1/012106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The new Cryogenic Flux Capacitor (CFC) technology employs nano-porous aerogel composites to store large quantities of fluid molecules in a physisorbed solid-state condition at moderate pressures and cryogenic temperatures. By its design architecture, a CFC device can be "charged" and "discharged" quickly and on demand according to standby/usage requirements. One of three main application areas is the CFC-Life for breathing air or oxygen supply to meet new demands in life support systems. Through the Liquid Oxygen Storage Module (LOXSM) Project, the National Institute for Occupational Safety and Health, and Cryogenics Test Laboratory have partnered to test the feasibility of applying the CFC technology to Closed-Circuit Escape Respirators (CCER), or respirators operating on the closed-circuit principle in general. The envisioned Cryogenic Oxygen Storage Module (COSM) is an innovative concept to store oxygen in solid-state form, according to physisorption processes at any cryogenic temperature, and deliver it as a gas using the CFC as the core storage element. Gaseous oxygen would be admitted into the breathing loop of the CCER by introducing heat into the storage module. Potentially replacing the gaseous or chemical based oxygen supply used in today's closed-circuit respirators, the COSM is a high capacity, conformal, small-size solution for future life support equipment of all kinds. In particular, are the CCER devices that must to be carried on the person, ready to be quickly deployed and used for escape in an emergency. Initial test data for physisorption of oxygen in aerogel materials and CFC core modules are presented. The basic operational parameters for charging and discharging are summarized through prototype testing of the cryogenic oxygen storage module.
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Ramage S, Armstrong S, Fernando R. Update on Vasopressors for Cesarean Delivery. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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del Arroyo A, Sanchez J, Patel S, Phillips S, Reyes A, Cubillos C, Fernando R, David A, Sultan P, Ackland G, Reeve A, Sodha S, Ciechanowicz S, Olearo E, Dick J, Stewart A. Role of leucocyte caspase-1 activity in epidural-related maternal fever: a single-centre, observational, mechanistic cohort study. Br J Anaesth 2019; 122:92-102. [DOI: 10.1016/j.bja.2018.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
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Leffert L, Butwick A, Carvalho B, Arendt K, Bates SM, Friedman A, Horlocker T, Houle T, Landau R, Dubois H, Fernando R, Houle T, Kopp S, Montgomery D, Pellegrini J, Smiley R, Toledo P. The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants. Anesth Analg 2018; 126:928-944. [DOI: 10.1213/ane.0000000000002530] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fernando R. TECHNOLOGIES FOR THE NEXT GENERATION CLOSED-CIRCUIT ESCAPE RESPIRATORS. TRANSACTIONS OF SOCIETY FOR MINING, METALLURGY, AND EXPLORATION, INC 2018; 2018:469-471. [PMID: 37020536 PMCID: PMC10071403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The National Institute for Occupational Safety and Health (NIOSH) National Personal Protective Technology Laboratory (NPPTL) is leading an effort to develop the next generation of self-escape breathing apparatus for egress from confined spaces in emergency scenarios. A backpack style closed-circuit mine escape respirator design was one configuration explored as part of the research imperative directed by the 2006 MINER Act. Stakeholder feedback from MSHA and at the NIOSH Breathing Air Supply Partnership Meeting indicated a smaller belt worn unit that does not sacrifice performance is desirable. This paper outlines some further technology advancements that may be investigated toward developing such a small-sized respirator. Technologies being considered are novel chemicals for improved carbon dioxide (CO2) absorption and oxygen (O2) production, eliminating a dedicated CO2 scrubber by incorporating its function in the spaces of the respirator's breathing loop and storing O2 in a liquid form with long standby capabilities. When these technologies are applied to a future design, there is the possibility of having an escape respirator that can be belt worn and capable of being certified to 42 Code of Federal Regulations (CFR) Part 84 standards, including sub-part O for escape purposes including mine escape.
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Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia 2017; 73:71-92. [DOI: 10.1111/anae.14080] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
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Sodha S, Reeve A, Fernando R. Central neuraxial analgesia for labor: an update of the literature. Pain Manag 2017; 7:419-426. [PMID: 28936908 DOI: 10.2217/pmt-2017-0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Numerous techniques are in use to provide analgesia for labor, of which central neuraxial block is widely considered superior to non-neuraxial options. Central neuraxial techniques have evolved over many years to provide greater efficacy, safety and maternal satisfaction. This narrative review focuses on the literature relating to central neuraxial labor analgesia from the past 5 years, from November 2010 to October 2015. We discuss the evidence related to the various central neuraxial techniques used, the increasingly widespread use of ultrasound guidance and the evidence surrounding other novel methods of central neuraxial block insertion. The timing of institution of central neuraxial analgesia in labor is considered, as are the advances in maintenance regimens for labor analgesia.
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Phillips SN, Fernando R, Girard T. Parenteral opioid analgesia: Does it still have a role? Best Pract Res Clin Anaesthesiol 2017. [DOI: 10.1016/j.bpa.2017.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fernando R, Munasinghe D, Gunasena A, Abeynayake P. Determination of nitrofuran metabolites in shrimp muscle by liquid chromatography-photo diode array detection. Food Control 2017. [DOI: 10.1016/j.foodcont.2015.08.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loubert C, Gagnon PO, Fernando R. Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using a prophylactic phenylephrine infusion: An up-down sequential allocation study. J Clin Anesth 2017; 36:194-200. [DOI: 10.1016/j.jclinane.2016.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 09/26/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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Mon W, Stewart A, Fernando R, Ashpole K, El-Wahab N, MacDonald S, Tamilselvan P, Columb M, Liu YM. Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial. J Clin Anesth 2016; 37:43-48. [PMID: 28235526 DOI: 10.1016/j.jclinane.2016.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022]
Abstract
Hypotension is a common side effect of spinal anesthesia. Phenylephrine and ephedrine are the two most frequently used vasopressors to treat spinal hypotension during cesarean delivery. In this randomized double-blind study, we aimed to evaluate cardiac output (CO) changes with phenylephrine or ephedrine infusions titrated to maintain baseline systolic blood pressure (bSBP) during spinal anesthesia. Women (n = 40) scheduled for elective cesarean delivery received either phenylephrine 100 μg/min or ephedrine 5 mg/min infusions. Baseline hemodynamics (cardiac output, heart rate, systolic blood pressure) were recorded in the left lateral tilt position before fluid preload, and recorded every minute after spinal anesthesia until delivery. Umbilical cord blood gases were analyzed within 5 minutes of delivery. Good systolic blood pressure control was attained in both groups with minimal periods of hypotension (SBP <80% of bSBP) or hypertension (SBP >120% of bSBP). Cardiac output and heart rate increased over time with ephedrine, but decreased with phenylephrine. The maximum increase in CO from the baseline was 12%, in the ephedrine group, and this occurred 20 minutes after spinal injection. Cardiac output fell by more than 17% in the phenylephrine group, maximal at 10 minutes following spinal injection. Despite good systolic blood pressure control and increased cardiac output with ephedrine, administration of ephedrine was associated with significantly more fetal acidosis [Median (Interquartile range, IQR) UApH - phenylephrine = 7.33 (7.31-7.34) and ephedrine = 7.22 (7.16-7.27), P < .05].
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