Anaesthetic management of a neonate with congenital cyst adenoid malformation.

We report the anaesthetic management of a male neonate with congenital cyst adenoid malformation (CCAM) of the lung who underwent thoracotomy for resection of CCAM 24 h after birth and again at 24 days. The initial operation involved a 10-day admission to a paediatric intensive care unit (PICU) requiring ventilation, and was complicated by a pneumothorax. This report concentrates on the anaesthetic management for the second thoracotomy. The combination of intra-operative remifentanil infusion and the use of ultrasound to confirm correct placement of epidural catheter allowed on-table tracheal extubation and a shorter stay in PICU. The use of one-lung ventilation (OLV) allowed for better surgical access and enabled complete resection of the lesion.

The production of an inducible antisense alternative oxidase (Aox1a) plant.

Plant mitochondria contain an alternative oxidase (AOX) acting as a terminal electron acceptor of the alternative pathway in the electron transport chain. Here we describe the production of inducible antisense Aox1a plants of Arabidopsis thaliana (L.) Heynh. and the procedures used to determine the resulting alternative pathway activity. The Arabidopsis Aox1a cDNA sequence was cloned behind a copper-inducible promoter system in the antisense orientation. Arabidopsis thaliana (Columbia) plants were transformed by in-planta vacuum infiltration with Agrobacterium containing the antisense construct. Whole-leaf ethanol production was used as a measure to investigate alternative pathway activity in the presence of antimycin A. After 24 h, leaves from the copper-induced, antisense line F1.1 produced up to 8.8 times more ethanol (via aerobic fermentation) than the non-induced and wild-type leaves, indicating effective cytochrome pathway inhibition by antimycin A and a decreased alternative pathway activity in induced F1.1 leaves. Transgene expression studies also revealed no expression in non-induced leaves and up until 24 h post-induction. Copper-induced transgenic leaves were less susceptible to alternative pathway inhibition than non-induced transgenic leaves, as seen via tissue-slice respiratory studies, and mitochondrial respiration, using F1.1 cell cultures, also supported this. These results demonstrate the successful production of a transgenic line of Arabidopsis in which the alternative pathway activity can be genetically manipulated with an inducible antisense system.

Discovery of left-sided superior vena cava during central venous catheterization.

We describe a 3-yr-old patient in whom a central venous catheter (CVC) was inadvertently inserted into a persistent left superior vena cava (PLSVC). This congenital anomaly was diagnosed using transthoracic echocardiography. The aetiology and the implications for the anaesthetist are discussed.

Sample design, sampling weights, imputation, and variance estimation in the 1995 National Survey of Family Growth.

OBJECTIVES: Cycle 5 of the National Survey of Family Growth (NSFG) was conducted by the National Center for Health Statistics (NCHS) in 1995. The NSFG collects data on pregnancy, childbearing, and women's health from a national sample of women 15-44 years of age. This report describes how the sample was designed, shows response rates for various subgroups of women, describes how the sampling weights were computed to make national estimates possible, shows how missing data were imputed for a limited set of key variables, and describes the proper ways to estimate sampling errors from the NSFG. The report includes both nontechnical summaries for readers who need only general information and more technical detail for readers who need an in-depth understanding of these topics. METHODS: The 1995 NSFG was based on a national probability sample of women 15-44 years of age in the United States and was drawn from 14,000 households interviewed in the 1993 National Health Interview Survey (NHIS). Of the 13,795 women eligible for the NSFG, 10,847 (79 percent) gave complete interviews. RESULTS: This report recommends using weighted data for analysis and a software package that will estimate sampling errors from complex samples (for example, SUDAAN or comparable software). The rate of missing data in the 1995 NSFG was very low. However, missing data were imputed for 315 key variables, called "recodes." Of the 315 recodes defined for Cycle 5, 271 variables had missing data on less than 1 percent of the cases; only 44 had 1 percent or more with missing data. These missing values were imputed for all of these 315 variables. The imputation procedures are described in this report.

Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States.

OBJECTIVES: Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. METHODS: A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. RESULTS: Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was $21.83 and $18.09, respectively. CONCLUSIONS: EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress.

Employment-based health insurance: implications of the sampling unit for policy analysis.

One of the least understood aspects of using employer data for the health reform debate concerns important differences between enterprise- and establishment-level surveys of employers. We demonstrate that the choice of sampling unit affects the size distribution of employees between large and small firms, as well as the estimated proportion of firms offering health insurance. Because health insurance decisions in multi-establishment enterprises generally are made for the entire enterprise rather than individual establishments, we conclude that enterprise surveys are most appropriate for collecting information on the factors affecting the decision to provide health insurance coverage. Nevertheless, an establishment-level survey may be preferred for evaluating decisions made at the state, regional, or industry level. But establishment-level surveys will underestimate the impact of an employer mandate on the unit that ultimately makes the decision to offer health insurance--the enterprise. Given the enormous human and financial stakes involved in health care reform, we urge policymakers and analysts to reflect on the strengths and limitations of alternative sampling units, and to consider the implications for interpreting survey data and formulating policy decisions.