RESUMEN
BACKGROUND: With increasing drug-herb combination and widespread use of Bombax costatum as analgesic in Africa, this research studies effects of Bombax costatum on piroxicam's efficacy and possible mechanisms of antinociception. MATERIALS AND METHODS: In efficacy studies, four groups of mice were respectively treated with 1mL/kg distilled water, 400mg/kg Bombax costatum, 20mg/kg piroxicam and a combination of both. Acetic acid and hot plate were used to induce pain in mice while prostaglandin-E2 and formalin were used to induce inflammation in rats. For mechanistic studies, different groups of mice were treated intraperitoneally with 2mg/kg naloxone, 1mg/kg yohimbine, 20mg/kg propranolol, 5mg/kg glibenclamide and 1mg/kg prazosin respectively. Two other groups were treated orally with 1mL/kg of the vehicle and 400mg/kg Bombax costatum respectively. 60minutes later, 10mL/kg of 0.6% acetic acid was administered via the intraperitoneal route and number of writhes were observed for 10minutes. RESULTS: Concurrent administration of Bombax costatum and piroxicam decreased the number of writhes significantly (P≤0.001), increased reaction time with decreased paw diameter in comparison to control. Additionally, this drug-herb combination showed enhanced anti-nocipective efficacy than when administered singly. Also, pre-treatment with yohimbine and naloxone significantly (P≤0.01) inhibited the antinociceptive activities of Bombax costatum. CONCLUSION: Bombax costatum posses antinociceptive and anti-inflammatory activities and may involve α-2 adrenergic receptor, opioidergic and arachidonic pathways. In addition, Bombax costaum augments the efficacy of piroxicam and could be of clinical benefits if studied on man.
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Bombax , Analgésicos/farmacología , Analgésicos/uso terapéutico , Animales , Humanos , Ratones , Naloxona/farmacología , Piroxicam/farmacología , Ratas , Receptores Adrenérgicos alfa 2 , Yohimbina/farmacologíaRESUMEN
OBJECTIVE: Concurrent administration of orthodox drugs and herbs is common in tropical Africa. This study investigates the effect of co-administration of piroxicam and Bombax costatum on hepatic and gastric toxicities and levels of oxidative stress markers. MATERIALS AND METHODS: Twenty male wistar rats were grouped into four. Rats in group one were administered 1mL/kg distilled water as normal control; group two were treated with 400mg/kg of extract; group three were treated with 20mg/kg of piroxicam; while those in group four were treated with both extract and piroxicam at 400mg/kg and 20mg/kg, respectively. All treatments were given orally for 14 days. At the end of the treatment period, the rats were euthanised; blood samples and stomach were collected for determination of hepatic and gastro-toxicity alongside with oxidative stress markers. RESULTS: Treatment with piroxicam alone shows the presence of oxidative stress with marked hepatic and gastric toxicities. Oxidative stress markers, hepatic and gastric toxicity indices after treatment with extract alone and in combination with piroxicam appear like that of the control group. CONCLUSION: Concurrent administration of piroxicam and Bombax costatum prevents piroxicam-induced hepatic and gastric toxicities with a positive effect on antioxidant levels. This may indicate important health benefits of this drug-herb combination.
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Antiinflamatorios no Esteroideos/toxicidad , Bombax/química , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Piroxicam/toxicidad , Extractos Vegetales/uso terapéutico , Gastropatías/inducido químicamente , Gastropatías/prevención & control , Animales , Antioxidantes/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Masculino , Nigeria , Estrés Oxidativo , Fitoterapia , Piroxicam/antagonistas & inhibidores , Ratas , Ratas Wistar , Gastropatías/patología , Úlcera Gástrica/inducido químicamente , Úlcera Gástrica/prevención & controlRESUMEN
We investigated the taxonomic significance of nest shape and its putative role in speciation in Trigona (Heterotrigona) carbonaria and T. (H.) hockingsi, two sibling species of stingless bee species from eastern Australia. These species are primarily distinguished by their nest architecture, as in all other respects they are nearly identical. We genotyped 130 colonies from six locations in Queensland at 13 microsatellite loci together with 106 additional colonies from six other Indo-Pacific Trigona species. Whether they were present in allopatry or in sympatry, colonies that displayed the T. carbonaria or the T. hockingsi nest architecture could be unambiguously differentiated at the genetic level. However, T. hockingsi colonies were classifiable into two highly differentiated paraphyletic and geographically separate populations, one in northern and one in southern Queensland. These two populations probably belong to two distinct species, T. hockingsi and T. davenporti nov. sp. Our results suggest that nest architecture characters are relevant but not sufficient criteria to identify species in this group. Consequently, modifications of nest architecture are probably not of prime importance in the speciation process of Australian stingless bees, although nest architecture differences probably result from relatively simple mechanisms. The rare interspecific hybrid colonies detected did not display a nest with an intermediate form between T. hockingsi and T. carbonaria.
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Abejas/genética , Variación Genética , Genética de Población , Comportamiento de Nidificación/fisiología , Fenotipo , Filogenia , Animales , Secuencia de Bases , Teorema de Bayes , Abejas/fisiología , Pesos y Medidas Corporales , Análisis por Conglomerados , Citocromos b/genética , Frecuencia de los Genes , Repeticiones de Microsatélite/genética , Datos de Secuencia Molecular , Queensland , Análisis de Secuencia de ADN , Especificidad de la EspecieRESUMEN
Sequence tagged microsatellite profiling (STMP) enables the rapid development of large numbers of co-dominant DNA markers, known as sequence tagged microsatellites (STMs). Each STM is amplified by PCR using a single primer specific to the conserved DNA sequence flanking the microsatellite repeat in combination with a universal primer that anchors to the 5'-ends of the microsatellites. It is also possible to convert STMs into conventional microsatellite, or simple sequence repeat (SSR), markers that are amplified using a pair of primers flanking the repeat sequence. Here, we describe a modification of the STMP procedure to significantly improve the capacity to convert STMs into conventional SSRs and, therefore, facilitate the development of highly specific DNA markers for purposes such as marker-assisted breeding. The usefulness of this technique was demonstrated in bread wheat.
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ADN/aislamiento & purificación , Repeticiones de Microsatélite , Reacción en Cadena de la Polimerasa/métodos , Lugares Marcados de Secuencia , Secuencia Conservada , Cartilla de ADN/química , Enzimas de Restricción del ADN , Marcadores GenéticosRESUMEN
Research with vulnerable populations, including those who are older and/or disabled, needs to be handled with added care regarding the dignity, welfare and protection of participants. Longstanding ethical concerns of research with participants who are disadvantaged by an imbalance of power within society, and in relation to the researcher, are explored in this article. In looking at shifting research paradigms, emancipatory research has emerged as a post-positive, post-interpretive approach. It is a method which can be used to research older, disabled populations without oppression or alienation, and can minimize conflicts of dual researcher roles.
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Personas con Discapacidad , Ética Médica , Investigación sobre Servicios de Salud/normas , Servicios de Salud para Ancianos/normas , Anciano , HumanosRESUMEN
PURPOSE: The color discrimination abilities of heterozygous deutan female carriers were measured using color mixture thresholds and compared with those of suspected nonheterozygous normal subjects. METHODS: Eight test subjects and 26 control subjects were run on a computer-controlled color test (color mixture thresholds) that presented 1 degree diameter spots on a color television monitor for 1/60 of a second. A QUEST procedure was used to determine visual thresholds for spots varying in brightness and/or color. Individual data points were graphed on an X/Y plot and fitted with an ellipse. The major and minor diameters of the ellipse represent the color and brightness thresholds, respectively. RESULTS: The mean axis angle of the ellipse for the heterozygous carriers did not differ from that for the controls (15.75 degrees vs. 14.93 degrees, p = 0.428, Mann-Whitney test). The carriers did show, however, a larger mean major axis length (68.79 vs. 46.78, p = 0.0218, Mann-Whitney test). Additionally, the length-to-width ratios for the carriers were higher than the controls (9.34 vs. 6.80, p = 0.0403, Mann-Whitney test). CONCLUSIONS: Deutan-carriers do show reduced color purity discrimination as measured using color mixture thresholds compared with nonheterozygous, color vision normals.
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Percepción de Color , Defectos de la Visión Cromática/diagnóstico , Adolescente , Adulto , Pruebas de Percepción de Colores , Defectos de la Visión Cromática/genética , Compensación de Dosificación (Genética) , Femenino , Heterocigoto , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Residual impairment after alcohol consumption implies that the relationship between blood alcohol concentration (BAC) and deficits in performance of some task is not the same when becoming intoxicated as it is when returning to sobriety. A pilot study was performed to determine the feasibility of and the appropriate methodology for studies on residual impairment of smooth pursuit performance. Four subjects consumed alcohol for 2 h. Measurements of BAC and smooth pursuit eye movements were made every 30 min during drinking and for 4 h after drinking. Pursuits were elicited by having subjects track a sinusoidal target (0.40 Hz and 0.60 Hz) for 10 s. Impairment of smooth pursuit was quantified with frequency analysis scores. Frequency analysis scores declined as BAC increased. As BAC decreased, frequency analysis scores tended to increase toward pre-drink levels. The relationship between BAC and frequency analysis score was not significantly different on the ascending and descending limbs of the blood alcohol curve. However, the idea that residual impairment does not occur could not be conclusively demonstrated for several reasons. First, as BAC returned to pre-drink levels, frequency analysis scores were inconsistent for each subject perhaps because of boredom and fatigue. Second, the relationship between BAC and frequency analysis score varied between subjects. Finally, because the recording periods were short, the effect of alcohol on sustained attention could not be assessed. In this paper, potential artifacts in studies of residual impairment of pursuits are discussed and potential solutions to the methodological problems encountered in the pilot study are provided.
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Consumo de Bebidas Alcohólicas/efectos adversos , Etanol/sangre , Trastornos de la Motilidad Ocular/etiología , Adulto , Consumo de Bebidas Alcohólicas/sangre , Análisis de Varianza , Estudios de Factibilidad , Humanos , Masculino , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/normas , Trastornos de la Motilidad Ocular/diagnóstico , Trastornos de la Motilidad Ocular/fisiopatología , Proyectos Piloto , Índice de Severidad de la Enfermedad , Factores de TiempoAsunto(s)
Enfermedad de Hodgkin/patología , Enfermedad de Hodgkin/cirugía , Cuello , Quiste Tirogloso/patología , Quiste Tirogloso/cirugía , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biopsia con Aguja , Diagnóstico Diferencial , Estudios de Seguimiento , Enfermedad de Hodgkin/diagnóstico , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Masculino , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND: The primary purpose of public policy requiring vision testing for driver license renewal is to identify individuals with functional vision impairments and, when necessary, to restrict their driving. This is based on the presumption that poor vision is causally related to poor driving and traffic crashes. METHODS: The AOA Environmental and Occupational Vision Committee performed a synthesis of relevant empirical literature on policy-based research and developed potential options for enhancing traffic safety. RESULTS: Presently, some states require vision testing for driver's license renewal and some do not. Regional and nationwide studies report that vision-related license renewal policies are associated with enhanced traffic safety. However, contemporary vision screening tests may be of limited value in identifying individuals with functional vision impairments. CONCLUSION: The most cost-effective and valid method for identifying, treating and counseling visually impaired drivers is to require a comprehensive eye examination as a condition for driver license renewal for those with a high prevalence or high probability of vision impairment.
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Examen de Aptitud para la Conducción de Vehículos , Conducción de Automóvil , Política de Salud , Optometría/normas , Pruebas de Visión/normas , Visión Ocular/fisiología , Accidentes de Tránsito/prevención & control , Envejecimiento/fisiología , Guías como Asunto , Humanos , Estados Unidos , Trastornos de la Visión/diagnósticoRESUMEN
PURPOSE: The purpose of this study was to determine whether experience improves detection of small eye movements similar to those seen in the cover test during ideal conditions. METHODS: Three groups of examiners with varying amounts of experience in eye movement detection tasks were studied. Eight examiners were 1st-year optometry students, six were 4th-year optometry students, and six were practicing optometrists. To determine thresholds for eye movement detection, examiners indicated the horizontal direction in which the eyes of one of the experimenters moved. The direction and extent of each eye movement was randomly selected. The extent of the eye movement was one of eight logarithmic steps from a maximum that was determined through an initial session where the approximate sensitivity of the examiners was found (generally +/- 1.75 prism diopters). RESULTS: Detection thresholds were determined by fitting the data with a cumulative Gaussian function. The mean horizontal eye movement eye movement necessary to obtain 99% correct judgments was 2.65 prism diopters for the 1st-year students, 2.47 prism diopters for the 4th-year students, and 2.40 prism diopters for the practicing optometrists. CONCLUSIONS: The results indicate that during ideal conditions, little or no training is required for efficient detection of small eye movements.
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Movimientos Oculares/fisiología , Optometría/educación , Adulto , Competencia Clínica , Fijación Ocular , Humanos , Persona de Mediana Edad , Estrabismo/diagnósticoRESUMEN
Our objective was to determine the usefulness of intraoperative rigid endoscopy in detecting incompletely removed cholesteatomas, and to learn whether "second-look" procedures are still needed in children. We used 30 degrees, 2.7-mm endoscopes to evaluate the middle ears of 14 children (29 procedures) with cholesteatomas once all visible disease had been removed under the operating microscope. If residual cholesteatoma was seen, removal continued until all disease visualized with the endoscope was removed. If the cholesteatoma was not removed intact, planned exploratory surgery was performed. The rigid endoscope detected incompletely removed cholesteatomas at surgery in 7 of the 29 cases (24%). In 2 of the 11 cases (18%) judged free of cholesteatoma by both otomicroscopy and otoendoscopy, residual disease was found at planned exploratory procedures. While otoendoscopy is clearly useful in detecting incompletely removed cholesteatoma, a substantial rate of residual disease following "complete" removal suggests the continued need for planned exploratory procedures.
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Colesteatoma/cirugía , Endoscopía/métodos , Endoscopía/normas , Adolescente , Niño , Preescolar , Humanos , Monitoreo Intraoperatorio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine whether the risk of death from type 1 insulin-dependent diabetes mellitus (IDDM) was similar among young non-Hispanic black, non-Hispanic white, and Hispanic patients. DESIGN: Retrospective study of death certificates for Chicago residents between 1 and 24 years of age with any mention of diabetes during 1987 through 1994. Prevalence was estimated by an ongoing incidence registry in the city, the 1990 US Census, and published studies. Autopsy reports and/or medical records were examined to determine more clearly the circumstances of death. Case-fatality rates for IDDM in non-Hispanic black, non-Hispanic white, and Hispanic patients were calculated. Deaths in those with diabetes were compared with the mortality experience of the underlying population using race-specific standardized mortality ratios. RESULTS: A total of 30 diabetes-related deaths occurred in the 8-year interval: 23 among non-Hispanic black, 5 among Hispanic, and 2 among non-Hispanic white paients. The average annual case-fatality rate for all ethnic groups combined was 247.2/10(5) (95% CI: 166. 9-353.5). Race-specific rates were 447.8/10(5) (283.9-671.7) for non-Hispanic black patients, 175.6/10(5) (56.9-409.2) for Hispanic patients, and 48.2/10(5) (5.8-174.0) for non-Hispanic white patients; there were no gender differences in risk. A total of 8 individuals died at the onset of disease (7 non-Hispanic black patients and 1 Hispanic patient). Compared with the underlying population, ethnic-specific standardized mortality ratios were elevated significantly for non-Hispanic black and Hispanic patients but not for non-Hispanic white patients. CONCLUSIONS: Short-term mortality is elevated substantially among non-Hispanic black and Hispanic youth with IDDM. The ninefold greater risk of death for non-Hispanic black compared with non-Hispanic white youth with diabetes may indicate gaps in access to comprehensive diabetes care.
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Diabetes Mellitus Tipo 1/etnología , Diabetes Mellitus Tipo 1/mortalidad , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Población Negra , Causas de Muerte , Chicago/epidemiología , Niño , Preescolar , Femenino , Accesibilidad a los Servicios de Salud , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Incidencia , Lactante , Masculino , Prevalencia , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Factores Socioeconómicos , Población Blanca/estadística & datos numéricosRESUMEN
Government agencies have used uncorrected visual acuity (UVA) standards for many years for police officer applicants. With the passage of the Americans With Disabilities Act of 1990, public employers have concern about the validity of these standards. This report shows how data can be used to set a reasonable standard. The report includes a description of a survey of incumbents, acuity testing of a sample of incumbents, collection of essential task information, and experimentation based on the essential tasks. A series of focus group meetings resulted in agreement that 2 essential tasks officers must be able to perform when visually incapacitated are identifying a weapon in a typical room and finding spectacles that have been dislodged. The experimentation showed that a noticeable performance decrement begins to appear at 20/125 level of acuity. As a result of the research, the City of Columbus, Ohio, changed the UVA standard from 20/40 to 20/125.
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Solicitud de Empleo , Control Social Formal , Agudeza Visual , Adulto , Personas con Discapacidad/legislación & jurisprudencia , Femenino , Humanos , Masculino , Rehabilitación Vocacional , Estados Unidos , Trastornos de la Visión/rehabilitaciónRESUMEN
The development of rigid bronchoscopes, Hopkins rod telescopes, and optical forceps has increased the efficacy and safety of removing endobronchial foreign bodies. These instruments have become the method of choice for managing the majority of foreign bodies. Spherical foreign bodies, such as beads, remain difficult to manage. Securing the foreign body by passing a Fogarty catheter through the lumen, inflating the balloon, and trapping the foreign body between the balloon and the bronchoscope allows controlled removal.
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Bronquios , Cateterismo/métodos , Cuerpos Extraños/terapia , Broncoscopía , Niño , Femenino , HumanosRESUMEN
OBJECTIVES: This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. METHODS: Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. RESULTS: In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. CONCLUSIONS: The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic.
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Trastornos de Estrés por Calor/mortalidad , Calor/efectos adversos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Chicago , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Estados Unidos , Tiempo (Meteorología)RESUMEN
Public health agencies across the country are beginning to view violence as a problem that demands a public health response. However, before such a response can be mounted effectively, there must be a sound data-based understanding of this epidemic. With this in mind, the Chicago Department of Public Health implemented an epidemiological analysis of homicide in the city. Using vital records, police data, and census data, we found that the city's homicide rate in 1993 was 31 per 100,000 population. This rate placed Chicago 14th among other large cities in the United States and 4th out of the eight cities with a population > 1 million. The homicide rate in the city has been increasing over the past 30 years, but not steadily. For some intervals, the homicide rate has remained almost constant. African Americans, Hispanics, the young, and males are overrepresented in the epidemic. While guns accounted for almost 75% of all homicides in Chicago in 1993, gangs accounted for only 15%. Homicide cannot be viewed in isolation from the context of society. The literature suggests that poverty and racism are important risk factors for this epidemic. Although we cannot wait until these risk factors are remedied to develop violence prevention interventions, we also cannot proceed effectively without understanding this context.
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Homicidio/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Censos , Chicago/epidemiología , Brotes de Enfermedades , Femenino , Armas de Fuego , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Delincuencia Juvenil/estadística & datos numéricos , Masculino , Policia , Población , Administración en Salud Pública , Registros , Factores Sexuales , Problemas Sociales/estadística & datos numéricos , Factores de Tiempo , Estados Unidos/epidemiología , Violencia/estadística & datos numéricosRESUMEN
Job-related vision standards benefit both employee and employer. By comparing employees' vision to specific job requirements, workers can be better placed into positions commensurate with their visual abilities. For a company without a vision care program, a project was undertaken to determine visual standards, and the need for vision care services for employees to better meet these standards. The critical factors for performing specific visual tasks for 40 job classifications were identified through direct observation and measurement, and through worker interviews. Additionally, a sample of employees was screened to determine plant population characteristics, and to determine what percentage of employees met the newly formed standards. This study can serve as a model for the application of visual standards to the workplace and is pertinent, as "reduced vision" is increasingly defined by government as a disability.
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Salud Laboral , Selección de Personal , Análisis y Desempeño de Tareas , Selección Visual , Adulto , Percepción de Color , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estándares de Referencia , Visión Binocular , Agudeza Visual , Campos VisualesRESUMEN
The ability to think critically is increasingly hypothesized to play an important role in a nurse's ability to function competently in complex health care settings. This cross-sectional exploratory survey used secondary data (Gendrop, 1989) to assess the critical thinking ability of a convenience sample of 160 nurses from two urban hospitals. Four variables hypothesized to be associated with critical thinking ability were explored: age, level of education, years of nursing experience, and area of expertise in nursing. Critical thinking was assessed using the Watson Glaser Critical Thinking Appraisal Tool (WGCTA). Study findings suggest that age and years of experience were negatively correlated with critical thinking ability. However, the level of education was positively related to critical thinking. Future needs for research were identified and implications for nursing education and practice were provided.
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Juicio , Proceso de Enfermería , Personal de Enfermería en Hospital/psicología , Pensamiento , Adulto , Competencia Clínica , Estudios Transversales , Hospitales Urbanos , Humanos , Persona de Mediana Edad , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/educaciónRESUMEN
Lens retention in metal and zyl safety frames was tested using both a high mass (500 g), low velocity impact (HM-LV), and a low mass (1.04 g), high velocity impact (LM-HV) for plano polycarbonate lenses of various thicknesses. The results showed that the metal safety frames retained lenses better than the zyl (p < 0.01) after a HM-LV impact. For the LM-HV impact, metal and zyl frames performed equally (p = 1.00). Lens thickness was not a factor in lens in frame retention for the HM-LV impact (p = 0.958). However, for the LM-HV impact, 1.6-mm thick lenses were more easily displaced than lenses with thicknesses of 2.0, 2.4, and 3.2 mm (p = 0.003).
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Dispositivos de Protección de los Ojos , Anteojos , Ensayo de Materiales , MetalesRESUMEN
BACKGROUND: Selective shunting during carotid endarterectomy is associated with the lowest operative stroke rate; therefore, patient selection for carotid shunting is critical. Electroencephalography (EEG) can detect ischemic brain cell dysfunction before irreversible injury. The carotid stump back pressure (CSP) has been inconsistent in determining the need for shunting, and contralateral carotid disease has had a variable impact. The purpose of this study was to evaluate CSP and operative EEG changes, and to determine the effect of contralateral carotid artery disease on determining the need for carotid shunting. METHODS: In 140 consecutive carotid procedures, operative EEG and CSP were monitored, and contralateral carotid disease was documented. The carotid stump pressure/mean arterial pressure index (CSP/MAP) was also calculated to determine if this was a better indicator of the need for shunting than the CSP alone. RESULTS: There was a 58% incidence of EEG changes when the CSP was < or = 25 mm Hg, 32% with a CSP of 26 to 50 mm Hg, and 4% with a CSP > 50 mm Hg. There was a 43% incidence of EEG changes and lower CSP among patients with a contralateral occlusion, both of which were significantly different from patients with a patent contralateral carotid artery. Three patients with CSP > 50 mm Hg had EEG changes, but none had a contralateral occlusion. Two patients had permanent neurologic deficits, and 2 had transient deficits. Excluding combined procedures, operative stroke rate was 0.8%. CONCLUSIONS: A CSP of < 50 mm Hg achieved a sensitivity of 89% in patients who developed ischemic EEG changes during carotid clamping, and a pressure > 50 mm Hg had a negative predictive value of 96%. However, a CSP of < 50 mm Hg had a positive predictive value of only 36%. Neither the addition of the status of the contralateral carotid artery or the calculation of the CSP/MAP improved the sensitivity of the CSP in determining the need for shunting. Operative EEG monitoring remains the most sensitive guide to carotid shunting in patients undergoing carotid endarterectomy under general anesthesia.