International Anesthesia Research Society

The nature and origin of the molecular gas component located in the circumstellar vicinity of $\eta$ Carinae are still far from being completely understood. Here, we present Atacama Large Millimeter/Submillimeter Array (ALMA) CO(3$-$2) observations with a high angular resolution ($\sim$0.15$''$), and a great sensitivity that are employed to reveal the origin of this component in $\eta$ Carinae. These observations reveal much higher velocity ($-$300 to $+$270 km s$^{-1}$) blue and redshifted molecular thermal emission than previously reported, which we associate with the lobes of the Homunculus Nebula, and that delineates very well the innermost contours of the red- and blue-shifted lobes likely due by limb brightening. The inner contour of the redshifted emission was proposed to be a {\it disrupted torus}, but here we revealed that it is at least part of the molecular emission originated from the lobes and/or the expanding equatorial skirt. On the other hand, closer to systemic velocities ($\pm$100 km s$^{-1}$), the CO molecular gas traces an inner butterfly-shaped structure that is also revealed at NIR and MIR wavelengths as the region in which the shielded dust resides. The location and kinematics of the molecular component indicate that this material has formed after the different eruptions of $\eta$ Carinae.

This study is an attempt to find out the information seeking behavior and satisfaction level regarding library resources of post graduates students of University of Rajasthan, Jaipur. Survey research design was used for the study and for collection of data questionnaire was distributed among randomly selected 464 Post Graduate students of eight faculties of University of Rajasthan, Jaipur. Out of them 378 questionnaires were returned back. Results of the study presented that majority of the students visited library for the purpose of borrowing the books (76.19%) followed by to access reference resource (70.63%), study purpose (68.52%) and reading newspapers (64.81%). While 38.36 percent of respondents visited library to avail reprography service and then only 27.78% of students visit library to access eresources. Further study depicted that majority of responders were very satisfied with collection of newspapers (37.30%) of the university library. 36.51% and 33.60% were in satisfied category with respect to collection of books and journals respectively but very dissatisfied with subscribed-e-sources of university library. Data pertaining to satisfaction level of students regarding library services provided by university library depicted that majority of respondents were very satisfied with issuing and return of books service (39.68%) followed by OPAC service (37%) and were dissatisfied with reading facilities, Internet facility, computers facility and with user guidance/awareness service of the library. Study recommended for subscription of more need based e-sources and user awareness/educational programme for efficiently utilization of university library sources and service.

We report new CO observations and a detailed molecular-line study of the mixed morphology (MM) supernova remnant (SNR) G359.1-0.5, which contains six OH (1720 MHz) masers along the radio shell, indicative of shock-cloud interaction. Observations of 12CO and 13CO J:1-0 lines were performed in a 38x38 arcmin area with the on-the-fly technique using the Kit Peak 12 Meter telescope. The molecular study has revealed the existence of a few clumps with densities around 1,000 cm$^{-3}$ compatible in velocity and position with the OH (1720 MHz) masers. These clumps, in turn, appear to be part of a larger, elongated molecular structure ~34 arcmin long extending between -12.48 and +1.83 km/s, adjacent to the western edge of the radio shell. According to the densities and relative position with respect to the masers, we conclude that the CO clouds depict unshocked gas, as observed in other remnants with OH (1720 MHz) masers. In addition, we investigated the distribution of the molecular gas towards the adjacent gamma-ray source HESS J1745-303 but could not find any morphological correlation between the gamma-rays and the CO emission at any velocity in this region.

For a binary protostellar outflow system in which its members are located so close to each other (the separation being smaller than the addition of the widths of the flows) and with large opening angles, the collision seems unavoidable regardless of the orientation of the outflows. This is in contrast to the current observational evidence of just a few regions with indications of colliding outflows. Here, using sensitive observations of the Atacama Large Millimeter/Submillimeter Array (ALMA), we report resolved images of carbon monoxide (CO) towards the binary flows associated with the BHR71 protostellar system. These images reveal for the first time solid evidence that their flows are partially colliding, increasing the brightness of the CO, the dispersion of the velocities in the interaction zone, and changing part of the orientation in one of the flows. Additionally, this impact opened the possibility of knowing the 3D geometry of the system, revealing that one of its components (IRS2) should be closer to us.

To investigate the hypothesis that the multiple-site injection technique is associated with better outcomes than the single-point injection method in children with cerebral palsy and spastic equinus gait. A total of 17 children (nine boys, eight girls ages 1.8-9.4 yrs; eight hemiplegics, eight diplegics, one quadriplegic; levels I-IV with the Gross Motor Function Classification System) with 25 treated lower limbs were randomized into two groups: a single-point group receiving a standard dose of botulinum toxin A injection into one site and a multiple-points group into two sites on both heads of the gastrocnemius. Active and passive range of movement, selective dorsiflexion, dynamic muscle length (modified Tardieu scale), calf tone (modified Ashworth scale), attainment of anticipated gait pattern (Goal Attainment Scale), and video gait analysis (Observational Gait Scale [OGS]) were assessed before and 1, 2, and 4 mos after intervention. Both groups improved in dynamic muscle length, muscle tone, OGS-total scores and initial foot contact scores and a similar number of children attained their goals on the Goal Attainment Scale. The only significant difference between the groups was observed at 2 mos in passive dorsiflexion with the knee flexed, favoring the single-point group. Though not significantly, the incidence of adverse effects was higher in the multiple-points group. Using the methods described, no major changes in main outcome measures were associated with the number of injection sites. Issues other than efficacy guide the decision on whether to inject in single or multiple sites when treating spastic equinus with botulinum toxin.

To explore the clinical relevance of injection site by comparing two different injection techniques in children with cerebral palsy who have spastic equinus gait. A total of 19 children (13 boys, 6 girls; range, 1 yr 6 mos to 7 yrs; nine hemiplegics, eight diplegics, two quadriplegics; levels I to IV with the Gross Motor Function Classification System) participated in the study. The children were randomized into two groups: the proximal group received a botulinum toxin A injection into the proximal part of both heads of the gastrocnemius, and the distal group received a botulinum toxin A injection into the mid-belly of the muscle bulks. A single-point injection of BOTOX, 3 units/kg per site, was used. Assessments of active and passive range of motion, dynamic muscle length (modified Tardieu scale), calf tone (modified Ashworth scale), and video gait analysis (Observational Gait Scale) were performed before treatment and 3, 8, and 16 wks posttreatment. Active and passive dorsiflexion and calf tone in both groups and Observational Gait Scale total scores in the distal group improved at all time points. The median change from baseline values in Observational Gait Scale initial foot contact and total scores at 8 wks showed a significant difference favoring the distal group, but the clinical relevance remained tenuous. Using the methods described, no major changes in main outcome measures were associated with changing the injection site.

We studied the effect of positive end-expiratory pressure (PEEP) release and positioning on the occurrence of venous air embolism (VAE). Eighteen consecutive patients (8 women, 10 men; ASA grade I-III) undergoing neurosurgery in the sitting position were studied. After induction of anesthesia ventilation was controlled with a PEEP of 5 cm H(2)O in an oxygen-air gas mixture. A transesophageal echocardiographic (TEE) probe was inserted. Preoperatively, a patent foramen ovale was excluded in all patients. TEE monitoring was performed during surgery, during PEEP release at the end of surgery with the patient still in the sitting position, and during change of the patient position into the supine position. The severity of VAE was differentiated as follows: grade 1 = only microbubbles; grade 2 = microbubbles and decrease of end-tidal carbon dioxide partial pressure (PETCO(2)) by more than 1.5 mm Hg; grade 3 = microbubbles combined with a decrease of PETCO(2) by more than 1.5 mm Hg, and a decrease of mean arterial blood pressure by at least 20 mm Hg. During surgery, VAE with a grade of 1, 2 or 3 occurred in 7, 4, and 2 patients, respectively. After PEEP release, VAE of grades 1, 2, and 3 were observed in 7, 2, and 1 patients, respectively. During repositioning from sitting to supine position, VAE of grades 1, 2, and 3 was observed in 6, 1, and 1 patients, respectively. The patient with VAE grade 3 needed inotropic support until 2 h after surgery to maintain sufficient blood pressure. No patient showed any sign of paradoxical arterial embolism or cardiac dysfunction. We conclude that VAE occurs not only during surgery in the sitting position, but also with release of PEEP and during repositioning to the supine position. This study shows that venous air embolism (VAE) occurs not only during surgery in the sitting position but also during positive end-expiratory pressure release and repositioning of the patient into the supine position. Continuous monitoring for VAE should be performed until the patient is returned to the supine position.

Cardiopulmonary bypass (CPB) with aortic cross-clamping represents a controlled period of global cardiac ischemia. We hypothesized that CPB (asanguineous prime), with aortic cross-clamping and repeated cardioplegia, alters myocardial function, which would be manifested as an exaggerated myocardial depression caused by halothane after CPB. In nine dogs anesthetized with fentanyl and midazolam, halothane dose-response curves (0.0%-2.0%) were compared before and after CPB. A reduced mean arterial blood pressure (46.4 +/- 3.7 vs 85.8 +/- 5.9 mm Hg), associated with a marked hemodilution (hematocrit, 19% +/- 1% vs 41% +/- 2%), was observed after CPB. Cardiac output and systolic shortening were not significantly different after versus before CPB during fentanyl-midazolam anesthesia. Normalized to fentanyl-midazolam hemodynamics, halothane dose-response curves before and after CPB were identical for all variables except cardiac output, where halothane caused a slight but statistically significantly more pronounced decrease after CPB compared with before CPB. The effect of halothane on left ventricular function, therefore, is relatively unaffected by CPB with cardioplegia.