Postanoxic alpha, theta or alpha-theta coma: Clinical setting and neurological outcome

Aim The aim of this study was to determine the prognosis of 26 consecutive adults with alpha coma (AC), theta coma (TC) or alpha-theta coma (ATC) following CRA and to describe the clinical setting and EEG features of these patients. Methods We retrospective analyzed a prospectively collected cohort of adult patients diagnosed as having AC, TC or ATC after CRA between January 2008 and June 2016. None of patients included in this analysis underwent therapeutic hypothermia (TH). Neurological outcome was expressed as the best score 6 months after CRA using the five-point Glasgow-Pisttsburgh Cerebral Performance Categories (CPC) Results Twenty-six patients were identified with a diagnosis of postanoxic AC, TC or ATC coma. There were 20 (77%) men and 6 (23%) women. The mean age was 63?±?16?years. The most frequent EEG pattern was TC (21 patients, 80%), followed by AC (3 patients, 12%) and ATC (2 patients, 8%). The cardiac rhythm as primary origin of the CRA was ventricular fibrillation (VF) in 16 patients (61.5%), asystole in 8 patients (34.6%) and ventricular tachycardia (VT) in one patient (3.8%). The presence of EEG reactivity was present in 8 patients (30%). The mortality rate was 85%. Of the 4 surviving patients, two (3.8%) had moderate disability (CPC 2), one (3.8%) had severe disability (CPC 3) and one (3.8%) reached a good recovery. The age was significantly lower in survivors 46.2?±?10.8 versus nonsurvivors 63.3?±?15.5 (p?=?0.04). There was increased association of EEG reactivity with survival (p?=?0.07). Conclusion Hypoxic-ischemic AC, TC and ATC are associated with a poor prognosis and a high rate of mortality. In younger patients with AC, TC and ATC and incomplete forms showing reactivity on the EEG, there is a greater probability of clinical recovery

Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma

Bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SEP) predicts poor neurological outcome in postanoxic coma after cardiopulmonary resuscitation (CPR). Although SEP is easy to perform and available in most hospitals, it is worthwhile to know how neurological signs are associated with SEP results. The aim of this study was to investigate whether specific clinical neurological signs are associated with either an absent or a present median nerve SEP in patients after CPR. Data from the previously published multicenter prospective cohort study PROPAC (prognosis in postanoxic coma, 2000–2003) were used. Neurological examination, consisting of Glasgow Coma Score (GCS) and brain stem reflexes, and SEP were performed 24, 48, and 72 h after CPR. Positive predictive values for predicting absent and present SEP, as well as diagnostic accuracy were calculated. Data of 407 patients were included. Of the 781 SEPs performed, N20 s were present in 401, bilaterally absent in 299, and 81 SEPs were technically undeterminable. The highest positive predictive values (0.63–0.91) for an absent SEP were found for absent pupillary light responses. The highest positive predictive values (0.71–0.83) for a present SEP were found for motor scores of withdrawal to painful stimuli or better. Multivariate analyses showed a fair diagnostic accuracy (0.78) for neurological examination in predicting an absent or present SEP at 48 or 72 h after CPR. This study shows that neurological examination cannot reliably predict absent or present cortical N20 responses in median nerve SEPs in patients after CPR

Organization of agricultural resources in the lower Rio Grande Valley of Texas with limiting and non-limiting water supply

Among the problems relating to water and land use in the Rio Grande Valley of Texas are: (1) periodic water shortages, (2) in-efficient management of resources including water, and (3) non-optimum selections of crop enterprise combinations. These problems are not new, but their significance has increased recently due to the decrease in water supply and the increase in municipal and industrial demand for water. This study treated these problems by determining the optimal combination of water and other resources in agricultural crop production in 1970 in the Valley given the amount of water currently available and by projecting the 1980 optimal resource and enterprise combinations with an increased water supply. The potentially irrigable cropland in the Valley was estimated to be 1,250,000 acres out of which 750,000 irrigated acres are currently used in the production of cotton, grain sorghum, vegetables, citrus fruits and pasture. About 78 percent of the cropland was classified as loam soils and about 22 percent as clay soils. The Rio Grande constitutes the major source of water for irrigation since ground water is limited and of poor quality. The 1970 water supply actually available was estimated to be 19,236,000 acre-inches out of which 16,919,100 acre-inches were considered to be available for irrigation oat Falcon Reservoir. A linear programming model was used to determine optimal resource use and enterprise combinations subject to marketing, institutional, agronomic and resource restrictions. Input-output coefficients necessary for this model were developed for loam and clay soil groups for two time periods, 1970 and 1980.

Outreach Out of Your Mind

Presented at the 2023 CTLC ConferenceLike many libraries, the Cowan-Blakley Memorial Library at the University of Dallas operates on a reduced budget, which severely limits our funding for outreach efforts. The University of Dallas also has a unique, almost quirky culture and the library’s low- / no-cost outreach activities engaging with that culture have made the library a bigger part of campus life. Armed with creative thinking, our librarians have produced numerous successful (and a few not-so-successful) campaigns. Join us to learn about which outreach efforts gave the best return on our time investment, which campaigns were most effective with various members of our campus community, and a discussion of attendees’ campus cultures with examples of related outreach activities to consider

An application of cost-benefit analysis to the Al-Qateef, Saudi Arabia, water management project

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