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Editor Richard Lambert. ISSN GomminioD Ruiuue No S O The Financial Tima Limited London SEI? Several potential candidates were approached, but the favoured candidate, a US hanker with leveraged buy- out and inv es tment h anking experience, declined. Despite some lobbying for a European candidate, the top banking position is essentially reserved for an American. This was part of a deal agreed between the bank’s 56 government share- holders in when the London-based bank was set up to facilitate transition of thp former centrally p lanned economie s to market meth- ods and institutions.
The US government, which insisted the new hank concentrate mainly on help- ing the emerging private sec- tor, is the largest single shareholder in the EBRD with a 10 per cent stake. The 15 EU governments have 57 per cent between them and the former com- munist member states another 12 per cent. Salomon Brothers is advis- ing the Romanian cities of Constanta and Brasov on municipal bond issues and planning eurobond issues for power and phone companies in Moscow, with a debut municipal eurobond for St Petersburg.
Press a few but- tons and redirect it for free. Want an e-mail address with- out having to pay anything to an Internet provider? That too is on offer for customers of KPN, the Dutch posts and telecoms utility which hopes that such services will help it beat the competition when its fixed-line monopoly ends in less than three months.
Its lib- eralisation. AH have been forced into a love-hate relationship with KPN, as The Hague’s rush to open the market has left in its wake a regulatory vac- uum. But the two are at the same time allies in apposing a govern- ment ruling that, whatever the tariff is. This would imply a higher charge to interconnect.
KPN regards this as a shift in the right direction, although Mrs Jorritsma made clear that the divide would not be simply on the basis of owning infrastruc- ture.
It is being formed from an existing supervisory department within the telecoms division of the transport ministry: officials insist the unit win have the power to make independent decisions, and make them stick.
But Mr Wim Dik. He is a potential benefi- ciary of the transport minis- try’s ruling that Interconnec- tion tariffs should not discriminate. As for many smaller operators that depends, however, on the interpretation of a distinc- tion drawn last week by Mrs Annemarie Jor ritsma , trans- port minister, between those In any event, the ministry sees its work as now done.
A new telecoms law is due to be reedy by next January. Amendments to current stat- utes, to ensure that full-scale competition can take effect from July, were approved by the cabinet last Friday.
Telfort argues that if Opta is to have teeth, it should be able to subject KPN calcula- tions of interconnection costs to scrutiny by an out- side accounting firm. These would stm be cheaper than anywhere else in the world, it points out KPN this week revised its retail charging structure to produce what it said would be an average bill the lowest hi Europe except for Luxem- bourg.
Customers can pick one of three subscription rates depending on how often they use the phone. But the package intended for infrequent callers – with a monthly charge 40 per cent below that offered to the highest volume residential users — will demand three times the standard price for international calls, and Lt will not allow carrier select At tiie wmo timw, ministe- rial objections forced KPN to withdraw a plan to provide all customers with voice- mail, replacing the need for an answering machine.
Hungary poised for modest recovery By Anatol Lieven in Budapest After two painful years of belt-tightening which cut living standards by 15 per cent as resources were shifted into repaying foreign and domestic debt and into exports, the Hungarian economy is poised for a modest export- and Investment-led recovery.
But the economy grew by 3 per cent in the last quarter of over the previous year and Hungarian officials and the International Mone- tary Fund predict the same for as a whole.
Western analysts believe that this may even err on the conservative side because of the continued strong flow of foreign direct investment FDD Into Hungary, totalling L8bn last year. Hungary remains in first place among the former communist coun- tries, with 35 per cent of total invest- ment in the region. General Motors.
Suzuki and Ford have all established big parts and assembly plants in Hungary, and have been joined by Audi, which last year established a factory to pro- duce diesel engines. The car industry was the major factor behind an impressive growth of 10 per cent in machinery expats last year and the growth figure for is expected to be twice that.
The government hopes to reduce inflation, running at 19 per cent in the first quarter of this year, to sin- gle figures by , but there are some doubts as to whether this is practicable, given the difficulties of further reducing spending, espe- cially in the health system. With the approach of the next elec- tions, due in May , the’ ruling coalition will also come under Increased political pressure not to cut spouting further.
However, Mr Peter Medgyessy. They said approval had been given despite the. Strasbourg Cyprus PM shuffles pack Cyprus prime minister, Mr Glafcos Clerides, yesterday reshuffle d his cahinet for the first time since taking office four years ago in what was seen as an attempt to bolster his image before next February’s presidential el ecti o n. He changed five of his member cabinet among them the foreign minister. Mr Alecos Michaelides. He has been. Also dropped were the ministers of communications, justice, education and health, who belonged to the rightwing Democratic Rally party, which Mr Clerides founded 20 years ago.
Andreas Hadjipapas, Nicosia Russian spies target Germany Germany is far and away the top European target for Russia’s intelligence services, whose methods are becoming more and more like those of the Soviet KGB, according to Germany’s counter-espionage body.
The annual report of the Federal Office for the. Protection of the Constitution BfV says that Russia’s intelligence activities focus especially on Germany’s attitude to the eastward enlargement of Nato and its stance on the Middle East peace process. But the co-operative forms, which fear ruin if forced to foot the bill, should have ea s ie r conditions for paying off the debts, the court said.
The rating was a setback far east German farmers and politicians who argued that Communist planners o fte n forced them to take unnecessary credits to finance nan-agricultural work such as building roads, schools or public offices in their villages. Eastern leaders wanted ‘ Bonn to shoulder the form debts in the same way it paid, off loans taken out by east German companies amd local governments. On the harmonised basis. Inflation averaged 2. JBut ABN. Exports are again t ak ing over from domestic demand as the wain ‘ motor of economic growth.
But retail sales data for-. January, released last Friday, still showed 7. So far, it is not a political party, more a refuge for some 3, conservative dis- senters from the course towards Emu set by Presi- dent Jacques Chirac and his prime minister, Mr Alain Juppe. But it could swing into action like a political party when France comes to ratify whatever emerges from the inter-governmental conference IGC on Euro- pean Union reform.
There seems little chance of Mr Chirac doing this. France has conceded to Ger- many that the stability coun- cil should be informal. Nor can the president be forced to bold a referendum. Politically, too, Mr Pasqua has, at least temporarily, lost his key ally in the anti-Maastricht referendum, Mr Philippe Sfeguin. The Gaullist president of the National Assembly is pri- vately no keener on the euro than he was formerly, but he is keeping quiet to preserve his chances of succeeding Mr Jupp6 as prime minister.
But Mr Pasqua, whose rows with Mr Juppe have not prevented him retaining a reasonable relationship with the president, still believes Mr Chirac might respond to a groundswell of pro-referendum opinion. Certainly, any issue con- cerning the single currency – even a complicated one such as the stability pact – Is more likely to engage the French public or parliament than probable IGC tinker ing with Brussels institutions. Though Demain La France is basically a conservative club, Mr Pasqua has care- fully cultivated contacts with other anti-Emu parties on left and right Another Euro-stick with which Mr Pasqua beats the Spain to ease spending curbs By Tom Bums in Madid Spain’s government says it will ease spending con- straints next year while con- tinuing to shrink the budget deficit, in a mark of its confi- dence that the economy is set for sustained growth and low inflation.
Its four-year convergence plan covering economic tar- gets from to will be approved by the government on Friday. Total spending is due to increase by 4. The government believes this year’s austerity drive has put It on track to achieve a budget deficit of 3 per cent of gross domes- tic product against an esti- mated 4.
This would fulfil a key requirement for joining the proposed European single currency in the first wave in January New hiring and firing guidelines, negotiated by employers and unions and due to be made public this month, would “ensure salary moderation and employment growth”. The March consumer price index is announced on Friday- Under the convergence plan, GDP is set to grow by an average 3.
Mr Alain Juppfi, the prime minister, said yesterday he I had ordered an examination of documents seized last month in a garage near Paris which contain tran- scripts of hundreds of tele- phone conversations alleg- edly tapped at the order of the late President Francois Mitterrand.
The information had alleg- edly been collected by Mr Christian Pronteau, the then head of the anti-terrorist unit at the presidential pal- ace. He is at the centre of the current judicial inqui- ries launched in Mr Pmatean, interrogated last Friday by the Paris judge.
Tapping had been far more widespread at the timp of General Charles de Gaulle, he said. When he was inte- rior minister, Mr Pasqua complained loudly that France’s EU partners failed to co-operate In the fight against terrorism.
He remains a staunch advocate of EU governments keeping security and justice in their hands and out of those of Brussels. We Gaulllsts used to incarnate these values, but we have increasingly let the Front appropriate them. Lawyers and information technology IT executives in Prague said it was an example of pitfalls awaiting buyers and sellers in a region spending heavily on imparted technology.
The deal was for the provi- sion of a Unisys computer system to modernise Spori- telna’s handling of savings accounts. In which it has a near-monopoly. The following January Unisys offered a written guarantee the problems would be solved, and a new contract was signed for com- pleting the installation. Sporitelna has already won one victory over Unisys in the dispute. Uiilsys is appealing against that ruling.
Unisys said yesterday it continued to service a main- tenance contract with Spori- telna in relation to parts of the disputed system that were installed before their relationship ended. No hassle.
No fuss. No problem. It follows 10 tense days of public brink- manship and private negoti- ations following the decision by Mr Sitaram Kesri, Con- gress president, to withdraw political support from the minority coalition. They said Congress’s appar- ent softening appeared to have resulted from strong pressure on Mr Kesri from his party’s MPs. Separately yesterday, a Delhi court dropped money laundering charges against a senior Congress politician, Mr V.
The charges were laid last Janu- ary In India’s biggest ever political bribes affair. With 65 per cent of Indian freight carried by road, the strike has led several com- panies to shut factories. It is affecting supplies of coal, steel, cement, chemicals and fUel to several states and has caused food shortages. Grain prices have risen by up to a quarter. The New Delhi factory owners’ associ- ation said the strike had hit local traders hard.
Export growth from April last year to Feb- ruary fell to a rate of just 6Ji per cent against a 20 per cent government target Free Lunch The Wall Street Journal Europe provides a diet of concise, substantive news, edited in the heart of Europe with the European businessperson, investor and professional in mind. For a 5-day free trial, without obligation call one of the numbers below.
The Kuala Lumpur stock exchange’s leading index climbed The central hank acted a mid cipnppm that Malaysian banks and finance houses, burdened by heavy expo s ure to the over-supplied property sector, may follow their counterparts in Thailand, where the authorities have unveiled rescue packages to bail out finance houses hit by the property price slump.
It also imposed new curbs on iprwWng by finanriat institu- tions for share purchases. That provoked miwVi con- fusion in the markets, mostly centred on the curbs on tending to the property sector. Yesterday, Mr Fong listed exemptions to the curbs, which took effect on April l, prompting the stock market rise.
Also exempt is the exten- sion of working capital to any business, even if it is in the propert y sector. In build- ing projects which combine houses costing less than MS Financial institutions with over 20 per cent of their loan portfolio already devoted to prop er ty need not call in any Hwwa of credit, Mr Fong said. World Stocks. While the national capital, Kuala Lumpur, now boasts the tallest buildings In the world, K elan tan’s state capital has only a few that rise above the tree tops.
Trishaws mingle with the sparse traffic and, in govern- ment offices, telephones can ring for minutes before someone sees fit to answer. The national government looks upon the state with some HiaHdn and blames its slower pace of development on the devoutly Islamic opposition party which runs it.
Far its part, PAS says the central government is responsible for its somewhat arrested progress because it discourages investment in Kelantan in an attempt to portray the apposition party as backward and too radical in its Islamic beliefs.
These conflicting asser- tions have given rise to much bickering since , when PAS won power in an election. Dr Mahathir emerged from the dialogue suggesting that a new era of co-operation was at hand with the only Malay- sian state that remains under opposition control. There were few details on the 2,ha project, which some say was kept purposely vague to provide an easy escape should the new coop- erative spirit turn sour.
They add that Petronas has not drilled because it wants to Manila shares fall 2. Continuing a six-day los- ing streak, the main fell 2. A recent report by the cen- tral bank said that banks’ exposure to the booming property sector amounted to about 10 per cent of total outstanding inarm and was not a cause for alarm.
The banking sector ended down 2. Overseas aid figures for other leading donor countries have not yet been released. Japan has been in the top position since L when it surpassed the US. Japanese foreign ministry officials pul part of the blame on the yen’s weakness against the US dollar – the Japanese currency weakened to a four- year low yesterday, touching YI26 against the dollar in Tokyo. They said the yen weakness drove down the dol- lar value of Japan’s official develop- ment assistance ODA in Other reasons were budgetary cots in ODA projects and the temporary sus- pension of official assistance to China.
In the new atmosphere of fiscal aus- terity and the government’s push for financial reform, overseas aid has become less of a priority. A working group established by the government and the ruling Liberal Democratic party is studying ODA appropriations and is likely to recommend further budgetary cuts and streamlining of the aid programme.
The new spirit of co-opera- tion may also boost the tour- ism industry, state officials said. Foreign businessmen in Kuala Lumpur said that the central government’s atti- tude toward proposed Invest- ments in Kelantan has. Others said that the state may be attrac- tive for manufacturing, partly because wages are lower there. In addition, there is a question about how much PAS really wants foreign investment The chief minis’ ter.
Speaking before discussions with airline Industry representatives later this month; and amid growing complaints over the level of costs, Mr Leeks said that proposed charges were still open to discussion. But he – played down the prospect of any significant change, argudng that the authority was bound by its ordinance to deliver a satisfactory rate of.
Kai Tak, the existing airport John ffiddma. Bong Kong Pakistan targets black market The Pakistani government is drafting a law to punish black marketing of flour. In the wake of acute shortages, a senior official said In Islamabad yesterday.
The banking index dosed 29 A points higher at 4,, with National “Australia Bhnfr and Commonwealth’ Bank among the strongest gainers. Nikki Tait,- Sydney Would you prefer more time to catch your flight? Formed by the merger of Ciba and Sandoz. Five year old Haley Engalman at home. Haley suffers from a combination of two rare genetic disorders.
Her body is unable to hold or digest any normal food. Novartis developed a new nutritional product and delivery system which gives Haley all the nutrients she needs to sustain life. Pressure for change arose after IMF and World Bank economists concluded that Ivory Coast would not qual- ify for assistance under the present rules, even though its external debts are rela- tively high compared to both government tax revenues and the size of its economy. Between eight and 20 coun- tries are eventually expected to benefit.
Mr Michel Camdessus, the IMF’s managing director, By Micheia Wrong in Mbuji-Mayi, Zaire Zaire’s rebel movement has signalled its intention to take diamond production In the regional capital of Mbuji- Mayi bade to pre-invasion levels and incorporate the economy of the traditionally rebellious east Kasai prov- ince into the rest of occupied territory.
Fighters from the Alliance of Democratic Forces for the Liberation of Congo ADFL chased away illegal diggers who had swarmed into the concession as law and order collapsed and the soldiers on guard started looting.
The officials said only two days of production – repre- senting a total of Zaire’s single biggest pro- ducer of diamonds, had been less serious than expected. The notion that there are French political interests involved here is very clear,” said one, arguing that Mr Camdessus’s comments in Paris might well harden the resolve of those opposing a rule change. But a senior official at the World Bank denied that a rule change was being sought simply to benefit Ivory Coast, but to to ruffle sensibilities in the town, which has a history of rejecting central authority.
Although ADFL officials address a general problem. The initiative involves creditor governments increasing the debt relief they normally offer poor countries, with multilateral institutions then providing any further help necessary to reduce total external debt to a sustainable level.
Sus- tainability is assessed by looking at the ratio of exter- nal public debt – measured on a net present value basis – to export earnings. The initiative was origi- nally drawn up on the assumption that countries could sustain debt-io-export ratios of between and per cent, although staff now concede that it Is sensible to set targets at the lower end of this range.
Of the coun- tries considered so far, deht- to-export targets have been proposed at per cent for Uganda, per cent for Burkina Faso and per cent for Bolivia. Both Uganda and Bolivia have argued for more generous debt targets and earlier “completion points” for the delivery of relief, which would raise the cost significantly.
Ivory Coast would not be eligible because its debt-to- export ratio is forecast to stand at only per cent at its assumed completion date In The country’s debt-to-ex- port ratio is low because it exports half as much again of its output as most other highly indebted poor coun- tries. But its debt-to-GDP ratio is twice as high as that for most other countries, while its ratio of debt to gov- After a meeting on Mon- day night with local dia- mond operators.
But others fear that setting targets for debt-to-revenue ratios would discourage countries from collecting tax carried out They have also treated the emotional Issue of east Kasai’s currency carefully. Tf such a change were to be made, it should he done at an early stage. The ADFL wants the prov- ince to adapt the new zaire, in use in the rest of the area under its control. On one issue, however, the ADFL appears to be standing firm. Diamond operators have been told that licences for buying counters must he bought in Goma, the ADFL’s administrative base.
That’s dangerous. For decades tiie money from Mbuji-Mayi was funnelled to Kinshasa with- out being invested locally. This necessitates a complete cessation of hostili- ties. In Lagos, which alone con- sumes nearly a third of national output, petrol Is trading on the black market at about five times the offi- cial rate of 16 US coots a litre. Many workers can no longer afford the Inflated prices charged by the few public transport operators stQl on the road. The authorities have offered no official explana- tion as to the cause of the most serious and prolonged petrol crisis since a national oil workers strike three years ago.
Mr Saparmnrat Niyazov, president of Turkmenistan, has named Mr Batyr Sard- jaev, the deputy prime min- ister, as oil and gas minister of the central Adrian state, according to a decree pub- lished yesterday. Reuter reports. Mr Saxdjaev replaces Mr Gochmurad Nazdzhanov, who will now be supervising the construction of planned It says this is Insufficient to meet demand estimated at 18m litres a day.
The NNPC further accuses the ministry of foiling to release m allocated for the refcrfctsb- ment of those foefifttas. Officials argue that it would be cheaper, more reliable and efficient to Import refined petroleum products. The dispute is the latest In a series between Mr Anthony Ani. Last October, Mr Ani advocated the total pri- vatisation of the NNPC, a move fiercely resisted by Mr Etete who has lobbied Instead for a more promi- nent rote for his ministry in ail sectors of the ofi Indus- try.
General Saul Abacha. With the crisis now spreading beyond the south-west where opposition to military rule is strongest, the government appears to have decided to resume petroleum imports. A diamond trader in Kisangani. The fall of Mbnjl May!
The Basle Committee, which groups supervisors from the central banks of the leading industrialised countries, has drawn up a set of 25 basic principles in collaboration with supervi- sory authorities from 15 developing countries. Includ- ing China and Russia. Its work was prompted in part by the Mexican finan- cial crisis at the end of and is published at a time when the h anking systems in a number of developing countries face difficulties. Rep- authorities worldwide, resentatives from Chile, The report says supervi- sors should operate within a consistent legal framework but should enjoy operational independence and adequate resources, as well as being free from political pressure.
Other sections detail pru- dential requirements such as the need for minimum capi- tal requirements, and out- line the need for licensing and the Importance of ade- quate records and informa- tion.
The report stresses the i mp ortance of links and the exchange of information between regulators in differ- ent countries. R Is hoped a final version of the document, which Is being released for consulta- tion, will be finalised in advance of the IMF and. World Bank annual meeting in Hong Kong in September. RMa ben w teAl bt aUn U. NDFR Port of Tallinn announces tender with preliminary negotiations for the lease of the grain terminal in Muuga port.
The tenn of the lease is 25 years: The capacity of the terminal is up to 5 million, tons per year. Port of Tallinp will hand over conditions of the tender at the address of Tallinn 25 Sadania Street, room , Estonia, on working days from 10 am.
For additional information please contact Port of Thllinn, tel. The tender will be carried out according to the applicable Estonian law. Port of Tallinn reserves the right to reject any of the bids or to nullify die tender for no given reason.
Port of Tallinn announces tender with preliminary negotiations for the tease of the container terminal under construction in Muuga port.
The term of the lease is 25 years. The capacity of the first stage is 60 TEU per year, the capacity after the second stage will be TEU per year. Port of Tallinn will hand over conditions of the tender at the address of Tallinn.
The participation fee in the amount of 5 EEK is to be paid to the account No! For additional information please contactPort of Tallinn, tel. The bids are to be presented in a sealed envelope in Estonian or English no later than 7th May, at p. The tender will be carried out according to die applicable Estonian law.
Port of Tallinn reserves the right to reject any of the bids or to nullify the tender forno given reason. Forget those big mobile phones of the past. The Ericsson GF is so small it hides in your hand.
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This is based on the degree application, the following tests can be required for a standard quantity of of penetration achieved by allowing a performed to evaluate the mechanical the fluid, at a given temperature, to standard cone to sink into the grease stability of a grease. The depth of Prolonged penetration test temperature, the temperature at which penetration is measured on a scale of The grease sample is filled into a cup it is measured is always stated. The mm and the softer greases allow and, using an automatic device called viscosity of base oils is always indicated the cone to penetrate further into the a grease worker subjected to , as a kinematic viscosity abbreviated to grease, hence the higher penetration double strokes.
The difference between the Refer to chart below measured penetration at 60 strokes and after , strokes penetration Classification of greases by NLGI consistency number is reported as the change in mm. Roll stability test hours at rpm is greater than 50 Water resistance The change in the grease structure grams, then it is rated as failed. The water resistance of lubricating amount of softening or hardening greases is measured in accordance can be evaluated by filling a cylinder Corrosion protection with DIN 51 part 1.
A glass strip with a pre—specified quantity of grease. Lubricating greases should protect is coated with the candidate grease, A roller is placed inside the cylinder metal surfaces from corrosive attack which is placed into a water—filled and the complete unit is rotated in service. The corrosion protection test tube. The test tube is immersed for 2 hours at room temperature in properties of rolling bearing greases in a water bath for three hours at a accordance with ASTM D The change modified the standard test procedure method, which is standardized under in the grease is evaluated visually and to reflect the application conditions ISO Under this test method reported as a value between 0 no under which the grease is used to a mixture of lubricating grease and change and 3 major change along either 72 or hours at a test distilled water is present in the with the test temperature.
At the during a defined test cycle between Oil separation end of the test period, the cylinder is standstill and rotation at 80 rpm. At Lubricating greases release oil when allowed to cool to room temperature the end of the test cycle, the degree of stored for long periods of time or and the penetration of the grease is corrosion is evaluated according to a when used in bearings as a function measured. The difference between scale between 0 no corrosion and 5 of temperature.
This phenomenon is the original penetration and the value very severe corrosion. A more severe necessary to ensure good lubrication. In addition, and manufacturing method. A cup is SKF V2F test the test can also be carried out by filled with a given quantity of grease The candidate grease is tested for continuously allowing water to flow or which is weighed before the test and mechanical stability using the following wash through the bearing arrangement a gram weight placed on top of procedure.
The test rig consists of a during the test cycle. The the same as that used under the the sieve is weighed and reported test is run at two different speeds, standardized method. However the as a percentage of weight loss. The and 1, rpm. If the grease, procedure places greater demands on amount of oil separation is measured which leaks from the housing through the corrosion protection properties of in accordance with DIN 51 If the total amount of copper alloys used in bearings from grease leakage after both tests 72 corrosive attack while in service.
If the grease using the standardized method DIN only fulfills the first part of the test A copper strip is immersed in 72 hours at rpm with a grease the grease sample and placed in an leakage of 50 grams or less but fails oven. The result is given. If the grease leakage after 72 rated by a numerical system. This test method large size bearings operate in housings. The test method is carried out under Three steel balls are held in a cup two different conditions.
Test A is and a fourth ball is rotated against conducted at ambient temperature and the three balls at a given speed. The at normal operating temperatures and test indicates the point at which the also in low vibrating applications. A extreme pressure limit of the grease is pass in the heated test Test B at exceeded. This test is performed with the same rig used in the 4—ball weld load test.
Then the wear on the determines the grease life and high three balls is measured. A standard temperature performance limit of a test uses a load of N. However, lubricating grease. Ten deep groove ball SKF has decided to increase that to bearings are fitted into 5 housings and 1, N in order to make the test filled with a given quantity of grease.
The test is undertaken at a pre— determined speed and temperature. False brinelling Both an axial and radial load is applied Anti—fretting properties of a grease and the bearings run until failure. The can be relevant for certain applications. Two ball thrust bearings the grease life.
This information can are loaded and oscillated. The wear be used to determine relubrication on each bearing is then measured. Greases offer good fretting protection when the measured wear is below 7 mg. LDTS 1 oil has been especially developed for the automatic lubrication of conveyors in the food processing industry. The base oils and additives of this lubricant comply with the FDA regulations and can be used according to EC regulations for incidental contacts with foodstuffs.
Number and registered by the phenomenon. LDTS 1 has an anti-wear bacterial development in equipment effect on partially worn conveyors. Product packaged in 5 liter cans; 4 cans per case. Specific gravity 0. Available pack sizes 5 liter can — ml automatic ml automatic ml automatic liter drum 0. Available pack sizes — g tube — ml cart. It provides an easy and clean alternative to manual grease packing of open bearings.
Screw in the gun tube changing cartridges, and proceed as 6. Close the toggle-type fastener The piston pumps with a block feeder follows: 7. Open the toggle-type fastener rod up to the stop stackers and construction machinery as 2. Unscrew the gun tube 8. Change the cartridge lubricant outlets depending on the Ordering details block feeder.
Every stroke of the lever Complete unit Number of outlets delivers 2 cm3 of lubricant to the feeder. VGBL VGBL 1 Gun only. The level of the lubricant in the cartridge can be checked by pulling See Accessories chapter for tubing, fittings and connectors. See Lubricants chapter for grease cartridges. When the cartridge is full, the piston rod can be pulled out approximately mm.
Ordering details Function diagram Progressive feeder Number of Number of plug outlet pairs maximum hexagon socket SW 3 pistons outlets. O-ring Dimensions of carrying case W x D x H x x mm Single—point automatic lubricators LAGE and Reliable, reusable lubricator system meets many needs. Accurate calculation of DialSet 4. After Russian, Chinese and Thai. DialSet 4. From www. SYSTEM MultiPoint automatic lubricator LAGD Multiple grease lubrication installations with multiple lubrication accuracy, makes it an excellent solution points, this can be a time—consuming for longer bearing life and increased points made easy and costly process.
The upper reservoir allow you to effectively adjust the is an airtight container storing correct oil level during running replacement oil. Through its extended conditions, optimizing machine neck, which dips into the oil of the performance and increasing the service lower reservoir, the two reservoirs life of the applications. Furthermore, are in direct contact with each other. Compact, automatic, dependable With our compact greaser we have succeeded in developing an automatic, electrically driven centralized lubrication system especially designed for linear guide systems.
The ETP compact greaser does not require a separate control unit. Unlike Permadose dispensers, the compact greaser lubricates only when the machine is running. The compact greaser is easy to install due to its small dimensions and low Ordering details weight. Number of Outlet Metering mm3 outlets assignment outlet no.
PA tube, 1. Adaptors for 2. VGKG M6 x 0. VGKG Compact greaser ETP. LAGD 60 60 ml 2. Lubricant included. The canister and battery pack may be used even at 12 months setting if acti- vated 3 years from production date.
SKF has taken the knowledge and expertise of Vogel Lubrication and developed three solutions for grease- lubricated fan and blower bearings. Fan and blower bearings are often critical to the operation of industrial manufacturing facilities. In some cases, they are in hard-to-access locations. The SKF grease lubrication units for fans can help users ensure that these bearings are being lubricated properly. These units are designed to deliver grease from 2 to 20 points consistently and effectively, providing the right amount of lubrication for extended bearing life.
Ordering details Part no. When ordering, specify the number of points A separate pump element is required for each outlet. Three pump elements with different delivery rates are available so that the volume of grease can be adjusted to the needs of the individual circuits. This feature ensures that every lube point is supplied with an adequate amount of grease in each lubrication cycle. Control is provided by an integral IGI control and monitoring unit; it can be operated in a time- or load- pulse dependent mode, and with or without monitoring.
Please order cable harness separately. Temperatures and pressures that deviate from these figures lead to different delivery rates. As general indices of donor quality,such as the donor risk index DRI [10], correlate with outcomes and resource utilization, use of extended criteria donors has significant implications.
Medical and economic implications of recipient severity of illness and donor quality vary markedly within the US. The median national MELD score in was 27, ranging from 21 to 35, reflecting the wide geographic disparity. Stroke volume response to volume loading is blunted as administered fluids are quickly redistributed to splanchnic circulation, worsening bleeding during the dissection phase of OLT. Restrictive fluid management and use of vasopressors, such as vasopressin or adrenergic receptor agonists, restore central filling volume, stroke volume and organ perfusion, but decrease portal flow and splanchnic hyperemia, and contribute to reduced bleeding during the dissection phase.
Diastolic dysfunction is associated with severity of the post reperfusion syndrome [13], and with development of post transplant heart failure. Similarly, platelet numbers are often reduced but upregulation of Factor VIII and von Willebrand Factor may offset the effects of thrombocytopenia. Clinically, both coagulopathy and pro thrombotic states are common in ESLD. Low grade fibrinolysis occurs frequently in OLT recipients providing a rationale for the use of antifibrinolytics.
Conventional tests, prothrombin time and activated thromboplastin time do not reflect the clotting function or predict bleeding in OLT [15]. Whole blood clotting assays, such as rotational thromboelastometry or thromboelastography, may better inform of the status of the clotting function and are commonly used as point of care tests to help guide a protocolized hemostatic management strategy [16]. Prothormbin complex and fibrinogen concentrates are being investigated as attractive alternatives to fresh frozen plasma and cryoprecipitate, as the association of transfusion with morbidity and mortality in ELSD is well established.
The number of transplants performed in individual centers is relatively small compared to other major surgeries. Consequently,most of the current evidence is based on data from small, non randomized series. Consensus on the best approach to common perioperative practices in OLT, such as transfusion practices, fluid management, etc.
Few health care disciplines are scrutinized as rigorously as the US transplant. Mandatory data reporting and state of the art analysis, result in the largest national outcomes report, the SRTR.
Thereport comparestrue outcomes with a rigorously developed, risk adjusted model based on multiple donor and recipient risk factors. Whereas the SRTR report provides critical information to inform governmental regulatory agencies, insurers and policymakers, it falls short of a comprehensive outcomes and quality database that would allow systematic examination of current practice and lead to quality improvement processes in liver transplantation [17].
One good example is perioperative blood transfusion,a factor strongly associated with mortality after liver transplantation. The program has developed a standardized approach to quality improvement with demonstrated potential for reduction in postoperative morbidity and mortality. Conclusions Orthotopic liver transplantation is a well established, effective treatment for patients with ESLD.
Although outcomes of liver transplantation are robust, transplant centers face significant challenges, including trends toward sicker and older recipients, increased use of marginal donors due to persistent donor shortage, and stricter regulatory and financial environment.
Current efforts are directed towards refining quality metrics and risk adjusted outcomes, and developing a standardized approach to quality improvement in perioperative care of liver transplant patients.
Homotransplantation of the liver. Transplantation ; 5 Suppl : — Designated liver transplant anesthesia team reduces blood transfusion, need for mechanical ventilation, and duration of intensive care. Liver Transpl ; Reduced use of intensive care after liver transplantation: influence of early extubation.
Anesthesia for liver transplantation in US academic centers: institutional structure and perioperative care. Liver Transpl ; 18 6 : A model to predict survival in patients with end stage liver disease.
Hepatol ; Axelrod D. Economic and financial outcomes in transplantation: whose dime is it anyway? Curr Opin Organ Transplant. Cardiovascular complications of cirrhosis. Postgrad Med J. A comparison of intra operative blood loss and acid base balance between vaso pressor and inotrope strategy during living donor liver transplantation. Anaesthesia ; — Influence of preoperative diastolic dysfunction on hemodynamics and outcomes of patients undergoing liver transplantation.
Int J Clin Exp Med ; 6: 7. Diastolic dysfunction in patients with end stage liver disease is associated with development of heart failure early after liver transplantation.
Transplantation ; Lisman T, Porte RJ. Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences. Blood ; 6 : Coagulation management with factor concentrates in liver transplantation: a single center experience. Transfusion ; e published: doi Am J Transpl ; 6: Blood transfusion requirement during liver transplantation is an important risk factor for mortality. J Am Coll Surg ; 1 6. Louis, USA E mail vannucca wustl.
While apparently a simple principle, the mechanisms of success and failure with direct laryngoscopy are still actively debated 2 Video laryngoscopy is performed with instruments that allow visualization of the glottis independently from the alignment of the line of sight with the laryngealstructures glottis and supporting cartilages.
These three separate components of a successful intubation have become more recognized by clinicians since the widespread adoption of video laryngoscopes in the clinical practice. In fact, it is a quite common problemwith the use of these devices tobe able to easily visualize the glottis,while facing difficulties in advancing the tube beyond the vocal cords. While adverse events at the induction of anesthesia have become progressively less frequent and severe, problems at the extubation appear to be an unresolved patient safety issue 9 Practice guidelines have had an important role in reinforcing the principle of planning in advance, suggesting modalities for airway assessment, establishing priorities in difficult airway management, proposing a sequence ofinterventions to adopt in case of difficulties, and endorsing the use of advanced tools to gain control of the airway, or, at least, to maintain oxygenation.
However, there is still a limited experience with the use of this algorithm and, at this point, it is not known if it is having an impact on clinician practices and patient outcomes. Developing technology and increasing efforts by National and International Societies in designing and diffusing effective guidelines have significantly contributed to reduce adverse outcomes.
References: 1. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Greenland KB. A proposed model for direct laryngoscopy and tracheal intubation. Levitan RM. The mystique of direct laryngoscopy. Respiratory care. Epstein SK. Decision to extubate. Intensive Care Med. Use of non invasive ventilation to wean critically ill adults off invasive ventilation: meta analysis and systematic review.
Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta analysis. Management of the difficult airway: a closed claims analysis.
Closed claims’ analysis. Part 1: anaesthesia. British journal of anaesthesia. Cavallone LF, Vannucci A. Extubation of the Difficult Airway and Extubation Failure.
Anesth Analg. The difficult airway with recommendations for management Part 2 Difficult airway. Canadian Journal of Anesthesia. Frova G, Sorbello M. Algorithms for difficult airway management: a review. Minerva Anestesiol. Predicting difficult intubation in apparently normal patients: a meta analysis of bedside screening test performance.
Review article: video laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? A survey assessing the procurement, storage and preferences of airway management devices by anaesthesia departments in German hospitals. Eur J Anaesthesiol. Mendonca C. Sugammadex to rescue a ‘can’t ventilate’ scenario in an anticipated difficult intubation: is it the answer?
Crosby ET. An evidence based approach to airway management: is there a role for clinical practice guidelines? The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Annals of emergency medicine. Cooper RM. Complications associated with the use of the GlideScope videolaryngoscope. Palatal injury associated with the GlideScope. Anaesthesia and intensive care. Avoiding palatopharyngeal trauma during videolaryngoscopy: do not forget the ‘blind spots’.
Acta anaesthesiologica Scandinavica. Preoperative endoscopic airway examination PEAE provides superior airway information and may reduce the use of unnecessary awake intubation. Kristensen MS. Ultrasonography in the management of the airway. Connor CW, Segal S. The importance of subjective facial appearance on the ability of anesthesiologists to predict difficult intubation. Accurate classification of difficult intubation by computerized facial analysis.
Is video laryngoscope assisted flexible tracheoscope intubation feasible for patients with predicted difficult airway? A prospective, randomized clinical trial. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Brief review: Supplementing oxygen through an airway exchange catheter: efficacy, complications, and recommendations.
Incidence and severity of respiratory insufficiency detected by transcutaneous carbon dioxide monitoring after cardiac surgery and intensive care unit discharge. The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry. Seeberger unibas.
In vitro and animal models suggested that administration of volatile anesthetic prior to myocardial ischemia reduced myocardial infarct size. Nevertheless, a recent meta analysis of randomized trials strongly suggest that volatile anesthetics provide clinically relevant anesthetic preconditioning in patients undergoing coronary artery bypass graft surgery.
However, studies on the clinical value of preconditioning by volatile anesthetics in noncardiac surgery are scarce. To obtain scientific data on the value of preconditioning in patients at coronary risk who undergo major noncardiac surgery, we performed a study in three centers in Switzerland University Hospital Basel, Kantonsspital Solothurn, Kantonsspital Liestal. Between and , we enrolled patients at increased cardiovascular risk. Patients were randomized to maintenance of anesthesia either with sevoflurane or propofol.
To assess occurrence of perioperative ischemia, we recorded continuous ECG for 48 hours perioperatively and measured troponin T on postoperative day 1 and 2. To assess the occurrence of major adverse cardiac events MACE , the patients were contacted by phone 6 and 12 months after surgery. MACE were defined as a composite of cardiac death, acute coronary events syndrome, and congestive heart failure or arrhythmia requiring hospitalization.
Patients and outcome assessors were blinded. Myocardial ischemia occurred in 75 Within 12 months, 14 7. The incidence of delirium did not differ The results of this study were published in the journal Circulation in Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med ; 8. Cardiac risk stratification for high risk vascular surgery. Circulation ; 5. Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery.
Anesthesiology ; Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med ; Effects of extended release metoprolol succinate in patients undergoing non cardiac surgery POISE trial : a randomised controlled trial.
Lancet ; Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery StaRRS study. J Am Coll Cardiol ; Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Slogoff S, Keats AS. Randomized trial of primary anesthetic agents on outcome of coronary artery bypass operations.
Does choice of anesthetic agent significantly affect outcome after coronary artery surgery? Anesthetic induced preconditioning: previous administration of isoflurane decreases myocardial infarct size in rabbits. Isoflurane mimics ischemic preconditioning via activation of K ATP channels: reduction of myocardial infarct size with an acute memory phase. Volatile anesthetics protect the ischemic rabbit myocardium from infarction.
Isoflurane pretreatment has immediate and delayed protective effects against cytokine induced injury in endothelial and vascular smooth muscle cells. Anaesthetic drugs and survival: a Bayesian network meta analysis of randomized trials in cardiac surgery.
Br J Anaesth ; Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high risk patients.
Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration. Anaesthetics and cardiac preconditioning.
Part II. Clinical implications. Sevoflurane but not propofol preserves myocardial function during minimally invasive direct coronary artery bypass surgery. Anesth Analg ; 6, table of contents. Preconditioning with sevoflurane decreases PECAM 1 expression and improves one year cardiovascular outcome in coronary artery bypass graft surgery. Circulation ; Randomized comparison of sevoflurane versus propofol to reduce perioperative myocardial ischemia in patients undergoing noncardiac surgery.
Risk scores and indices In the past 30 years, several risk indices, based on multivariable analyses of observational datato represent the relationship between clinical characteristics and perioperative cardiac mortality and morbidity, have been developed.
Between them, the indices developed by Goldman et al. The Lee index, or revised cardiac risk index, is a modified version of the original Goldman index and it was designed to predict complications such as postoperative myocardial infarction, pulmonary oedema, ventricular fibrillation or cardiac arrest, and complete heart block.
The Lee index has been developed from prospectively collected data from a total of patients divided into a derivation and a validation cohort,and it was considered by many clinicians and researchers to be the best currently available cardiac risk prediction index in noncardiac surgery.
It [9]. Biomarkers A biomarker biological marker is defined as a substance used as an indicator of a biological state, which can be objectively measured and evaluated as an indicator of normal biological processes, pathologic processes, or pharmacologic responses to a therapeutic intervention.
According to World Health Organization definition, a biomarker is any parameter chemical, physical or biological which can be used to measure the interaction of environmental agents and biological systems. National Institutes of Health defines biomarkers as molecular indicators of specific biological and biochemical characteristics which can be used to assess disease progression or treatment effects.
The ideal biomarker should have specific characteristics: a ability to differentiatewith high accuracy healthy and a illpatient; b opportunity to be present in early stage of disease so to achieve effective and early therapeutic interventions ; c to be present in high enough level and in an easily accessible tissue fluid; d tolead to the development of tests that will ultimately impact in reduced mortality.
Due to these precise characteristics, an ideal biomarker is difficult to find. In the perioperative setting, especially in cardiac risk assessment for non cardiac surgery, biomarkers can be divided into markers focusing on myocardial ischaemia and damage, inflammation and LV function. Inflammatory markers, such is C reactive protein CRP , might pre operatively identify those patients with increased risk of unstable coronary plaque. CRP has been implicated in many aspects of atherogenesis and plaque vulnerability, and it is also expressed in smooth muscle cells within diseased atherosclerotic arteries.
However, in the surgical setting, no data are currently available to recommend use of CRP as a marker for the initiation of risk reduction strategies [13]. Cardiac troponins T and I cTnT and cTnI, respectively remain the preferred markers for the diagnosis of myocardial infarction because of demonstrated higher sensitivity and tissue specificity if compared with other available biomarkers.
Existing evidence suggests that even small increases in cTnT in the perioperative period reflect clinically relevant myocardial injury with worsened cardiac prognosis and outcome[12,15 16]. Development of new biomarkers, including high sensitivity troponins, will likely further enhance the assessment of myocardial damage. However, for the combined endpoint, the AUC for hsTnT was larger but this difference did not reach statistical significance [12].
Conclusion Today, biomarkers play pivotal role in cardiac risk assessment for non cardiac surgery. Very recent guidelines stipulate that the assessment of both cardiac troponins and natriuretic peptides measurements may be considered for obtaining independent prognostic information for peri operative and late cardiac events in high risk patients.
The impact of these guidelines on perioperative management of patients who must undergo non cardiac surgery is still to be determined, but these recommendations clearly set up the beginning of use of biomarkers as part of peri operative management. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet ; — A surgical safety checklist to reduce morbidity and mortality in a global population.
N Engl J Med ; — Association between postoperative troponin levels and 30 day mortality among patients undergoing noncardiac surgery. JAMA ; — Naughton C, Feneck RO. The impact of age on 6 month survival in patients with cardiovascular risk factors undergoing elective noncardiac surgery.
Int J ClinPract ; — Eur J Anaesthesiol ; Eur J Anaesthesiol ; — Multifactorial index of cardiac risk in noncardiac surgical procedures.
Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med ; — Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation ; — Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation ; — Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med ; — Incremental value of highsensitive troponin T in addition to the revised cardiac index for perioperative risk stratification in noncardiac surgery.
Eur Heart J ; — C reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. Guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery.
Cardiac biomarkers: a contemporary status report. Nat ClinPractCardiovasc Med ; — Third universal definition of myocardial infarction. In addition, increased procoagulant activity, inflammation, as well as the plaque rupture and subsequent thrombosis may be the pathophysiological mechanism as well. However, ideal strategy remains unattainable. The European guidelines for perioperative risk assessment and perioperative cardiac management in non cardiac surgery have been published recently.
Also, stress response to surgery may lead to neuroendocrine disturbances, catecholamine release and consequent cardiovascular response tachycardia and hypertension , as well as altered balance between prothrombotic and fibrinolytic factors. All these elements, individually or combined, may cause heart failure and coronary thrombosis. Vascular surgery is considered as one with the highest risk for the new cardiac events.
Determination of functional capacity is indispensable step in assessing cardiac risk. Climbing two stairs equals 4 METs and this is used as a cutoff point for poor functional capacity. Patients with less than 4METs are considered as patients with poor functional capacity, which can be related to increased mortality. On the other hand, prognosis is excellent when the functional capacity is high, even in the presence of stable coronary artery disease.
Several risk indices have been developed in order to define the relationship between clinical characteristics of the patients and new perioperative cardiac events.
Nowadays, the Lee index,which is a modificationof the original Goldman index,is considered the best currently available. All factors are marked with one point and total sum of points gives the estimation of incidence of major perioperative cardiac complications 0. Identifying the risk has major implications for perioperative care of the patients. Patients considered carrying low cardiac risk after the assessment could be operated on safely without any additional strategies for reducing the risk any further.
Patients at higher risk could benefit from pharmacological treatment. Also, they could be candidates for additional testing such as non invasive cardiac imaging techniques.
However, any noninvasive testing which leads to surgery delay should be reserved only for those patients in whom results would influence management. All efforts to assess perioperative cardiac risk in the past were focused in detection of myocardium at risk of ischemia that could lead to some cardiac treatment before surgery. Now, the focus has been put on cardioprotective measures during the surgery, which led to different pharmacological measures on order to decrease perioperative cardiac risk.
Stepwise evaluation of exercises capacity, surgical risk, clinical risk factors and additional noninvasive testing has been used for assessing the perioperative cardiac risk. Cardio protective measures in order to reduce the incidence of major cardiac complications are of particular interest. Literature 1 Devereaux P. Perioperative cardiac events in patients undergoingnoncardiac surgery: a review of the magnitudeof the problem, the pathophysiology of the eventsand methods to estimate and communicate risk.
Surveillance and prevention of major perioperativeischemic cardiac events in patients undergoingnoncardiac surgery: a review. CMAJ ; 7 Perioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients. Relationship between the inability to climb two flights of stairs andoutcome after major non cardiac surgery: implications for the pre operativeassessment of functional capacity. Anaesthesia ;— Br J Anaesth ; S1 :i3 i Clinical application of the cardioprotective effects of volatileanaesthetics: PRO — get an extra benefit from a provenanaesthetic free of charge.
Eur J Anaesthesiol ;— Clinical application of the cardioprotective effects of volatileanaesthetics: CON — total intravenous anaesthesia or not totalintravenous anaesthesia to anaesthetise a cardiac patient? Although this study has from the beginning been critisized because of major methodological issues2 the publication a few years later of another study demonstrating a similar beneficial effect of perioperative beta blocking therapy3 seemed to confirm the protective effects of such therapy.
In the following years several randomized controlled trials were published, some of them showing a beneficial effect of perioperative beta blocking therapy4 10, whereas others failed to demonstrate such an effect11 15 and even reported adverse effects such as perioperative bradycardia and hypotension and an increased rate of perioperative stroke.
Despite these contradictory findings, it became generally accepted that beta blockers provided protection against perioperative cardiac events and improved perioperative morbidity and mortality16 18 finally resulting in guidelines that recommended very liberal use of beta blocking therapy in the perioperative period19, In the meantime critical signals with respect to the liberal use of perioperative beta blockade came from systematic reviews and meta analyses.
In this study over 10, patients with increased cardiac risk undergoing non cardiac surgery were randomized to receive either placebo or metoprolol.
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The administration, led by President Emil Constantinescu and Mr Victor Ciorbea, the prime minister, was elected last Novem- ber on a platform which included a pledge to fight corr up tion and organised crime. Its efforts so far have helped ensure, according to opinion polls, that their public support has actually increased since the November ejections, in spite of a very painful price liber- alisation.
Mr Ettori says that crime and corruption in Romania, although a problem, have not reached any- thing like the levels in some parts of the former Soviet Union.
It has not become a place in which corruption acts as an acid, dissolving society, in the way that you see elsewhere. Maybe that is one rea- son why we have remained hon- est. So he has dean bands. A thorough investigation of all the privatisations and loans bom state hanfcg that took place under the previous administration of President Ian Qiescn would risk disrupting the reform process and even the Romanian econ- omy. Such an investigation is flpgirpd by many in Mr Constant!
These groups are partly drawn from tbo old anti-communist dis- sident movement Many of their members believe that not only was much of the privatisation process under the previous administration corrupt, but that much of the original cap- ital of many Romanian compa- nies was drawn from the accounts of state trading compa- nies controlled by the Securitate, the notorious secret police of the Communist dictator Nicolae Ceausescu who was overthrown in From the administration’s point of view,’ this would kill a political and an ethical bird with one well -aimed stone.
Italy faces transport strikes By Robert Graham in Rome A strike called for today by Italy’s air traffic controllers was yesterday called off after mediation by Mr Claudio Burlando, transport minister. But a string of other pro- tests are due thfe month in the transport sector unless the minister can appease Transport unions are tak- ing advantage of their strong bargaining position to sustain privileges long protected by regulation and the absence of competition.
They are also able to exploit laws that are benign towards strikes. Equally, governments over the past five years have lacked the will and time to clip the power of transport unions. The 1, air traffic con- trollers are trying to improve employment terms and ensure they monitor changes in the new traffic control authority. Some Progres s has been compli- cated by the large number of unions involved. On April 16 station managers are due to go on a hour strike while the train drivers affili- ated to the most radical union have called for a hour stoppage on April Municipal transport work- ers, meanwhile, are protest- ing about the fail ore to tie up a new contract after 15 months of negotiations.
The talks foundered because the government declined to release new funds to upgrade local transport until work forces are trimmed and productivity raised.
The , workers in municipal transport have already staged a strike and are due to hold another tomorrow. Yesterday also saw the beginnings of union protest in the electricity industry. Employees at Enel, the state-owned electricity com- pany, staged a four-hour stoppage to highlight oppo- sition to electricity privati- sation plans.
KbdnweupUQ 3. Repre- sented m Frankfurt by J. Water Brand. Deputy Guimun. Primer Hfimjer Intonations! VabpgsdJsctafi mbit Admiral-Roses, dahi- Scum 3a. Responsible Editor. Tetenhcme 01 Fax pi 82SL Printer S. Editor Richard Lambert. ISSN GomminioD Ruiuue No S O The Financial Tima Limited London SEI? Several potential candidates were approached, but the favoured candidate, a US hanker with leveraged buy- out and inv es tment h anking experience, declined.
Despite some lobbying for a European candidate, the top banking position is essentially reserved for an American.
This was part of a deal agreed between the bank’s 56 government share- holders in when the London-based bank was set up to facilitate transition of thp former centrally p lanned economie s to market meth- ods and institutions.
The US government, which insisted the new hank concentrate mainly on help- ing the emerging private sec- tor, is the largest single shareholder in the EBRD with a 10 per cent stake. The 15 EU governments have 57 per cent between them and the former com- munist member states another 12 per cent. Salomon Brothers is advis- ing the Romanian cities of Constanta and Brasov on municipal bond issues and planning eurobond issues for power and phone companies in Moscow, with a debut municipal eurobond for St Petersburg.
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That too is on offer for customers of KPN, the Dutch posts and telecoms utility which hopes that such services will help it beat the competition when its fixed-line monopoly ends in less than three months. Its lib- eralisation. AH have been forced into a love-hate relationship with KPN, as The Hague’s rush to open the market has left in its wake a regulatory vac- uum.
But the two are at the same time allies in apposing a govern- ment ruling that, whatever the tariff is. This would imply a higher charge to interconnect. KPN regards this as a shift in the right direction, although Mrs Jorritsma made clear that the divide would not be simply on the basis of owning infrastruc- ture. It is being formed from an existing supervisory department within the telecoms division of the transport ministry: officials insist the unit win have the power to make independent decisions, and make them stick.
But Mr Wim Dik. He is a potential benefi- ciary of the transport minis- try’s ruling that Interconnec- tion tariffs should not discriminate.
As for many smaller operators that depends, however, on the interpretation of a distinc- tion drawn last week by Mrs Annemarie Jor ritsma , trans- port minister, between those In any event, the ministry sees its work as now done. A new telecoms law is due to be reedy by next January. Amendments to current stat- utes, to ensure that full-scale competition can take effect from July, were approved by the cabinet last Friday.
Telfort argues that if Opta is to have teeth, it should be able to subject KPN calcula- tions of interconnection costs to scrutiny by an out- side accounting firm. These would stm be cheaper than anywhere else in the world, it points out KPN this week revised its retail charging structure to produce what it said would be an average bill the lowest hi Europe except for Luxem- bourg.
Customers can pick one of three subscription rates depending on how often they use the phone. But the package intended for infrequent callers – with a monthly charge 40 per cent below that offered to the highest volume residential users — will demand three times the standard price for international calls, and Lt will not allow carrier select At tiie wmo timw, ministe- rial objections forced KPN to withdraw a plan to provide all customers with voice- mail, replacing the need for an answering machine.
Hungary poised for modest recovery By Anatol Lieven in Budapest After two painful years of belt-tightening which cut living standards by 15 per cent as resources were shifted into repaying foreign and domestic debt and into exports, the Hungarian economy is poised for a modest export- and Investment-led recovery. But the economy grew by 3 per cent in the last quarter of over the previous year and Hungarian officials and the International Mone- tary Fund predict the same for as a whole.
Western analysts believe that this may even err on the conservative side because of the continued strong flow of foreign direct investment FDD Into Hungary, totalling L8bn last year.
Hungary remains in first place among the former communist coun- tries, with 35 per cent of total invest- ment in the region.
General Motors. Suzuki and Ford have all established big parts and assembly plants in Hungary, and have been joined by Audi, which last year established a factory to pro- duce diesel engines.
The car industry was the major factor behind an impressive growth of 10 per cent in machinery expats last year and the growth figure for is expected to be twice that. The government hopes to reduce inflation, running at 19 per cent in the first quarter of this year, to sin- gle figures by , but there are some doubts as to whether this is practicable, given the difficulties of further reducing spending, espe- cially in the health system.
With the approach of the next elec- tions, due in May , the’ ruling coalition will also come under Increased political pressure not to cut spouting further.
However, Mr Peter Medgyessy. They said approval had been given despite the. Strasbourg Cyprus PM shuffles pack Cyprus prime minister, Mr Glafcos Clerides, yesterday reshuffle d his cahinet for the first time since taking office four years ago in what was seen as an attempt to bolster his image before next February’s presidential el ecti o n.
He changed five of his member cabinet among them the foreign minister. Mr Alecos Michaelides. He has been. Also dropped were the ministers of communications, justice, education and health, who belonged to the rightwing Democratic Rally party, which Mr Clerides founded 20 years ago. Andreas Hadjipapas, Nicosia Russian spies target Germany Germany is far and away the top European target for Russia’s intelligence services, whose methods are becoming more and more like those of the Soviet KGB, according to Germany’s counter-espionage body.
The annual report of the Federal Office for the. Protection of the Constitution BfV says that Russia’s intelligence activities focus especially on Germany’s attitude to the eastward enlargement of Nato and its stance on the Middle East peace process. But the co-operative forms, which fear ruin if forced to foot the bill, should have ea s ie r conditions for paying off the debts, the court said.
The rating was a setback far east German farmers and politicians who argued that Communist planners o fte n forced them to take unnecessary credits to finance nan-agricultural work such as building roads, schools or public offices in their villages. Eastern leaders wanted ‘ Bonn to shoulder the form debts in the same way it paid, off loans taken out by east German companies amd local governments. On the harmonised basis. Inflation averaged 2. JBut ABN. Exports are again t ak ing over from domestic demand as the wain ‘ motor of economic growth.
But retail sales data for-. January, released last Friday, still showed 7. So far, it is not a political party, more a refuge for some 3, conservative dis- senters from the course towards Emu set by Presi- dent Jacques Chirac and his prime minister, Mr Alain Juppe.
But it could swing into action like a political party when France comes to ratify whatever emerges from the inter-governmental conference IGC on Euro- pean Union reform. There seems little chance of Mr Chirac doing this. France has conceded to Ger- many that the stability coun- cil should be informal.
Nor can the president be forced to bold a referendum. Politically, too, Mr Pasqua has, at least temporarily, lost his key ally in the anti-Maastricht referendum, Mr Philippe Sfeguin.
The Gaullist president of the National Assembly is pri- vately no keener on the euro than he was formerly, but he is keeping quiet to preserve his chances of succeeding Mr Jupp6 as prime minister. But Mr Pasqua, whose rows with Mr Juppe have not prevented him retaining a reasonable relationship with the president, still believes Mr Chirac might respond to a groundswell of pro-referendum opinion. Certainly, any issue con- cerning the single currency – even a complicated one such as the stability pact – Is more likely to engage the French public or parliament than probable IGC tinker ing with Brussels institutions.
Though Demain La France is basically a conservative club, Mr Pasqua has care- fully cultivated contacts with other anti-Emu parties on left and right Another Euro-stick with which Mr Pasqua beats the Spain to ease spending curbs By Tom Bums in Madid Spain’s government says it will ease spending con- straints next year while con- tinuing to shrink the budget deficit, in a mark of its confi- dence that the economy is set for sustained growth and low inflation.
Its four-year convergence plan covering economic tar- gets from to will be approved by the government on Friday. Total spending is due to increase by 4. The government believes this year’s austerity drive has put It on track to achieve a budget deficit of 3 per cent of gross domes- tic product against an esti- mated 4.
This would fulfil a key requirement for joining the proposed European single currency in the first wave in January New hiring and firing guidelines, negotiated by employers and unions and due to be made public this month, would “ensure salary moderation and employment growth”. The March consumer price index is announced on Friday- Under the convergence plan, GDP is set to grow by an average 3. Mr Alain Juppfi, the prime minister, said yesterday he I had ordered an examination of documents seized last month in a garage near Paris which contain tran- scripts of hundreds of tele- phone conversations alleg- edly tapped at the order of the late President Francois Mitterrand.
The information had alleg- edly been collected by Mr Christian Pronteau, the then head of the anti-terrorist unit at the presidential pal- ace. He is at the centre of the current judicial inqui- ries launched in Mr Pmatean, interrogated last Friday by the Paris judge. Tapping had been far more widespread at the timp of General Charles de Gaulle, he said.
When he was inte- rior minister, Mr Pasqua complained loudly that France’s EU partners failed to co-operate In the fight against terrorism.
He remains a staunch advocate of EU governments keeping security and justice in their hands and out of those of Brussels. We Gaulllsts used to incarnate these values, but we have increasingly let the Front appropriate them. Lawyers and information technology IT executives in Prague said it was an example of pitfalls awaiting buyers and sellers in a region spending heavily on imparted technology. The deal was for the provi- sion of a Unisys computer system to modernise Spori- telna’s handling of savings accounts.
In which it has a near-monopoly. The following January Unisys offered a written guarantee the problems would be solved, and a new contract was signed for com- pleting the installation. Sporitelna has already won one victory over Unisys in the dispute.
Uiilsys is appealing against that ruling. Unisys said yesterday it continued to service a main- tenance contract with Spori- telna in relation to parts of the disputed system that were installed before their relationship ended. No hassle. No fuss. No problem. It follows 10 tense days of public brink- manship and private negoti- ations following the decision by Mr Sitaram Kesri, Con- gress president, to withdraw political support from the minority coalition.
They said Congress’s appar- ent softening appeared to have resulted from strong pressure on Mr Kesri from his party’s MPs. Separately yesterday, a Delhi court dropped money laundering charges against a senior Congress politician, Mr V. The charges were laid last Janu- ary In India’s biggest ever political bribes affair. With 65 per cent of Indian freight carried by road, the strike has led several com- panies to shut factories.
It is affecting supplies of coal, steel, cement, chemicals and fUel to several states and has caused food shortages. Grain prices have risen by up to a quarter. The New Delhi factory owners’ associ- ation said the strike had hit local traders hard. Export growth from April last year to Feb- ruary fell to a rate of just 6Ji per cent against a 20 per cent government target Free Lunch The Wall Street Journal Europe provides a diet of concise, substantive news, edited in the heart of Europe with the European businessperson, investor and professional in mind.
For a 5-day free trial, without obligation call one of the numbers below. The Kuala Lumpur stock exchange’s leading index climbed The central hank acted a mid cipnppm that Malaysian banks and finance houses, burdened by heavy expo s ure to the over-supplied property sector, may follow their counterparts in Thailand, where the authorities have unveiled rescue packages to bail out finance houses hit by the property price slump.
It also imposed new curbs on iprwWng by finanriat institu- tions for share purchases. That provoked miwVi con- fusion in the markets, mostly centred on the curbs on tending to the property sector. Yesterday, Mr Fong listed exemptions to the curbs, which took effect on April l, prompting the stock market rise. Also exempt is the exten- sion of working capital to any business, even if it is in the propert y sector.
In build- ing projects which combine houses costing less than MS Financial institutions with over 20 per cent of their loan portfolio already devoted to prop er ty need not call in any Hwwa of credit, Mr Fong said. World Stocks. While the national capital, Kuala Lumpur, now boasts the tallest buildings In the world, K elan tan’s state capital has only a few that rise above the tree tops.
Trishaws mingle with the sparse traffic and, in govern- ment offices, telephones can ring for minutes before someone sees fit to answer. The national government looks upon the state with some HiaHdn and blames its slower pace of development on the devoutly Islamic opposition party which runs it. Far its part, PAS says the central government is responsible for its somewhat arrested progress because it discourages investment in Kelantan in an attempt to portray the apposition party as backward and too radical in its Islamic beliefs.
These conflicting asser- tions have given rise to much bickering since , when PAS won power in an election. Dr Mahathir emerged from the dialogue suggesting that a new era of co-operation was at hand with the only Malay- sian state that remains under opposition control. There were few details on the 2,ha project, which some say was kept purposely vague to provide an easy escape should the new coop- erative spirit turn sour.
They add that Petronas has not drilled because it wants to Manila shares fall 2. Continuing a six-day los- ing streak, the main fell 2. A recent report by the cen- tral bank said that banks’ exposure to the booming property sector amounted to about 10 per cent of total outstanding inarm and was not a cause for alarm. The banking sector ended down 2. Overseas aid figures for other leading donor countries have not yet been released.
Japan has been in the top position since L when it surpassed the US. Japanese foreign ministry officials pul part of the blame on the yen’s weakness against the US dollar – the Japanese currency weakened to a four- year low yesterday, touching YI26 against the dollar in Tokyo. They said the yen weakness drove down the dol- lar value of Japan’s official develop- ment assistance ODA in Other reasons were budgetary cots in ODA projects and the temporary sus- pension of official assistance to China.
In the new atmosphere of fiscal aus- terity and the government’s push for financial reform, overseas aid has become less of a priority. A working group established by the government and the ruling Liberal Democratic party is studying ODA appropriations and is likely to recommend further budgetary cuts and streamlining of the aid programme.
The new spirit of co-opera- tion may also boost the tour- ism industry, state officials said. Foreign businessmen in Kuala Lumpur said that the central government’s atti- tude toward proposed Invest- ments in Kelantan has.
Others said that the state may be attrac- tive for manufacturing, partly because wages are lower there. In addition, there is a question about how much PAS really wants foreign investment The chief minis’ ter. Speaking before discussions with airline Industry representatives later this month; and amid growing complaints over the level of costs, Mr Leeks said that proposed charges were still open to discussion. But he – played down the prospect of any significant change, argudng that the authority was bound by its ordinance to deliver a satisfactory rate of.
Kai Tak, the existing airport John ffiddma. Bong Kong Pakistan targets black market The Pakistani government is drafting a law to punish black marketing of flour. In the wake of acute shortages, a senior official said In Islamabad yesterday.
The banking index dosed 29 A points higher at 4,, with National “Australia Bhnfr and Commonwealth’ Bank among the strongest gainers.
Nikki Tait,- Sydney Would you prefer more time to catch your flight? Formed by the merger of Ciba and Sandoz. Five year old Haley Engalman at home. Haley suffers from a combination of two rare genetic disorders.
Her body is unable to hold or digest any normal food. Novartis developed a new nutritional product and delivery system which gives Haley all the nutrients she needs to sustain life. Pressure for change arose after IMF and World Bank economists concluded that Ivory Coast would not qual- ify for assistance under the present rules, even though its external debts are rela- tively high compared to both government tax revenues and the size of its economy. Between eight and 20 coun- tries are eventually expected to benefit.
Mr Michel Camdessus, the IMF’s managing director, By Micheia Wrong in Mbuji-Mayi, Zaire Zaire’s rebel movement has signalled its intention to take diamond production In the regional capital of Mbuji- Mayi bade to pre-invasion levels and incorporate the economy of the traditionally rebellious east Kasai prov- ince into the rest of occupied territory.
Fighters from the Alliance of Democratic Forces for the Liberation of Congo ADFL chased away illegal diggers who had swarmed into the concession as law and order collapsed and the soldiers on guard started looting. The officials said only two days of production – repre- senting a total of Zaire’s single biggest pro- ducer of diamonds, had been less serious than expected. The notion that there are French political interests involved here is very clear,” said one, arguing that Mr Camdessus’s comments in Paris might well harden the resolve of those opposing a rule change.
But a senior official at the World Bank denied that a rule change was being sought simply to benefit Ivory Coast, but to to ruffle sensibilities in the town, which has a history of rejecting central authority. Although ADFL officials address a general problem. The initiative involves creditor governments increasing the debt relief they normally offer poor countries, with multilateral institutions then providing any further help necessary to reduce total external debt to a sustainable level.
Sus- tainability is assessed by looking at the ratio of exter- nal public debt – measured on a net present value basis – to export earnings. The initiative was origi- nally drawn up on the assumption that countries could sustain debt-io-export ratios of between and per cent, although staff now concede that it Is sensible to set targets at the lower end of this range. Of the coun- tries considered so far, deht- to-export targets have been proposed at per cent for Uganda, per cent for Burkina Faso and per cent for Bolivia.
Both Uganda and Bolivia have argued for more generous debt targets and earlier “completion points” for the delivery of relief, which would raise the cost significantly. Ivory Coast would not be eligible because its debt-to- export ratio is forecast to stand at only per cent at its assumed completion date In The country’s debt-to-ex- port ratio is low because it exports half as much again of its output as most other highly indebted poor coun- tries.
But its debt-to-GDP ratio is twice as high as that for most other countries, while its ratio of debt to gov- After a meeting on Mon- day night with local dia- mond operators. But others fear that setting targets for debt-to-revenue ratios would discourage countries from collecting tax carried out They have also treated the emotional Issue of east Kasai’s currency carefully.
Tf such a change were to be made, it should he done at an early stage. The ADFL wants the prov- ince to adapt the new zaire, in use in the rest of the area under its control. On one issue, however, the ADFL appears to be standing firm. Diamond operators have been told that licences for buying counters must he bought in Goma, the ADFL’s administrative base.
That’s dangerous. For decades tiie money from Mbuji-Mayi was funnelled to Kinshasa with- out being invested locally. This necessitates a complete cessation of hostili- ties. In Lagos, which alone con- sumes nearly a third of national output, petrol Is trading on the black market at about five times the offi- cial rate of 16 US coots a litre.
Many workers can no longer afford the Inflated prices charged by the few public transport operators stQl on the road. The authorities have offered no official explana- tion as to the cause of the most serious and prolonged petrol crisis since a national oil workers strike three years ago. Mr Saparmnrat Niyazov, president of Turkmenistan, has named Mr Batyr Sard- jaev, the deputy prime min- ister, as oil and gas minister of the central Adrian state, according to a decree pub- lished yesterday.
Reuter reports. Mr Saxdjaev replaces Mr Gochmurad Nazdzhanov, who will now be supervising the construction of planned It says this is Insufficient to meet demand estimated at 18m litres a day. The NNPC further accuses the ministry of foiling to release m allocated for the refcrfctsb- ment of those foefifttas. Officials argue that it would be cheaper, more reliable and efficient to Import refined petroleum products. The dispute is the latest In a series between Mr Anthony Ani.
Last October, Mr Ani advocated the total pri- vatisation of the NNPC, a move fiercely resisted by Mr Etete who has lobbied Instead for a more promi- nent rote for his ministry in ail sectors of the ofi Indus- try. General Saul Abacha.
With the crisis now spreading beyond the south-west where opposition to military rule is strongest, the government appears to have decided to resume petroleum imports. A diamond trader in Kisangani.
The fall of Mbnjl May! The Basle Committee, which groups supervisors from the central banks of the leading industrialised countries, has drawn up a set of 25 basic principles in collaboration with supervi- sory authorities from 15 developing countries.
Includ- ing China and Russia. Schouten O et al. Am Heart J ; — 52 9. J Am Coll Cardiol ; — 9 Dunkelgrun M. Juul AB et al. Am Heart J ; — 83 Brady AR et al. J Vasc Surg ; — 9 Lindenauer PK et al. N Engl J Med ; — 61 Br Med J ; — 9 Yang H et al. Am Heart J ; — 90 Warltier D. Anesthesiology ; 2 — 5 Jones KG et al. Br J Surg ; — 90 Anesthesiology ; 4 — 7 Fleisher LA et al.
Circulation ; e — e Eur Heart J ; — Devereaux PJ et al. Br Med J ; — 21 Bangalore S et al. Lancet ; — 76 POISE study group. Lancet ; — 47 Bouri S et al. Heart ; — 64 Kristensen SD et al. Eur Heart J ; in press Badgett RG et al. Anesthesiology ; — 92 Anesthesiology ; — 5 Flu WJ et al. Ellenberger C et al. Anesthesiology ; — 23 Nozawe T et al.
J Cardiovasc Pharmacol ; — 20 Shin J et al. Pharmacotherapy ; — 87 Bijl MJ et al. Clin Pharmacol Ther ; 45 — 50 Rau T et al. Clin Pharmacol Ther ; — 72 Baker JG. Br J Pharmacol ; — 22 Anesthesiology ; ; — 5 Clev Clin J Med ; 76 Suppl 4 : — 92 Wallace AW et al. Anesthesiology ; — 36 Ashes C et al. Anesthesiology ; — 87 London MJ et al. JAMA ; — 13 Mashour A et al. Anesthesiology ; — 6 Beattie WS et al.
Anesthesiology ; 25 33 Le Manach Y et al. Anesthesiology ; — 11 Andersson C et al. Zaugg M et al. The basic tool in this second challenge is the WHO Checklist. Designed to be used for every patient coming for any surgical procedure it has three separate sections which have to be completed before the patient undergoes any form of anaesthesia, before skin incision and once the surgical procedure is completed but before the patient leaves the operating area.
It was designed by a group of health care professionals, surgeons, anaesthetists and nurses, from all around the world. The group evaluated the 30 day morbidity and mortality in over patients divided into two groups; the first under normal procedures and the second after introduction of the checklist.
The results were spectacular; morbidity and mortality in both affluent and less affluent regions dropped markedly after introduction of the checklist. This highly influential study was widely highlighted by those involved and the WHO encouraged launches of the checklist around the world. The use of checklists is not new in anaesthesia or theatre practice and has followed on from their use in areas like the aviation and the nuclear power industries.
Many, while realising the importance of the process, tend to skip over all of the written checks or assume that other personnel who are assisting them have performed the checks.
This is so different from the use of checklists in the aviation industry where pilot and co pilot patiently work through and complete long checklists before every flight. It is interesting to speculate on the rationale for this difference when all recognise the importance of the basic safety procedures and yet many doctors seem willing to assume the responsibility for the equipment they use without performing the checks as mandated.
There are no excuses that can be made for errors that then ensue and the medical, moral, ethical and legal sequelae can be devastating for all, including the patient. One of the most influential aspects included in the pre anaesthesia aspect of this WHO checklist was the check that a pulse oximeter had been attached to the patient. These again included affluent and less affluent countries.
In the UK the National Patient Safety Agency made it mandatory that the checklist be used in every theatre situation in and this was implemented rapidly. But such a statement hides a huge variation in activity and practice. Operating theatres in the UK are very complex hierarchical structures and not all those who worked within them welcomed the changes that the introduction of the checklist required.
This then was the first difficulty that this checklist required with its use that of a culture change of everyone working in a single team instead of a series of hierarchical subsets. Secondly it required everyone in the operating theatre environment being equally supportive and thirdly it needed to be done correctly by everyone. There was a report of a pilot study of its implementation in one hospital early in Despite a series of training sessions, initial use of the checklist was fraught with problems amongst which incomplete areas particularly the sign out part, hurried utilisation because of perceived time pressure on the operating list, dismissive replies and absence of key team members during completion were all highlighted.
Also the presence of a research team in theatre collecting data artificially increased the rate of completion which fell immediately the research team left. This pilot study did not see the improvements in morbidity seen in the original NEJM published study but there were noticeable improvements in some aspects of care like the timely administration of perioperative antibiotics.
Poor implementation of a checklist, for whatever reason, can cause severe problems particularly by creating a false sense of security. This has been reported in the airline industry. As the use of this checklist had been mandated as compulsory throughout the UK it was obviously going to take time to provide the required levels of training and an understanding of the required change from a hierarchical structure to one of a unified team all of whom were focussed on the patient.
Other papers soon demonstrated similar effects with poor compliance in completing the forms being directly related to an ability to demonstrate a change in mortality. Good compliance with the checklist could demonstrate a positive outcome but not as high as with some earlier studies in one such paper from The Netherlands.
The use of the WHO Checklist should have presumably removed these from any future listing but this is not the case. There must be multiple reasons why the use of the WHO checklist is not effective in preventing what can only be considered by anyone as preventable mistakes.
The hierarchical historical basis for theatre activity is one of the major challenges to the success of this type of work. Despite superficial agreement from senior people within the operating theatre environment that there is a need to promote team working, if any anaesthetist or surgeon does not fully accept the process then the use of the checklist is doomed.
Indeed what is worse is the false sense of security it creates. I do not believe this is an age related phenomenon. There are plenty of young people who do not rigorously apply the checklist and plenty of older people who do.
Checklists work but only if they are adhered to in a rigorous manner. Their use needs to be audited and the results of those audits need to be fed back to those involved and behaviours modified as required. Patients, their relatives and all of the general public would not believe that corners were being cut and it is to them that all in the operating theatre are responsible.
Haynes AB. The New England Journal of Medicine. Vats A. British Medical Journal ; b Degani A. Cockpit checklists: concepts, design and use. Human Factors ; Annals of Surgery ; 44 GRADE classifies evidence as High: We are very confident that the true effect lies close to that of the estimate of the effect Moderate: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect Fluid management in hospitals is fundamental to patient care but paradoxically has been largely ignored.
Medical students get taught a little, very little, about the physiology of fluid compartments but on qualifying the practical use and prescription of fluids is often handed down rather than taught. Many senior clinicians are relatively ignorant of fluid physiology, tend to leave fluid management to the juniors and hence perpetuate a cycle of ignorance. This major dilemma is then made worse by the fact that the individuals most interested in fluids and fluid research focus on the erudite.
They discuss which fluid and why, how much fluid in certain special circumstancesand argue over relative minutia. Examples include the use of albumin, the problems of starch whether restrictive or liberal is best and whether saline causes problems. Meanwhile complications with basic fluid management are very common in the wards. This well known to all, but yet there is little data to support this statement as it has rarely been audited.
Such information as exists highlights the following. Poor documentation, too much fluid, too little fluid and major electrolyte disturbances such as hyponatraemia. Renal failure and pulmonary oedema are often the consequence. The intrinsic mortality is unknown and nor is the morbidity beyond thinking it is major. The NICE guidelines is the first step in correcting this anomaly in health care. They are not intended to dictate to specialist units or specialities where fluid management is their specialist area but rather are for general use.
The main problem is in the wards and that is what needs correcting. The aims are to educate people administering fluid as follows; physiological principles that underpin fluid prescribing pathophysiological changes that affect fluid balance in disease states indications for IV fluid therapy reasons for the choice of the various fluids available principles of assessing fluid balance.
Of these assessment is key. Assessment and regular reassessment. Resuscitation, Routine maintenance, Replacement, Redistribution Reassessment. There are appropriate algorithms for each and these provide a basis for understanding and a framework for management. The individual algorithms are all linked so it provides a very useful and pragmatic teaching aide. The principles are simple. Assessment and reassessment determines which algorithm to use and also indicates how things progress.
History and examination are very important. Assessing fluid status involves: pulse, blood pressure, capillary refilland jugular venous pressure presence of pulmonary or peripheral oedema presence of postural hypotension I In particular is the patient hypovolaemic?
Do they need IV fluid resuscitation. Then monitoring which recognises that fluid management is dynamic, requirements change and so monitoring is also dynamic. Clinical monitoring status and trends : NEWS fluid balance charts weight. Of course if resuscitation is involved then additional tests such as Lactate and base excess may be helpful.
Routine maintenance is most common and least studied. Only give IV fluid if needed and reassess need regularly. Use Dextrose saline as it meets sodium and water requirements if at low volume and hyponatraemia is rare and will be identified if it is being monitored.
The old days of 3 litres a day for everyone should be long gone. If a patient has unusual and or excessive losses then assessment and replacement should be appropriate to their losses. Different bodily fluids have different compositions and this should be taken into account along with clinical and biochemical monitoring as identifying volume and content of some fluids can be difficult.
Again key in this advice is seeking help early. A significant part of the guidelines addresses the need for formalising training in this area. It recognises that it will take time to make fluid administration as important as , for example, infection control and it will require establishing this new ethos in the new generation of hospital doctors.
It will require an individual in each hospital to take responsibility for teaching training auditing and correcting fluid management in each Hospital. It will be difficult but it will reduce morbidity rapidly. Identification and recognition of complications is emphasised as is the need to record and audit fluid management. This is long overdue as standard practice. Complications include; Dehydration Pulmonary oedema Hyponatraemia Hypernatraemia Peripheral oedema Hyperkalaemia Hypokalaemia The Guidelines do not pretend to be a complete fix of the problem.
They provide a sound basis for changing the cultural approach to fluids in the wards, to recognising the importance of doing it well and the problems with doing it badly. It takes time to alter behaviour but it is a start. To be successful requires compliance with the guidelines but they are simple and easy to understand and along with education and audit should be a good start to sorting out a major previously ignored yet fundamentally vital part of hospital management.
NICE Guideline.. Anaesthesiologists often work closely with the team members. Because of the manpower problem in anaesthesia, residents and nurses in some countries are allowed to administer anaesthetics with supervision. Up to some extent, all the team members could be helpful in observational evaluation of clinical and theoretical characteristics and anaesthesiologists behaviour in the operating theatre.
Methodology This paper is based on review of existing relevant observational studies on this topic. With intention to explore the connection between Excellence in Anaesthesiology and Patient Safety, we searched the US National Library of Medicine, National Institutes of Health database PubMed , looking for the articles related to this topic in last 10 years.
Initially we detected 53 articles. Later on, we reduced the number down to 5 with a selection of observational studies in anaesthesiology education. Empathic approach tended to decrease patient concern. In the operating room, patients who had the same anaesthesiologist continuing care expressed greater satisfaction levels regarding anaesthesiologist behaviour and quality of care.
To describe each of the characteristics, surveyed individuals explained what exactly they expect in particular situations. Good communicator referred to interaction with patients and other staff members and included the capability to resolve any problem situation in a diplomatic manner with intercession. He also needs to know to apologize. Few major elements where categorized under the anaesthesia excellence teaching: ability to inspire through enthusiasm for the subject; a willingness to teach not only trainee anaesthesiologists, but also other team members and students and finally, specific role in supporting trainees.
Academic excellence was not felt to be the indicator of universal excellence. Still, lots of the statements presumed applied knowledge. Errors in medical practice could be avoided by systematic collection of data, conduction of methodologically well organized research, interventions for improvement, as well as targeted education to health care personnel, patients and their families.
Achieving the higher standards in education and knowledge has encouraged changes in practice and behaviour and consequently provoked declining in adverse outcomes. All these efforts need endorsement of local governments, health care institutions and professional associations, as well as support of private foundations.
The result was proposed reform of the medical education and training, from premedical preparation and medical school admission through continuing physician professional development. The Declaration gave strategic foundation and short term plan for improvement to all parties in the safety process: anaesthesiology professionals, industry and patients.
The concept of Excellence in Anaesthesiology can become one of the major patient safety goals, because it has been proven in everyday clinical and teaching practice. Reference 1.
Smith AF, Mishra K. Interaction between anaesthetists, their patients, and the anaesthesia team. Br J Anaesth. How excellent anaesthetists perform in the operating theatre: a qualitative study on non technical skills. Consensus development methods and their use in clinical guideline development.
Health Technol Assess ; 2: 1—88 4. Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence.
Can J Anaesth. Continuous care and empathic anaesthesiologist attitude in the preoperative period: impact on patient anxiety and satisfaction. Defining excellence in anaesthesia: the role of personal qualities and practice environment. Eichhorn JH. The Anesthesia Patient Safety Foundation at a pioneering success in safety, 25th anniversary provokes reflection, anticipation.
Foucault’s “fearless speech” and the transformation and mentoring of medical students. Philos Ethics Humanit Med. Anaesthesia teachers training — advanced approach. Scientific symposium, , 30 Training of teachers in anaesthesiology: the less affluent society — the more challenging results. Three years after the launch of the Helsinki Declaration on patient safety in anaesthesiology: the history, the progress and quite a few challenges for the future.
In order achieve rapid hemodynamic stability without overtreatment, which can have serious side effects, balanced used of proper hemodynamic variables should be used for hemodynamic assessment and monitoring.
Hemodynamic monitoring, on the other hand, represents continuous measurement of relevant hemodynamic variables in order to detect unexpected deterioration and titratethe treatment. Correct treatment with fluids, vasopressors and inotropic agents should rely on proper assessment of arterial pressure, preload, flow and flow adequacy.
Basic hemodynamic assessment On admission basic hemodynamic assessment should be made by clinical examination and classical vital signs: non invasive blood pressure, heart rate, frequency of breathing, body temperature and saturation measured by pulse oximeter. Basic vital signs do not allow conclusions about preload, flow and flow adequacy, and non invasive measurement of arterial blood pressure is frequently inaccurate and inadequate in critically ill patients.
Tachycardia and tachypnea can be associated with all kind of shock, sepsis, pain, anxiety, febrile state, hyperthyrosis, hypo and hypervolemia, heart failure, anaemia, hypoxia and many other conditions. Hypotension, on the other hand, can be normal, result of incorrect measurement and caused by vasodilation, inadequate vasoconstriction and by various drugs.
The low value of arterial oxygen saturation is diagnostic for hypoxia, but gives no information concerning its etiology.
So, it is clear that such assessment is inadequate for hemodynamic stabilisation. Hemodynamic assessment before volume loading Since the first step in hemodynamic stabilisation is optimisation of preload by volume loading, the basic question is which variables are required for safe use of fluids.
It seems logical that assessment of preload and fluid responsiveness is mandatory. Assessment of preload can rely on pressures or volumes. Unfortunately pressures central venous pressure and pulmonary artery occlusion pressure are not accurate measures of preload and they cannot predict fluid responsiveness.
Nevertheless,they should be measured as safety parameters: i. Therefore, for correct volume assessment, static pressure and volume variables intrathoracic blood volume, global end diastolic volume, end diastolic areas and volumes must be measured, together with dynamic variables which can predict fluid responsiveness. The increase of stroke volume after volume challenge depends on thefunction of right and left ventricle and both should be assessed before giving fluids to the patient.
Finally, there is no need to increase oxygen delivery if it is adequate, and determination of at least one marker of flow adequacy lactate level, mixed venous oxygen saturation, central venous oxygen saturation is mandatory. The decision for volume loading should therefore rely on determination of preload, fluid responsiveness, cardiac function and flow adequacy.
Most information can be provided by transthoracic echocardiography but transesophageal echocardiography can be performed in patients with bad visibility. In hemodynamic unstable patients in whom after preload optimisation cardiac output estimated by transthoracic echocardiography remains low and the inotropic support is considered, monitoring of cardiac output is mandatory.
Since there are many methods for measurement, relatively reliable value of cardiac output can be obtained very easily in most critically ill patients, but the problem is proper interpretation. Basically, echocardiography is mandatory for selection of most appropriate method for cardiac output monitoring.
We believe that in patients with similar preload and function of both ventricles methods based on arterial pulse contour analysis are preferred. On the other hand, in patients with different right and left ventricle preload and function we prefer monitoring with pulmonary artery catheter.
There are no normal or optimal values for cardiac output and many factors should be considered for its interpretation such as preload, afterload, flow adequacy, heart rate and rhythm and microcirculation. They should be therefore interpreted together with other hemodynamic variables, but assessment of preload and adequacy of tissue perfusion is most important and mandatory.
The measurement and monitoring of cardiac output without assessment of preload and flow adequacy is needless and can lead to erroneous therapeutic decisions. Hemodynamic assessment requires therefore integrative approach with measurement of variables by various methods.
Unfortunately, the monitoring of microcirculation is not ready for routine use, nevertheless, its improvement and normalisation remains the main goal of hemodynamic support stabilisation. Finally, hemodynamic assessment and monitoring, despite being mandatory, are only the first step of hemodynamic stabilisation. They have to be followed by proper treatment in order to improve the outcome of critically ill patients. Assessment of cardiac performance Inadequate cardiac performance is one of the most frequent causes of hemodynamic instability and circulatory failure in critically ill patients.
Prompt and exact diagnosis of heart diseases and assessment of cardiac function is therefore an integral part of intensive care medicine. The method provides high quality real time images of heart, great vessels and mediastinal structures and enables qualitative and quantitative blood flow assessment. TTE is noninvasive, can be performed immediately at the bedside and frequently repeated. In patients with inadequate visibility and in specific indications transesophageal echocardiography TEE is successfully employed.
Assessment of cardiac function represents the most frequent indication for TTE in the hemodynamically unstable critically ill patients. Increasingly important indication for TEE is becoming intraoperative diagnostic evaluation and cardiac function monitoring in patients with cardiac or non cardiac surgery during hemodynamic instability. Cardiac output can be calculated simply by measuring flow over valves and the diameter of the valve opening.
However, it can be replaced by velocity time integral, which is closely related to stroke volume. Global and regional left and right ventricular systolic function can be assessed by TTE. In patients with inadequate visibility the simple measurement of TAPSE tricuspid annulus plane systolic excursion and MAPSE mitral annulus plane systolic excursion reflects right and left ventricular function respectively.
Nevertheless, in majority of critically ill patients the visual estimation of systolic function eye balling is performing. Segmental wall motion abnormalities can significantly impair global cardiac function. Regional hypokinesis or akinesis detected by TTE is the earliest sign of myocardial ischemia. Assessment of preload Left ventricular diastolic area can be easily measured by TTE in the short axis at the mid papillary level and correlates closely with the left ventricular end diastolic volume.
It estimates preloadmore reliably than other methods and is suitable also for bedside assessment the fluid responsiveness. In patients with chronic heart failure, inadequate preload can be associated with normal or even large left ventricular end diastolic area.
The usual initial assessment of preload is performed by measuring diameter and respiratory change of inferior vena cavain the subcostal view. Evaluation of left ventricular filling pattern transmitral flow and pulmonary venous flow pattern must be included in the assessment of left ventricular function since it provides valuable information about left ventricular diastolic function and left ventricular filling pressure. Abnormal compliance is a frequent problem in critically ill and cannot be detected or assessed with the pulmonary artery catheter.
TTE should be routinely used for assessment of cardiac function, but cannot simply replace several other already established technologies in the ICU.
The basic echocardiographic characteristics in various hemodynamic conditions are listed in the table Tab 1. Tom and I usually have fun making use of your points in what we need to do in a few days.
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Accurate calculation of DialSet 4. After Russian, Chinese and Thai. DialSet 4. From www. SYSTEM MultiPoint automatic lubricator LAGD Multiple grease lubrication installations with multiple lubrication accuracy, makes it an excellent solution points, this can be a time—consuming for longer bearing life and increased points made easy and costly process.
The upper reservoir allow you to effectively adjust the is an airtight container storing correct oil level during running replacement oil. Through its extended conditions, optimizing machine neck, which dips into the oil of the performance and increasing the service lower reservoir, the two reservoirs life of the applications.
Furthermore, are in direct contact with each other. Compact, automatic, dependable With our compact greaser we have succeeded in developing an automatic, electrically driven centralized lubrication system especially designed for linear guide systems. The ETP compact greaser does not require a separate control unit.
Unlike Permadose dispensers, the compact greaser lubricates only when the machine is running. The compact greaser is easy to install due to its small dimensions and low Ordering details weight. Number of Outlet Metering mm3 outlets assignment outlet no. PA tube, 1. Adaptors for 2. VGKG M6 x 0. VGKG Compact greaser ETP. LAGD 60 60 ml 2.
Lubricant included. The canister and battery pack may be used even at 12 months setting if acti- vated 3 years from production date. SKF has taken the knowledge and expertise of Vogel Lubrication and developed three solutions for grease- lubricated fan and blower bearings.
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Please order cable harness separately. Temperatures and pressures that deviate from these figures lead to different delivery rates. The indicated values must be taken as a basis in the design of a centralized lubrication system.
The completely autonomous unit with integrated control system and feeder can supply as many as 20 lube points with exactly metered quantities of grease. Ordering details Integrated control unit with Standard version with Maximum number of Weight visual and acoustic warning filling level monitoring outlet points including grease Order no.
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The use of circulating oil lubrication may also reduce bearing vibration associated 30 liter tank — basic unit, no controls with the use of grease lubricant at higher speeds.
The SKF circulating oil lubrication units are available in three tank sizes; 30 liter 7. Product selection – important note The following table is only a guide to assist in selecting the appropriate SKF circulating oil lubrication unit. Please consult SKF Application Engineering before purchasing and installing this product to ensure the proper unit has been selected based on all operating and application parameters.
Ordering details Housing no. Description Specification. Single-circuit pumps The pump units specified in this section are lubricant delivery pumps without pressure relief fixtures and are designed for continuous operation in circulating and hydrostatic lubrication systems.
These pump units may also be used for hydraulic tasks to the extent permitted by the pressure and viscosity ranges stated in the tables. The permissible pressure and Explanation of the delivery rates vary with the viscosity. The leaves flanged port R2 open — contrary for further information. If air external port R1. Flanged port R2 of may become thin-bodied or highly is entrained due to low oil level in the the return duct discharges directly into viscous due to changes in temperature.
Use a special sealed pump for horizontal flange-mounting of the unit beneath oil level. Figure 1 Figure 2 Figure 3. Single-circuit units complete with reservoir see page DIN and special reservoirs on request.
Return line R screw-plugged before delivery. The base is made of durable aluminum. The flow tube is made of glass, so high temperatures and the use of synthetic oils should present no problems. The Safeflow flowmeter has a straight glass flow tube with an internal calibrated cone extending along its vertical axis.
The float is cylindrical, its O. In operation, the calibrated cone extends through the annular opening in the float, creating the variable orifice needed for measurement as the float moves with flow changes. Because the oil flows Flow change alarm system switch, which identifies the location through the float, rather than around of a metal float in the tube. The The oil flow through each Safeflow it as in ordinary flowmeters, the float monitoring unit contains the terminals flowmeter can be remotely and is always clearly visible.
A white Teflon and the power supply for ten sensors. The alarm ring on the float marks the reading The system transmits either a single system consists of one alarm sensor point and wipes the inside wall of the alarm from each bank of meters or a for each flow tube and one monitoring glass tube.
For use with. Various versions are available to meet the different requirements necessary for the monitoring of fluid levels. Before the second switching point is reached, there is still enough oil in the reservoir for a shift to be completed without having to stop the machine or interrupt work.
Pay attention to the viscosity of oil! If necessary, the contact tube can be used to trigger a signal that calls for the reservoir to be topped off.
The level switch WS The first switching point issues the advance warning. The second switching point can, after the float travels roughly 25 mm, break a connected command link and thus shut down a machine. The advance warning remains in effect. Contact 1 — 3 closes after the fluid After the level of fluid drops to 25 rises to a maximum level; mm above the minimum filling level, Contact 1 — 2 opens after the fluid contact 1 — 3 closes; if the level of fluid drops to a minimum level.
Please observe preferred lengths. Preferred lengths for order length L: , , , , , , , , , , , mm. Using special lubricants, these systems have been developed to lubricate belt conveyor surfaces, as well as the conveyor guides, for the transport of products on bottling and packaging conveyors. With these systems, it is not special lubricant. Injection points for guides Guide. Coating plate for surface. Pre-adjusted piston Adjustable piston Main line distributors for guides distributors for surface.
Compact units for oil Group MKU — 0. Ordering details Order no. Group 0. For single-line total-loss to cover the total oil demand can then Different distributor groups can be be further regulated via the lubricating used in one installation. Please note: Seal material: NBR. To meet the required quantities In general, the operating conditions Piston distributors meter out and and comply with spatial constraints, specified for the respective pump units distribute the oil delivered by an it is possible to choose among four will also apply to the distributors.
The amount needed. Piston distributors, group 0. Piston distributors available only with metering nipples installed Order no.
Metering nipple with O-ring, exchangeable Related metered Marking on the Order no. To order: Please note: The order no. The piston distributors comprising To complete the order no.
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