From Mike Darwin

 
The graphs are all from the various published papers dealing with the RhinoChill, and these are all available on the Benechill web site. To save time, I'll send you the extracted graphs (there are many more in the papers that YOU may want to use, but which I did not use).
 
This is the URL to get to the full text papers:
 
http://www.benechill.com/literature/index.html
 
Below is a list of the papers and abstracts on that URL. About 75% of them are full text PDFs. It is possible that the links will copy into this email and that you can access them from it. The web site is (IMHO), badly designed in that you have to explore every nook and cranny to find the bonanza of information present in the papers. When you and I looked at the web site in AZ, the papers were not yet up, and most of the really interesting stuff was just being published.
 
To reiterate my key points: To me, at least, it is pretty clear that the RhinoChill is NOT going to give the maximum (laboratory determined) benefit of MTH because it, like all other cooling noninvasive modalities other than LAPC, it cannot cool FAST enough or DEEP enough. This doesn't make it useless, far from it! It just means that cooling modalities will have to be COMBINED to get to -3 deg C in <15 min. This is simple physics and you can prove it with two polynomial equations that lay out the mechanics of heat transfer in a human head and in a human body under these conditions.
 
So, you have decide whether you want to do a study that validates some existing single modality, or tries to, for the first time, show what really happens when patients ARE cooled by the laboratory specified amounts in the laboratory specified time frame (or closer to them). Both have merit; but one is groundbreaking. You pays your money and you takes your chances. I think you need to lay out those two options to your colleagues and the people who will make this happen in just that way and tell them that THEY have a choice as to which study will be done (if in fact they do). Do they want to make history??????
 
If the answer is yes, then there will be a LOT of extra work and risk. As our famous General George Armstrong Custer used to say: "The greater the risk, the greater the Glory!" Custer had a glorious career, but alas, he had a really infamous failure that ended it and his life. BTW, that failure was totally a function of absolutely incredibly hubris and truly amazing piss poor planning. He wanted to be famous, and he wanted to be President of the US; he got careless. Don't be careless, but still, understand there is risk, and that Custer's maxim always applies.
 
I send the package with tracer capability and will tend to that directly. The CD had lots of stuff of on it and the book was my copy of Crippen's memoirs.
 

Articles

Maaret Castrén, Per Nordberg, Leif Svensson, Fabio Taccone, Jean-Louise Vincent, Didier Desruelles, Frank Eichwede, Pierre Mols, Tilmann Schwab, Michel Vergnion, Christian Storm, Antonio Pesenti, Jan Pachl, Fabien Guérisse, Thomas Elste, Markus Roessler, Harald Fritz, Pieterjan Durnez, Hans-Jörg Busch, Becky Inderbitzen and Denise Barbut. Intra-Arrest Transnasal Evaporative Cooling. A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness. Published online in Circulation (Journal of the American Heart Association). August 2, 2010. Article (PDF) » Editorial by Lance Becker, MD (PDF) »

Manuel Boller, Joshua W. Lampe, Joseph M. Katz, Denise Barbut, Lance B. Becker. Feasibility of intra-arrest hypothermia induction: A novel nasopharyngeal approach achieves preferential brain cooling. Published in Resuscitation (2010), doi:10.1016/j.resuscitation.2010.04.005 (PDF)

H.-J. Busch, F. Eichwede, M. Födisch, F.S. Taccone, G. Wöbker, T. Schwab, H.-B. Hopf, P. Tonner, S. Hachimi-Idrissi, P. Martens, H. Fritz, Ch. Bodea, J.-L. Vincent, B. Inderbitzen, D. Barbut, F. Sterz, A. Janata. Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Published in Resuscitation (2010), doi:10.1016/ j.resuscitation.2010.04.027 (PDF)

Tao Yu, Denise Barbut, Giuseppe Ristagno, Jun Hwi Cho, Shijie Sun, Yongqin Li, Max Harry Weil, Wanchun Tang. Survival and neurological outcomes after nasopharyngeal cooling or peripheral vein cold saline infusion initiated during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest. Published in Critical Care Medicine 2010; 38:916-21 (PDF)

Hao Wang, Denise Barbut, Min-Shan Tsai, Shijie Sun, Max Harry Weil, Wanchun Tang. Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest. Published in Resuscitation (2010), doi:10.1016/j.resuscitation.2010.01.027 (PDF)

Min-Shan Tsai, Denise Barbut, Hao Wang, Jun Guan, Shijie Sun, MD, Becky Inderbitzen, Max Harry Weil, Wanchun Tang. Intra-arrest rapid head cooling improves postresuscitation myocardial function in comparison with delayed postresuscitation surface cooling. Published in Critical Care Medicine 2008; 36[Suppl.]:S434-S439. (PDF)

Jun Guan, Denise Barbut, Hao Wang, Yongqin Li, Min-Shan Tsai, Shijie Sun, Becky Inderbitzen, Max Harry Weil, Wanchun Tang. A comparison between head cooling begun during cardiopulmonary resuscitation and surface cooling after resuscitation in a pig model of cardiac arrest. Published in Critical Care Medicine 2008; 36[Suppl.]:S428-S433. (PDF)

Min-Shan Tsai, Denise Barbut, Jun Guan, Joe Bisera, Becky Inderbitzen, Max Harry Weil, Wanchun Tang. The amplitude spectrum area correctly predicts improved resuscitation and facilitated defibrillation with head cooling. Published in Critical Care Medicine 2008;36[Suppl.]:S413-S417. (PDF)

Min-Shan Tsai, Denise Barbut, Wanchun Tang, Hao Wang, Jun Guan, Tong Wang, Shijie Sun, Becky Inderbitzen, Max Harry Weil. Rapid Head Cooling Initiated Coincident with CPR Improves Success of Defibrillation and Post-Resuscitation Myocardial Function In a Porcine Model of Prolonged Cardiac Arrest. Published in JACC 2008 May 20; 51(20).

Marla R. Wolfson, Daniel J. Malone, Jichuan Wu, John Hoffman, Allan Rozenberg, Thomas H. Shaffer, and Denise Barbut. Intranasal Perfluorochemical Spray for Preferential Brain Cooling in Sheep. Published in Neurocritical Care 2008; 8(3);437-47, Humana Press Inc.

Abstracts

H. Busch, H. Fritz, F. Eichwede, B .Inderbitzen, D Barbut, T Schwab. Intra-arrest cooling using a novel intra-nasal cooling method for immediate induction of therapeutic hypothermia in Germany. 30th Annual International Symposium for Intensive Care & Emergency Medicine (ISICEM), Brussels; Poster presentation (March 2010). (PDF)

F.S. Taccone, J.L. Vincent. Trans-nasal cooling during CPR: a single-center experience. 30th Annual International Symposium for Intensive Care & Emergency Medicine (ISICEM), Brussels; Poster presentation (March 2010). (PDF)

Maaret Castrén, Per Nordberg, Didier Desruelles, Frank Eichwede, Pierre Mols, Fabio Silvio Taconne, Jean-Louis Vincent, Leif Svensson, Hans-Jörg Bush, Michel Vergnion, Chirstian Storm, Antonio Pesenti, Jan Pachl, Fabien Guérisse, Thomas Elste, Markus Roessler, Harald Fritz, Pieterjan Durnez, Denise Barbut. Intra-arrest Transnasal Cooling: A Randomized Prehospital Study: PRINCE (Pre-ROSC Intra Nasal Cooling Effectiveness). American Heart Association Meeting, Orlando, FL.
View Oral presentation (November 2009) (PDF). • View PowerPoint presentation.

Tao Yu, Giuseppe Ristagno, Yongqin Li, Max H. Weil, Wanchun Tang. Nasopharyngeal Cooling Improves Coronary Perfusion Pressure and Amplitude Spectrum Area During CPR in Comparison to Systemic Cold Saline Infusion in a Porcine Model of Prolonged Cardiac Arrest. American Heart Association Meeting, Orlando, FL; Poster presentation (November 2009). (PDF)

Per Nordberg, Maaret Castren, Leif Svensson, Denise Barbut. New method of intra-arrest trans-nasal cooling in Stockholm – The PRINCE II study. 3rd International Hypothermia Symposium, Lund, Sweden; Oral presentation (September 2009) (PDF)

F. Taccone, D. Deloungueville, D. Desruelles, F. Eichwede, T. Schwab, M. Vergnion, C. Storm, L. Stamakakis, T. Elste, H. Fritz, P Durnez, M. Roesseler, H.-J. Busch, D. Barbut. PRINCE (Pre-ROSC Intra-Nasal Cooling Effectiveness): A Randomized Study. International Symposium on Intensive Care and Emergency Medicine; Poster presentation (March 2009) (PDF)

Jun Hwi Cho, Giuseppe Ristagno, Tao Yu, Yongqin Li, Shijie Sun, Carlos Castillo, Max Harry Weil, Wanchun Tang. Early Intra-Nasal Cooling During CPR Using Either Oxygen Or Air As A Propellant of the Evaporative Cooler. Society for Critical Care Medicine Meeting; Poster presentation (February 2009). (PDF)

Jun Hwi Cho, Denise Barbut Giuseppe Ristagno, Tao Yu, Yongqin Li, Shijie Sun, Max Harry Weil, Wanchun Tang. Survival and neurological outcomes after trans-nasal cooling initiated during CPR and maintained for either one or four hour following resuscitation. Society for Critical Care Medicine Meeting; Poster presentation (February 2009). (PDF)

Tao Yu, Denise Barbut, Giuseppe Ristagno, Jun Hwi Cho, Shijie Sun, Yongqin Li, Carlos Castillo, Max Harry Weil, Wanchun Tang. Comparison between nasopharyngeal cooling and IV injection of cold saline initiated during CPR on resuscitation outcome in a porcine model of prolonged cardiac arrest. Society for Critical Care Medicine Meeting; Poster presentation (February 2009). (PDF)

H.-J. Busch, H. Schwab, C. Bode, T. Schwab. Rapid electrical and hemodynamic stabilization during cardiac arrest via trans-nasal cooling in a patient with prehospital cardiac arrest: A case report. Society for Critical Care Medicine Meeting; Poster presentation (February 2009). (PDF)

Giuseppe Ristagno, Denise Barbut, Jun Hwi Cho, Shijie Sun, Max Harry Weil, Wanchun Tang. Safety and efficacy of head cooling in a porcine model of cardiopulmonary resuscitation with chest compression only and without airway protection. American Heart Association Meeting, New Orleans, LA; Poster presentation (2008). (PDF)

Giuseppe Ristagno, Jun Hwi Cho, Tao Yu, Shijie Sun, Max Harry Weil, Wanchun Tang. Selective head cooling initiated during CPR induces post-resuscitation carotid artery dilation and increases in carotid artery flow and cerebral cortical microcirculation. American Heart Association Meeting, New Orleans, LA; Oral presentation (2008). (PDF)

Simona Tantillo, Giuseppe Ristagno, Shijie Sun, Max Harry Weil, Wanchun Tang. Early Selective Head Cooling During CPR Improves Post-ROSC Hemodynamic Stability And Decreases Recurrence Of Ventricular Fibrillation. American Heart Association Meeting, New Orleans, LA; Oral presentation (2008). (PDF)

Jun Hwi Cho, Denise Barbut, Giuseppe Ristagno, Yongqin Li, Shijie Sun, Carlos Castillo, Max Harry Weil, Wanchun Tang. Early Selective Trans-nasal Cooling during CPR Improves Success Of Resuscitation In A Porcine Model Of Pulseless Electrical Activity Cardiac Arrest. American Heart Association Meeting, New Orleans, LA; Poster presentation (2008). (PDF)

Tao Yu, Denise Barbut, Giuseppe Ristagno, Jun Hwi Cho, Shijie Sun, Max Harry Weil, Wanchun Tang. Exploratory Study on Mechanism By Which Hypothermia Improves Outcomes of CPR. American Heart Association Meeting, New Orleans, LA; Poster presentation (2008). (PDF)

H.-J. Busch, A. Janata, F. Eichwede, M. Födisch, G. Wöbker, M. Stefan, T. Schwab, E. Karassimos, H. Fritz, B. Inderbitzen, D. Barbut, F. Sterz. Safety and feasibility of a new innovative cooling approach for immediate induction of therapeutic hypothermia in patients after successful resuscitation – Trans-nasal cooling after cardiac arrest. American Heart Association Meeting, New Orleans, LA; (2008).
View Poster presentation (PDF) View Abstract (PDF).

G.Y. Sung, M. Torbey. RhinoChill: A novel hypothermia delivery system. World Stroke Organization Annual congress, Vienna, Austria; Poster presentation (2008). (PDF)

H.-J. Busch, M. Brunner, H. Schwab, B. Inderbitzen, D. Barbut, T. Schwab. Pre-treatment with trans-nasal cooling for the induction of therapeutic hypothermia in patients with cardiac arrest leads to a significant faster achievement of target temperature during systemic cooling. European Society of Intensive Care Medicine Meeting, Lisbon, Portugal; Poster presentation (2008). (PDF)

Markus J. Foedisch, Andreas Viehoefer, Christina Knuth, Becky Inderbitzen, Denise Barbut. Rapid induction of therapeutic Hypothermia after Cardiac Arrest with intranasal cooling- a preliminary report. European Society of Intensive Care Medicine Meeting, Lisbon, Portugal; Poster presentation (2008). (PDF)

Andreas Janata, Heidrun Losert, Keywan Bayegan, Moritz Haugk, Jasmin Arrich, Danica Krizanac, Anton N. Laggner, Denise Barbut, Fritz Sterz. Nasal Cooling With a New Cooling Device in Patients After Cardiac Arrest and Successful Resuscitation. European Resuscitation Council Biannual Congress, Ghent, Belgium; Oral presentation (2008). (PDF)

Hao Wang, Min-Shan Tsai, Jun Guan, Wanchun Tang, Shijie Sun, Denise Barbut, Max Harry Weil. Intra-arrest intranasal cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest. European Resuscitation Council Biannual Congress, Ghent, Belgium; Oral presentation (2008). (PDF)

Jun Guan, Wanchun Tang, Hao Wang, Tong Wang, Yongqin Li, Shijie Sun, Min-Shan Tsai, Denise Barbut, Max Harry Weil. Intranasal Spray of Perfluorocarbon Can Rapidly Reduce Brain Temperature and Culminate in Systemic Hypothermia in a Pig Model of Prolonged Cardiac Arrest. Society of Critical Care Medicine Meeting, Honolulu, HI; Poster presentation (2008). (PDF)

Jun Guan, Wanchun Tang, Hao Wang, Yongqin Li, Min-Shan Tsai, Shijie Sun, Denise Barbut, Becky Inderbitzen, Max Harry Weil. A Comparison Between Head Cooling Begun During CPR and Surface Cooling after Resuscitation. Society of Critical Care Medicine Meeting, Honolulu, HI; Poster presentation (2008). (PDF)

Hao Wang, Denise Barbut, Wanchun Tang, Min-Shan Tsai, Shijie Sun, Max Harry Weil. Intra-Arrest Intra-Nasal Cooling Improves Resuscitation After Prolonged Cardiac Arrest In Pigs. Society of Critical Care Medicine Meeting, Honolulu, HI; Poster presentation (2008). (PDF)

Min-Shan Tsai, Wanchun Tang, Hao Wang, Jun Guan, Shijie Sun, Denise Barbut, Becky Inderbitzen, Max Harry Weil. Intra-arrest Rapid Head Cooling Improves Cardiac Arrest Outcomes Over Delayed Post-resuscitation Systemic Cooling In A Porcine Model of Prolonged Ventricular Fibrillation. Society of Critical Care Medicine Meeting, Honolulu, HI; Poster presentation (2008). (PDF)

Min-Shan Tsai, Wanchun Tang, Hao Wang, Jun Guan, Shijie Sun, Denise Barbut, Becky Inderbitzen, Max Harry Weil. Intra-Arrest Rapid Head Cooling Improves Amplitude Spectrum Area of Ventricular Fibrillation And Facilitates Defibrillation. Society of Critical Care Medicine Meeting, Honolulu, HI; Poster presentation (2008). (PDF)

Min-Shan Tsai, Wanchun Tang, Hao Wang, Jun Guan, Shijie Sun, Denise Barbut, Max Harry Weil. Rapid brain cooling during cardiopulmonary resuscitation followed by systemic therapeutic hypothermia reduces myocardial damage in a porcine model of prolonged ventricular fibrillation. Society of Critical Care Medicine Meeting, Honolulu, HI; Poster presentation (2008). (PDF)

Manuel C. Boller, Joshua Lampe, Lance B. Becker, Denise Barbut. Feasibility of selective brain cooling during cardiac arrest: a novel nasopharyngeal approach. American Heart Association Meeting, Orlando, FL; Poster presentation (2007). (PDF)

Jun Guan, Wanchun Tang, Hao Wang, Min-Shan Tsai, Yongqin Li, Shijie Sun, Denise Barbut, Max H. Weil. Rapid Induction Of Head Cooling By The Intranasal Route During Cardiopulmonary Resuscitation Improves Survival and Neurological Outcomes. American Heart Association Meeting, Orlando, FL; Oral presentation (2007). (PDF)

Min-Shan Tsai, Wanchun Tang, Hao Wang, Jun Guan, Shijie Sun, Max Harry Weil, Denise Barbut. Rapid Intranasal Cooling Initiated Coincident with CPR Improves Success of Defibrillation and Post-Resuscitation Myocardial Function in a Porcine Model of Prolonged Cardiac Arrest. American Heart Association Meeting, Orlando, FL; Poster presentation (2007). (PDF)

Wolfson M.R., Malone D.J., Wu J., Hoffman J., Rozenberg A., Shaffer T.H., Barbut D. A novel approach for inducing selective brain hypothermia. 2006 Hot Topics in Neonatology Meeting, Washington, DC; Poster presentation (4 Dec 2006).

Wolfson M.R., Malone D.J., Wu J., Hoffman J., Rozenberg A., Shaffer T.H., Barbut D. Perfluorochemical (PFC) nasopharyngeal cooling induces selective brain hypothermia. 2006 Pediatric Academic Societies' Meeting, San Francisco, CA; Poster presentation (1 May 2006).

Good luck and let me know what you decide to do. Also, let me know what happens with Benechill. You should look over their Board of Directors and management staff and, if you approach them, have a letter perfect proposal that is the essence of professional and preferably tendered by the MOST INFLUENTIAL PERSON YOU CAN MUSTER. A stellar physician (published) and/or someone who KNOWS one of the Directors or Managers would be an enormous help. Believe me, I know whereof I speak.

Mike Darwin

 

 
 
 
In a message dated 9/27/2010 2:34:58 P.M. GMT Daylight Time, chriscotton69@yahoo.com writes:

 

Hi Mike,
Thanks for your detailed response. Much appreciated as always. I have taken all your comments on board, and like you  I agree a staged approach might be more feasible.
I never got the book or CD you were going to send me. I remember you saying you were going to send them through - I think one was going to be a copy of Crippen's memoirs and the other was going to be a photocopy of ?Negovsky's book.
Are the graphs you have quoted from the RhinoChill company's website or some other source?
Chris Cotton
Intensive Care Paramedic
Souh Australia
 
 
 
 
 
Chris,
 
OK, here goes.
 
Mostly, these is just my opinions and prejudices, so take them with a grain of salt. Secondly, my approach to animal and clinical research is IMMENSELY unpopular and considered 'unscientific.'  Why? Because I believe in common sense and RESULTS, rather than nice clean papers with easily isolated variables; but where the patients die or fail to benefit maximally. I also like risk!
 
Let's look at your situation, in particular. Good data (considering CPR research) now exist for cold IV saline AND for use of the RhinoChill. Both work to reduce mortality and improve neurologically intact survival. That work has been done already. Now, there is genuine benefit in REPEATING either of these studies to CONFIRM their validity, especially if you (or the world) have doubts about their validity; or you want to make the data more robust to facilitate clinical acceptance. Such studies BORE me to tears; that's a personal quirk. If I had wanted to go about spending my life validating the work of others, I'd have been a medical doctor working in some university setting. I want to explore and break new ground. Having said that, remember that a pioneer is someone with an arrow in his back or some weird and unknown micro-parasite in his body!
 
Now, the fact is that NEITHER chilled IV saline or the RhinoChill are going to give cooling of ~3 deg C in under 15 minutes. The laws of physics, as well as ample animal and human experience, show that it just isn't going to happen. In consequence, if you REALLY want to achieve the Holy Grail of cooling 3 deg C as quickly as possible, you will have to combine modalities. THAT however, is easier said than done. Doing one new thing is difficult, doing two at once in a clinical setting is damn near impossible, but, importantly, NOT impossible. It comes down to how much risk you want to take and how much time and money you have.
 
I think Wake EMS did it exactly right. They clearly understood that several modalities had to be combined to improve survival; high impulse continuous compression CPR, an airway impedance valve and intra-arrest cooling. Considering that most people are morons and intractably stubborn, they quite wisely decided to introduce these three interventions in a phased program, so that each modality could be digested and mastered and, of course, so that they could get a good signal from the data as to effect of each intervention as it was added. Finally, thy had ENOUGH PATIENTS to generate statistically valid data.
 
What should you do? I don't know because I don't have all the facts and cannot be given them; much depends on intangibles like how good your paramedical staff is, what their attitude is, how keen they are to try stacked modalities, how your medical community will react, and so on. Human clinical trials very often live or die by these factors, rather than by their scientific or technical feasibility. If those factors are favorable, I'd do what Wake did; start with the modality you are most comfortable with and then ADD the RhinoChill. If you think you can get away with it, I'd add the gel cooling cap (which can be kept in the cold saline fridge) as a final intervention only after the first two are in place and working smoothly.
 
The nice thing about this study design is that if you have problems, or cannot get enough patients for 'phase II', you can simply stop at phase I. Alternatively, you can do EXTENSIVE training with ALL the personnel involved using BOTH systems PRIOR to the start of the human trial. This is not nearly as good as real world experience, but if you at least have everyone thoroughly familiar with the hardware and protocol, the chances of a logistic meltdown, or revolt against 'complexity' of the whole thing are greatly reduced.
 
All the data I showed, and those that are presented below, are from the published papers. A trick few people seem to know is to set the Adobe viewer to 400% or 800% and then copy the graphic you want to use. This captures the image at a very high resolution. (PDFs are compressed and by expanding the view you are decompressing the data soyou can copy it.) You can then paste it into any editing program of your choice and manipulate it as you like. I use Photoshop, Paint and Powerpoint. Powerpoint is great for adding text and arrows in a hurry. If you can master the basics of Photoshop, the world is your oyster.
 
As to getting a machine from Benechill: GOOD LUCK! My guess is that you will find your limitation in protocol design is your ABILITY TO GET BENECHILL TO GIVE YOU THE TIME OF DAY. This is so because the costs of developing a new modality are so staggeringly high that a company can no longer afford even one negative trial. EVERY trial has to be positive and preferably 'perfect.' This means that the companies go for high profile institutions with big names (and a lot of them) and restrict access to their technology as if it were a CIA or MI5 secret the fate of the free world depended upon. Ironically, this is what, in large measure, sunk the Alliance partial liquid vent trials because centers of excellence tend to do everything well and PFC was thus put up against the VERY BEST of mechanical ventilation. Of course, in the real world MOST centers do a crappy job of preventing baro and volutrauma, and if Alliance had put PLV in those settings, they would have shown positive results AND THEY WOULD HAVE GOTTEN THE NUMBERS THEY NEEDED BEFORE LUNG PROTECTIVE VENTILATION WAS ON THE SCENE. In short, they would have had an approved product on the market today. And, while PLV is not the cat's meow for Tx of ARDS, it has plenty of other great uses that will now not be possible because it was never approved.
 
And yes, you are right that temp measurement is going to be a big logistic problem. I have a number of ideas on how to deal with this, but they are not for discussion here. One approach I've used is to insert a soft vinyl clad TC probe approved for medical use into the external ear canal in a plug of the silicone putty-type swimmers' ear sealing wax. It's quick, effective and gives readings that are as accurate as Ttymps, albeit with a bit more lag. Other solutions are possible.
 
Finally, most people end up taking baby steps because it is so much less work and so much safer. And, often they are forced to by logistics; my bet is Benechill is going to politely say "no," which is vastly better than Alliance's RUDELY saying "f-off!"
 
It's a scary business to make a decision to go with a more complicated higher risk strategy. And, if you have no experience doing field trials, then unless you are VERY good and moderately lucky, you will probably not have a good outcome.
 
Below is part of a book Chapter that deals with the RhinoChill I just wrote. You may find it useful. If you need any of the figures in it, let me know and I'll send them to you as high res JPGs.
 
Mike Darwin
 
PS: did you get the book & CD I sent you some months ago?