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Total Intravenous Anaesthesia (TIVA) is an innovative alternative to traditional inhalational anaesthesia. Often incorrectly perceived as overly complex, TIVA has numerous advantages over inhalational drugs, such as a lower risk of nausea, less pain and better cognitive recovery. Taking on TIVA is a practical, easy to read and engaging guide to TIVA. It demystifies this important technique and will empower the novice but also support more experienced practitioners. It is a clear step-by-step approach to treating everything from routine elective to paediatric, geriatric, obese and pregnant patients. Pharmacokinetic models, dosage calculations, and the use of TIVA in emergency medicine are also elucidated. Written by international experts in the field with many years of experience both conducting and teaching TIVA, this handbook is an essential resource for experienced and novice anaesthetists alike who want to improve their understanding and confidence with the technique.
Recent literature on philanthropy and business has focused on the returns to businesses and entrepreneurs from giving. In this article, we show how historical context impacts the motivations and organizational forms created over time in philanthropic giving that effect and affect such returns. We do this through the prism of the changing ownership structures in the Scotch whisky industry in the twentieth century using an institutional theory lens. In doing so, we capture the story of three sisters who inherited a Scotch whisky business in the 1940s and transformed it into a hybrid philanthropic-commercial vehicle that remains in operation today. We present an extended theoretical model illustrating the interplay of context, motivation, and organizational structure over time on exchanges of capital in entrepreneurial philanthropy.
Poor performance and ill-health of calves in the pre-wean period can affect future productivity. Increasing numbers of producers are opting to use calf jackets as a means of mitigating the potential negative effects of low ambient temperatures, wind speed and precipitation on growth and health. This study aimed to use a range of noninvasive monitoring technologies to investigate the effects of using calf jackets in the first 3 weeks of life on calf performance and behavioural and physiological parameters. Ninety Holstein-Friesian calves were allocated to one of the two treatments: (i) Jacketed until 21 days of age and (J; n = 44) ii. Nonjacketed (NJ; n = 46). Calves were group housed and fed milk replacer (MR) and concentrate solid feed via automatic feeders. Calves were weaned at day 56, and the experiment was completed at day 63. Health assessments were conducted on a daily basis throughout the experiment using predefined faecal and respiratory scoring protocols. A range of novel, noninvasive monitoring technologies were used to examine the activity, heart rate and thermal profiles of calves on an individual basis throughout the experimental period. There were no differences in calf live weight (LWT), average daily gain (ADG) or feed conversion efficiency (FCE) in J and NJ calves between days 5 to 20. However, NJ calves consumed more MR and had more unrewarded visits to the milk feeder than J calves during this period. Although calf LWT was comparable across treatments in the week following jacket removal (days 21 to 28), both ADG and FCE tended to be greater in NJ calves. There were no treatment differences in calf LWT at the end of the study (d63). When measured over a period of 24 h and at a mean ambient temperature of 7.7°C, skin surface temperature was 6.37°C higher in J calves. Core body temperature was higher in J calves between days 5 to 20; however, there were no differences in IR eye or IR rectal temperature. No differences in lying behaviour occurred, with calves spending 18 and 17 h/day lying between days 5 to 20 and days 21 to 28, respectively. Under the climatic and management conditions described, no significant benefits to calf performance were found as a result of the provision of calf jackets to group-housed calves in the first 3 weeks of life. The higher frequency of unrewarded visits to the milk feeder in NJ calves during the first 3 weeks of life could be suggestive of a lack of satiety in these calves.
We evaluated the impact of an electronic health record based 72-hour antimicrobial time-out (ATO) on antimicrobial utilization. We observed that 6 hours after the ATO, 21% of empiric antimicrobials were discontinued or de-escalated. There was a significant reduction in the duration of antimicrobial therapy but no impact on overall antimicrobial usage metrics.
Four experiments examine how lack of awareness of inequality affect behaviour towards the rich and poor. In Experiment 1, participants who became aware that wealthy individuals donated a smaller percentage of their income switched from rewarding the wealthy to rewarding the poor. In Experiments 2 and 3, participants who played a public goods game – and were assigned incomes reflective of the US income distribution either at random or on merit – punished the poor (for small absolute contributions) and rewarded the rich (for large absolute contributions) when incomes were unknown; when incomes were revealed, participants punished the rich (for their low percentage of income contributed) and rewarded the poor (for their high percentage of income contributed). In Experiment 4, participants provided with public education contributions for five New York school districts levied additional taxes on mostly poorer school districts when incomes were unknown, but targeted wealthier districts when incomes were revealed. These results shed light on how income transparency shapes preferences for equity and redistribution. We discuss implications for policy-makers.
X-ray microscopy is a field that has developed rapidly in recent years. Two different approaches have been used. Zone plates have been employed to produce focussed beams with sizes as low as 0.07 pm for x-ray energies below 1 keV. Images of biological materials and elemental maps for major and minor low Z have been produced using above and below absorption edge differences. At higher energies collimators and focussing mirrors have been used to make small diameter beams for excitation of characteristic K— or L-x rays of all elements in the periodic
Evidence from animal models indicates that exposure to an obesogenic or hyperglycemic intrauterine environment adversely impacts offspring kidney development and renal function. However, evidence from human studies has not been evaluated systematically. Therefore, the aim of this systematic review was to synthesize current research in humans that has examined the relationship between gestational obesity and/or diabetes and offspring kidney structure and function. Systematic electronic database searches were conducted of five relevant databases (CINAHL, Cochrane, EMBASE, MEDLINE and Scopus). Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed, and articles screened by two independent reviewers generated nine eligible papers for inclusion. Six studies were assessed as being of ‘neutral’ quality, two of ‘negative’ and one ‘positive’ quality. Observational studies suggest that offspring exposed to a hyperglycemic intrauterine environment are more likely to display markers of renal dysfunction and are at higher risk of end-stage renal disease. There was limited and inconsistent evidence for a link between exposure to an obesogenic intrauterine environment and offspring renal outcomes. Offspring renal outcome measures across studies were diverse, with a large variation in offspring age at follow-up, limiting comparability across studies. The collective current body of evidence suggests that intrauterine exposure to maternal obesity and/or diabetes adversely impacts renal programming in offspring, with an increased risk of kidney disease in adulthood. Further high-quality, longitudinal, prospective cohort studies that measure indicators of offspring renal development and function, including fetal kidney volume and albuminuria, at standardized follow-up time points, are warranted.
Concentrate inclusion levels in dairy cow diets are often adjusted so that the milk yield responses remain economic. While changes in concentrate level on performance is well known, their impact on other biological parameters, including immune function, is less well understood. The objective of this study was to evaluate the effect of concentrate inclusion level in a grass silage-based mixed ration on immune function. Following calving 63 (45 multiparous and 18 primiparous) Holstein Friesian dairy cows were allocated to one of three isonitrogenous diets for the first 70 days of lactation. Diets comprised of a mixture of concentrates and grass silage, with concentrates comprising either a low (30%, LC), medium (50%, MC) or high (70%, HC) proportion of the diet on a dry matter (DM) basis. Daily DM intakes, milk yields and BW were recorded, along with weekly body condition score, milk composition and vaginal mucus scores. Blood biochemistry was measured using a chemistry analyzer, neutrophil phagocytic and oxidative burst assessed using commercial kits and flow cytometry, and interferon-γ production evaluated by ELISA after whole blood stimulation. Over the study period cows on HC had a higher total DM intake, milk yield, fat yield, protein yield, fat+protein yield, protein content, mean BW and mean daily energy balance, and a lower BW loss than cows on MC, whose respective values were higher than cows on LC. Cows on HC and MC had a lower serum non-esterified fatty acid concentration than cows on LC (0.37, 0.37 and 0.50 mmol/l, respectively, P=0.005, SED=0.032), while cows on HC had a lower serum β-hydroxybutyrate concentration than cows on MC and LC (0.42, 0.55 and 0.55 mmol/l, respectively, P=0.002, SED=0.03). Concentrate inclusion level had no effect on vaginal mucus scores. At week 3 postpartum, cows on HC tended to have a higher percentage of oxidative burst positive neutrophils than cows on LC (43.2% and 35.3%, respectively, P=0.078, SED=3.11), although at all other times concentrate inclusion level in the total mixed ration had no effect on neutrophil phagocytic or oxidative burst characteristics, or on interferon-γ production by pokeweed mitogen stimulated whole blood culture. This study demonstrates that for high yielding Holstein Friesian cows managed on a grass silage-based diet, concentrate inclusion levels in early lactation affects performance but has no effect on neutrophil or lymphocyte immune parameters.
The use of monthly intranasal mupirocin was associated with a significant reduction in the rate of methicillin-resistant Staphylococcus aureus transmission and Staphylococcus aureus invasive infection in a large neonatal intensive care unit. Resistance to mupirocin emerged over time, but it was rare and was not associated with adverse clinical outcomes.
Current commercial poultry production in the UK faces many challenges which make it difficult to confidently predict the future. Changing legislation, responding largely to welfare pressures, is one such challenge. Additionally, consumer demands are widening. Eggs and meat from stock which is organically produced, or fed on rations containing no genetically modified ingredients, or free range produced, or corn fed are some of the assurances sought by the purchaser and consumer. Although the market place already offers such produce it is difficult to predict the extent to which they will penetrate a market which developed largely through the use of intensive production systems. The alternatives to intensively produced eggs and meat are more expensive to produce and therefore purchase and consequently are susceptible to changes in standards of living and the affluence of the consumer.
This paper briefly describes current commercial practices and some of the specific challenges arising from new legislation.
A description of some specific requirements of birds highlights areas where improvements, in terms of performance, production efficiency, and welfare might be gained. Since the overwhelming majority of eggs and meat is produced in intensive, highly automated systems, there is an obvious need for an integrated approach featuring engineers and the poultry industry to refine and further develop technology which better serves the birds, and ultimately, the consumer.
It is concluded that the UK cannot compete in production costs with some other areas of the world and as retailers increasingly source their goods worldwide, the UK poultry producer may have to resort to the production of products which satisfy niche demands.
Scientists have long known that certain pesticides, industrial chemicals and heavy metals have a detrimental impact on the reproductive health of a wide range of species (including humans) by disrupting the endocrine system. As exposure to, and the effects of, ‘endocrine disrupters’ are likely to be more pronounced in wild species with a short gestation period and life-cycle we have chosen to develop non-invasive tools based upon faecal steroid analysis to monitor the reproductive status of the short-tailed field vole (Microtus agrestis). This approach is hoped to eventually provide a sensitive means of detecting environmental disturbances that could adversely affect humans, livestock and wildlife by establishing the the field vole as a terrestrial biomarker. Faecal steroid hormone analysis has already been demonstrated as being a convenient and reliable means of diagnosing reproductive state in a large range of mammalian species (including gazelle, rhino, macaque and mice), however, as of yet little is known regarding the hormonal changes that occur during pregnancy in M. agrestis.
Reliable and affordable technology for collecting and managing livestock production process information is being developed. The advances in data measurement, collection and transfer technology enable us to retrieve information from one or more remote sites to be processed and managed centrally. This opens up the opportunity to advance from open loop, prescriptive production to closed loop systems where factors influencing the actual performance of animals are used to modify and improve their production parameters (feed, environment, medication). We strive from producing animals by predicting what is needed using outdated data, to measuring what is actually happening as they grow, processing this information and acting to optimise animal performance by modifying production parameters in real time.
This paper describes commercially available systems that make possible the retrieval, collection, processing and distribution of near real time production information. Various aspects of production management using this technology are discussed, and examples of how it can be applied to monitor water usage, how it relates to pig performance and how energy usage can be influenced, are considered.
A common moral argument is that shareholders have a special status because of risk when considering the duties of corporate management. The privileges of this status usually include the idea that management should adopt the goal of maximizing shareholder wealth. We argue that modern financial theory demonstrates that this argument should be modified by the recognition of a principle of desert, the shareholder desert principle (SDP). Financial theory can usefully circumscribe the duty owed to shareholders and the extent to which risk bearing justifies a claim on corporate value. When combined with the SDP, the result provides management with a guideline for what is owed to shareholders before other stakeholder non-contractual claims may be satisfied. As such, our approach provides management with some guidance through the thicket of competing stakeholder claims.
Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).
Prospective, randomized, double-blinded, crossover study
Three ICUs at a large teaching hospital
In total, 51 HCWs involved in direct patient care were enrolled in and completed the study.
All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4–7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.
On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs.
In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.
Collagen associated with bone samples is frequently used for radiocarbon (14C) dating of bones recovered from archaeological sites. However, submersion and exposure to moisture favors the degradation of collagen, which leads to difficulty in reliably dating bones from tropical, humid, or previously submerged archaeological sites. In this paper, we characterized the preservation state of a series of bones, through parameters such as %C, %N, C/N ratio, and collagen recovery. We performed 14C analyses of three collagen fractions obtained through the pretreatment steps (total, ultrafiltered, and insoluble collagen) in order to link the preservation state and the reproducibility of 14C values obtained from the three fractions. Collagen ultrafiltration resulted in a decrease of C/N ratio, although collagen yield was reduced. When two or three collagen fractions were obtained, ages were reproducible and consistent with expected values, according to archaeological or hydrogeological criteria. The pretreatment steps were monitored by infrared spectroscopy in order to analyze the collagen fractions at the molecular level. The presence of collagen in the total and insoluble fractions was confirmed. Since many of the Mexican samples had poor ultrafiltered collagen yield (<3%) or nonexistent yield, our results show that if additional contextual information is carefully considered, the remnant collagen in the total and insoluble fraction can be dated, especially from sites where no other datable fraction exists.
Alterations of foetal development in utero can affect the structure and physiology of the adult offspring, a process known as “foetal programming” (Barker, 1994). Results from the first phase of this study indicated that offspring from mature ewes offered a restricted energy intake in early pregnancy were heavier at birth and had improved survival rates to weaning (Muñoz et al., 2006). The aim of the second phase of the study was to determine the effects of plane of ewe nutrition in early and mid pregnancy on carcass characteristics of male offspring and on reproductive performance and concentrations of the adiposity indicator, leptin, in female offspring, post-weaning.
A number of equations for predicting methane energy output (CH4-E) in ruminants have been published since 1930. However the data used to develop these equations were collected from diets containing mainly dried or high dry matter (DM) forages, rather than low DM heavily fermented grass silages. Since 1992 a number of calorimetric studies have been carried out with growing and lactating cattle offered grass-silage based diets at the Agricultural Research Institute of Northern Ireland. The objective of the present study was to use these data to develop new relationships between CH4-E output and animal and dietary factors.
One of the cornerstones in the development of a new feed rationing system for dairy cows must involve a reappraisal of both the concepts and ‘numbers’ adopted in defining the energy requirements for dairy cows. This is particularly important in the present scenario where increasingly high levels of animal output are being achieved from very different animal genotypes to those used in UK dairying 20 - 30 years ago. One of the tasks within the Feed Into Milk (FIM) project was to develop a new system to predict the energy requirements of todays dairy cow. The objective of the present study was to collate all available energy metabolism data with dairy cows in the UK and to develop relationships for describing metabolisable energy (ME) requirement for maintenance (MEm) and efficiency of ME use for lactation (kl) using both existing and new methodologies.