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Emergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico. A critical approach and review of the literature are discussed.
Two critically ill patients were managed in an austere environment as a result of the devastation from Hurricane Maria (Yabucoa, Puerto Rico; 2017). They both exhibited signs of respiratory distress, hemodynamic instability, and distributive shock requiring definitive airway management and hemodynamic support prior to aeromedical evacuation.
The novel use of field expedient vasopressors prior to induction for rapid sequence intubation was successfully and safely employed in both cases. Both patients had multiple risk factors for peri-induction cardiac arrest given their presenting hemodynamics. Despite their illness severity, both patients were induced, transported, and ultimately admitted to the intensive care unit (ICU) in stable condition following administration of the field expedient vasopressors.
Field expedient vasopressors were safely and effectively employed in an austere field environment during a disaster response. This case series contributes to the growing body of literature of safe bolus-dose vasopressor use by emergency physicians to temporize hypotensive patients in resource-constrained situations.
HardwickJM, MurnanSD, Morrison-PonceDP, DevlinJJ. Field Expedient Vasopressors During Aeromedical Evacuation: A Case Series from the Puerto Rico Disaster Response. Prehosp Disaster Med. 2018;33(6):668–672.
The most important factors known to influence the eating quality of beef are well established and include both pre- and post-slaughter events with many of the determinants interacting with each other. A substantial programme of work has been conducted by the Agri-Food and Biosciences Institute in Northern Ireland aimed at quantifying those factors of most importance to the local beef industry. Post-slaughter effects such as carcase chilling and electrical stimulation, ageing, carcase hanging and cooking method have been shown to have a significant impact on eating quality when compared with pre-slaughter activities such as animal handling and lairage time in the Northern Ireland studies. However, the effect of animal breed, particularly the use of dairy breed animals, was shown to significantly improve eating quality. Many of these factors were found to interact with each other.
The eastern bettong Bettongia gaimardi, a potoroid marsupial, has been extinct on the Australian mainland since the 1920s. Sixty adult bettongs were reintroduced from the island of Tasmania to two predator-free fenced reserves on mainland Australia. We examined baseline health parameters (body weight, haematology and biochemistry, parasites and infectious disease exposure) in a subset of 30 (13 male, 17 female) individuals at translocation and again at 12–24 months post-reintroduction. The mean body weight increased significantly post-reintroduction but there were no significant differences in body weight between the two reintroduction sites or between the sexes in response to reintroduction. Differences were evident in multiple haematological and biochemical variables post-reintroduction but there were few differences between the two reintroduced populations or between the sexes in response to reintroduction. Ectoparasite assemblages differed, with five of 13 species failing to persist, and an additional four species were identified post-reintroduction. None of the bettongs had detectable antibodies to the alphaherpesviruses Macropodid herpesvirus 1 and 2 post-reintroduction, including one individual that was seropositive at translocation. Similarly, the novel gammaherpesvirus potoroid herpesvirus 1 was not detected by polymerase chain reaction (PCR) in any of the bettongs post-reintroduction, including one individual that was PCR-positive at translocation. None of the bettongs had detectable antibodies to Toxoplasma gondii either at translocation or post-reintroduction. Our data demonstrate changing baseline health parameters in eastern bettongs following reintroduction to the Australian mainland are suggestive of improved health in the reintroduced populations, and provide additional metrics for assessing the response of macropodoids to reintroduction.
Herpes virus infections can cause cognitive impairment during and after acute encephalitis. Although chronic, latent/persistent infection is considered to be relatively benign, some studies have documented cognitive impairment in exposed persons that is untraceable to encephalitis. These studies were conducted among schizophrenia (SZ) patients or older community dwellers, among whom it is difficult to control for the effects of co-morbid illness and medications. To determine whether the associations can be generalized to other groups, we examined a large sample of younger control individuals, SZ patients and their non-psychotic relatives (n=1852).
Using multivariate models, cognitive performance was evaluated in relation to exposures to herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2) and cytomegalovirus (CMV), controlling for familial and diagnostic status and sociodemographic variables, including occupation and educational status. Composite cognitive measures were derived from nine cognitive domains using principal components of heritability (PCH). Exposure was indexed by antibodies to viral antigens.
PCH1, the most heritable component of cognitive performance, declines with exposure to CMV or HSV-1 regardless of case/relative/control group status (p = 1.09 × 10−5 and 0.01 respectively), with stronger association with exposure to multiple herpes viruses (β = −0.25, p = 7.28 × 10−10). There were no significant interactions between exposure and group status.
Latent/persistent herpes virus infections can be associated with cognitive impairments regardless of other health status.
A microwave assisted process for production of continuous fiber reinforced ceramic matrix composites is described. A simple apparatus combining a chemical vapor infiltration reactor with a conventional 700 W multimode oven is described. Microwave induced inverted thermal gradients are exploited with the ultimate goal of reducing processing times on complex shapes. Thermal gradients in stacks of SiC (Nicalon) cloths have been measured using optical thermometry. Initial results on the “inside out” deposition of SiC via decomposition of methyltrichlorosilane in hydrogen are presented. Several key processing issues are identified and discussed.
The Balloon-borne Large Aperture Submillimeter Telescope (BLAST) has recently conducted an extragalactic submillimetric survey of the Chandra Deep Field South region of unprecedented size, depth, and angular resolution in three wavebands centered at 250,
350, and 500 µm. BLAST wavelengths are chosen to study the Cosmic Infrared Background near its peak at 200 µm.
We find that most of the CIB at these wavelengths is contributed by galaxies detected at 24 µm by the MIPS instrument on Spitzer, and that the source counts distribution shows a population with strongly evolving density and luminosity. These results anticipate what can be expected from the surveys that will be conducted with the SPIRE instrument on the Herschel space observatory.
Following an episode of water contamination with sewage in a rural Irish town, a community-wide survey of gastrointestinal-associated illness and health service utilization was conducted. Random sampling of households yielded residents who were surveyed using a self-administered questionnaire. Of 560 respondents from 167 (84%) households, equal proportions lived in areas known to have been exposed and unexposed to the contaminated water, although 65% of subjects reported using contaminated water. Sixty-one percent of subjects met the case definition. The most common symptoms among cases were abdominal cramps (80%), diarhoea (75%), appetite loss (69%), nausea (68%) and tiredness (66%). Mean duration of illness was 7·4 days. Only 22 % of cases attended their general practitioner. Drinking unboiled water from the exposed area was strongly associated with being a case. A substantial degree of community illness associated with exposure to contaminated water was observed. The episode ranks as one of the largest reported water-borne outbreaks causing gastrointestinal illness in recent times.
Mixing of cattle prior to slaughter which results in aggressive activity (Mohan Raj et al 1992) leads to glycogen depletion pre-slaughter and subsequently meat with a higher ultimate pH (pHu). Purchas et al (1990) reported a quadratic relationship between pHu and tenderness with highest shear force values recorded between pHu 5.8 to 6.2. The aim of this study was to determine the effect of fasting and mixing of steers prior to slaughter on the meat eating quality of longissimus dorsi (LD) muscle.
The earliest possible seeding of wheat crops in the southern Australian dryland cropping zone is prevented by the lack of a weed control practice that adequately controls initial weed seedling emergence at the start of the growing season. The objective of this study was to determine the potential for using residual herbicides applied up to 1 mo before the start of the growing season to control rigid ryegrass seedlings that emerge after the season-opening rains. In a series of glasshouse studies, S-metolachlor and propyzamide were found to effectively persist on the soil surface through prolonged exposure to hot, dry, and intense sunlight conditions, preventing the establishment of rigid ryegrass seedlings. In addition, these herbicides caused little or no effect on subsequently seeded wheat. It also was determined that S-metolachlor had the potential to retain efficacy on rigid ryegrass seedlings after 12 wk of exposure on the soil surface to these conditions. These studies have identified two herbicides with the potential for use at the novel application timing, i.e., before the commencement of the growing season, in Mediterranean climates of southern Australia.
A disturbed calcium homeostasis characterizes diabetic pregnancy. This study documents changes in bone mineral composition in diabetic pregnant rats and examines the effect of insulin replacement. Control pregnant (CP), diabetic pregnant (DP) and insulin-treated DP (DPi) rats were assessed for femoral calcium and magnesium content, bone mineral density (BMD) and the ratio of hypertrophic to maturing and proliferative cells in the femoral growth plate. DP rats showed a significantly (P < 0·01) lower body weight, femoral weight and length than CP rats. Femoral calcium and magnesium content was also significantly (P < 0·05) lower in DP rats, as was ash weight. When calcium and magnesium were normalized for ash weight no signficant differences were apparent. A significantly (P < 0·05) lower total BMD at the distal femur was seen in DP rats. This comprised a significantly (P < 0·01) lower trabecular BMD with no significant change in cortical BMD. A significantly (P < 0·05) higher ratio of hypertrophic to maturing and proliferative cells of the femoral growth plate was evident in DP animals. DPi rats showed normal blood glucose concentrations and femoral growth plate histology. DPi rats also showed normal femoral weight and length but only partially restored femoral ash weight and mineral content. Insulin failed to normalize total or trabecular BMD. Diabetes mellitus clearly has a marked effect on bone growth and mineral content in pregnancy which may be relevant to overall calcium homeostasis. The lower bone growth, bone calcium content and trabecular BMD may be unfortunate consequences of the marked hypercalciuria reported elsewhere in diabetes and may serve to maintain normocalcaemia in the disease.
Attractants were found for males of 12 moth species: Acronicta grisea Walker, Andropolia contacta Walker, Argyrotaenia dorsalana Dyar, Chrysaspidia putnami (Grote), Chrysaspidia venusta Walker, Eurythmia hospitella Zeller, Exartema appendiceum Zeller, Mutuuraia mysippusalis (Walker), Decodes horarianus Walsingham, Polia atlantica Grote, Sitochroa chortalis Grote, and Pandemis canadana Kearfott. For five of these species single pure compounds were useful attractants, while the remaining seven required binary mixtures whose components when tested singly showed little or no attractancy.
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