A world wide web informational reference source for viral ocular disease

This World Wide Web page is a quick reference source for anyone wishing to research ocular viral disease. Doctors and medical students will find the web site helpful to aid in the diagnosis and treatment of ocular viral disease. Topics within the site are cross-linked and presented in subjective, objective, assessment, plan format (SOAP). Photographs are included as are references for further study

Reintegration Of Crop-Livestock Systems In Europe : An Overview

International audienceOngoing specialization of crop and livestock systems provides socioeconomic benefits to the farmer but has led to greater externalization of environmental costs when compared to mixed farming systems. Better integration of crop and livestock systems offers great potential to rebalance the economic and environmental trade-offs in both systems. The aims of this study were to analyze changes in farm structure and review and evaluate the potential for reintegrating specialized intensive crop and livestock systems, with specific emphasis on identifying the co-benefits and barriers to reintegration. Historically, animals were essential to recycle nutrients in the farming system but this became less important with the availability of synthetic fertilisers. Although mixed farm systems can be economically attractive, benefits of scale combined with socio-economic factors have resulted in on-farm and regional specialization with negative environmental impacts. Reintegration is therefore needed to reduce nutrient surpluses at farm, regional and national levels, and to improve soil quality in intensive cropping systems. Reintegration offers practical and cost-effective options to widen crop rotations and promotes the use of organic inputs and associated benefits, reducing dependency on synthetic fertilisers, biocides and manure processing costs. Circular agriculture goes beyond manure management and requires adaptation of both food production and consumption patterns, matching local capacity to produce with food demand. Consequently, feed transport, greenhouse gas emissions, nutrient surpluses and nutrient losses to the environment can be reduced. It is concluded that reintegration of specialized farms within a region can provide benefits to farmers but may also lead to further intensification of land use. New approaches within a food system context offer alternatives for reintegration, but require strong policy incentives which show clear, tangible and lasting benefits for farmers, the environment and the wider community

Improvement in hypercapnia does not predict survival in COPD patients on chronic noninvasive ventilation

Purpose: It has recently been shown that chronic noninvasive ventilation (NIV) improves a number of outcomes including survival, in patients with stable hypercapnic COPD. However, the mechanisms responsible for these improved outcomes are still unknown. The aim of the present study was to identify parameters associated with: 1) an improved arterial partial pressure of carbon dioxide (PaCO2) and 2) survival, in a cohort of hypercapnic COPD patients treated with chronic NIV. Patients and methods: Data from 240 COPD patients treated with chronic NIV were analyzed. Predictors for the change in PaCO2 and survival were investigated using multivariate linear and Cox regression models, respectively. Results: A higher level of bicarbonate before NIV initiation, the use of higher inspiratory ventilator pressures, the presence of anxiety symptoms, and NIV initiated following an exacerbation compared to NIV initiated in stable disease were associated with a larger reduction in PaCO2. A higher body mass index, a higher FEV1, a lower bicarbonate before NIV initiation, and younger age and NIV initiation in stable condition were independently associated with better survival. The change in PaCO2 was not associated with survival, neither in a subgroup of patients with a PaCO2 >7.0 kPa before the initiation of NIV. Conclusion: Patients with anxiety symptoms and a high bicarbonate level at NIV initiation are potentially good responders in terms of an improvement in hypercapnia. Also, higher inspiratory ventilator pressures are associated with a larger reduction in PaCO2. However, the improvement in hypercapnia does not seem to be associated with an improved survival and emphasizes the need to look beyond PaCO2 when considering NIV initiation

Well-being, multidisciplinary work and a skillful team:essential elements of successful treatment in severe challenging behavior in dementia

Objective: Conceptualize successful treatment of persons with dementia and severe challenging behavior as perceived by professionals. Methods: In this concept mapping study 82 experts in dementia care participated. The study followed two phases of data collection: (1) an online brainstorm where participants completed the focus prompt: ‘I consider the treatment of people with severe challenging behavior in dementia successful if.’; (2) individual sorting and rating of the collected statements followed by data analysis using multidimensional scaling and hierarchical cluster analysis, resulting in a concept map. Results: Three clusters were identified, the first addressing treatment outcomes and the latter two addressing treatment processes, each divided into sub-clusters: (1) well-being, comprising well-being of the person with dementia and all people directly involved; (2) multidisciplinary analysis and treatment, comprising multidisciplinary analysis, process conditions, reduction in psychotropic drugs, and person-centered treatment; and (3) attitudes and skills of those involved, comprising consistent approach by the team, understanding behavior, knowing how to respond to behavior, and open attitudes. Conclusions: Successful treatment in people with dementia and severe challenging behavior focuses on well-being of all people involved wherein attention to treatment processes including process conditions is essential to achieve this.</p