Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia

Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV) fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 μg/mL at 0.1 mL/kg/hr) or intrathecal morphine (n = 50; 300 μg in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively) was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, P = .06), less postoperative IV fluids (median 1200 mL versus 4300 mL, P = .03) than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, P = .05) and had shorter hospital stays than those managed with epidural infusions (4.7 ± 0.9 days versus 6.8 ± 1.2 days, P = .02). Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection

Teaching children with autism spectrum disorder with restricted interests : a review of evidence for best practice

Inclusive education requires teachers to adapt to children’s learning styles. Children with autism spectrum disorder bring challenges to classroom teach- ing, often exhibiting interests restricted to particular topics. Teachers can be faced with a dilemma either to accommodate these restricted interests (RIs) into teaching or to keep them out of the classroom altogether. In this article, we examined all peer-reviewed studies of teaching children with autism spec- trum disorder with RIs published between 1990 and 2014. We find that posi- tive gains in learning and social skills can be achieved by incorporating children’s RIs into classroom practice: Of 20 published studies that examined 91 children, all reported gains in educational attainment and/or social engagement. Negative consequences were limited to a decrease in task per- formance in one child and a transient increase in perseverative behaviors in two children. The evidence supports the inclusion of RIs into classroom prac- tice. Methods of inclusion of RIs are discussed in light of practical difficulties and ideal outcomes

Bearing Failure On A Boiler Feed Water Pump

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Centrifugal Pump Operation, Maintenance, and Reliability

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Lubrication

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First report of Lyme borreliosis leading to cardiac bradydysrhythmia in two cats

Case series summary:Two cats were presented for investigation of bradyarrhythmia detected by their referring veterinarians during routine examination. Both cats had extensive investigations, including haematology, serum biochemistry with electrolytes and thyroxine concentrations, systolic blood pressure measurement, echocardiography, electrocardiography and infectious disease testing. Infectious disease testing included serology for Toxoplasma gondii, Ehrlichia canis, Anaplasma phagocytophilum and Borrelia burgdorferi, and PCR for B burgdorferi antigen in both cats. Case 1 was also assessed by PCR for Bartonella henselae antigen and case 2 was assessed for Dirofilaria immitis by serology. All infectious disease tests, other than for B burgdorferi, were negative. Case 1 was diagnosed with Lyme carditis based on marked bradydysrhythmia, positive B burgdorferi serology, a structurally normal heart and clinical resolution with appropriate treatment with a 4-year follow-up. Case 2 was diagnosed with Lyme carditis based on marked bradydysrhythmia and positive B burgdorferi PCR; however, this cat had structural heart disease that did not resolve with treatment. Relevance and novel information:This small case series describes two B burgdorferi positive cats presenting with newly diagnosed cardiac abnormalities consistent with those found in humans and dogs with Lyme carditis. Both cats were asymptomatic as perceived by their owners; the arrhythmia was detected by their veterinarians

How Financial Planners Can Collaborate with Professional Counselors

Permission to include in repository granted by the Financial Planning Association.Financial planners are dealing with more than just money. Clients are increasingly seeking the advice of financial planners for financial situations that are intrinsically interwoven with personal and psychological issues. Some financial planners may feel overwhelmed by the magnitude of personal issues, while others may feel that they do not have the time to effectively deal with these issues. This paper examines the melding of financial concerns with personal issues and how they subsequently lead to the need for referral and collaboration between financial planners and psychologists.Ye

Centrifugal Pump Operation, Maintenance, and Reliability

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Life After Sport: Athletic Career Transition and Transferable Skills

Permission to include this article granted by Journal of ExcellenceAthletes transitioning out of sport are faced with many obstacles. Well-trained counselors have the appropriate skills to assist athletes through athletic career transition. An examination of the literature focused on career retirement and transferable skills lead to the development of intervention recommendations for athletes transitioning out of sport. Treatment recommendations include psycho-educational and cognitive behavioural interventions that focus on the emotions associated with transitioning from sport as well as an emphasis on transferable skills.Ye