The choice of the intravenous fluid influences the tolerance of acute normovolemic anemia in anesthetized domestic pigs

The correction of hypovolemia with acellular fluids results in acute normovolemic anemia. Whether the choice of the infusion fluid has an impact on the maintenance of oxygen (O2) supply during acute normovolemic anemia has not been investigated so far. Methods: Thirty-six anesthetized and mechanically ventilated pigs were hemodiluted to their physiological limit of anemia tolerance, reflected by the individual critical hemoglobin concentration (Hbcrit). Hbcrit was defined as the Hb-concentration corresponding with the onset of supply-dependency of total body O2-consumption (VO2). The hemodilution protocol was randomly performed with either Tetrastarch (6% HES 130/0.4, TS-group, n=9), Gelatin (3.5% urea-crosslinked polygeline, GEL-group, n=9), Hetastarch (6% HES 450/0.7, HS-group, n=9) or Ringer's solution (RS-group, n=9). The primary endpoint was the dimension of Hbcrit, secondary endpoints were parameters of central hemodynamics, O2-transport and tissue oxygenation. Results: In each animal, normovolemia was maintained throughout the protocol. Hbcrit was met at 3.7+/-0.6 g/dl (RS), 3.0+/-0.6 g/dl (HS P<0.05 vs. RS), 2.7+/-0.6 g/dl (GEL, P<0.05 vs. RS) and 2.1+/-0.4 g/dl (TS, P<0.05 vs. GEL, HS and RS). Hemodilution with RS resulted in a significant increase of extravascular lung water index (EVLWI) and a decrease of arterial oxygen partial pressure (paO2), O2-extraction ratio was increased, when animals of the TS-, GEL- and HS-groups met their individual Hbcrit. Conclusions: The choice of the intravenous (i.v) fluid has an impact on the tolerance of acute normovolemic anemia induced by acellular volume replacement. Third-generation Tetrastarch preparations (e.g., HES 130/0.4) appear most advantageous regarding maintenance of tissue oxygenation during progressive anemia. The underlying mechanism includes a lower degree of extravasation and favourable effects on microcirculatory function

The changing face of Rhodes University: exploring aspects of visuality, sexuality and protest between the apartheid and postapartheid periods

This thesis seeks to provide an historical overview of changing trends within specific spheres of the institutional and student culture of Rhodes University between the apartheid and post-apartheid periods. In particular, this thesis seeks to examine changes and developments within the visual and aesthetic culture of the university, and within the sphere of sexual norms and relations within the Rhodes student community. The historical dimensions of these two spheres of the university’s culture will be explored in light of the #RhodesMustFall protest of 2015 and the #RUReferenceList protest of 2016, which drew attention to a perceived lack of institutional transformation related to these two areas

Incorporating Uncertainties in Atomic Data Into the Analysis of Solar and Stellar Observations: A Case Study in Fe XIII

Information about the physical properties of astrophysical objects cannot be measured directly but is inferred by interpreting spectroscopic observations in the context of atomic physics calculations. Ratios of emission lines, for example, can be used to infer the electron density of the emitting plasma. Similarly, the relative intensities of emission lines formed over a wide range of temperatures yield information on the temperature structure. A critical component of this analysis is understanding how uncertainties in the underlying atomic physics propagates to the uncertainties in the inferred plasma parameters. At present, however, atomic physics databases do not include uncertainties on the atomic parameters and there is no established methodology for using them even if they did. In this paper we develop simple models for the uncertainties in the collision strengths and decay rates for Fe XIII and apply them to the interpretation of density sensitive lines observed with the EUV Imagining spectrometer (EIS) on Hinode. We incorporate these uncertainties in a Bayesian framework. We consider both a pragmatic Bayesian method where the atomic physics information is unaffected by the observed data, and a fully Bayesian method where the data can be used to probe the physics. The former generally increases the uncertainty in the inferred density by about a factor of 5 compared with models that incorporate only statistical uncertainties. The latter reduces the uncertainties on the inferred densities, but identifies areas of possible systematic problems with either the atomic physics or the observed intensities.Comment: in press at Ap

Vitamin D predicts all-cause and cardiac mortality in females with suspected acute coronary syndrome: a comparison with brain natriuretic peptide and high-sensitivity C-reactive protein

Vitamin D may not only reflect disease but may also serve as a prognostic indicator. Our aim was to assess the gender-specific utility of vitamin D measured as 25-hydroxy-vitamin D [25(OH)D] to predict all-cause and cardiac death in patients with suspected acute coronary syndrome (ACS) and to compare its prognostic utility to brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hsCRP). Blood samples were harvested on admission in 982 patients. Forty percent were women (65.9 ± 12.6 years). Mortality was evaluated in quartiles of 25(OH)D, BNP, and hsCRP, respectively, during a 5-year follow-up, applying univariate and multivariate analyses. One hundred and seventy-three patients died; 78 were women. In 92 patients (37 women), death was defined as cardiac. In women, the univariate hazard ratio (HR) for total death of 25(OH)D in Quartile (Q) 2 versus Q1, Q3 versus Q1, and Q4 versus Q1 was 0.55 (95% CI 0.33–0.93), 0.29 (95% CI 0.15–0.55), and 0.13 (95% CI 0.06–0.32), respectively. In females, it was an independent predictor of total and cardiac death, whereas BNP and hsCRP were less gender-specific. No gender differences in 25(OH)D were noted in a reference material. Accordingly, vitamin D independently predicts mortality in females with suspected ACS.publishedVersio

Recent Legal Literature

Reeves: A Treatise on speacial Subjects of the Law of Real Property; Miller: The Data of Jurisprudence; American State Reports, Vols. 96, 97, 98.; Flanders: An Exposition of the Constitution of the United States; Mikell: Cases on Criminal Law; Longsdorf (ed.): Current Law, a complete Encyclopedia of New Law; Harris: A Treatise on American Advocacy; Edgington: The Monroe Doctrin

Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation.

BackgroundThe first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.MethodsMARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.DiscussionA mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation

Incentive-based approaches to sustainable fisheries

The failures of traditional target-species management have led many to propose an ecosystem approach to fisheries to promote sustainability. The ecosystem approach is necessary, especially to account for fishery-ecosystem interactions, but by itself is not sufficient to address two important factors contributing to unsustainable fisheries — inappropriate incentives bearing on fishers, and the ineffective governance that frequently exists in commercial, developed fisheries managed primarily by total harvest limits and input-controls. We contend that much greater emphasis must be placed on fisher motivation when managing fisheries. Using evidence from more than a dozen ‘natural experiments’ in commercial fisheries, we argue that incentive-based approaches that better specify community, individual harvest, or territorial rights and also price ecosystem services — coupled with public research, monitoring and effective oversight — promote sustainable fisheries.incentives, sustainability, rights, fisheries management