The Relationship Among Financial Institutions, Safeguards and Hydroelectric Dams in the Amazon

Since 2015, the Amazon experienced an infrastructure boom with more than $70 billion in infrastructure projects planned in the coming years. Large-scale projects have resulted in detrimental environmental and social impacts in the region over the last fifty years. This paper uses policy analysis and case studies to examine the evolution of financial institutions and their safeguards over time and how this evolution has affected the environmental and social impacts of hydroelectric dams in the Amazon. The case studies of two hydroelectric projects, the Coca Codo Sinclair Dam in Ecuador and the Belo Monte Dam in Brazil, highlight that the dams caused extensive environmental and social damage, including deforestation, loss of biodiversity, displacement and loss of livelihoods, among others. The safeguard approach of the financial institutions in these cases had little effect at mitigating the impact of the dams, demonstrating that the evolution of safeguards over time has not resulted in less environmentally and socially harmful hydroelectric projects in the Amazon. Financial institutions with minimal safeguards, mainly the national development banks from Brazil and China, have emerged as dominant actors in the region with little concern for the consequences of their financing. In order to protect this vulnerable ecosystem, governments of Amazonian countries should not develop any more large-scale hydroelectric dams and the Brazilian and Chinese national development banks should implement their own safeguards in order to approve new projects for funding

Preoperative Acute Normovolaemic Hemodilution (ANH) in combination with Hypotensive Epidural Anaesthesia (HEA) during knee arthroplasty surgery. No effect on transfusion rate. A randomized controlled trial [ISRCTN87597684]

BACKGROUND: Hypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient. Mean artery blood pressure is reduced to 45–50 mmHg and hereby a reduced blood loss. In this study we have combined HEA with preoperative acute normovolaemic hemodilution (ANH) in attempt to further reduce the blood loss and need for blood transfusion in total knee arthroplasty surgery (TKR). METHODS: Twenty-eight patients scheduled for TKR are randomised to ANH or no hemodilution (non-ANH). Both groups are anaesthetized with HEA. ANH is established with predonation of 20 % of the total blood volume, and replacement with equal volume of HAES 6 %. Blood re-transfusion is completed within 6 h. RESULTS: A mean of 877 ml blood was predonated (19.7 % of the total blood volume). Blood loss was, except from the intraoperative loss, significantly higher in ANH group. The total loss was 1306 mL (ANH) vs. 1026 mL (non-ANH), p < 0.05. Except from the first hour postoperatively, hematocrit was identical in between groups postoperatively. The amount of blood transfusion was identical 386 ml (ANH) vs. 343 ml (non-ANH) (ns). 50 % went through surgery without receiving blood (ANH) vs. 58 % (non-ANH). No renal, neurological or cardiopulmonary complications were registered. CONCLUSIONS: These data suggest no benefits in combining HEA and ANH in TKR surgery. Probably because of the reduced viscosity of the blood after ANH, there is an increased postoperative blood loss. The need for homologous blood transfusion was identical

The effect of postoperative pain on postoperative blood loss after sequential bilateral total knee arthroplasty

BACKGROUND: Bilateral total knee arthroplasty is generally accompanied by a significant amount of blood loss. We investigated the relationship between the intensity of pain and the amount of blood loss in the early postoperative period after bilateral total knee arthroplasty. METHODS: A prospective study was conducted on 91 patients who underwent elective sequential bilateral total knee arthroplasty for osteoarthritis. All patients received combined spinal and epidural anesthesia. Patients were divided into three groups based on their scores on the verbal numerical rating scale (VNRS) for pain at 6 hours postoperatively. The VNRS was classified as follows; mild pain (n = 34, VNRS score 0-4), moderate pain (n = 24, VNRS score 5-6), and severe pain (n = 33, VNRS score 7-10). We compared the mean arterial pressures and the amount of blood loss during the first 24 postoperative hours in the three groups. Factors influencing postoperative blood loss were analyzed. RESULTS: Postoperative mean arterial pressures and blood loss were not different among the groups. Of the factors examined, the amount of postoperative blood loss was only dependent on the amount of intraoperative blood loss (P = 0.001). CONCLUSIONS: Early postoperative pain has no effect on postoperative blood pressure and the amount of blood loss after bilateral total knee arthroplasty. For postoperative blood loss, intraoperative blood loss is the main determinant.ope

The Use of Preoperative Epoetin-α in Revision Hip Arthroplasty

PURPOSE: To evaluate the efficacy of preoperative epoetin-α on the revision hip arthroplasty patient. We hypothesized that epoetin-α will reduce blood transfusion. A pertinent review of the literature is provided. METHODS: Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-α. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used. RESULTS: Blood transfusion and length of stay were decreased in the epoetin-α group. Hemoglobin in the intervention group increased from 12.0 to 14.5, preoperatively. Patients who received epoetin-α were 0.78 (RR=0.225) times as likely to receive a transfusion. Number Needed to Treat (NNT) to avoid one allogeneic transfusion was 1.84. Age, Gender, BMI, ASA, total and hidden blood loss, preoperative Iron supplements, preop Hct, preop PLT, PT, PTT, and INR were similar. One (6.0%) patient developed an uncomplicated deep venous thrombosis in the intervention group. CONCLUSIONS: The mildly anemic revision hip arthroplasty patient is at increased risk for transfusion. Epoetin-α increased preoperative hemoglobin counts and reduced transfusions in this study; it also decreased patient length of hospital stay likely allowing for an earlier readiness to resume normal activities and/or meet short-term milestones. A randomized study to evaluate the direct and indirect costs of such a treatment methodology in the mildly anemic revision patient may be warranted

Being lahu in a Thai school : an inquiry into ethnicity, nationalism, and schooling

Ph.D. University of Hawaii at Manoa 2013.Includes bibliographical references.At the heart of the transformation of Thailand from a Buddhist Kingdom into a modern nation state was the "invention" of a Thai national identity, which was spread throughout the country using a state-run education system. Some groups of people, however, were considered so distinct that they were unable to adopt the national heritage; as a result, they were regarded as 'non-Thai' ethnic minorities and occupied marginal positions within the nation. In northern Thailand, the Lahu are one such ethnic minority group. During the past 60 years, many Lahu have attended Thai schools. While scholars have noted that the primary aim of Thai schools has been the national integration of a diverse population, little research has been conducted on the experiences of ethnic minorities within this context. This study inquires into and describes their lived experiences of being ethnically Lahu at Banrongrian Secondary School in Chiang Rai Province, Thailand. Specific attention was given to participants' interpretation of the significance of their ethnicity during their time in secondary school. In order to achieve this purpose, a qualitative transcendental phenomenological approach was employed. From June to September 2012, I recruited and interviewed ten Lahu individuals who attended Banrongrian Secondary School. There were three common themes among most of the participants. First, most participants attended primary schools founded for ethnic minority students in the mountains. As a result, during secondary school, they were ill-prepared and saw themselves as having inferior knowledge as compared to their Thai classmates. Next, most participants spoke Lahu as their native language. As Thai was the language used in school, several participants experienced academic and social challenges. Lastly, all participants believed that their Thai peers looked down on them because of their ethnicity. The findings suggest two conclusions. First, being ethnically Lahu was a difference that made a significant difference in participants' experiences of school. Second, policies of national integration contributed to the marginalization of the participants as ethnic minority students in the context of school