Lateral positioning for critically ill adult patients

We aim to assess the effect of the lateral position compared to other body positions on patient outcomes (mortality, morbidity and clinical adverse events during and following positioning) in critically ill adult patients. We will examine the single use of the lateral position (that is on the right or left side) and repeat use of the lateral position(s) in a positioning schedule (that is lateral positioning). We plan to undertake subgroup analysis for primary disease and condition, severity of illness, the presence of assisted ventilation and angle of lateral rotation.<br /

Evaluation of Methods for Diagnosing Contamination in Rural Wells

Three diagnostic procedures were tested to determine their potential usefulness in identifying faulty rural wells: (1) monitoring wells were constructed at three depths near each of three rural wells having a history of nitratenitrogen and/or herbicide contamination, and all wells were sampled daily for four weeks and tested for nitrate-nitrogen, atrazine, alachlor, metolachlor, and chloride; (2) a chloride tracer solution was ponded around each of the water supply wells, and the shallowest monitoring well at each test site, for a period of 8 h during which the wells were continuously pumped and sampled for the tracer; and (3) nitrate-nitrogen and herbicide samples were collected from the water supply wells during the 8-h pumping period to observe contaminant variability during periods of continuous drawdown. Daily sampling revealed little temporal variability in the quality of water from the monitoring wells or the contaminated water supply wells. The monitoring wells, though limited in number, identified significant contaminant stratification within the shallow glacial drift aquifers supplying the water supply wells, and identified one water supply well that was producing water with much poorer quality than the shallow aquifer was capable of producing. The chloride tracer test was successful in distinguishing contaminant entry via preferential flow from that occurring through matrix flow in two of the case study wells, but proved ineffective on a third well where monitoring well data strongly suggested casing leakage. Nitrate-nitrogen and herbicide data showed little variability during the 8-h period of continuous well drawdown

Two Quality Assurance Measures for Pesticide Analysis of Wellwater: Degradation in Storage and GC/ELISA Comparison

At the request of Environmental Protection Agency (EPA) project coordinators, two special quality assurance components were included in a study of herbicides in rural wells in Iowa. Since the study involved daily sampling of 88 rural wells for a period of four to five weeks, it was anticipated that samples would be in refrigerated storage for up to eight weeks during which microbial and chemical activity could lead to analyte loss. The sample degradation study reported here was conducted to insure that water samples containing three herbicides (atrazine, alachlor, and metolachlor) did not undergo excessive losses during storage. Results indicate no reduction in pesticide concentrations in six refrigerated water samples analyzed weekly during an eight-week storage period

Performance Evaluation of a Passively-Aerated Plastic-Wrapped Composting System Designed for Emergency Disposal of Swine Mortalities

Monitoring of a passively-aerated plastic-wrapped mortality composting system designed for emergency disposal of diseased swine highlighted the importance of the physical characteristics of materials used to envelop the carcasses. Inadequate moisture was a problem when using envelope materials such as ground cornstalks or straw having low density and high air-filled porosity. High O2 concentrations throughout these materials, and significantly higher moisture levels in the top layers than in the materials surrounding the carcasses, suggested significant air movement and transport of carcass moisture away from the carcasses, resulting in carcass desiccation and incomplete decay. Although internal temperatures and moisture levels in test units constructed with corn silage were much more favorable than in those constructed with cornstalks or straw, less carcass decomposition occurred. Settling and compaction, resulting in high bulk density and low air-filled porosity, caused low O2 concentrations that appeared to impair carcass decay in the silage test units

Performance of a Bio-secure Emergency Composting System for Disposal of Swine Carcasses

A plastic-wrapped passively-ventilated composting system used by the Canadian Food Inspection Agency for bio-secure emergency disposal of poultry mortalities during an avian influenza outbreak in 2004, was adapted and field tested to determine its feasibility for emergency disposal of infectious swine carcasses. System performance was evaluated during triple-replicated 8-week long trials, and 10-day long lab-scale studies were carried out to supplement the field results. Treatment variables included season (warm or cool), type of envelope material (cornstalks, oat straw, corn silage, wood shavings, alfalfa hay, and soybean straw), and initial moisture content of the envelope materials (low\u3c 20% w.b; moderate 40-65%). Performance variables included: final moisture content and leachate production; ability to sustain desirable internal O2 concentrations; % carcass (soft tissue) decomposition; and ability to attain and sustain pathogen-killing temperatures. Despite release of significant amounts of water from carcasses, and being wrapped in plastic sheeting, little leachate accumulation was observed and the moisture content of envelope materials was generally lower at the end of the trail than at the beginning. All materials, except corn silage, were able to maintain internal O2 concentrations of 10% or higher when air was supplied through flexible 10 cm diameter ducts spaced at 2m intervals. O2 concentrations in corn silage often dropped below 10% even though aeration ducts were spaced at 0.5m intervals. Corn silage demonstrated superior pathogen killing potential. Average daily temperatures in the carcass layer of silage test units during the first 30 days of composting (T30) exceeded 50 oC, and USEPA Class B criteria for pathogen reduction were achieved at 90% of monitored locations. T30 values for cornstalks, soybean straw, and alfalfa hay are about 40 oC, and Class B criteria were achieved in only 45-57% of monitored locations in the carcass layer. Wood shavings and oat straw had the worst temperature performance with T30 values of only about 30 oC, and a Class B success rate of about 35%. Mean soft tissue decomposition in the field was lowest in corn silage (72%), and highest in cornstalks and soybean straw (87% and 85% respectively)

Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder: an indirect treatment comparison

CONTEXT: OnabotulinumtoxinA and mirabegron have recently gained marketing authorisation to treat symptoms of overactive bladder (OAB). OBJECTIVE: To evaluate the relative efficacy of mirabegron and onabotulinumtoxinA in patients with idiopathic OAB. DESIGN: Network meta-analysis. DATA SOURCES: A search of 9 electronic databases, review documents, guidelines and websites. METHODS: Randomised trials comparing any licensed dose of onabotulinumtoxinA or mirabegron with each other, anticholinergic drugs or placebo were eligible (19 randomised trials were identified). 1 reviewer extracted data from the studies and a second reviewer checked the data. Candidate trials were assessed for similarity and networks were developed for each outcome. Bayesian network meta-analysis was conducted using both fixed-effects and random-effects models. When there were differences in mean baseline values between mirabegron and onabotulinumtoxinA trials they were adjusted for using network meta-regression (NMR). RESULTS: No studies directly comparing onabotulinumtoxinA to mirabegron were identified. A network was created for each of the 7 outcomes, with 3-9 studies included in each individual network. The trials included in the networks were broadly similar. Patients in the onabotulinumtoxinA trials had more urinary incontinence and urgency episodes at baseline than patients in the mirabegron trials and these differences were adjusted for using NMR. Both onabotulinumtoxinA and mirabegron were more efficacious than placebo at reducing the frequency of urinary incontinence, urgency, urination and nocturia. OnabotulinumtoxinA was more efficacious than mirabegron (50 and 25 mg) in completely resolving daily episodes of urinary incontinence and urgency and in reducing the frequency of urinary incontinence, urgency and urination. NMR supported the results of the network meta-analysis. CONCLUSIONS: In the absence of head-to-head trials comparing onabotulinumtoxinA to mirabegron, this indirect comparison indicates that onabotulinumtoxinA may be superior to mirabegron in improving symptoms of urinary incontinence, urgency and urinary frequency in patients with idiopathic OAB

Assessment of Dental Undergraduate Students’ Skills in Local Anesthesia Administration: A Longitudinal Study

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