Moral demands and not doing the best one can

The problem of extreme demands is one of the most intractable in contemporary moral theory. On the one hand, it seems that a failure to prevent great suffering at little cost to ourselves is morally wrong; given the amount of suffering in the world and the comparatively trivial nature of the requisite sacrifices, this intuition demands that we give up quite a lot. On the other hand, it doesn’t seem to us that we act wrongly in living lives characterised by only moderate sacrifice, in which our time and resources are disproportionately used to benefit ourselves and those close to us. These two intuitions are extremely difficult to reconcile within any moral theory that recognises a duty to promote the general good. In this paper, however, I will suggest one possible way of doing so. My suggestion requires taking a closer look at the way in which the demand to the promote the good is derived: specifically, at the way our option set is characterised and the information that we take into account in weighing these options. I will suggest that there are certain assumptions it is plausible to make regarding the relevance of information about our own and other agents’ actions, and that once these assumptions are made, we can see how permissions may be derived within the framework of good-promotion.Jennie Louis

Improving spatial resolution in soil and drainage data to combine natural and anthropogenic water functions at catchment scale in agricultural landscapes

Discrepancies in time-space representation of indata and calibration/validation data obstructs analysis of hydrological processes thatlink natural and anthropogenic water infrastructure in catchments and landscapes. To improve indata for hydrological- and modelling of the soil-plant-atmosphere-continuum, this paper presents a high-resolution dataset of hydrological functions in the agricultural landscape of Tidan, Sw Sweden. We firstly address spatial representation of soil physical parameters, describing soil water flows and storage. Secondly, we derive tile drainage datasets from historical maps. Lastly, we explore delineation and spatial location of streams, ditches and waterbodies to improve description of water connectivity. The new soil datasets with top- and subsoil descriptions varied in depicting the sensitivity of saturated hydraulic conductivity and water holding capacity. The most representative soil map showed moderate (34%) - to very rapid (21%) saturated hydraulic conductivity, water holding capacity below 40 mm 10 cm−1 (94%) and a dry bulk density ranging between 1.2 and 1.8 g cm−3 (71%). The digitalization of drained fields suggests that 69% of the arable fields are under tile drainage, dominated by sandy loam, loam and clay loam. The combined stream network resulted in 5350 km of streams and ditches, + 14% km and + 129%, respectively, compared to available best resolution datasets. Landscape surface water storage increased with a small addition (+ 6439 m3 storage potential) compared to previously available datasets. The improved descriptors of natural and anthropogenic flow and storage can potentially serve to improve water quantity and quality modelling under current and future climate- and hydrological changes

Anaesthesia for cesarean section in the dog – a litterature review

Kunnskap om anestesi ved keisersnitt hos hund er viktig, da keisersnitt ofte er en akutt prosedyre hvor tispe og valper kan være påkjente, tispas fysiologi er forandret, og legemidler krysser placenta og kan påvirke valpene negativt. Drektige tisper har et fysiologisk økt slagvolum og hjertefrekvens, som medfører en dårligere evne til å kompensere for kardiovaskulære forandringer under anestesien. Maternal hypotensjon leder til redusert perfusjon av placenta, og økt risiko for hypoksemi hos valpene. Drektige tisper har i tillegg økt oksygenforbruk, som gjør dem mer utsatt for hypoksemi og hyperkapni ved hypoventilering eller apné. Flere faktorer, som økt buktrykk, redusert tonus i det øsofageale sfinkteret og forsinket tømming av ventrikkelen, gjør drektige tisper mer utsatt for regurgitering og aspirasjonspneumoni. I tillegg har anestesimidler en smalere terapeutisk indeks hos drektige tipser, og de har behov for en dosereduksjon på ca. 30 – 60 %. Det er viktig å ta hensyn til disse fysiologiske forandringene ved å drive hensiktsmessig overvåkning og støttebehandling. Tispa og de ufødte valpene kan ha stor økonomisk og emosjonell verdi for oppdretteren, og komplikasjoner kan føre til konflikter mellom oppdretter og veterinær. I denne oppgaven er det gjennomgått dagens tilgjengelige studier som omhandler anestesi ved keisersnitt hos hund. Litteratursøket er gjort i søkemotoren PubMed, og det er brukt søkeordene ‘dog’ + ‘caesarean/cesarean’ og ‘bitch’ + ‘caesarean/cesarean’. Det ble til slutt inkludert 22 artikler. Ved gjennomgang av tilgjengelig litteratur er det funnet at gassanestesi gir gode resultater ved keisersnitt, og dataene tyder på at alfaksaloninduksjon gir bedre apgarscore hos valpene enn propofol. Hvis man ikke har tilgang på gassanestesi, kan det benyttes injeksjonsanestesi. Ketamin og barbiturater bør trolig unngås, da begge er vist å gi nedsatt vigør hos valpene, og barbiturater er assosiert med økt valpedødelighet. Det er behov for mer forskning på alfaksalon- og propofol-TIVA, men det som foreligger viser en negativ effekt på valpe- og tisperelaterte faktorer sammenlignet med gass- eller epiduralanestesi. Epiduralanestesi kan brukes alene eller i kombinasjon med generell anestesi, og har gitt gode resultater på valpevigør og -overlevelse. Derimot har man sett uheldige kardiovaskulære effekter hos tispa. Hvis det skal benyttes premedikasjon er det vanskelig å komme med klare anbefalinger, da det er gjort få gode studier på dette. Opioider er trolig et godt alternativ, og medetomidin og deksmedetomidin har gitt gode resultater i studier på hund, men ikke på andre dyrearter. Xylazin, fenotiaziner og benzodiazepiner bør trolig unngås.Caesarean section is a common surgical procedure in the bitch, and the need for knowledge regarding this surgery has become increasingly important. One must take into consideration the state of the bitch and puppies, in addition to the numerous physiological changes in the parturient patient. The parturient patient has a decreased ability to compensate for cardiovascular changes during anaesthesia, because of an increased heart rate and stroke volume, which causes a decreased cardiac reserve. If maternal hypotension occurs, perfusion of the maternal placenta is reduced, which makes the foetus more exposed to developing hypoxemia. Pregnant bitches also have an increased oxygen consumption, leading to a greater chance of developing hypercapnia and hypoxemia if hypoventilation or apnea should occur

Metformin and dietary advice to improve insulin sensitivity and promote gestational restriction of weight among pregnant women who are overweight or obese: the GRoW Randomised Trial

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Obesity is a significant global health problem, with approximately 50% of women entering pregnancy having a body mass index greater than or equal to 25 kg/m2. Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant. Currently available data from large scale randomised trials and systematic reviews highlight only modest effects of antenatal dietary and lifestyle interventions in limiting gestational weight gain, with little impact on clinically relevant pregnancy outcomes. Further information evaluating alternative strategies is required. The aims of this randomised controlled trial are to assess whether the use of metformin as an adjunct therapy to dietary and lifestyle advice for overweight and obese women during pregnancy is effective in improving maternal, fetal and infant health outcomes. Methods Design: Multicentre randomised, controlled trial. Inclusion Criteria: Women with a singleton, live gestation between 10+0-20+0 weeks who are obese or overweight (defined as body mass index greater than or equal to 25 kg/m2), at the first antenatal visit. Trial Entry & Randomisation: Eligible, consenting women will be randomised between 10+0 and 20+0 weeks gestation using an online computer randomisation system, and randomisation schedule prepared by non-clinical research staff with balanced variable blocks. Stratification will be according to maternal BMI at trial entry, parity, and centre where planned to give birth. Treatment Schedules: Women randomised to the Metformin Group will receive a supply of 500 mg oral metformin tablets. Women randomised to the Placebo Group will receive a supply of identical appearing and tasting placebo tablets. Women will be instructed to commence taking one tablet daily for a period of one week, increasing to a maximum of two tablets twice daily over four weeks and then continuing until birth. Women, clinicians, researchers and outcome assessors will be blinded to the allocated treatment group. All women will receive three face-to-face sessions (two with a research dietitian and one with a trained research assistant), and three telephone calls over the course of their pregnancy, in which they will be provided with dietary and lifestyle advice, and encouraged to make change utilising a SMART goals approach. Primary Study Outcome: infant birth weight >4000 grams. Sample Size: 524 women to detect a difference from 15.5% to 7.35% reduction in infants with birth weight >4000 grams (p = 0.05, 80% power, two-tailed). Discussion This is a protocol for a randomised trial. The findings will contribute to the development of evidence based clinical practice guidelines

Handling misclassified stratification variables in the analysis of randomised trials with continuous outcomes

Many trials use stratified randomisation, where participants are randomised within strata defined by one or more baseline covariates. While it is important to adjust for stratification variables in the analysis, the appropriate method of adjustment is unclear when stratification variables are affected by misclassification and hence some participants are randomised in the incorrect stratum. We conducted a simulation study to compare methods of adjusting for stratification variables affected by misclassification in the analysis of continuous outcomes when all or only some stratification errors are discovered, and when the treatment effect or treatment-by-covariate interaction effect is of interest. The data were analysed using linear regression with no adjustment, adjustment for the strata used to perform the randomisation (randomisation strata), adjustment for the strata if all errors are corrected (true strata), and adjustment for the strata after some errors are discovered and corrected (updated strata). The unadjusted model performed poorly in all settings. Adjusting for the true strata was optimal, while the relative performance of adjusting for the randomisation strata or the updated strata varied depending on the setting. As the true strata are unlikely to be known with certainty in practice, we recommend using the updated strata for adjustment and performing subgroup analyses, provided the discovery of errors is unlikely to depend on treatment group, as expected in blinded trials. Greater transparency is needed in the reporting of stratification errors and how they were addressed in the analysis

Endangered Archaeology in the Middle East and North Africa: Introducing the EAMENA Project

This project uses satellite imagery and historic aerial photographs to discover and interpret archaeological sites. It has created an open access database of archaeological records that provides basic information so that the sites can be better under- stood and preserved in the future. The threats to sites in the Middle East and North Africa are increasing and creating a record of previously unrecorded sites using this methodology may be our the last chance before they are destroyed