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

Robustfisk Analyse af markedsmuligheder for økologiske ørredprodukter på det danske, tyske, østrigske, schweiziske og franske seafood marked

Denne markedsanalyse har haft til formål at undersøge markedet for økologisk regnbueørred og forsøge at afdække det fremtidige marked for økologisk ørred i udvalgte europæiske lande. Tyskland er et af de største markeder for økologiske ørred produkter og er den største aftager af danske økologiske ørred produkter. Analysen er fortaget ved hjælp af telefoninterviews, personlige interviews, besøg i forretninger (primært Tyskland), besøg på udstillinger og via tilgængelig litteratur og statistiske oplysninger. Hovedresultaterne er: Der er en stigende efterspørgsel efter økologiske produkter på de forskellige nationale markeder i Europa (EU). Priserne på økologiske ørredprodukter ligger omkring 30% over priserne for konventionelle ørredprodukter. Danmark er en af de største producenter af økologiske ørreder i verden og blandt de største producenter i EU. Frankrig kan med sin egen produktion på ca. 720 tons økologiske ørreder i 2015 på sigt udgøre en trussel for danske producenter på det tyske marked. Yderligere produktion i Danmark, vil gavne forsyningssikkerheden på markedern

Evaluation of Clinical and Clinical Chemical Parameters in Periparturient Cows

Certain blood parameters and clinical symptoms have been connected with milk fever and a hypocalcemic condition in the cow. The present study intended to establish a mutual connection between relevant blood parameters and potentially valuable background information about the cow and its observed clinical symptoms at calving. Two veterinarians were summoned within 12 h of parturition of 201 cows, distributed among 41 Danish commercial herds. Cows were at different parity levels (2 to 10) and breeds and management differed broadly among herds. A blood sample was taken from the vena jugularis or the tail vein and was subsequently analyzed in the laboratory. Furthermore, 13 different clinical symptoms were recorded as categorical data. We investigated associations among the data obtained. We assessed an interpretative model for actual blood calcium level with blood parameters and background knowledge of the animals. We established a path analysis using background knowledge, blood parameters, and results of clinical examinations to uncover causal connections among the variables. Twenty-six percent of the animals were diagnosed as having milk fever and subsequent blood analyses revealed a high frequency of hypocalcemia within the general range from 0.69 to 2.73 mmol of Ca per liter. Rectal temperature, inorganic blood phosphate, and potassium were all directly correlated with blood calcium, while glucose, lactate, and magnesium were inversely associated with calcium. Blood osteocalcin was significantly lower in hypocalcemic animals, indicating that de novo synthesis of bone was arrested during hypocalcemia. A mixed effect linear interpretative model explained 75% of the variation in blood calcium. Clinical symptoms like mood, appetite, muscle shivering, rumen motility, and paresis were individually correlated with blood calcium and were thereby predictive of hypocalcemia. The path analysis showed the central role of calcium in affecting the clinical symptoms. However, several other factors contributed to hypocalcemia

The organizational design of offshoring

Offshoring can be defined as the relocation of organizational tasks and services to foreign locations. Increasingly, firms experience that unforeseen costs and difficulties of managing offshoring undercut anticipated benefits; that unexpected challenges of offshoring jeopardize and eventually undermine initial objectives. Guided by the research question—what are the organizational consequences of offshoring?—the purpose of this thesis is to investigate why some firms fail when offshoring and other do not. The thesis consists of four research papers using various datasets and methodologies that investigate offshoring in an organizational context. The first paper investigates how the complexity of offshoring leads to ‘hidden costs’ of implementing offshoring activities. The second paper looks at how these hidden reconfiguration costs influence the process performance of the offshored activity and how this relationship is moderated by the modularity of that activity. The third paper investigates the effect of the organizational reconfiguration of offshoring on firms’ strategies. The final paper studies different strategies of adaptation in offshoring. Taken together, this thesis argues that whether firms relocate activities with the purpose of accessing resources or as a response to political pressures, the process of offshoring presents firms with the challenge of coordinating and integrating offshoring activities in a global organization. The complexities and uncertainties of an organization consisting of a number of offshored activities (in contrast to an organization with only co-located activities) require firms to invest additional resources in coordination mechanisms so that an efficient reintegration can be achieved