The evidence for small-volume resuscitation with hyperoncotic albumin in critical illness

Small-volume resuscitation of critically ill patients with hyperoncotic albumin offers a number of theoretical advantages, such as increasing intravascular volume in excess of the volume of fluid administered and reducing interstitial edema. Whilst iso-oncotic albumin has been shown to be equi-effective to isotonic saline for the resuscitation of critically ill patients without associated traumatic brain injury, the efficacy of hyperoncotic albumin for resuscitation has not been evaluated in large-scale randomized-controlled trials. Overall, the evidence for resuscitation with hyper-oncotic albumin is limited by studies of poor methodological quality with heterogenous study populations and control regimens. There is marginal qualitative evidence of improvements in surrogate outcomes in disparate patient populations, but no evidence of any survival benefit associated with resuscitation with hyperoncotic albumin. Given the lack of evidence and clinical uncertainty about the efficacy of hyperoncotic albumin, a large-scale randomized-controlled trial is required to determine its role in the acute resuscitation of hypovolemic or hypoalbuminemic critically ill patients

Community–groundwater compatibility assessments: An approach towards sustainable groundwater development

To address water availability problems in a semi-arid country like South Africa, the National Water Act (RSA, 1998) proposes that specialists adopt an approach that is strategic, deliberate and dictated by socio-political reforms and socioeconomic development needs on a programmatic basis for long-term sustainability. To achieve this goal an approach is developed to determine community–groundwater compatibility as part of the initial stages of regional rural groundwaterdevelopment projects in the Eastern Cape Province, South Africa. The steps followed in the community–groundwater compatibility assessment include:• A desktop study where available literature is collected and reviewed. From this information and history, the sociopolitical challenges that will have to be faced for the successful completion of the groundwater-development project in the study area can often be established. This is valuable information to assist the hydrogeological team in planning the community–groundwater compatibility assessment, taking note of pitfalls and lessons learnt from previous approaches that might not always have been successful.• A socio-economic characterisation includes setting up a contact database for the community authorities and technical managers within the study. The contact database includes all contact details of the ward  councillors/technical managers as well as any relevant information or comments made by the ward councillor/technical manager during the conversation. All identified stakeholders must also be contacted, informing them of the project and study. The data obtained from the role-players are used to develop a social-character map.• Site surveys and sampling are based on the social-character map. The study team assesses the knowledge communities carry concerning groundwater as well as their general attitude towards the use of  groundwater.• Data processing and analyses include the statistical processing of the collected data to assess the comprehensive measure of groundwater compatibility per area, and the individual indicators of the groundwater-compatibility index are given a relative score. This enables the different indicators for groundwater compatibility per area to be combined to give a single composite score for each spatial area. Target areas are finally characterised in terms of their ‘community–groundwater compatibility index’. Maps showing the social and basic hydrogeological character of target areas are valuable tools towards assisting local authorities indecision-making

The Unborn and A, B, & C v Ireland

From text: A, B, and C v Ireland (ABC-case) arose from an application lodged on 15 July 2005 to the European Court of Human Rights, which was directly referred to the Grand Chambers (thus indicating the importance of the case) for a hearing which commenced on 9 December 2009

Linking climate change and progressive eutrophication to incidents of clustered animal mortalities in different geographical regions of South Africa

Cyanobacterial blooms have become an increasing problem in South African freshwater bodies. Since certain species of cyanobacteria are well-known for biosynthesis of potent hepatic and neurotoxins, such blooms can pose a significant threat to the health of animals and humans. The massiveproliferation of these organisms in rivers and lakes is largely due to progressive eutrophication. However, a warming trend in the Southern hemisphere, indicated by a threefold increase in the minimum temperature compared to maximum temperature between 1950 and 1990, is likely the cause of the increasing occurrence of toxic cyanobacterial bloom forming species, previously hampered by low water temperatures in different geographical regions of South Africa

The effect of infusions of adrenaline, noradrenaline and dopamine on cerebral autoregulation under isoflurane anaesthesia in an ovine model

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsThe effects of infusions of adrenaline, noradrenaline and dopamine on cerebral autoregulation under steady-state isoflurane anaesthesia were compared with the awake state. Six studies each were conducted in two cohorts of adult ewes: awake sheep and those anaesthetized with 2% isoflurane anaesthesia. In random order, each animal received ramped infusions of adrenaline, noradrenaline (0-40 µg/min) and dopamine (0-40 µg/kg/min). Cerebral blood flow was measured continuously from changes in Doppler velocities in the sagittal sinus. Autoregulation was determined by linear regression analysis between cerebral blood flow and mean arterial pressure. Isoflurane did not significantly alter cerebral blood flow relative to pre-anaesthesia values (P>0.05). All three catecholamines significantly and equivalently increased MAP from baseline in a dose dependent manner in both the awake and isoflurane cohorts. Although adrenaline significantly increased cerebral blood flow from baseline in the awake cohort (P0.05). Over a specific dose range, systemic hypertension induced by adrenaline, noradrenaline and dopamine did not significantly increase cerebral blood flow under 2% isoflurane anaesthesia. The concomitant administration of isoflurane and the catecholamines was not associated with altered autoregulatory function compared to the awake state.http://www.aaic.net.au/Article.asp?D=200236

Cerebrovascular carbon dioxide reactivity in sheep: Effect of propofol or isoflurane anaesthesia

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsPropofol and isoflurane are commonly used in neuroanaesthesia. Some published data suggest that the use of these agents is associated with impaired cerebral blood flow/carbon dioxide (CO₂) reactivity. Cerebrovascular CO₂ reactivity was therefore measured in three cohorts of adult merino sheep: awake (n=6), anaesthetized with steady-state propofol (15 mg/min; n=6) and anaesthetized with 2% isoflurane (n=6). Changes in cerebral blood flow were measured continuously from changes in velocities of blood in the sagittal sinus via a Doppler probe. Alterations in the partial pressure of carbon dioxide in arterial blood (PaCO₂) over the range 18-63 mmHg were achieved by altering either the inspired CO₂ concentration or the rate of mechanical ventilation. Cerebral blood flow/CO₂ relationships were determined by linear regression analysis, with changes in cerebral blood flow expressed as a percentage of the value for a PaCO₂ of 35 mmHg. Propofol decreased cerebral blood flow by 55% relative to pre-anaesthesia values (P=0.0001), while isoflurane did not significantly alter cerebral blood flow (88.45% of baseline, P=0.39). Significant linear relationships between cerebral blood flow and CO₂ tension were determined in all individual studies (r2 ranged from 0.72 to 0.99). The slopes of the lines were highly variable between individuals for the awake cohort (mean 4.73, 1.42-7.12, 95% CI). The slopes for the propofol (mean 2.67, 2.06-3.28, 95% CI) and isoflurane (mean 2.82, 2.19-3.45, 95% CI) cohorts were more predictable. However, there was no significant difference between these anaesthetic agents with respect to the CO₂ reactivity of cerebral blood flow.J. A. Myburgh, R. N. Upton, G. L. Ludbrook, A. Martinez, C. Granthttp://www.aaic.net.au/Article.asp?D=200137

Response of Grape and Wine Phenolic Composition in Vitis vinifera L. cv. Merlot to Variation in Grapevine Water Status

Grape and wine phenolic composition was monitored over two consecutive seasons in Vitis vinifera cv. Merlotfollowing application of irrigation treatments that produced seasonal average stem water potentials rangingbetween -0.7 MPa and -1.4 MPa. Fresh weight of berries was significantly reduced in response to water deficit,primarily due to decreases in pericarp weight. Increases in the concentration of grape anthocyanins andflavonols in response to water deficit were found when expressed per unit grape berry fresh weight. Skin-derivedtannin concentration in grape berries was not affected by the irrigation treatments. The concentration of grapederivedphenolics was monitored during five days of fermentation in a small-lot winemaking experiment. Duringfermentation, the concentration of anthocyanins and flavonols in wine were highest in the non-irrigated and lowfrequency-irrigated treatments, which was reflected in changes in the wine colour of ferments. Finished winesfrom non-irrigated and low frequency irrigated grapevines showed increases in bisulphite-resistant pigmentswhen compared with those irrigated at a high frequency, but differences in phenolic composition were minor.Increases in bisulphite-resistant pigments were associated with increases in vitisin A and polymeric pigmentin the first and second seasons of the study respectively. Ageing of wines for an 18-month period increasedbisulphite-resistant pigments, and treatment differences in wine colour density were enhanced, such thatincreases in both parameters were associated with the non-irrigated and low-frequency-irrigated treatments

New sepsis definition changes incidence of sepsis in the intensive care unit

Sepsis lacks pathognomonic clinical features and a definitive biochemical or histological diagnostic test. As a result, since 1992, diagnosis of sepsis has been based on the presence of two or more of the criteria characterising the systemic inflammatory response syndrome (SIRS) (Table 1) arising from suspected or proven infection. In response to data questioning this construct, new criteria redefining sepsis, based on the Sequential Organ Failure Assessment (SOFA) score, have been proposed: Sepsis-3 (Table 1). The epidemiological and clinical implications of adopting these new criteria are currently unknown. We aimed to estimate the impact of adopting SOFA-based diagnostic criteria for sepsis on the diagnosis and apparent mortality of sepsis in Australian and New Zealand intensive care units