Efficacy and safety of 6% hydroxyethyl starch 130/0.4 (Voluven) for perioperative volume replacement in children undergoing cardiac surgery: a propensity-matched analysis

Introduction: Six percent hydroxyethyl starch (HES) 130/0.4 is considered an alternative to human albumin (HA) and crystalloids for volume replacement in children undergoing cardiac surgery. In this large propensity-matched analysis, we aimed to assess the efficacy and safety of replacing HA with HES for intraoperative volume therapy in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: We retrospectively reviewed our database, including children who underwent cardiac surgery between January 2002 and December 2010. Four percent HA was used until 2005; it was replaced by HES thereafter. Demographic data, intra- and postoperative blood loss and blood component transfusions were recorded, together with the incidence of postoperative complications and mortality. We performed a propensity-matched analysis using 13 possible confounding factors to compare children who received either HES or HA intraoperatively. The primary objectives included the effects of both fluids on intraoperative fluid balance (difference between fluids in and fluids out (efficacy)) and blood loss and exposure to allogeneic blood products (safety). Secondary safety outcomes were mortality and the incidence of postoperative renal dysfunction. Results: Of 1,832 children reviewed, 1,495 were included in the analysis. Intraoperative use of HES was associated with a less positive fluid balance. Perioperative blood loss, volume of red blood cells and fresh frozen plasma administered, as well as the number of children who received transfusions, were also significantly lower in the HES group. No difference was observed regarding the incidence of postoperative renal failure requiring renal replacement therapy or of morbidity and mortality. Conclusions: These results confirm that the use of HES for volume replacement in children during cardiac surgery with CPB is as safe as HA. In addition, its use might be associated with less fluid accumulation. Further large studies are needed to assess whether the reduction in fluid accumulation could have a significant impact on postoperative morbidity and mortality

Creating agroforestry innovation and best practice leaflets

A key output of the EU FP7 project AGFORWARD was a series of 46 agroforestry innovation and 10 agroforestry best practice leaflets for European farmers and other stakeholders. This paper describes the process of over 80 people working together to create the leaflets and the overall result

Agroforestry for high value tree systems in Europe

Most farm-based agroforestry projects focus on the integration of trees on arable or livestock enterprises. This paper focuses on the integration of understorey crops and/or livestock within high value tree systems (e.g., apple orchards, olive groves, chestnut woodlands, and walnut plantations), and describes the components, structure, ecosystem services and economic value of ten case studies of this type of agroforestry across Europe. Although their ecological and socio-economic contexts vary, the systems share some common characteristics. The primary objective of the farmer is likely to remain the value of tree products like apples, olives, oranges, or nuts, or particularly high value timber. However there can still be production, environmental or economic benefits of integrating agricultural crops such as chickpeas and barley, or grazing an understorey grass crop with livestock. Three of the systems focused on the grazing of apple orchards with sheep in the UK and France. The introduction of sheep to apple orchards can minimise the need for mowing and provide an additional source of revenue. Throughout the Mediterranean, there is a need to improve the financial viability of olive groves. The case studies illustrate the possibility of intercropping traditional olive stands with chickpea in Greece, or the intercropping of wild asparagus in high density olive groves in Italy. Another system studied in Greece involves orange trees intercropped with chickpeas. Stands of chestnut trees in North-west Spain can provide feed for pigs when the fruit falls in November, and provide an excellent habitat for the commercial production of edible mushrooms. In Spain, in the production of high quality walnut trees using rotations of up to 50–60 years, there are options to establish a legume-based mixed pasture understorey and to introduce sheep to provide financial and environmental benefits

How is agroforestry perceived in Europe? An assessment of positive and negative aspects by stakeholders

Whilst the benefits of agroforestry are widely recognised in tropical latitudes few studies have assessed how agroforestry is perceived in temperate latitudes. This study evaluates how stakeholders and key actors including farmers, landowners, agricultural advisors, researchers and environmentalists perceive the implementation and expansion of agroforestry in Europe. Meetings were held with 30 stakeholder groups covering different agroforestry systems in 2014 in eleven EU countries (Denmark, France, Germany, Greece, Hungary, Italy, Netherlands, Portugal, Spain, Sweden and the United Kingdom). In total 344 valid responses were received to a questionnaire where stakeholders were asked to rank the positive and negative aspects of implementing agroforestry in their region. Improved biodiversity and wildlife habitats, animal health and welfare, and landscape aesthetics were seen as the main positive aspects of agroforestry. By contrast, increased labour, complexity of work, management costs and administrative burden were seen as the most important negative aspects. Overall, improving the environmental value of agriculture was seen as the main benefit of agroforestry, whilst management and socio-economic issues were seen as the greatest barriers. The great variability in the opportunities and barriers of the systems suggests enhanced adoption of agroforestry across Europe will be most likely to occur with specific initiatives for each type of system

France

Current practices and problems of forest vegetation management in France are described in the context of research on alternatives to herbicides

France

chap. 4Current practices and problems of forest vegetation management in France are described in the context of research on alternatives to herbicides

France

Current practices and problems of forest vegetation management in France are described in the context of research on alternatives to herbicides

Administrative Texts from Tell Beydar (Seasons 1996-2000)

info:eu-repo/semantics/publishe