Elevating the Head of Bed During Preoxygenation for Obese Patients Undergoing General Anesthesia: A Clinical Policy Proposal

Preoxygenation plays a vital role in ensuring patient safety for all patient populations, especially those considered clinically obese. The negative pathophysiological effects obesity has related to body habitus and respiratory mechanics increases the risk of unexpected adverse events. Obese patients encounter a 50% decrease in functional residual capacity (FRC) when undergoing general anesthesia. Dixon et al., (2005) addressed the link between efficient oxygenation and improving oxygen storage by lessening atelectasis and intrapulmonary shunting via preoxygenation in a more upright position. Can standardizing preoxygenation techniques among anesthesia providers improve patient safety and decrease hospital system’s risk by implementing an evidence-based clinical policy? An evidence review and evaluation was conducted with six articles being used as primary references in addition to supplementary articles and scholarly textbooks. A policy was developed using strong evidence, facility procedures, and AGREE II methods. A panel of experts was formed to assist with policy review, critiques, and expert opinions. An evaluation questionnaire assessed the available knowledge on the topic, clinical relevance, and adoptability of policy in clinical practice. The data indicated members of the expert panel were willing to adopt the evidence-based clinical policy within the Anesthesiology department and deemed the policy suitable for submission to the hospital clinical policy committee. Current evidence supports the need for elevating the head of bed during preoxygenation of obese patients undergoing general anesthesia. Anesthesia providers and operating room staff members would benefit from further education on this topic. Educational opportunities can further increase patient safety and decrease hospital system’s risk

On the breaking of collinear factorization in QCD

We investigate the breakdown of collinear factorization for non-inclusive observables in hadron-hadron collisions. For pure QCD processes, factorization is violated at the three-loop level and it has a structure identical to that encountered previously in the case of super-leading logarithms. In particular, it is driven by the non-commutation of Coulomb/Glauber gluon exchanges with other soft exchanges. Beyond QCD, factorization may be violated at the two-loop level provided that the hard subprocess contains matrix element contributions with phase differences between different colour topologies.Comment: Version 2: minor improvements for journal publicatio

MP716: New Forestry in Eastern Spruce-Fir Forests: Principles and Applications to Maine

Eastern North America\u27s spruce-fir forests have a unique ecological and human history which is reflected in their current vegetation, ownership patterns, and forest management practices. Furthermore, there are important differences within the region between the true boreal forest and the sub-boreal Acadian forest; this paper emphasizes the Acadian forest. Applying New Forestry to this region will require a modified approach which we outline by describing three basic principles. First, to provide the landscape context for New Forestry, we propose a triad of forest land allocation in which reserves and plantations would co-exist, surrounded by and embedded within a landscape managed by alternative silvicultural systems based on New Forestry principles. The second principle is that silvicultural systems should be patterned after local natural disturbance regimes. The third principle is that ecosystems that have been altered by past practices should be restored. Implementing these principles is discussed in a review of specific silvicultural practices: conservation and restoration of seed sources; retention of residual trees; long rotations; limited whole-tree harvesting; and two-aged stands maintained by irregular shelterwood cutting. At the landscape level we discuss how the triad might be implemented and the importance of size and distribution of harvest areas and riparian zones.https://digitalcommons.library.umaine.edu/aes_miscpubs/1027/thumbnail.jp

Oyster disease in a changing environment: Decrypting the link between pathogen, microbiome and environment

© 2018 Elsevier Ltd Shifting environmental conditions are known to be important triggers of oyster diseases. The mechanism(s) behind these synergistic effects (interplay between host, environment and pathogen/s) are often not clear, although there is evidence that shifts in environmental conditions can affect oyster immunity, and pathogen growth and virulence. However, the impact of shifting environmental parameters on the oyster microbiome and how this affects oyster health and susceptibility to infectious pathogens remains understudied. In this review, we summarise the major diseases afflicting oysters with a focus on the role of environmental factors that can catalyse or amplify disease outbreaks. We also consider the potential role of the oyster microbiome in buffering or augmenting oyster disease outbreaks and suggest that a deeper understanding of the oyster microbiome, its links to the environment and its effect on oyster health and disease susceptibility, is required to develop new frameworks for the prevention and management of oyster diseases