A first step in determining appropriate amounts of obstetric anesthesia work

Abstract Ginosar, et al. describe a new performance indicator, the Obstetric Anesthesia Activity Index, to represent the current amount of obstetric anesthesia work done daily at each of 25 Israeli hospitals. The authors claim, correctly, that this index is a closer reflection of the anesthetic workload than simply looking at the number of deliveries at each hospital. However, the Obstetric Anesthesia Activity Index could easily be refined to reflect more closely the actual obstetric anesthesia workload by using the average cesarean delivery time for each hospital rather than one value for all hospitals. Although the authors state that they developed the Obstetric Anesthesia Activity Index out of concern for inadequate obstetric anesthesia manpower in Israel, they have not compared the Obstetric Anesthesia Activity Index with the size of the patient population or any measure of patient satisfaction or patient safety. In its current form, the Obstetric Anesthesia Activity Index describes the current work situation but does not evaluate the extent of the unmet need for additional anesthesia providers. Despite these shortcomings, the Obstetric Anesthesia Activity Index is an important first step in developing a tool to assess unmet obstetric anesthesia needs.</p

The reversal of essential fatty acid deficiency symptoms in the cheetah

Two members of the Order Carnivore (the lion and the domestic cat) are known to be Δ-6-desaturase deficient. Two anoestrous 8-year-old female cheetahs exhibiting symptoms consistent with essential fatty acid (EFA) deficiency were treated with encapsulated natural oils as supplement to their normal meat diet. The condition of both animals improved markedly, they came into full oestrus, mated, became pregnant, and have since produced healthy litters of cubs. This may be the first indication of a possible requirement for Δ-6-desaturase reaction products in this species

Applying Behavioural Insights to Policy: From Evidence to Practice

Evidence from the behavioural sciences is increasingly used to inform and improve policy around the world across many domains. These behavioural insights can be used for a number of purposes, such as improving communication to the public, encouraging healthier behaviour, and increasing the uptake of social services that improve life outcomes. However, not all evidence can be equally applied to any policy; the strength of the evidence and suitability for the situation at hand should be assessed case by case and ideally more evidence within the new context should be established. This report presents an approach to incorporating behavioural insights into policy using a number of examples while leveraging original work on mental health, trust, and decision-making in Lebanon. The aim is not to present a specific recipe or set of recommendations, but to share general concepts and examples for consideration in establishing a behavioural policy framework.This publication is funded through the UK Research and Innovation GCRF Research for Health in Conflict (R4HCMENA); developing capability, partnerships and research in the Middle and North Africa ES/P010962/1

Droplet Impingement Chemical Reactors and Methods of Processing Fuel

Fuel processors, methods of using fuel processors, and the like, are disclosed

Yeyunostomía de alimentación en cirugía. Contribución técnica y experiencia

The necessity to maintain the nutritional integrity in patients subjected to major surgery of the superior digestive tract has been broadly accepted. The enteral nutrition for yeyunostorny is accepted as more physiologic, sure and effective than the parenteral one. Materials ami Method: 171 yeyunostomies were indicated in: 151 patients with rnahignant neoplasm of the superior digestivelract, 15 with infected pancreatíc necrosis, 3 hi le-duodenum-pancreatic traumatisms and in 1 stenosis for gastroesophagic reflux.Depending on the pathological type, a yeyunostorny using the Witzell technique was carried out with either local or generalanesthesia ata 15 to 20 cm. of the Treitz angle. To facihitate the fixation of the catheter and to avoid the stenosis of the jejunum we have incorporated, as an original technical detail, the proximal serous section with cold scalpel in about 4 cm, that is to say in the sector to be tunneled. Results: There was not mortality in relation to the yeyunostomy. Among the minor complications we crnphasize the abdominal distension, cohic pain and diarrhea, situations that were reverted, controlling the debit and the feedi ng characteri sties. This approach could be maintained for period of 2 months and in sorne cases at home.Conclusions: Wc emphasize the great importance of the enteral feeding for yeyunostomy, for its of easy handling, securityand low cost that, together with the suggested technical detail, has allowed us to obtain a deeding road almost without inherentcomplications.La necesidad de mantener la integridad nutricional en pacientes sometidos a cirugía mayor del tracto digestivo superior ha sidoampliamente reconocida. La nutrición enteral por yeyunostomía se acepta como más fisiológica, segura y eficaz que la parenteral. Materiales y Método: 171 yeyunostomías fueron indicadas en 15 1 pacientes con neoplasias malignas del tracto digestivo superior, 15 necrosis pancreáticas infectadas, 3 traumatismos hi ho-duodeno-pancreáticos y una estenosis por reflujo gastroesofágico. Dependiendo del tipo de patología se realizó con anestesia, local o general, una veyunostomía a lo Witzell a 15 020cm. del ángulo de Treitz. Para facilitar la fijación del catéter y evitar la estenosis del yeyuno hemos incorporado como detalle técnico original la sección serosa proxirnal con bisturí frío en unos 4 cm, es decir en el sector a tunelizar. Resultados: No hubo mortalidad en relación a la yeyunostomía. Entre las complicaciones menores destacamos la distención abdominal, dolor eólico y diarrea, situaciones que revirtieron controlando el débito y las características de la alimentación. Esta vía pudo ser mantenida hasta por un período de 2 meses y en algunos casos a domicilio. Conclusiones: Destacamos la gran importancia de la alimentación enteral por yeyunostomía, por su fácil manejo seguridad y bajo costo que unido al detalle técnico sugerido en el presente trabajo nos ha permitido obtener una vía de alimentación prácticamente sin complicaciones inherentes a la misma