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Selection of the anesthetic technique to be employed during a procedure begins during the preoperative evaluation with consideration of factors such as the patient’s comorbidities and preferences and the type of procedure to be performed. Oftentimes, general anesthesia is not necessary and the procedure can be performed under a lesser depth of sedation. Procedural sedation is a technique that allows the patient to tolerate the discomfort of a procedure while still maintaining cardiorespiratory function. In order to accomplish this, the anesthesia provider administers sedative, dissociative, and/or analgesic agents alone or in combination [1].
Preoperatively, the patient will transition from different depths of anesthesia, including the levels of sedation, to general anesthesia (GA). Sedation is a continuum of symptoms that range from minimal symptoms of anxiolysis to symptoms of moderate and deep sedation. Moderate sedation is defined by the patient remaining asleep, but being easily arousable. Deep sedation is achieved when the patient is only arousable to painful stimulation. GA refers to medically induced loss of consciousness with concurrent loss of protective reflexes and skeletal muscle relaxation. GA is most commonly achieved via induction with intravenous sedatives and analgesics, followed by maintenance of volatile anesthetics [1]. Table 9.1 lists the depths of anesthesia and associated characteristics.
Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
Aims
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
Method
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
Results
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Conclusions
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
Coronavirus disease 2019 (COVID-19) spread globally, including across Europe, resulting in different morbidity and mortality outcomes. The aim of this study was to explore the progression of the COVID-19 pandemic over 18 mo in relation to the effect of COVID-19 vaccination at a population level across 35 nations in Europe, while evaluating the data for cross-border epidemiological trends to identify any pertinent lessons that can be implemented in the future.
Methods:
Epidemiological data were obtained from European Centre for Disease Prevention and Control and Our World in Data databases while Ministry of Health websites of each respective country and local newspapers were used for COVID-19-related vaccination strategies. Case, mortality, and vaccination incidence comparative analyses were made across neighboring countries.
Results:
Similar morbidity and mortality outcomes were evident across neighboring countries over 18 mo, with a bidirectional relationship evident between cumulative fully vaccinated population and case fatality rates.
Conclusion:
Countries’ COVID-19 outcome is related on national mitigative measures, vaccination rollouts, and neighboring countries’ actions and COVID-19 situations. Mass population vaccination appeared to be effective in reducing COVID-19 case severity and mortality rates. Vaccination equity and pan-European commitment for cross-border governance appear to be the way forward to ensure populations’ return to “normality.”
Seven half-day regional listening sessions were held between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide-resistance management. The objective of the listening sessions was to connect with stakeholders and hear their challenges and recommendations for addressing herbicide resistance. The coordinating team hired Strategic Conservation Solutions, LLC, to facilitate all the sessions. They and the coordinating team used in-person meetings, teleconferences, and email to communicate and coordinate the activities leading up to each regional listening session. The agenda was the same across all sessions and included small-group discussions followed by reporting to the full group for discussion. The planning process was the same across all the sessions, although the selection of venue, time of day, and stakeholder participants differed to accommodate the differences among regions. The listening-session format required a great deal of work and flexibility on the part of the coordinating team and regional coordinators. Overall, the participant evaluations from the sessions were positive, with participants expressing appreciation that they were asked for their thoughts on the subject of herbicide resistance. This paper details the methods and processes used to conduct these regional listening sessions and provides an assessment of the strengths and limitations of those processes.
Herbicide resistance is ‘wicked’ in nature; therefore, results of the many educational efforts to encourage diversification of weed control practices in the United States have been mixed. It is clear that we do not sufficiently understand the totality of the grassroots obstacles, concerns, challenges, and specific solutions needed for varied crop production systems. Weed management issues and solutions vary with such variables as management styles, regions, cropping systems, and available or affordable technologies. Therefore, to help the weed science community better understand the needs and ideas of those directly dealing with herbicide resistance, seven half-day regional listening sessions were held across the United States between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide resistance management. The major goals of the sessions were to gain an understanding of stakeholders and their goals and concerns related to herbicide resistance management, to become familiar with regional differences, and to identify decision maker needs to address herbicide resistance. The messages shared by listening-session participants could be summarized by six themes: we need new herbicides; there is no need for more regulation; there is a need for more education, especially for others who were not present; diversity is hard; the agricultural economy makes it difficult to make changes; and we are aware of herbicide resistance but are managing it. The authors concluded that more work is needed to bring a community-wide, interdisciplinary approach to understanding the complexity of managing weeds within the context of the whole farm operation and for communicating the need to address herbicide resistance.
To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days.
Design
A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall.
Setting
Community-dwelling adults living in the State of Victoria, Australia.
Subjects
Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years).
Results
Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, meat, poultry, milk products and gravy/sauces accounted for 71 % of dietary Na.
Conclusions
Mean salt intake (24 h urine collection) was more than 60 % above the recommended level of 5 g salt/d and 8–14 % more salt was consumed at weekends than on weekdays. Substantial reductions in the Na content of staple foods, processed meat, sauces, mixed dishes (e.g. pasta), convenience and takeaway foods are required to achieve a significant consistent reduction in population salt intake throughout the week.
Rock glaciers are periglacial alpine landforms that are found in many locations worldwide. Whereas well-developed models of deformation are established for traditional alpine glaciers, rock glacier deformation is poorly understood. Geophysical data from Lone Peak Rock Glacier (LPRG), southwest Montana, USA, are paired with lidar bare-earth 1 m digital elevation model (DEM) analysis to explore potential genetic relationships between internal composition, structure and regularly spaced arcuate transverse ridges expressed at the rock glacier surface. The internal composition of LPRG is heterogeneous, with frozen debris and clean ice overlain by an unconsolidated talus mantle. Upslope-dipping, clearly distinguished reflectors in the ground-penetrating radar (GPR) longitudinal survey at LPRG correspond to transverse ridges. The spacing and slope of individual features at the surface and in the subsurface were measured and compared and are found to be similar. The structures observed at LPRG and other rock glaciers are similar to structures detected in glaciotectonically altered sediment, ice-cored moraines and other rock glacier settings. This finding suggests that transverse ridges on rock glaciers may be used as geomorphic indicators of internal deformation. This study contributes to the body of research on the application of GPR to rock glaciers, and is the first to directly pair and analyze individual surface topographic features with internal structures.
Quizalofop controlled 2- to 3-leaf and 5- to 6-leaf red rice better than fluazifop-P, haloxyfop, or sethoxydim applied alone. Red rice control increased when acifluorfen was tank mixed with haloxyfop, fluazifop-P, or sethoxydim. Antagonism was most severe when imazaquin was tank mixed with any of the grass herbicides. The efficacy of sethoxydim, fluazifop-P, and haloxyfop was reduced when applied with chlorimuron or bentazon. In greenhouse experiments, all of the grass herbicides, except for fenoxaprop, reduced fresh weight of red rice 71% or more. Based on fresh weight reduction, acifluorfen, fomesafen, and lactofen only reduced the activity of fluazifop-P, while imazaquin decreased the activity of all grass herbicides.
Field experiments were established to investigate the effects of tank-mixing sethoxydim or quizalofop with imazaquin, chlorimuron, or lactofen for barnyardgrass control in soybeans. Sequential applications, where the grass herbicide was applied 24 h before or after the broadleaf weed herbicide, were also evaluated. There was an antagonistic decrease in barnyardgrass control when sethoxydim or quizalofop was tank mixed with any of the broadleaf weed herbicides. Antagonism was also observed when either grass herbicide was applied 24 h after imazaquin or lactofen, but not with chlorimuron. Control was not affected when the grass herbicide was applied 24 h before the broadleaf weed herbicide. In greenhouse experiments, the effects of tank-mixing sethoxydim, quizalofop, fluazifop-P, haloxyfop, fenoxaprop, or clethodim with imazaquin, lactofen, chlorimuron, acifluorfen, fomesafen, bentazon, or 2,4-DB were also evaluated for barnyardgrass control. Although acifluorfen provided 45% barnyardgrass control, tank-mixing it with fluazifop-P, haloxyfop, or fenoxaprop was antagonistic. Antagonism also occurred when chlorimuron was tank mixed with any of the grass herbicides except fenoxaprop. Barnyardgrass control by all of the grass herbicides applied in the field or greenhouse was most severely antagonized by tank mixes containing imazaquin.
Corn and soybean growers in Illinois, Indiana, Iowa, Mississippi, Nebraska, and North Carolina, as well as cotton growers in Mississippi and North Carolina, were surveyed about their views on changes in problematic weeds and weed pressure in cropping systems based on a glyphosate-resistant (GR) crop. No growers using a GR cropping system for more than 5 yr reported heavy weed pressure. Over all cropping systems investigated (continuous GR soybean, continuous GR cotton, GR corn/GR soybean, GR soybean/non-GR crop, and GR corn/non-GR crop), 0 to 7% of survey respondents reported greater weed pressure after implementing rotations using GR crops, whereas 31 to 57% felt weed pressure was similar and 36 to 70% indicated that weed pressure was less. Pigweed, morningglory, johnsongrass, ragweed, foxtail, and velvetleaf were mentioned as their most problematic weeds, depending on the state and cropping system. Systems using GR crops improved weed management compared with the technologies used before the adoption of GR crops. However, the long-term success of managing problematic weeds in GR cropping systems will require the development of multifaceted integrated weed management programs that include glyphosate as well as other weed management tactics.
Research was conducted to compare the results of an enzyme-linked immunosorbent assay (ELISA) to high-performance liquid chromatography (HPLC) for detecting fluometuron in the environment. A linear relationship for HPLC (R2 > 0.90) and ELISA (R2 > 0.66) analysis was observed between the natural logarithm of the detected fluometuron concentrations regressed against time in soil collected from a cropped area, a grass filter strip, and a riparian forest. Both methods detected the same initial fluometuron concentration (y-intercept) for two of the three soils evaluated. The ELISA and HPLC measurements of fluometuron concentrations compared favorably with r values from 0.83 to 0.98. Predicted fluometuron half-lives determined from HPLC and ELISA measurements were: 110 and 112 d in the cropped watershed, 28 and 29 d in the riparian area, and 11 and 11 d in the grass filter strip, respectively. Results from both techniques indicated shorter half-lives in soil from the grass filter strip and riparian area than in cropped area soil. There was an inverse correlation between predicted half-lives and soil organic matter, pH, clay, and cation exchange capacity.
Guinea-Bissau has been regularly described as a ‘narco-state’. Yet, few studies analyse how drug trafficking has evolved here. Based on extensive interviews in Guinea-Bissau over several years, this paper documents the process. It concludes that using the term ‘narco-state’, where much of the state has little or no capacity, is inappropriate. A better approach is to analyse the actions of key players as an elite protection network. In Guinea-Bissau, that network did not act on its own, but relied on a series of ‘entrepreneurs' who operated as an interface between traffickers and the elite. While the military as an institution is often said to be in charge of trafficking, exclusive control by high-ranking military personnel within the elite network only occurred relatively late. Senior soldiers' attempts to provide more than just protection, and to enter the drug market themselves, led to the network's undoing.
The Microgastrinae wasp Diolcogaster claritibia (Papp, 1959) (Hymenoptera: Braconidae), a parasitoid of the diamondback moth, Plutella xylostella (Linnaeus, 1758) (Lepidoptera: Plutellidae), is recorded from the Nearctic region (Alberta, Manitoba, and Ontario, Canada) for the first time. In spite of some minor morphological and molecular (DNA barcoding) differences, the available data indicate that the European and New World specimens should be considered one species, but more specimens and loci need to be sampled to conclusively determine the phylogeographic history of the species. Diolcogaster claritibia seems to be widely distributed within the Holarctic, and the molecular data suggest that it was recently introduced to North America from Europe.
Police officers often serve as first responders during out-of-hospital cardiac arrests (OHCA). Current knowledge and attitudes about resuscitation techniques among police officers are unknown.
Hypothesis/problem
This study evaluated knowledge and attitudes about cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) among urban police officers and quantified the effect of video self-instruction (VSI) on these outcomes.
Methods
Urban police officers were enrolled in this online, prospective, educational study conducted over one month. Demographics, prior CPR-AED experience, and baseline attitudes were queried. Subjects were randomized into two groups. Each group received a slightly different multiple-choice test of knowledge and crossed to the alternate test after the intervention, a 10-minute VSI on CPR and AEDs. Knowledge and attitudes were assessed immediately before and after the intervention. The primary attitude outcome was entering “very likely” (5-point Likert) to do chest compressions (CC) and use an AED on a stranger. The primary knowledge outcomes were identification of the correct rate of CC, depth of CC, and action in an OHCA scenario.
Results
A total of 1616 subjects responded with complete data (63.6% of all electronic entries). Randomization produced 819 participants in group 1, and 797 in group 2. Groups 1 and 2 did not differ significantly in any background variable. After the intervention, subjects “very likely” to do CC on a stranger increased by 17.2% (95% CI, 12.5%-21.8%) in group 1 and 21.2% (95% CI, 16.4%-25.9%) in group 2. Subjects “very likely” to use an AED on a stranger increased by 20.0% (95% CI, 15.3%-24.7%) in group 1 and 25.0% (95% CI, 20.2%-29.6%) in group 2. Knowledge of correct CC rate increased by 59.0% (95% CI, 55.0%-62.8%) in group 1 and 64.8% (95% CI, 60.8%-68.3%) in group 2. Knowledge of correct CC depth increased by 44.8% (95% CI, 40.5%-48.8%) in group 1 and 54.4% (95% CI, 50.3%-58.3%) in group 2. Knowledge of correct action in an OHCA scenario increased by 27.4% (95% CI, 23.4%-31.4%) in group 1 and 27.2% (95% CI, 23.3%-31.1%) in group 2.
Conclusion
Video self-instruction can significantly improve attitudes toward and knowledge of CPR and AEDs among police officers. Future studies can assess the impact of VSI on actual rates of CPR and AED use during real out-of-hospital cardiac arrests.
AldeenAZ, HartmanND, SequraA, PhullA, ShawDM, ChiampasGT, CourtneyDM. Video Self-instruction for Police Officers in Cardiopulmonary Resuscitation and Automated External Defibrillators. Prehosp Disaster Med. 2013;28(5):1-6.