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Vernon H Vivian,1 Tyson L Pardon,2 Samuel Vivian,3 André Van Zundert4,5 1Department of Anaesthesiology, Gympie General Hospital, Sunshine Coast, QLD, Australia; 2Emergency Department, Sunshine Cost Health Services, Sunshine Coast, QLD, Australia; 3Prehospital EMS, Queensland Ambulance Services, Brisbane, QLD, Australia; 4Department of Anesthesiology, Royal Brisbane & Women’s Hospital, Brisbane, Australia; 5The University of Queensland, Brisbane, QLD, AustraliaCorrespondence: Vernon H Vivian Email vjcsviv@hotmail.comAbstract: The laryngeal mask airway (LMA) is widely used for airway management in the emergency and elective treatment of patients in both the in-hospital and prehospital setting. The rate of prehospital use is increasing. The LMA is a vital link in the vortex approach to managing a difficult airway. Clinicians will be increasingly faced with the dilemma of managing the patient who has an LMA in place, but still requires the airway secured by an endotracheal tube (ETT). Flexible endoscopic intubation through an LMA is a simpler procedure than awake flexible endoscopic intubation. Furthermore, intubating flexible endoscopes are increasingly available and affordable (now single use) making its use out of the domains of the operating theater and intensive care unit feasible. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to a new device, the Rescue™ ETT (Genesis Airway Innovations®, Sunshine Coast, Australia), designed specifically for intubation through an LMA over a flexible endoscope and compare them to current devices used for this purpose.Keywords: laryngeal mask airway, intubation, fiberoptic, emergency, airway, scope, vortex

The T6 ion thruster is providing in-space propulsion for the BepiColombo mission, currently en route to Mercury. Simulations of the accelerator grid erosion during flight operation were carried out...

Newson falls into his own trap of seeking ‘evidence’ to reinforce his own prejudices. There are many more possible explanations for his anecdotal diagnostic delays than training or skills of individual GPs. With regard to his …

Nasotracheal intubation remains an underused but invaluable technique for securely managing the airway during oral and maxillofacial surgery. In this article, we present a modified clinical technique that allows for the potential introduction into clinical practice of 2 new airway devices: a nasal laryngeal mask airway and an interchangeable oral/nasal endotracheal tube. We hypothesize that with the use of proper techniques, these devices can add new and safer alternatives for securing an airway by the nasal route. The advantage of this novel technique is that the airway is secured by the oral route prior to performing a modified retrograde nasal intubation, eliminating the danger of profuse epistaxis precipitating a “cannot intubate, cannot ventilate” scenario. In addition, the design and materials used in the components of the devices may minimize trauma. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to these new devices.

Background Cancer patients with recently placed drug-eluting stents (DESs) often require premature dual antiplatelet therapy (DAPT) discontinuation for cancer-related procedures. Optical coherence tomography (OCT) can identify risk factors for stent thrombosis such as stent malapposition, incomplete strut coverage and in-stent restenosis and may help guide discontinuation of DAPT. Methods We conducted a single-center prospective study in cancer patients with recently placed (1-12 months) DES who required premature DAPT discontinuation. Patients were evaluated with diagnostic coronary angiogram and OCT. Individuals with appropriate stent strut coverage, expansion, apposition, and absence of in-stent restenosis or intraluminal masses were considered low risk and transiently discontinued DAPT to allow optimal cancer therapy. Patients who did not meet all these criteria were considered high risk and underwent further endovascular treatment when appropriate and bridging with low-molecular weight heparin. The incidence of adverse cardiovascular events was assessed after the procedure and at 12 months. Results A total of 40 patients were included. Twenty-seven patients (68%) were considered low risk by OCT criteria and DAPT was transiently discontinued. Thirteen patients (32%) were considered high risk with one or more OCT findings: uncovered stent struts (4 patients, 10%); stent underexpansion (3 patients, 8%); malapposition (8 patients, 20%); in-stent restenosis (2 patients, 5%). The high-risk patients with uncovered stent struts and malapposition underwent additional stent dilatation. There were no cardiovascular events in the low-risk group. One myocardial infarction occurred in the high-risk group. Fourteen non-cardiac deaths were registered before 12 months due to cancer progression or cancer therapy. Conclusion OCT imaging allows identification of low-risk cancer patients with DES placed who may safely discontinue DAPT and proceed with cancer-related surgery or procedures.

Despite the massive efforts that have been made to conserve plant diversity across the world during the past few decades, it is becoming increasingly evident that our current strategies are not sufficiently effective to prevent the continuing decline in biodiversity. As a recent report by the CBD indicates, current progress and commitments are insufficient to achieve the Aichi Biodiversity Targets by 2020. Threatened species lists continue to grow while the world's governments fail to meet biodiversity conservation goals. Clearly, we are failing in our attempts to conserve biodiversity on a sufficient scale. The reasons for this situation are complex, including scientific, technical, sociological, economic and political factors. The conservation community is divided about how to respond. Some believe that saving all existing biodiversity is still an achievable goal. On the other hand, there are those who believe that we need to accept that biodiversity will inevitably continue to be lost, despite all our conservation actions and that we must focus on what to save, why and where. It has also been suggested that we need a new approach to conservation in the face of the challenges posed by the Anthropocene biosphere which we now inhabit. Whatever view one holds on the above issues, it is clear that we need to review the effectiveness of our current conservation strategies, identify the limiting factors that are preventing the Aichi goals being met and at the same time take whatever steps are necessary to make our conservation protocols more explicit, operational and efficient so as to achieve the maximum conservation effect. This paper addresses the key issues that underlie our failure to meet agreed targets and discusses the necessary changes to our conservation approaches. While we can justifiably be proud of our many achievements and successes in plant conservation in the past 30 years, which have helped slow the rate of loss, unless we devise a more coherent, consistent and integrated global strategy in which both the effectiveness and limitations of our current policies, action plans and procedures are recognized, and reflect this in national strategies, and then embark on a much bolder and ambitious set of actions, progress will be limited and plant diversity will continue to decline. Keywords: Plant conservation, Anthropocene, Aichi targets, Biodiversity governance, Protected areas

Background The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. Methods A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epidural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Results Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor characteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). Conclusions The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl.

In certain high-power RF devices, such as isolators and circulators, a static magnetic field is present in parallel with the oscillating RF electric field. This parallel magnetic field imposes electron Larmor motion, which restricts the trajectories of electrons accelerated by the RF field. In open geometries, magnetic confinement reduces electron losses in the multipactor region and can reduce the breakdown threshold. In this paper, the effect of magnetic confinement on multipactor breakdown threshold was measured experimentally using a stripline fixture with an externally applied uniform magnetic field. Multipactor threshold power was reduced from the unmagnetized case by as much as 3 dB at magnetic fields of about 0.5 kG. Multipactor gap aspect ratio has a significant impact on the degree of threshold reduction.

BACKGROUND:Women and minorities are underrepresented in US academic medicine. The Sullivan Commission on Diversity in the Healthcare Workforce emphasized the importance of diverse leadership for reducing health care disparities. The objective of this study was to evaluate the demographics of the Ame

Background:The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacain

Gerada is right that doctors need to develop healthy psychological defence mechanisms.1 But this should be seen in a societal context and in company with other workers. Society today encourages the open disclosure of emotional distress. But the work of the emergency services and clinicians can continue effectively only if this …

The first rule of covering a hurricane? Get footage of palm trees bending to the storm. They sway, arch, bow through 50 degrees, then rebound like elastic to recover their form and position. Cars and pylons cartwheel and buckle in the tempest. But with its heavy root network, its trunk a cable of bundled fibre and fronded leaves that fold up, the canny, durable palm has worked out how to ride a storm by flexing, without falling over. Resilience has attained treasured status in general practice’s belief system since our specialty’s popularity, resourcing, and recruitment began to head south, along with the banks, after 2008. Like an advanced stage of enlightenment, it has become the key attribute for anyone wanting to survive and thrive as a GP in today’s harsh NHS environment.1 That GPs work hard and long, in tough conditions, mostly alone with their patients; that they are exposed to distress and tragedy through their working lives; that they carry formidable responsibilities, and hold unbearable secrets, is not news. Being resolute, courageous, of a calm temperament, committed, able to go without sleep, face abuse and the threat of violence, yet remain open minded and kind — all these are taken as read in a good GP; and that’s before you get on to being up to date, a patient listener, and a smart decision maker. Bags of emotional intelligence and great interpersonal skills make up the full kit list. We embrace the description ‘resilient’ as a sex- and judgement-free upgrade from some of its heroic predecessors: robust, …

Background It is unclear whether recognition of epidural catheter failures is delayed with combined spinal epidural technique (CSE) compared to traditional epidural technique (EPID) when used for labor analgesia. The authors hypothesized that recognition of failed catheters is not delayed by CSE. Methods Anesthetic, obstetric, and quality assurance records from 2,395 labor neuraxial procedures (1,440 CSE and 955 EPID) performed at Forsyth Medical Center (Winston-Salem, North Carolina) between June 30 and December 31, 2012, were retrospectively analyzed. The primary outcome was catheter survival (failure-free) time during labor analgesia. A proportional hazards model with the counting method was used to assess relationships between the techniques and survival (failure-free) time of catheters, while controlling for subjects’ body mass index and providers’ level of training in the final best-fit multivariable regression model. Results Cumulative incidence of epidural catheter failures was 6.6% for CSE and 11.6% for EPID (P = 0.001). In the multivariable regression model, catheters placed with CSE versus epidural were less likely to fail (hazard ratio, 0.58; 95% CI, 0.43 to 0.79; P = 0.0002) for labor analgesia. Among the catheters that failed, there was no overall difference in failure time course between the techniques (hazard ratio, 1.17; 95% CI, 0.89 to 1.54; P = 0.26) even though more failed catheters with CSE (48.4%) than with EPID (30.6%) were recognized within the first 30 min of placement (P = 0.009). Conclusions In this cohort, CSE has a significantly lower risk of overall epidural catheter failures than EPID and does not delay recognition of epidural catheter failures. Choice of CSE versus EPID should be based on overall risk of failure, efficacy, and side effects.

Four business professors at a state university in the Midwestern United States launched a collaborative learning project grounded in cognitive learning theory and knowledge convergence theory with the objective of assessing student learning gains in cross-functional knowledge (CFK), course-related knowledge (CRK), and overall satisfaction with this teaching approach. The project involved the start-up and operation of an entrepreneurial campus lunch delivery service from local restaurants to university faculty, students, and staff. A total of 46 students participated in the project, and comprised seven groups across four business courses: Strategy, Project Management, Marketing Promotion, and Marketing Research. A survey instrument was developed comprising 21 items. Survey results indicated significant increases in cross-functional and course-related knowledge, and in student involvement and teamwork when using this cross-functional, multicourse approach to an entrepreneurial endeavor.

The conservation of plant species in situ is a complex and multifaceted procedure which involves both the maintenance and management of protected areas and actions targeted at the species and population level. Most effort has been aimed so far at the occurrence and persistence of species in protected areas as a measure of conservation. However, species-level actions such as conservation or recovery plans have been undertaken for only a small percentage of threatened plant species, mostly by a few countries. The reasons for this are complex and involve scientific, social and political considerations. The planning of targets for biodiversity conservation in situ by the Convention on Biological Diversity suffers from a failure to coordinate area-based and species-based actions leading to overlap and confusion. A set of recommendations is given to help remedy the neglect of targeted species conservation.

This research addresses consumers' willingness-to-punish the corporate brand for corporate social irresponsibility (CSI). It is supported by the extant literature on consumer stakeholders, corporate brands, brand personality, regulatory fit, and psychological contract, as well as by punishment in psychology and philosophy, which are new to the marketing literature. Using an experimental design with a control group, this research examines consumers' willingness-to-reward and its converse willingness-to-punish a corporate brand under three treatment conditions of socially responsible, socially irresponsible, and environmentally friendly. Data were collected on four outcome variables of willingness-to-punish, willingness-to-reward, brand attitude, and purchase intention for each treatment group. MANOVA results indicated that there were systematic differences in the levels of outcomes among the four groups. Discriminant function analysis found the socially irresponsible group was statistically significantly different from the other three experimental groups for all four outcome variables. Consumers dealing with socially irresponsible corporate brands were more likely to punish and less likely to reward than consumers in the other three treatment conditions. This study illustrates the latent negative impact from CSI activities on four important dimensions of consumer response. The findings indicate there is a pragmatic need for corporate brand strategists to recognize consumers' willingness-to-punish the corporate brand and the subsequent necessity to avoid activities that consumers may perceive to be socially irresponsible.

This paper describes a low cost, easy-to-implement circuit for triggering ignitrons in plasma physics experiments and other pulsed power applications. Using insulated gate bipolar transistors (IGBTs) for rapid switching, the circuit delivers >2 peak current from a 0.1-μF capacitor to the ignitron trigger pin with a rise time of ~ 0.6 μs. The trigger circuit is isolated from the ignitron by a pulse transformer. Details of the circuit design and practical considerations for working with IGBTs are discussed. Sources of inductance in the system are identified, and leakage inductance associated with the pulse transformer is shown to be the primary factor limiting the pulse rise time.

Objectives To determine sex bias in the selection of strategies to evaluate patients with acute myocardial infarction (AMI), and determine if the choice of strategy influences survival. Background Controversy exists regarding the role of female sex in the use of invasive evaluation for AMI and its possible effect on adverse outcomes. Methods Electronic health record data from the Geisinger Acute Myocardial Infarction Cohort (GAMIC) was analyzed which included 1,968 men and 1,047 women admitted to the Geisinger Medical Center between January 2001 and December 2006 with acute myocardial infarction (AMI).Multivariate logistic regression analyses were used to determine independent correlates of an invasive evaluation. Multivariate logistic regression modeling stratified on sex was used to determine when invasive evaluation was done and whether there was a correlation with mortality. Results In unadjusted analyses, male sex was a significant predictor for the use of invasive evaluation (odds ratio = 1.71, 95% CI = [1.46, 2.00]). Adjusted for baseline differences (like age, renal function, co-morbid conditions) multivariate analyses found no significant relationship between male sex and invasive evaluation (OR = 1.02, 95% CI = [0.82, 1.23]). Females in the STEMI group were found to be less revascularized. No difference was observed in the one-year mortality between women and men regardless of invasive evaluation or revascularization. Conclusions Sex was not independently associated with the occurrence of an invasive evaluation of a MI. Females in the STEMI group were less revascularized. There was no strong gender effect on survival irrespective of the performance on an invasive evaluation or revascularization. (J Interven Cardiol 2013;26:14–21)

Brazilian asset-backed securities (ABS) appeal to investors because of their relatively high yields and diversification benefits. However, Brazilian and international investors struggle to price these ABS because of the country’s unique financial calculations, lack of transparency, and the scarcity of quantitative pricing tools in Brazil. Even Bloomberg presents these securities with analytical tools for mutual funds rather than for typical ABS. Brazil’s lack of standardization with respect to calculations and documentation compounds the pricing problems. This forces pricing tools to use more-complicated algorithms and pricing models. The authors show that this extra work is worth the effort. Arbitrage-free pricing models provide more insight into the potential returns and risks embedded in the shares (tranches) of a Brazilian ABS. They also propose norms for standardizing the information needed to trade in secondary markets for Fundos de Investimento em Direitos Creditorios (FIDCs—the most prevalent ABS vehicle). All market participants would benefit from the increased liquidity and capital flows that would result from adopting the best practices for pricing described in this article.

Multipactor breakdown is a resonant electron phenomena that is observed in spacecraft RF systems. While multipactor breakdown thresholds are well documented for parallel metal surfaces, susceptible breakdown geometries in passive RF components frequently deviate from this ideal parallel-plate geometry. A common feature of concern is an angled or chamfered edges placed on dielectrics inside RF components. Using a 3D electromagnetic tool coupled with an electron tracking tool, a simplified angled gap geometry is analyzed. The breakdown threshold increase from a parallel gap to an angle gap is calculated and discussed. The analysis results will be compared with laboratory measurements to demonstrate the applicability of this analysis technique.

The Brazilian asset-backed security (ABS) market presents many opportunities and obstacles to investors, especially foreign investors who are accustomed to transparent markets and a wealth of information. This article shows that financial models can actually help with this problem, if they are used correctly. Rather than taking the data for the structures at face value and feeding them to a financial model in one direction, this approach utilizes a feedback loop in which the model benchmarks the performance of the security. The author shows how this approach can be used to evaluate and track the risks in this evolving market by analyzing two similar deals with different structures and tracking their performance from 2007–2009. The analysis focuses on the tumultuous life of Fundo de Investimento em Direitos Creditorios (FIDC) PanAmericano Veiculos I, a Brazilian FIDC backed with vehicle loans that were originated by Banco PanAmericano. This FIDC is the perfect subject for such a study. It encountered the “perfect storm” of problems. Its investors were lucky to have received their capital back, as well as to have earned the indicated return. The FIDC matured five months before Banco PanAmericano was restructured because of a massive fraud carried out by management. The FIDC survived only because the bank was able to support the deal through frequent transfusions of new loans and the lax enforcement of regulations in Brazil.The model proposed here was used to analyze FIDC PanAmericano Veiculos I during this turbulent period.

Background:It is unclear whether recognition of epidural catheter failures is delayed with combined spinal epidural technique (CSE) compared to traditional epidural technique (EPID) when used for labor analgesia. The authors hypothesized that recognition of failed catheters is not delayed by CSE.Met

Ethnopharmacological relevance It is becoming increasingly clear that ethnopharmacology cannot be disassociated from food production, human nutrition and the conservation of the biodiversity that constitutes its resource base. Aim of the study This paper aims to provide a perspective of ethnopharmacology that explicitly extends the range of disciplines it covers so as to embrace food and nutrition and the biodiversity basis, both wild and agricultural, and also places it in the context of the dramatic changes to our planet that we are experiencing during a period of rapid global change and the impacts that these changes are having on human health and nutrition and on its resource base. Materials and methods A review is made of recent initiatives and developments that show linkages between ethnopharmacology, agriculture, food production, nutrition and biodiversity conservation. Results Ethnopharmacology, biodiversity, agriculture, food and nutrition are inextricably linked but suffer from compartmentalization and a lack of communication which have to be overcome if progress is to be made. Fortunately, a convergence of interest between the agricultural biodiversity and the biodiversity conservation sectors has emerged in recent years and there is an increased appreciation of the need to adopt a wider approach to human nutrition than the conventional agricultural model allows; there is also a greater awareness of the important role played by diversity of crops, especially local species, and consumption of wild species in achieving balanced nutrition. An increased recognition of the key role of local communities in managing agricultural biodiversity is evident. While ethnopharmacologists have expressed concern at the relentless loss of biodiversity, there has been little direct involvement but it is perhaps now time to consider a more proactive role. Attention is also drawn to the need to assess the implications of global change for ethnopharmacology. Conclusions Ethnopharmacologists need to take much more cognizance of the fate of the resource base – the plants, animals and microorganisms – and of the actions being undertaken under the auspices of treaties, such as the Conservation on Biological Diversity and its Global Strategy for Plant Conservation, and the International Treaty on Plant Genetic Resources for Food and Agriculture, to counter its degradation and loss. In addition, they should play a more active role in determining the actions needed to assess, monitor and conserve the resource base. Although it has been suggested that the ‘golden days’ of ethnopharmacology may be over, it is proposed that by embracing the challenges of broadening the remit so as to include the health aspects of wild biodiversity employed in nutrition, a new ‘golden age’ beckons. The paper concludes with some suggestions for action.

Percutaneous coronary intervention (PCI) in acute myocardial infarction (MI) has been associated with a high incidence of slow-, no-reflow. The slow-, no-reflow phenomenon is known to complicate both thrombolytic therapy and PCI. Removing intracoronary thrombus before PCI in acute MI patients may reduce the incidence of slow-, no-reflow phenomena. We studied the procedural outcome of 21 patients who underwent rheolytic thrombectomy using Possis® rheolytic thrombectomy catheter in the setting of acute MI as compared to twenty-eight patients who underwent PCI in the setting of acute MI using other modalities (PTCA with or without stenting) without thrombectomy. The study included 49 consecutive patients with 21 patients in the rheolytic thrombectomy group, and 28 patients in the no-rheolytic thrombectomy group. There was no significant difference between the two groups as regards to gender, age, and prevalence of coronary artery risk factors. The left ventricular ejection fraction was 44.7 ± 12 in the rheolytic thrombectomy group, and 37.6 ± 10.8 in the no-rheolytic thrombectomy group (p = 0.08). Thirty eight percent of the patients in the rheolytic thrombectomy group experienced slow flow, no-reflow, while 28.6% of the patients in the no-rheolytic thrombectomy group experienced slow flow, no-reflow (p = 0.5). In this matched series of patients with acute MI undergoing PCI, rheolytic thrombectomy by the Possis rheolytic thrombectomy catheter device does not appear to reduce the risk of slow flow, no-reflow, or in-hospital death, compared to standard PTCA and stenting of the infarct-related artery.

In light of the growing concern over the potentially devastating impacts on biodiversity and food security of climate change and the massively growing world population, taking action to conserve crop wild relatives (CWR), is no longer an option — it is a priority. Crop wild relatives are species closely related to crops, including their progenitors, many of which have the potential to contribute beneficial traits to crops, such as pest or disease resistance, yield improvement or stability. They are a critical component of plant genetic resources for food and agriculture (PGRFA), have already made major contributions to crop production and are vital for future food security; their systematic conservation in ways that ensure their continuing availability for use is therefore imperative. This is a complex, interdisciplinary, global issue that has been addressed by various national and international initiatives. Drawing on the lessons learnt from these initiatives we can now propose a global approach to CWR conservation, the key elements of which are: (1) estimating global CWR numbers, (2) assessment of the global importance of CWR diversity, (3) current conservation status, (4) threats to CWR diversity, (5) systematic approaches to CWR conservation, (6) CWR informatics, and (7) enhancing the use of CWR diversity.

While Murphy et al are clear in their findings and robust in their recommendations,1 they appear to regard malnutrition (and particularly undernutrition) as a diagnosis to be treated in its own …

One of the consequences of global change, especially demographic and climatic, will be a demand for novel plant germplasm of all kinds suited to the new ecoclimatic conditions predicted and plant introduction will assume a new importance. As a consequence, botanic gardens will face an unprecedented opportunity to regain their role as introduction centres and become major actors in the assessment of new germplasm, both of ornamentals as well as other economically important plants. Plant introduction has remained largely unchanged over the past 400 years and is as often ad hoc, poorly organized and insufficiently collaborative, but if it is to meet the needs of today’s situation it needs to be overhauled. In particular: (1) the basis of plant introduction needs to be broadened; (2) closer cooperation with agricultural genebanks should be established; (3) agreement should be reached between botanic gardens and the agricultural sector on their respective responsibilities (4) the quality and sampling of the accessions should be more strictly controlled; (5) proper evaluation of the introductions before they are disseminated; (6) information on the accessions of introduced plants and their fate needs to be more effectively maintained and disseminated; and (7) full cognizance should be taken of policies to protect against invasive species and care should be taken to evaluate the risks that new introductions might represent. Finally, consideration should be given to preparing a set of guidelines or even a code of conduct for plant introductions by botanic gardens in association with other agencies.

Background Comparison of air versus saline for loss of resistance technique (LORT) in combined spinal epidural labor analgesia (CSE) has not been evaluated, and neither has the relation between CSE characteristics (the presence/absence of initial spontaneous clear fluid return or upon aspiration) and spinal/epidural analgesia outcomes. The authors hypothesized that there is no difference in the spinal analgesia success or epidural catheter efficacy between using air versus saline LORT for CSE. Methods A total of 360 patients were randomized to air or saline LORT for CSE. Primary outcome was spinal analgesia success as defined by verbal pain score of no more than 3 at 15 min after spinal dose administration. Secondary outcomes were CSE characteristics, catheter replacement, and average hourly epidural drug consumption. Results Results from 345 patients were analyzed. Spinal analgesia success, epidural catheter replacement, and drug consumption were not different between using air or saline LORT and were also independent of the presence/absence of fluid return on aspiration if initial spontaneous fluid returned to the spinal needle. However, epidural catheters inserted in absence of initial fluid return had a significantly higher catheter replacement rate (28.6%) than the 4.1% among those with initial fluid return (P < 0.03). Conclusions Spinal analgesia success rate and epidural efficacy are independent of whether air or saline is used for LORT during CSE. Practice of aspiration for fluid after observing initial fluid return may be unnecessary because this practice does not alter spinal/epidural analgesia outcomes. However, epidural catheters inserted with the absence of initial fluid returned to spinal needle may pose a high failure risk.

Conservation of crop wild relatives (CWRs) is a complex interdisciplinary process that is being addressed by various national and international initiatives, including two Global Environment Facility projects ('In situ Conservation of Crop Wild Relatives through Enhanced Information Management and Field Application' and 'Design, Testing and Evaluation of Best Practices for in situ Conservation of Economically Important Wild Species'), the European Community-funded project 'European Crop Wild Relative Diversity Assessment and Conservation Forum (PGR Forum)' and the European 'In situ and On Farm Network'. The key issues that have arisen are: (1) the definition of what constitutes a CWR, (2) the need for national and regional information systems and a global system, (3) development and application of priority-determining mechanisms, (4) the incorporation of the conservation of CWRs into existing national, regional and international PGR programmes, (5) assessment of the effectiveness of conservation actions, (6) awareness of the importance of CWRs in agricultural development at local, national and international levels both for the scientific and lay communities and (7) policy development and legal framework. The above issues are illustrated by work on the conservation of a group of legumes known as grasspea chicklings, vetchlings, and horticultural ornamental peas (Lathyrus spp.) in their European and Mediterranean centre of diversity.

BACKGROUND: Saskatchewan Aboriginal people are experiencing epidemics of both type 2 diabetes (T2DM) and tuberculosis (TB). The purpose of this study was to determine if a relationship exists between diabetes and TB in Saskatchewan and to establish whether there is a difference in the degree of any association between Aboriginal and non- Aboriginal people. METHODS: Utilizing Saskatchewan Health databases, TB incidence (cases identified from 1986–2001) was compared between four subpopulations identified from 1991–1995: Registered Indians (RI) with and without diabetes, and other Saskatchewan people (OSKP) with and without diabetes. RESULTS: Diabetic women aged 20–59 years had higher average annual incidence rates of TB than non-diabetic women, but within-population rate ratios of TB in diabetic versus non-diabetic women were only significant in those aged 50–59 (2.7 [CI 1.28, 5.72] in RI and 3.9 [CI 1.58, 9.67] in OSKP). No other within-population diabetic subgroup had significantly higher rates of TB. The only male diabetic group that had a higher rate of TB were RI plus OSKP men aged 50–59 years. Overall, diabetes preceded TB in 87/111 individuals with both diseases (p

Anesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012,90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable.

BACKGROUND: Tuberculosis (TB) remains a major health problem for Aboriginal people in Canada, with high rates of clustering of active TB cases. Bacille Calmette-Guérin (BCG) vaccination has been used as a preventive measure against TB in this high-risk population.OBJECTIVE: The study was designed to determine if BCG vaccination in Aboriginal people influenced recent TB transmission through an analysis of the clustering of TB cases.METHODS: A retrospective analysis of all culture-positive Mycobacterium tuberculosis cases in Aboriginal people in western Canada (1995 to 1997) was performed. Isolates were analyzed using standard methodology for restriction fragment length polymorphism and spoligotyping.RESULTS: Of 256 culture-positive Aboriginal TB cases, BCG status was confirmed in 216 (84%) cases; 34% had been vaccinated with BCG, 57% were male and 56% were living on-reserve. Patients who had been vaccinated with BCG were younger than unvaccinated individuals (mean age 32.4±1.65 years versus 45.0±1.8 years, PCONCLUSIONS: BCG vaccinated Aboriginal people were no less likely to have active TB from recently transmitted disease. BCG vaccination appears to have limited value in preventing clustering of TB cases within this high-risk community.

Objectives The goal of this randomized study was to compare the incidence of postdural puncture headache (PDPH) and postdural puncture backache (PDPB), and the success rate between two small-gauge spinal needle designs used in women undergoing subarachnoid block anesthesia. Methods After Institutional Review Board approval, 215 patients presenting for tubal ligation were randomly assigned to have 26-gauge Atraucan (AT group) or 25-gauge Whitacre (WH group) spinal needles used in their spinal anesthesia. The number of attempts to successful cerebrospinal fluid return and the success rate of the spinal blockade were documented. Postoperatively, an investigator blinded to the study interviewed patients daily. Results The incidence of PDPH was similar between the AT group (3.9%) and the WH group (4.0%). The total duration of all PDPHs was 5 days for the AT group and 15 days for the WH group. Both groups had a similar one-attempt success rate of 61% (AT group) and 62% (WH group). Failure to obtain cerebrospinal fluid occurred in only one in the AT group and two in the WH group. The incidence of PDPB was similar and the severity was mild in both groups. Conclusions The low complication and failure rates make these two types of smaller size spinal needle design good candidates for dural puncture procedures, such as spinal anesthesia, diagnostic lumbar punctures, and myelograms.

A review is given of the major conceptual changes that have taken place during the last 50 years in our understanding of the nature of plant conservation and of the principal methodological advances in undertaking conservation assessments and actions, largely through the incorporation of tools and techniques from other disciplines. The interrelationships between conservation and sustainable use are considered as well as the impact of the development of the discipline of conservation biology, the effects of the general acceptance of the concept of biodiversity and the practical implications of the implementation of the Convention on Biological diversity. The effect on conservation policy and management of the accelerating loss or conversion of habitats throughout the world and approaches for combating this are discussed.

We treated a 23-year-old aboriginal woman with drug-resistant pulmonary tuberculosis (TB). She experienced intolerance to her oral anti-TB medications, had subtherapeutic drug levels, and failed to respond to treatment. She then was effectively treated with percutaneous gastrojejunostomy tube (PGJT) administration of drugs. We present our data on the serum drug levels of rifampin, para-aminosalicylic acid, and levofloxacin after PGJT administration, and compare these values to published levels for oral administration of these drugs. In our patient, serum drug levels peaked and began to decline earlier than in the published data for oral administration of the same drugs.

Hard evidence regarding diagnosis, care, and management of this area of practice is, unsurprisingly, hard to come by. It is disappointing that the article by Chew-Graham et …

Electron collecting current probes are the most reliable diagnostic of multipactor and radiofrequency (RF) ionization breakdown; however, stand-alone probes can only be used in test setups where the breakdown region is physically accessible. This paper describes techniques for measuring multipactor current directly on the center conductor of a coaxial RF device (or more generally, on the signal line in any two-conductor RF system) enabling global multipactor detection with improved sensitivity compared to other common diagnostics such as phase null, third harmonic, and reflected power. The center conductor diagnostic may be AC coupled for use in systems with a low DC impedance between the center conductor and ground. The effect of DC bias on the breakdown threshold was studied: in coaxial geometry, the change in threshold was

I couldn’t help noticing the possibly unfortunate juxtaposition of these two editorials in your latest issue. While accepting that both childhood bullying and derogatory banter regarding general practice and psychiatry (the latter having existed for generations) are unacceptable, I …

This paper (SPE 57080) was revised for publication from paper SPE 52672, originally presented at the 1999 SPE/EPA Exploration and Production Environmental Conference held in Austin, Texas, 28 February–3 March. Original manuscript received 13 January 1999. This paper has not been peer reviewed. Summary An emissions inventory is a powerful, multipurpose tool used by regulators, public-interest groups, and other stakeholders in the environmental protection arena. Given the growing conviction that market-based approaches are more effective than command-and-control regulations, inventories will increasingly be used to influence the behavior of companies in the marketplace. Carbon dioxide (CO2) and other greenhouse-gas (GHG) emissions are becoming important elements in the emissions inventory. Under the Framework Convention for Climate Change and now the Kyoto Protocol, emissions inventory of nations, as well as of the regulated community, will come under additional scrutiny when emissions targets and timetables have to be met once the protocol is put in place. Data accuracy and consistency and the cost and timing of delivery of data from Texaco's worldwide business units (BU's) were important considerations in the selection of the company's emissions inventory method. This method is based primarily on the coupling of emissions factors with fuel or product throughput or with equipment-component count. The emissions source list is comprehensive, and, in some cases, the emissions factors used are based on more recent source measurements with greater accuracy. This paper describes the basis for generation of a worldwide emissions inventory for the company. Introduction In 1998, Texaco Inc. decided to inventory the 1997 GHG emissions that come from its worldwide operations. The purpose of the inventory is to provide data for GHG-emissions management and for participation in the ongoing GHG dialogue. The company took the following steps to complete the inventory.Management announced a corporate goal to complete the inventory in 1998 and commissioned an emissions inventory team for this inventory collection. The team included representatives from the Health, Safety, and Environmental (HSE) staff of the BU's; from technology and general engineering centers; from the corporate center; and from among other BU staff.The emissions inventory team prepared a guidance document that defined the scope and method for the inventory. A subteam created the questionnaire that was completed by the operating units within the BU's.The questionnaire was completed on schedule, with coordination, follow-up, and verification provided by BU HSE offices.The data from the BU's were compiled and organized by the inventory team to complete the corporate emissions inventory. The inventory team realized that issues regarding the scope of the inventory and choice of method needed resolution before the inventory could be completed. The issues at stake included inventory cost and reliability and data comparability and consistency within the company and over extended time frames. There was a need for agreement within the company before the BU's were asked to supply data or information necessary to do the companywide inventory. We had to be certain that the BU's were capable of supplying data within the time frame allotted for data collection. The inventory team considered these issues and formalized the conclusions into the Texaco Emissions Inventory Document. The method detailed in this document is summarized in this paper. Principles to Ensure Usefulness of Inventory Data Comparability and Consistency. The inventory method addresses oil and gas fields, refineries, oil and gas pipelines, gas plants, and petroleum-product marketing operations in many countries and from offshore operations. It also addresses emissions from joint ventures, including those that are operated by other companies and those that are the operating company for assets that are partially owned by other companies. Texaco's operations are operated with a high degree of autonomy by BU's, which have their own HSE organizations and generally manage their environmental issues to meet local environmental concerns and regulations. In consideration of cost and time, the BU's supplied data for the inventory that were already available or that could be obtained quickly. The guidance document stressed consistent emission factors for determining emissions across our companywide business segments. We needed to achieve comparability in the inventory that would allow quantitative assessment of the similarities and differences among different facilities and different sectors of the company. In addition, consistency was needed to allow comparison over time of information from the same facility, same sector, and even the company itself. Because the company plans to grow its business, correlation of product-production rate with GHG-emission rates was stressed. In areas of the world where environmental regulations are relatively mature, much of the data needed for the inventory data already existed in databases of operating units. These data typically would be obtained by methods that satisfied state or local regulatory agency requirements. For other segments of our company and in other parts of the world, emission data were either not available or not readily available.

After the tragic 1995 collision between a school bus and a commuter train outside of Chicago, Illinois, much attention has been given to the subject of highway-rail grade crossing safety. The 1988 edition of the Manual on Uniform Traffic Control Devices for Streets and Highways (MUTCD) addresses traffic signal preemption for intersections near grade crossings as well as the electrical circuit or “interconnection” that makes traffic signal preemption possible. The objective of this study is to examine the basic interconnection circuit, as defined in the MUTCD, and explore some of its limitations. Possible improvements to the basic interconnection circuit are presented and evaluated.

BACKGROUND: There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinalepidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initiation of subarachnoid anesthesia between SSS and CSE techniques in morbidly obese parturients undergoing elective cesarean delivery. METHODS: Morbidly obese parturients presenting for elective cesarean delivery were randomized to receive subarachnoid anesthesia performed either with a SSS or a CSE technique. The spinal procedure in the sitting position was attempted by an experienced resident for up to 10 minutes, and if unsuccessful, the attending obstetric anesthesiologist assumed control of the procedure. The primary outcome was the time it took from the insertion of the introducer needle (SSS group) or insertion of the epidural needle (CSE group) to the end of intrathecal injection of drugs (procedure time). RESULTS: Forty-four patients were enrolled and completed the study. Three were excluded due to protocol violations. Of the remaining, 21 patients were in the SSS group and 20 in the CSE group. Demographic variables and mean (SD) body mass index (48.7 ± 7.6 kg/m 2 for SSS; 49.9 ± 8.6 kg/m 2 for CSE) were not different between groups. The median [interquartile range] for procedure time was 210 [116–692] seconds and 180 [75–450] seconds for SSS and CSE groups, respectively (P = 0.36), while the 95% confidence interval (CI) of the difference was −80 to +180 seconds. The first operator completed the procedure in

In response to reports of negative cooperation between sufferers of chronic fatigue syndrome (CFS) and their doctors, semi-structured interviews were conducted with sufferers from two different patient samples. Satisfaction with support received and with medical professionals in general was low. Sufferers complained about insufficient informational as well as emotional support from their doctors, and as a consequence most opted for alternative or complementary forms of treatment. In addition, disagreements over illness aetiology and treatment precluded effective cooperation. If satisfaction and compliance are to improve, sufferers will need more information about CFS and more support.

Background. The acceptance of local operative therapy for mammary carcinoma has stimulated scrutiny of specific techniques with the goals of minimizing the incidence of local recurrence while optimizing the cosmetic result. Intraductal spread of carcinoma has been established as a major factor in determining the rate of local recurrence after breast-conserving therapy for mammary carcinoma. The relationship of the anatomic location of a recurrent neoplasm to that of the primary tumor is likely to be instructive in evaluating the effectiveness of various proposed approaches to primary excision. Methods. Using the tumor registry of a tertiary care medical center, the authors reviewed all patients with mammary carcinoma treated with primary local excision during a 9-year period (1984-1992; n = 86), and identified all patients who subsequently experienced local recurrence (n = 5). The pathologic anatomic findings in each case were reviewed carefully and correlated with clinical and mammographic data. Results. The rate of local recurrence in this series was 5.8%, similar to that of Veronesi's “lumpectomy” group (7%). In all five patients, the recurrent lesion was located in the same breast quadrant, along a radius from the nipple to the edge of the breast disc that crossed the site of the initial lesion. Conclusion. Local recurrence of mammary carcinoma after breast-conserving operative therapy most often occurs within the same segment; it is therefore proposed that its incidence may be substantially reduced with the use of a primary excision technique (based on normal breast anatomy) that removes en bloc the dominant tumor mass and the associated (possibly disease) duct system. Cancer 1995;75:1612-8.