Transporting neonates with hypoxic-ischemic encephalopathy utilizing active hypothermia

OBJECTIVE

The objective of this report was to evaluate a servo-controlled active hypothermia device used during the transport of neonates with HIE.

STUDY DESIGN

Retrospective review of all cases of therapeutic hypothermia, both passive and active, using a servo-controlled device in a single regional referral neonatal intensive care unit from 2009-2013 RESULTS: An ambulance (43%), fixed wing aircraft (25%), or helicopter (32%) transported 28 neonates with active hypothermia. The servo-controlled device captured core temperatures in all 28 neonates, resulting in 2,985 minutes of data. All neonates attained a core temperature between 33-34 °C by 33 minutes of the transport. Once the neonates attained a core temperature, the average temperature for the remainder of the transport was 33 ± 0.2 °C. The neonates maintained the core temperature regardless of the type of transport vehicle.

CONCLUSION

Servo-controlled hypothermia enables rapid attainment of targeted temperatures and maintains the temperature throughout the transport process in both ground and air transport.

Efficacy of controlled-release capsules containing monensin for the prevention of subclinical ketosis in pasture-fed dairy cows

AIMS

To determine the effectiveness of intra-rumenal controlled release capsules (CRC) containing 32 g of monensin administered pre-calving to reduce the cumulative incidence of subclinical ketosis (SCK) in mainly pasture-fed dairy cows.

METHODS

Cows (n=837) due to calve in the first 6 weeks of the spring calving period were enrolled from four commercial herds in the Waikato region of New Zealand in a blinded, randomised, negative-controlled field trial. Three weeks before the start of the calving period cows were randomly allocated to receive either no treatment (control) or a single CRC containing monensin and then blood sampled on two occasions, 7 days apart within 12 days following calving for measurement of concentrations of beta hydroxybutyrate (BHBA) in blood. Cows were diagnosed with SCK if the concentration of BHBA in blood in either of these samples was ≥1.2 mmol/L.

RESULTS

Fewer treated cows were diagnosed with SCK within 12 days post-calving than control cows (144/340 (42.4%) vs. 192/336 (57.1%); p<0.001). There was no interaction between treatment group and age, breed or herd of origin. From the final multivariable model it was estimated that treatment with CRC containing monensin reduced the absolute cumulative incidence of SCK by 17.9 (95% CI=9.2-25.8)% compared to no treatment.

CONCLUSIONS

Treatment with a CRC containing monensin>10 days prior to calving reduced the cumulative incidence of SCK of pasture-based dairy cows in commercial dairy herds within 12 days post-calving.

CLINICAL RELEVANCE

Administration pre-calving of an intra-rumenal bolus containing monensin can be considered as one of a range of management options for the control of SCK in early lactation.

New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural/bleeding management. Australasian Society of Thrombosis and Haemostasis

New oral anticoagulants (NOAC) are becoming available as alternatives to warfarin to prevent systemic embolism in patients with non-valvular atrial fibrillation and for the treatment and prevention of venous thromboembolism. An in-depth understanding of their pharmacology is invaluable for appropriate prescription and optimal management of patients receiving these drugs should unexpected complications (such as bleeding) occur, or the patient requires urgent surgery. The Australasian Society of Thrombosis and Haemostasis has set out to inform physicians on the use of the different NOAC based on current available evidence focusing on: (i) selection of the most suitable patient groups to receive NOAC, (ii) laboratory measurements of NOAC in appropriate circumstances and (iii) management of patients taking NOAC in the perioperative period, and strategies to manage bleeding complications or 'reverse' the anticoagulant effects for urgent invasive procedures.

Biogeochemical environments of streambed-sediment pore waters with and without arsenic enrichment in a sedimentary rock terrain, New Jersey Piedmont, USA

Release of arsenic (As) from sedimentary rocks has resulted in contamination of groundwater in aquifers of the New Jersey Piedmont Physiographic Province, USA; the contamination also may affect the quality of the region's streamwater to which groundwater discharges. Biogeochemical mechanisms involved in the release process were investigated in the streambeds of Six Mile Run and Pike Run, tributaries to the Millstone River in the Piedmont. At Six Mile Run, streambed pore water and shallow groundwater were low or depleted in oxygen, and contained As at concentrations greater than 20 μg/L. At Pike Run, oxidizing conditions were present in the streambed, and the As concentration in pore water was 2.1 μg/L. The 16S rRNA gene and the As(V) respiratory reductase gene, arrA, were amplified from DNA extracted from streambed pore water at both sites and analyzed, revealing that distinct bacterial communities that corresponded to the redox conditions were present at each site. Anaerobic enrichment cultures were inoculated with pore water from gaining reaches of the streams with acetate and As(V). As(V) was reduced by microbes to As(III) in enrichments with Six Mile Run pore water and groundwater, whereas no reduction occurred in enrichments with Pike Run pore water. Cloning and sequencing of the arrA gene indicated 8 unique operational taxonomic units (OTUs) at Six Mile Run and 11 unique OTUs at Pike Run, which may be representative of the arsenite oxidase gene arxA. Low-oxygen conditions at Six Mile Run have favored microbial As reduction and release, whereas release was inhibited by oxidizing conditions at Pike Run.

A short-pulse X-ray beamline for spectroscopy and scattering

Experimental facilities for picosecond X-ray spectroscopy and scattering based on RF deflection of stored electron beams face a series of optical design challenges. Beamlines designed around such a source enable time-resolved diffraction, spectroscopy and imaging studies in chemical, condensed matter and nanoscale materials science using few-picosecond-duration pulses possessing the stability, high repetition rate and spectral range of synchrotron light sources. The RF-deflected chirped electron beam produces a vertical fan of undulator radiation with a correlation between angle and time. The duration of the X-ray pulses delivered to experiments is selected by a vertical aperture. In addition to the radiation at the fundamental photon energy in the central cone, the undulator also emits the same photon energy in concentric rings around the central cone, which can potentially compromise the time resolution of experiments. A detailed analysis of this issue is presented for the proposed SPXSS beamline for the Advanced Photon Source. An optical design that minimizes the effects of off-axis radiation in lengthening the duration of pulses and provides variable X-ray pulse duration between 2.4 and 16 ps is presented.

Solvation dynamics monitored by combined X-ray spectroscopies and scattering: photoinduced spin transition in aqueous [Fe(bpy)3]2+

We have studied the photoinduced low spin (LS) to high spin (HS) conversion of aqueous Fe(bpy)₃ with pulse-limited time resolution. In a combined setup permitting simultaneous X-ray diffuse scattering (XDS) and spectroscopic measurements at a MHz repetition rate we have unraveled the interplay between intramolecular dynamics and the intermolecular caging solvent response with 100 ps time resolution. On this time scale the ultrafast spin transition including intramolecular geometric structure changes as well as the concomitant bulk solvent heating process due to energy dissipation from the excited HS molecule are long completed. The heating is nevertheless observed to further increase due to the excess energy between HS and LS states released on a subnanosecond time scale. The analysis of the spectroscopic data allows precise determination of the excited population which efficiently reduces the number of free parameters in the XDS analysis, and both combined permit extraction of information about the structural dynamics of the first solvation shell.

Biota-sediment accumulation factor (BSAF), bioaccumulation factor (BAF), and contaminant levels in prey fish to indicate the extent of PAHs and OCPs contamination in eggs of waterbirds

Samples of pond sediment, fish, and shrimp were collected from the Ramsar site at Mai Po marshes, Hong Kong (south China), and samples of pond sediment, fish, and shrimp, as well as eggs of water birds (Chinese Pond Herons (Ardeola bacchus) and Little Egrets (Egretta garzetta)), were collected from two smaller wetland sites at Jiangsu Province (mid-China), between 2004 and 2007. Accumulation levels of polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs) in the biota were used to calculate biota-sediment accumulation factor (BSAF) and bioaccumulation factor (BAF). For fish and shrimp, BSAFs of OCPs (3.8-56) were greater than those of PAHs (0.12-6.3). BSAFs and BAFs of 11-79 and 4-34, respectively, were registered for OCPs in eggs of the birds and were greater than those for PAHs (0.11-1.5 and 0.02-1.3, respectively). Assuming that fish were the main prey of the birds, greater bioaccumulation of OCPs was detected for both bird species (BAFs =4.5-34), while accumulation of PAHs was only detected in Little Egret (BAF=1.3). A significant linear relationship (p<0.01) was observed between concentrations of OCPs in bird eggs and in the prey fish. The present study provides a new possibility of using OCP levels detected in prey fish to predict the extent of OCPs contamination in eggs of waterbirds including the endangered species, as a noninvasive method.

The use of a co-design model in improving timely bleed reporting by adults with haemophilia living in the Auckland region of New Zealand

Many adult patients diagnosed with phenotypically moderate and severe haemophilia living in the Auckland region of New Zealand do not report bleeding episodes within a timeframe that allows for optimal assessment and management. This can result in poor clinical outcomes for patients and poor oversight of the use of expensive clotting factor concentrates. Our goal was to improve both the number and speed at which bleeding episodes were reported to our centre, improving access to care and clinical oversight of the use of expensive factor concentrates and aiding the development of a care partnership with patients. We worked with 70 adult PWH living in the Auckland region of New Zealand with moderate and severe haemophilia A and B. Over a 5-month period between March and July 2013 we used a co-design model to develop and implement a range of strategies to improve the timing and frequency of bleed reporting. Mean bleed reporting time was reduced threefold, with a threefold increase in the number of bleeds reported per month. We reduced the number of bleeding episodes reported outside of a prespecified 48-h time limit by 68%. We significantly improved bleed reporting and time to report, indicating improved access to our services, improved clinical oversight and improved accountability to our national funder. We have achieved a care partnership and a reduction in factor consumption for the study population without compromising the quality of care they receive.