Background
The use of norepinephrine in the case of life-threatening haemorrhagic shock is well established but widely discussed. The present study was designed to compare the effects of early ...norepinephrine treatment vs. no treatment on cerebral energy metabolism during haemorrhagic shock.
Methods
Twelve pigs were subjected to haemorrhagic shock, 4 in the control group and 8 in the norepinephrine (NE) group. Following a 60 min baseline period haemorrhagic shock was achieved by bleeding all animals to a pre-defined mean arterial blood pressure (MAP) of approximately 40 mm Hg. When mean arterial pressure had decreased to 40 mmHg NE infusion started in the treatment group. After 90 min, NE infusion stopped, and all pigs were resuscitated with autologous blood and observed for 2.5 h. During the experiment cerebral tissue oxygenation (PbtO
2
) was monitored continuously and variables reflecting cerebral energy metabolism (glucose, lactate, pyruvate, glutamate, glycerol) were measured by utilizing intracerebral microdialysis.
Results
All 12 pigs completed the protocol. NE infusion resulted in significantly higher MAP (
p
< 0.001). During the shock period lactate/pyruvate (LP) ratio group increased from 20 (15–29) to 66 (38–82) (median (IQR)) in the control group but remained within normal limits in the NE group. The significant increase in LP ratio in the control group remained after resuscitation. After induction of shock PbtO
2
decreased markedly in the control group and was significantly lower than in the NE group during the resuscitation phase.
Conclusion
NE infusion during haemorrhagic shock improved cerebral energy metabolism compared with no treatment.
The glacial geology of Himmerland in the north-eastern part of Jylland, south of Limfjorden (Fig. 1) has never received any special attention. However, the occurrence of parallel ridges south of ...Torup was mentioned by Milthers (1948) who interpreted them as marginal moraines. The ridges were recently studied during mapping of eastern Himmerland. Systematic geological mapping of the area north and south of Mariager Fjord started in 2009 and was completed in 2013 (map sheet 1316 III; Pedersen et al. 2013). This was followed by the map sheet to the north (1316 IV). During the recent mapping the extent of the terrain with parallel ridges was determined (Fig. 2); the western boundary is found in Rold Skov (Pedersen & Jakobsen 2005) and the eastern boundary follows an ancient coastline in eastern Himmerland. The most impressive parallel ridges occur in a forested area east of Madum Sø where the top level of the ridge crests reaches an elevation of 95 m a.s.l. However, the majority of the crests are at 60–70 m a.s.l. and most of the ridges are c. 10–15 m high. The sediments in the ridges are dominated by coarse-grained sand and gravel, and accumulations of erratic boulders are found on the surface of the ridges.
This article explains how and why limited use of force contributed to the surprising elimination of Somali piracy that no-one had expected. It proposes an analytical framework identifying four ...conditions for limited force success derived from the existing literature: (1) great power leadership, (2) Support at the international, regional and local levels, (3) Effective military forces capable of establishing escalation dominance, and (4) Limited use of force minimising collateral damage and adversary casualties. The analysis demonstrates that these four factors apply in the Somali case and explains how and why they were created even though implementation was costly and incentives for free-riding high. Although the Somali success will be hard to replicate, this case remains important because it improves our understanding of the conditions under which limited use of force can contribute to sustainable outcomes.
Since the Great Recession in 2008, the academic debate has been flooded with literature that predicts the sunset of the liberal world order including the practice of humanitarian intervention as ...initiated at the United Nations (UN) in the early 1990s and regulated by the adoption of the Responsibility to Protect (R2P) in 2005. In contrast, this article argues that the practice of humanitarian intervention continues to operate under post-hegemonic and multipolar conditions, but in new ways. Based on a theorization of fundamental institutional change and exploratory case studies of the international reactions to the humanitarian crises in Libya, Côte d’Ivoire, Syria and Mali, and supportive evidence from Gambia and DR Congo, we show that contemporary humanitarian intervention is closely related to a normalization of the fundamental institution of great power management and a regionalization of international society. In this post-hegemonic world order, humanitarian intervention is shaped, facilitated or hampered by various practices of great power management including concert, soft balancing and hard balancing. The return of great-power competition means an inconsistent and sometimes counterproductive resort to humanitarian intervention far from the ideals of the R2P, but the growing importance of regional ownership affects the great powers, keeps this potential response to mass atrocity crimes on the table and adds to its legitimacy.
In the European Union (EU) project Terrafirma, which is supported by the European Space Agency to stimulate the Global Monitoring Environment System, we are using the latest technology to measure ...terrain motion on the basis of satellite radar data. The technique we employ is known as persistent scatterer interferometry (PSI); in Denmark, it was previously used to map areas of subsidence susceptible to flooding in the Danish part of the Wadden Sea (Vadehavet) area (Pedersen et al. 2011). That study was part of the flooding risk theme under the TerraFirma Extension project. Another coastal protection monitoring activity in the EU seventh framework project SubCoast followed, in which the low-lying south coast of Lolland, prone to flooding, was studied. The Geological Survey of Denmark and Greenland (GEUS) is also involved in the three-year EU collaborative project PanGeo in which GEUS is one of 27 EU national geological surveys. The objective of PanGeo is to provide free and open access to geohazard information in support of the Global Monitoring Environment System. This will be achieved by providing a free, online geohazard information service for the two largest cities in each EU country, i.e. 52 towns throughout Europe with c. 13% of EU’s population.
Background
Damage control resuscitation (DCR) and damage control surgery (DCS) is the main strategy in patients with uncontrollable hemorrhagic shock. One aspect of DCR is permissive hypotension. ...However, the duration of hypotension that can be tolerated without affecting the brain is unknown. In the present study we investigate the effect of 60 min severe hypotension on the brain’s energy metabolism and seek to verify earlier findings that venous cerebral blood can be used as a marker of global cerebral energy state.
Material and methods
Ten pigs were anaesthetized, and vital parameters recorded. Microdialysis catheters were placed in the left parietal lobe, femoral artery, and superior sagittal sinus for analysis of lactate, pyruvate, glucose, glycerol, and glutamate. Hemorrhagic shock was induced by bleeding the animal until mean arterial pressure (MAP) of 40 mmHg was achieved. After 60 min the pigs were resuscitated with autologous blood and observed for 3 h.
Results
At baseline the lactate to pyruvate ratios (LP ratio) in the hemisphere, artery, and sagittal sinus were (median (interquartile range)) 13 (8–16), 21 (18–24), and 9 (6–22), respectively. After induction of hemorrhagic shock, the LP ratio from the left hemisphere in 9 pigs increased to levels indicating a reversible perturbation of cerebral energy metabolism 19 (12–30). The same pattern was seen in LP measurements from the femoral artery 28 (20–35) and sagittal sinus 22 (19–26). At the end of the experiment hemisphere, artery and sinus LP ratios were 16 (10–23), 17 (15–25), and 17 (10–27), respectively. Although hemisphere and sinus LP ratios decreased, they did not reach baseline levels (
p
< 0.05). In one pig hemisphere LP ratio increased to a level indicating irreversible metabolic perturbation (LP ratio > 200).
Conclusion
During 60 min of severe hypotension intracerebral microdialysis shows signs of perturbations of cerebral energy metabolism, and these changes trend towards baseline values after resuscitation. Sagittal sinus microdialysis values followed hemisphere values but were not distinguishable from systemic arterial values. Venous (jugular bulb) microdialysis might have a place in monitoring conditions where global cerebral ischemia is a risk.
Danish geological maps of deposits occurring at the terrain surface are published under the name of Geological map of Denmark 1:50 000 and are based on geological field mapping at 1:25 000. Most of ...the published maps follow the map sheet division shown in Fig. 1. However, in some instances it is appropriate to publish geological maps covering a regional unit, such as an island. Hence, the geological map of Mors appears as the 1:50 000 map sheet Mors, which covers parts of map sheets 1116 I, 1116 II and 1116 III (Figs 1, 2; Pedersen & Jakobsen 2012). Mors shows spectacular examples of glaciotectonic structures that are beautifully exposed in coastal cliff sections. It also has a unique geological history, which is briefly described in this paper.
This article identifies the institutional mechanisms that have created and sustained the surprisingly high level of political support that has characterized the two flagships of the activist Danish ...foreign policy for nearly 60 years: international military operations and development assistance. The high support results from two policy communities involving the key actors and using standard- and crisis-management procedures in the form of white papers, commissions, multi-year budget agreements, consultation, political agreements and strategies to build compromises within the two policy-areas. The high level of political support is underpinned by public disinterest in the two areas and the need to establish an international reputation as a reliable partner. The key to understanding the future of Denmark’s activist foreign policy consequently does not lie abroad or in opinion polls as it is generally assumed. It lies in the Danish parliament and the ministries involved in the two policy-areas.
Artiklen identificerer de institutionelle mekanismer, som har skabt og vedligeholdt den overraskende høje politiske opbakning, som har kendetegnet den aktivistiske udenrigspolitiks to flagskibe i ...næsten 60 år: de internationale militære operationer og udviklingsbistanden. Den høje og konstante opbakning skyldes to policy-fællesskaber, der inddrager de centrale aktører og anvender standard- og krisestyringsprocedurer i form af ekspertudredninger, kommissioner, flerårige budgetaftaler, konsultationer, politiske forlig og strategier til at skabe kompromiser på de to policy-områder. Den høje politiske opbakning understøttes af manglende folkelig interesse for de to områder og behovet for at fremstå som en troværdig international samarbejdspartner. Nøglen til at forstå den udenrigspolitiske aktivismes fremtidige udvikling ligger derfor ikke i udlandet eller i meningsmålingerne, som det normalt antages. Den ligger på Slotsholmen.
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