The introduction of new technology, management practices, and alternative production systems has resulted in rapid structural change in the US dairy industry. This paper examines adoption rates and ...adopter characteristics for the following dairy technologies, practices, and systems: holding pen with an udder washer, milking units with automatic take-offs, genetic selection technologies, recombinant bovine somatotropin, membership in the Dairy Herd Improvement Association, computerized feed delivery systems, computerized milking systems, use of a nutritionist to design feed rations, grazing, milking cows 3 times daily, and milking parlors. Four of these were used on a greater percentage of farms in 2005 than in 2000, but increased farm sizes and the interaction of farm size with adoption suggest a greater percentage of milk being produced under each, with the exception of grazing. Except for grazing, technologies were generally complementary.
Abstract Background Pancreatic cystic neoplasms (PCN) frequently undergo surgery, given malignant potential. Pancreatic cyst surgery is associated with significant rates of morbidity and mortality. ...It is crucial to accurately characterize these lesions pre-operatively to avoid unnecessary surgery in patients with benign pancreatic cysts. Aim We aimed to assess the correlation between pre-operative (pre-op) diagnosis based on imaging and clinical presentation, and post-operative (post-op) diagnosis based on histopathology in patients undergone pancreatic cyst surgery. Methods From January 2000 to January 2012, we randomly selected 2000 patients with ICD-9 code 211.6 and 577.2. Amongst these we identified 281 patients undergone pancreas surgery. Patients with no pre-op imaging or non-cyst indication for surgery were excluded (n = 107). Imaging details, demographics, pre-operative physician diagnosis and histopathologic details of pancreatic cysts were recorded in 174 patients. Results There was a discrepancy between the pre- and post-operative pancreatic cyst diagnosis in 54 (31%) patients. There was no difference in the proportion of various imaging studies (CT, EUS or MRI) between patients with a correct and patients with an incorrect pre-op diagnosis. The pre-op diagnosis was confirmed at pathology in 87.5% of the presumed SCNs, in 80% of the presumed pseudocysts, in 73.3% of the presumed BD-IPMNs, in 66.7% of the presumed MD/mixed-IPMNs and in 53.6% of the presumed MCNs. The accuracy of the pre-operative diagnosis of presumed MCN was significantly lower compared to the non-MCN cysts (53.6% vs. 75%; p = 0.037). Fourteen percent of resections were performed for asymptomatic benign cysts, preoperatively suspected to be potentially pre-malignant cysts. Conclusion In nearly 1 out of 3 patients undergone pancreas cyst surgery, there is a discrepancy between pre- and post-op diagnosis. Pre-op diagnosis of presumed MCN is more likely to be incorrect, compared to the other cysts.
Introduction: Solid waste management is a major issue in Nepal with Kathmandu valley generating the highest amount of solid waste. After recovery, the solid waste generated in Kathmandu valley is ...transferred to the Sisdol landfill site. There are waste workers in Sisdol landfill site who sustain their livelihood by collecting recyclables from those wastes. Personal protective equipment (PPE) is necessary to protect the frontline waste workers against infection. In addition, the waste workers need to know the proper usage of PPE in order to protect themselves from contamination. This study aimed to assess the awareness and proper usage of PPE along with the challenges faced by the waste workers at Sisdol landfill site.
Methods: A descriptive cross-sectional study was conducted to collect data from landfill waste workers of Sisdol located at Kakani Rural Municipality in Nuwakot district of Nepal. A convenience sampling method was used based on the availability of landfill waste workers on that day and their willingness to participate. The data was collected using the structured questionnaire and personal interview of available waste workers.
Results: The study comprised of 65% female and 35% male waste workers. The highest percentage of waste workers belong to 27-37 age group occupying 43% of total respondents. Around 92% waste workers had participated in any orientation/training or session related to PPE and its usage. About 60% landfill waste workers were found only using mask and gloves.
Conclusion: There is small number of waste workers who wish to wear full set of PPE. Most of them only like to wear mask and gloves. The gender, age group and the education level of waste workers had no association with the usage of PPE during the work.
It is known that patients with renal disease are often administered inappropriate dosages of drugs. A lack of quantitative data in the available drug information sources and inconsistency in dosing ...information may augment the problem of dosing error.
To determine the concordance among five drug information sources regarding the dosing recommendations provided for drugs considered problematic in patients with renal impairment and to determine the consistency among the sources regarding the definition of renal impairment and categorisation of chronic kidney disease.
Five standard drug information sources were reviewed for 61 drugs recommended to be used with caution in renal impairment. Information on recommendations for dosage adjustment in renal impairment was extracted and analysed. Further, the definition and classification of renal impairment were recorded. The recommendation for each drug was coded into six different categories and the intersource reliability was calculated.
Only slight agreement was observed among the sources (Fleiss Kappa: 0.3). Qualitative data were not well defined, and there was a lack of consistency in quantitative values. Some drugs marked as contraindicated in one source were not mentioned as such in others. Also, drugs considered as not requiring dosage adjustment in one source had explicit recommendations in other sources. The definition and classification of renal impairment differed among the five information sources.
There should be an evidence-based approach to drug dosage adjustment in order to bring uniformity to the recommendations. Regular updating of the content of the drug information sources is also important.
Symmetrical poly(ethylene oxide)–poly(propylene oxide)–poly(ethylene oxide), PEO–PPO–PEO, triblock copolymers with 80% polyethylene oxide (PEO, the hydrophilic end blocks) and polypropylene oxide ...(PPO, the hydrophobic middle block) usually remain as molecularly dissolved at ambient temperature even at fairly high-concentrations (2
wt.% or more). However, the micellization is induced at lower concentration/temperature in the presence of salts. The results on salt induced micellization from four such hydrophilic copolymers Pluronic
® F38, F68, F88 and F108 obtained from several independent techniques are described. FTIR and fluorescence results provide essentially identical critical micelle temperatures (CMTs) showing marked decrease with increase in PPO molecular weight and in the presence of salt. These copolymers were weakly surface active and did not show a clear break point in surface tension concentration plot typical of surfactants. While addition of salt decreases the cloud point, no significant micelle growth was observed even at temperature close to cloud point (CP). Marked increased in solubilization of an oil dye was observed in presence of KCl. Different methods showed good agreement in temperature/salt-induced micellization of these hydrophilic copolymers.
To review the product information (PI) for various brands of the same generic drugs and investigate the extent to which information is currently available on dosing in renal impairment and the ...concordance between the dosing recommendations for the same generic drug.
The Monthly Index of Medical Specialities (MIMS) was examined for 28 generic drugs recommended to be used with caution in renal impairment. For each generic drug all available brands listed as having solid oral dosage form were recorded. For each identified brand, the current PI was consulted and data referring to renal impairment was collated. The dissimilarity between these PI regarding the renal dosage recommendation was determined.
There was generally a lack of detailed information in the PI on the use of drugs in patients with renal impairment. The majority of PI documents (88 of 155 PI; 57%) provided quantitative dosage recommendations, but this was often not detailed enough to help users to make an informed decision. For 37 PI documents (24%), an altered dosage regimen was proposed without a quantifiable measure of renal function reported in the dose recommendation. The renal function severity category terms used and the associated quantitative values were also not consistent. It was observed that the recommendations varied among different brands of hydromorphone, morphine, oxycodone, tramadol, metformin and topiramate.
The reporting of renal function quantification methods, and associated dosage recommendations, in PI requires standardisation to ensure optimal drug dosing. Regularly updating of PI is also necessary.
Background & AimBoth chemokine receptor CXCR4 antagonist plerixafor (P) as well as high volume (HV) leukapheresis have been shown to reduce mobilization failure rates. However, no direct comparisons ...of such collection methods currently exist. In this single center retrospective study, we compared the collection efficiency in adult patients diagnosed with multiple myeloma (MM) or non-Hodgkins Lymphoma (NHL) undergoing autologous stem cell transplantation (ASCT) comparing yields based on pre apheresis peripheral blood (PB) CD34+ cell number (<50 or >50 cells/µL, Fig 1).Methods, Results & ConclusionThe collection methods used included HV vs. regular volume (RV) with or without P. There was a total of 116 patients (78 MM & 38 NHL) in the study group with a total of 191 collections. RV without P was used for patients whose pre-apheresis CD34 count was >50/µL. RV (+P) or HV (+P) or HV without P groups were used to investigate whether HV can substitute RV (+P) for poor mobilizers (<50 CD34+ cells /µl). While the addition of P failed to augment CD34 collection efficiency (CD34/L), RV (+P) notably increased CD34 collection efficiency in comparison to HV without P but the difference was not statistically significant (20.14 ± 3.42 vs 14.29 ± 1.71 × 10 6/L CD34+ cells, p = 0.06). The CD34+ cell yields (CD34/kg) from a single collection when compared between groups with or without P displayed no significant difference (Table 1). However, when collection efficiency was compared based on basal CD34 number, both RV and HV groups yielded significantly greater CD34+ cells when P was added. HV yielded greater CD34+ cells/kg recipient body weight than RV with basal CD34 cells <50/µL while HV yielded significantly lower CD34+ cells than RV (+P) (Table 1). When the basal CD34+ cells was <50/µL mobilization failure rate was 68% for RV but HV displayed only 34% failure rate and becomes 0% if basal PB is above 50 CD34+ cells/µl (Table 1). Thus the majority of patients having <50 CD34+ cells/µL can be rescued without P by employing HV with comparable adverse effects to RV (+P). HV group experienced notably higher incidents of platelet transfusions while RV group required more electrolyte replacement. In summary, both RV (+P) and HV apheresis are capable of reducing the failure rates to reach the minimal CD34+ yields. Our data suggest that except the poorest mobilizers (<20 CD34/µL), HV apheresis can be a cost effective substitute to P to obtain an optimal CD34 graft without exerting any additional adverse effects.
Abstract Postoperative skeletal stability and accuracy were evaluated in a combination of Le Fort I and horseshoe osteotomies for superior repositioning of maxilla in bi-maxillary surgeries in 19 ...consecutive patients. 9 underwent Le Fort I osteotomy alone (preoperative planned superior movement <3.5 mm). 10 underwent Le Fort I and horseshoe osteotomy (combination group) (preoperative planned superior movement >3.5 mm). The maxilla was osteotomized and fixed with 4 titanium Le Fort plates followed by bilateral sagittal split ramus osteotomy of the mandible, fixed with 2 semi-rigid titanium miniplates. Maxillomandibular fixation was performed for 1 week. Lateral cephalograms were obtained preoperatively, 1 week postoperatively, 3, 6, 12 months later. The changes in point A, point of maxillary tuberosity, and upper molar mesial cusp tip were examined. Discrepancy between the planned and measured superior movement of the maxilla in the Le Fort I and combination groups was 0.30 and 0.23 mm, respectively. The maxillae in both groups were repositioned close to their planned positions during surgery. 1 year later, both groups showed skeletal stability with no significant postoperative changes. When high superior repositioning of the maxilla is indicated, horseshoe osteotomy combined with Le Fort I is reliable and useful for accuracy and postoperative stability.
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