To overcome the environmental challenges faced by the global agricultural sector while also ensuring economic viability, dairy farmers must improve the efficiency of their systems. To improve system ...efficiency, the performance of an average production system must be determined, as it establishes a benchmark from which the efficacy of proposed management practices and mitigation strategies can be assessed. Identified management practices and mitigation strategies can then be compiled to create ambitious but realistic targets for the sector to strive toward. Therefore the objective of this study was to calculate the environmental performance of an average spring-calving pasture-based dairy system and an ambitious target dairy system. Life cycle assessment (LCA) of 2 pasture-based dairy systems were conducted: (1) current average spring-calving pasture-based dairy system (current), and (2) a spring-calving pasture-based dairy system that has achieved key performance targets set by the most efficient dairy systems (target). An existing dairy LCA model was updated with country-specific emission factors, life cycle inventory data, and recommended methodologies. The environmental impact categories assessed were global warming potential, nonrenewable energy depletion, acidification potential, and eutrophication potential (marine and freshwater). Two functional units were used: per kilogram of fat- and protein-corrected milk (FPCM), and per hectare. To assess the effects of the model updates, the current dairy system was simulated twice, once with the previous version of the dairy LCA model, and second with the updated LCA model. The addition of country-specific emission factors, updated inventory data, and implementation of recommended methods has resulted in global warming potential and nonrenewable energy depletion being reduced by 10.4% and 10.9%, respectively. The updates had negligible effects on acidification and eutrophication potential. The inclusion of assumptions around carbon sequestration in grassland further reduced global warming potential by 16.4%. Moving from the current dairy system to the target dairy system was reported to reduce the environmental impact per kilogram of FPCM across all impact categories investigated. When expressed per hectare, transitioning toward the target dairy system reduced acidification, freshwater eutrophication, and nonrenewable energy depletion by 2.0%, 8.8%, and 13.8%, respectively. In contrast, transitioning toward the target dairy system increased global warming per hectare and, to a lesser degree, marine eutrophication potential per hectare. The increase in global warming and marine eutrophication potential per hectare was attributed to the increase in stocking rate and subsequently milk production per hectare (9,950 vs. 14,100 kg of FPCM/ha). This study demonstrates that the adoption of management practices that improve system efficiency will reduce the environmental impact per kilogram of FPCM and can contribute to the future sustainability of pasture-based dairy systems. However, improved system efficiency can be offset by the associated increase in productivity, highlighting the importance of reporting multiple environmental impact categories and functional units to prevent pollution swapping. New research and mitigation strategies will be required to improve the environmental sustainability of dairy systems beyond the target system in the future.
Abstract
Introduction
Catastrophic hemorrhage is the leading cause of preventable trauma deaths in the military and civilian populations. The use of tourniquets by first responders (medical and ...nonmedically trained) is supported and has the potential to save lives if applied correctly.
Aims
We sought to examine the use of 5 tourniquets: 1 improvised and 4 commercially available tourniquets to investigate the time taken to stop simulated bleeding and to secure the device; evidence of rebleeding when the “blood pressure” was restored and to gain qualitative feedback on their application.
Materials and Methods
Four commercially available tourniquets (Combat Application Tourniquet C-A-T, Special Operations Forces Tactical Tourniquet - Wide (SOFTT-W), stretch, wrap, and tuck tourniquet SWAT-T, and the Tourni-key) and an improvised tourniquet (tie & wooden spoon) were tested on a complex silicone simulation model used to replicate catastrophic hemorrhage from a blast injury with above traumatic knee amputation (SAM 4.1 Trauma Simulation Ltd, UK). To limit the user variability, the same investigator applied each tourniquet and each was tested 3 times. No ethical approval was required to conduct this study.
Results
None of the devices took longer than 1 minute to secure. The C-A-T and SOFTT-W were quickest to occlude and secure. Although the Tourni-key took longer statistically, this was unlikely to be a clinically important difference. Compared to the others, the SOFTT-W rebled on 2 out of 3 applications. The improvised tourniquet had an obvious ligature effect because of its narrowness, followed by the Tourni-key. This effect was least evident with the SWAT-T; however, particular care was needed to ensure it was safely secured as it was slippery when wet.
Conclusions
All tourniquets tested were effective and swift to apply. The Tourni-key’s antipinch card seems helpful in reducing local pain under the windlass. Reinspection for rebleeding is important and should be routinely performed irrespective of the device. The width of the SWAT-T may be beneficial, thereby, reducing the risk of crush injury.
Eustachian tube dysfunction (ETD) is a common condition faced by primary care physicians with a variety of available treatments, none of which are particularly efficacious.
A 28 year old male soldier ...presented with ETD following swimming at depth which did not resolve with initial therapies. His condition resolved rapidly after implementation of the Modified Butyenko Breathing technique.
The breathing technique offers a series of methods that can be used to treat patients who are refractory to conventional treatments and can add to the range of non-surgical treatments for this common condition.
The British Army's contribution to tropical medicine Herron, Jonathan Blair Thomas; Alexander Thomas Dunbar, James
Clinical medicine (London, England),
October 2018, 2018-10-00, 20181001, Volume:
18, Issue:
5
Journal Article
Peer reviewed
Open access
Infectious disease has burdened European armies since the Crusades. Beginning in the 18th century, therefore, the British Army has instituted novel methods for the diagnosis, prevention and treatment ...of tropical diseases. Many of the diseases that are humanity's biggest killers were characterised by medical officers and the acceptance of germ theory heralded a golden era of discovery and development. Luminaries of tropical medicine including Bruce, Wright, Leishman and Ross firmly established the British Army's expertise in this area. These innovations led to the prevention of many deaths of both military personnel and civilians. British Army doctors were instrumental in establishing many of the teaching facilities that we now consider to be global leaders in tropical medicine. The impact of the Army in this field has certainly been significant in the past and its contribution continues to this day.
Few pathophysiological processes have a higher morbidity and mortality than sepsis. Implementing effective strategies to improve these poor outcomes remains a challenge. Previous work has shown ...improvements using single and multifaceted approaches, many with inclusion of sepsis training for doctors and nurses. However, previous work has not necessarily trained all those involved in the recognition and treatment of sepsis. After sepsis simulation training using cognitive-constructivist teaching methods, reaudit demonstrated highly significant improvement in 'sepsis-six' delivery. This study found inclusion of healthcare assistants in sepsis training is of great importance. This training should be tailored to personnel's current knowledge base and level of experience.
Current public sector austerity measures necessitate efficiency savings throughout the NHS. Performance targets have resulted in activity being performed in the private sector, waiting list ...initiative lists and requests for staff to work overtime. This has resulted in staff fatigue and additional agency costs. Adoption of extended operating theatre times (0800-1800 hours) may improve productivity and efficiency, with potentially significant financial savings; however, implementation may adversely affect staff morale and patient compliance. A pilot period of four months of extended operating times (4.5 hour sessions) was completed and included all theatre surgical specialties. Outcome measures included: the number of cases completed, late starts, early finishes, cancelled operations, theatre overruns, preoperative assessment and 18-week targets. The outcomes were then compared to pre-existing normal working day operating lists (0900-1700). Theatre staff, patient and surgical trainee satisfaction with the system were also considered by use of an anonymous questionnaire. The study showed that in-session utilisation time was unchanged by extended operating hours 88.7% (vs 89.2%). The service was rated as ‘good’ or ‘excellent’ by 87.5% of patients. Over £345,000 was saved by reducing premium payments. Savings of £225,000 were made by reducing privately outsourced operation and a further £63,000 by reviewing staff hours. Day case procedures increased from 2.8 to 3.2 cases/day with extended operating. There was no significant increase in late starts (5.1% vs 6.8%) or cancellation rates (0.75% vs 1.02%). Theatre over-runs reduced from 5% to 3.4%. The 18 weeks target for surgery was achieved in 93.7% of cases (vs 88.3%). The number of elective procedures increased from 4.1 to 4.89 cases/day. Only 13.33% of trainees (n = 33) surveyed felt that extended operating had a negative impact on training. The study concludes that extended operating increased productivity from 2.8 patients per session to 3.2 patients per session with potential savings of just over £2.4 million per financial year. Extrapolating this to the other 155 trusts in England could be a potential saving of £372 million per year. Staff, trainee and patient satisfaction was unaffected. An improved 18 weeks target position was achieved with a significant reduction in private sector work. However, some staff had difficulty with arranging childcare and taking public transport and this may prevent full implementation.
White clover (WC) offers an alternative source of nitrogen (N) for pasture-based systems. Substituting energy- and carbon-intensive synthetic N fertilizers with N derived from biological fixation by ...WC has been highlighted as a promising environmental mitigation strategy through the omission of emissions, pollutants, and energy usage during the production and application of synthetic fertilizer. Therefore, the objective was to investigate the effect of the inclusion of WC in perennial ryegrass (PRG) swards on the environmental impact of pasture-based dairy systems. Cradle-to-farm gate life cycle assessment of 3 pasture-based dairy systems were conducted: (1) a PRG–WC sward receiving 150 kg of N/ha per year (CL150), (2) a PRG–WC sward receiving 250 kg of N/ha per year (CL250), and (3) a PRG-only sward receiving 250 kg of N/ha per year (GR250). A dairy environmental model was updated with country-specific N excretion equations and recently developed N2O, NH3, and NO3− emission factors. The environmental impact categories assessed were global warming potential, nonrenewable energy, acidification potential, and eutrophication potential (marine and freshwater). Impact categories were expressed using 2 functional units: per hectare and per metric tonne of fat- and protein-corrected milk. The GR250 system had the lowest milk production and highest global warming potential, nonrenewable energy, and acidification potential per tonne of fat- and protein-corrected milk for all systems. The CL250 system produced the most milk and had the highest environmental impact across all categories when expressed on an area basis. It also had the highest marine eutrophication potential for both functional units. The impact category freshwater eutrophication potential did not differ across the 3 systems. The CL150 system had the lowest environmental impact across all categories and functional units. This life cycle assessment study demonstrates that the substitution of synthetic N fertilizer with atmospheric N fixed by WC has potential to reduce the environmental impact of intensive pasture-based dairy systems in temperate regions, not only through improvement in animal performance but also through the reduction in total emissions and pollutants contributing to the environmental indicators assessed.
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