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In recent years, increasing attention has been drawn to improving productivity in logging passages while reducing negative impact on soil and water. The position of landings and extraction routes is crucial in these efforts, as it has a huge impact on efficient and sustainable forwarder passages. In this paper, we propose a two-phase approach to identify the best possible landing locations integrated with log extraction route design. The first phase identifies potential landing zones adjacent to forest roads. It considers practical restrictions such as slopes, stoniness, and closeness to infrastructure. The second phase uses an optimization model to evaluate the potential impact of each zone and aggregate zones, selecting one or two complete landings. This model is a relaxation of a formulation for an extraction route design; it is used to minimize a weighted objective of the total driving distance, avoid steep terrains and impact on soil and water. The proposed approach has been tested on a set of harvest areas in southern Sweden. The results not only show the potential to identify feasible landing zones but also identify a shorter driving distance and hence lower contractual cost with optimized positioning. The possibility to increase efficiency in forest operations by performing scenario analysis and thus forwarding distances with different landing sites is among the results. [ABSTRACT FROM AUTHOR]

Improving productivity in forest logging operations while reducing negative impact on soil and streams has gained increasing attention. Positioning primary extraction routes is crucial in these efforts, as it has a huge impact on efficient and sustainable forwarder passages. To minimize the total forwarding distance and avoid steep terrain and impact on soil and water, we developed a decision support system, including a detailed optimization model and solution method. The main source of information consisted of a detailed digital terrain model, depth-to-water maps, and forest volume density. The information was supplemented with the extent of the stand, position of the landing(s), nature and culture conservation sites, and any known unavoidable crossings in the terrain (e.g., streams). Because fast solution time was a critical requirement, we developed a decomposition method based on Lagrangian relaxation. The system was evaluated in two case studies in Sweden. In the first case, the optimization model performance was analyzed at 30 final harvesting sites. In the second case, experienced forest company staff evaluated the primary extraction routes at 19 harvest sites in operational conditions. The results indicated that the model allowed for faster planning, shorter driving distances, and the potential to reduce negative impact on soil and water. [ABSTRACT FROM AUTHOR]

Planning activities of harvest teams (harvesting and forwarding) and transportation is critical for efficient procurement of roundwood from forests to mills. The planning process involves many integrated decisions that consider process, spatial and temporal aspects. The spatial aspect concerns which area to harvest, which machine team to use, the mill to which the timber should be allocated and where to store the timber. The process decisions involve which bucking instruction to use. The temporal aspect concerns when to harvest, when to transport in order to meet specific demand at mills, and when to store the timber. Temporal decisions also include determining a detailed schedule for each harvest team. Such a schedule includes starting time and movement time between harvest areas. This is complicated by the harvest team having different home bases and different machine systems with their specific performance description and capacities. The overall planning problem can be formulated into one optimization model, but such a model is too large for practical use and cannot be solved in a reasonable time. We propose a decomposition scheme where a sequence of aggregated models, or limited parts of the model, is solved to find high-quality solutions quickly. We test the scheduling in cases involving two large Swedish forest companies. [ABSTRACT FROM AUTHOR]

Bioenergy is becoming a more important energy source. An important bioenergy assortment in Sweden is given by primary forest fuels. These account for about 14% of the biofuels or about 4% of Sweden's total energy. There are large volumes of forest fuel available. However, it is a low-value commodity and it is very sensitive to logistic cost to make it profitable. In this article, we analyse alternatives to lower the logistic costs. This includes the scheduling of the harvest and chipping operations in relation to transportation, delivered mix of assortments to customers and collaboration. We study these alternatives in a case that accounts for all operations in Sweden, involving 200,000 registered transports of about 6.1 million tons of forest biomass, equivalent to 17.4 TWh of energy consumption. We define a number of instances for these alternatives and formulate an optimization model based on linear programming. The solution is obtained by using a decision support system. We identify savings potential of about 22% from changing the operations. These savings can have a large impact on the industry and, more importantly, increase the use of bioenergy. We also test cost allocation methods to spread the savings based on cooperative game theory concepts. [ABSTRACT FROM AUTHOR]

This paper provides an integrated model for harvesting and logistic planning for tactical purposes over several years. The logistic planning includes both road upgrading and transportation between harvest areas and industries. The former is particularly important when dealing with problems when the accessibility of the road network is low due to, for example, thawing and heavy rains. The optimization model uses a detailed description of harvest areas including their spatial location, volume output of different assortment computations and net present value (NPV) for each year in the planning horizon. The model also uses a detailed description of the road network using the Swedish national road database. The model is very large and hard to solve, and hence, we are developing a solution approach based on an aggregation technique. An important part of the planning process is to select areas for the next 5 years, for example, and we analyze three different approaches. One approach is based on maximizing the NPV of the forest value, that is, the value at roadside. The second one is based on minimizing the logistic cost, and the third one combines NPV of the forest value at roadside and logistic. We analyze differences in a case study with over 6000 areas from the Swedish forest company Sveaskog. The results show that an integrated approach is necessary in order to avoid sub-optimal solutions. [ABSTRACT FROM PUBLISHER]

Background Little is known about perioperative microcirculatory changes during major abdominal surgery, and the main objectives of this study were to evaluate perioperative microcirculatory alterations in this setting, and if changes in microcirculatory parameters are associated with post-operative morbidity and/or with changes in parameters reflecting oxygen delivery. Methods Patients scheduled for major abdominal surgery with an estimated Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity ( P- POSSUM) score of > 30 and operation time > 3 h were eligible for inclusion. Perioperative microcirculatory alterations were evaluated in the sublingual mucosa using Sidestream Dark Field ( SDF) imaging. Perfused vessel density ( PVD), vessel perfusion [microvascular flow index ( MFI)], and flow heterogeneity [heterogeneity index ( HI)] were analysed. Central venous oxygen saturation ( ScvO2) and lactate were measured simultaneously. During a 30-day follow-up period, post-operative complications were registered according to predefined criteria. Results Forty-two patients with a median P- POSSUM of 33 were included in the study. MFI was higher during anaesthesia than pre- and post-anaesthesia. PVD and HI did not change during the observation period. Lactate and ScvO2 increased during surgery. Perioperative lactate and ScvO2 values were not correlated with microcirculatory parameters. Complications occurred in 16 patients. No differences in microcirculatory parameters were detected between patients with and without complications. Conclusions Perioperative changes in the sublingual microcirculatory parameters measured with the SDF-imaging technique appear to be minor, and no association with outcome after major abdominal surgery could be demonstrated. Changes in ScvO2 and serum lactate do not reflect sublingual microcirculatory alterations in this setting. [ABSTRACT FROM AUTHOR]

The importance of road databases for distance calculations and route selection is increasing. One reason is that payments and invoicing are often based on the distance driven. However, it can be hard to agree on a 'best' distance because of drivers' preferences. These preferences can be described by road features such as road length, quality, width, speed limits, etc. Moreover, a pure standard 'shortest path', which is often used in road databases, can result in a route that is considerably shorter than a preferred and agreed distance. Consequently, there is a need to find suitable weights for the features of the roads that provide fair and agreed distances at the same time for all users. We propose an approach to find values of such weights for the features. The optimization model to find weights is an inverse shortest path problem formulated in a mixed integer programming model. The approach is tested for the Swedish Forestry National Road database. Since 2010, it has been in daily use to establish distances and is available for all forestry companies and haulers in Sweden through an online system. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prognostic capacity of a new method for automatic quantification of the length of suppression time in the electroencephalogram (EEG) of a group of asphyxiated newborn infants. Methods: Twenty-one full-term newborn infants who had been resuscitated for severe birth asphyxia were studied. Eight channel continuous EEG was recorded for prolonged time periods during the first days of life. Artefact detection or rejection was not applied to the signals. The signals were fed through a pretrained classifier and then segmented into burst and suppression periods. Total suppression length per hour was calculated. All surviving patients were followed with structured neurodevelopmental assessments to at least 18 months of age. Results: The patients who developed neurodevelopmental disability or died had significant suppression periods in their EEG during the first days of life while the patients who had a normal follow-up had no or negligible amount of suppression. Conclusions: This new method for automatic quantification of suppression periods in the raw, neonatal EEG discriminates infants with good from those with poor outcome. [ABSTRACT FROM AUTHOR]

Objective: To study whether indomethacin used in conventional dose for closure of patent ductus arteriosus affects cerebral function measured by Electroencephalograms (EEG) evaluated by quantitative measures. Study design: Seven premature neonates with haemodynamically significant persistent ductus arteriosus were recruited. EEG were recorded before, during and after an intravenous infusion of 0.2 mg/kg indomethacin over 10 min. The EEG was analysed by two methods with different degrees of complexity for the amount of low-activity periods (LAP, “suppressions”) as an indicator of affection of cerebral function. Results: Neither of the two methods identified any change in the amount of LAPs in the EEG as compared to before the indomethacin infusion. Conclusion: Indomethacin in conventional dose for closure of patent ductus arteriosus does not affect cerebral function as evaluated by quantitative EEG. [ABSTRACT FROM AUTHOR]

We describe the decision support system RuttOpt, which is developed for scheduling logging trucks in the forest industry. The system is made up of a number of modules. One module is the Swedish road database NVDB, which consists of detailed information of all of the roads in Sweden. This also includes a tool to compute distances between locations. A second module is an optimization routine that finds a schedule, i.e., set of routes for all trucks. This is based on a two-phase algorithm where linear programming and a standard tabu search method are used. A third module is a database storing all relevant information. At the center of the system is a user interface where information and results can be viewed on maps, Gantt schedules, and result reports. The RuttOpt system has been used in a number of case studies and we describe four of these. The case studies have been made in both forest companies and hauling companies. The cases range from 10 to 110 trucks and with a planning horizon ranging between 1 and 5 days. The results show that the system can be used to solve large case studies and that the potential savings are in the range 5%–30%. Nous décrivons le système d’aide à la décision RuttOpt, qui a été développé pour planifier le déplacement des grumiers dans l’industrie forestière. Le système est composé de plusieurs modules. La base de données des routes suédoises (NVDB), qui contient des informations détaillées sur toutes les routes de la Suède, est l’un de ces modules. Ce module contient également un outil qui permet de calculer la distance entre deux endroits. Un deuxième module est constitué d’un sous-programme d’optimisation qui permet de générer un calendrier de transport, c.-à-d. un ensemble de trajets pour tous les camions. Cette opération est réalisée à l’aide d’un algorithme à deux phases dans lequel la programmation linéaire et une méthode de recherche tabou standard sont utilisées. Le troisième module est une base de données qui permet d’emmagasiner toutes les informations pertinentes. Au cœur du système se trouve une interface utilisateur qui permet de visualiser les informations et les résultats par le biais de cartes, de graphiques de Gantt et de rapports des résultats. Le système RuttOpt a été utilisé dans le cadre de plusieurs études de cas et nous décrivons quatre de ces études. Les études de cas ont été réalisées chez des compagnies forestières et des entreprises de transport. Selon le cas, le nombre de camions varie de 10 à 110 et l’horizon de planification d’un à 5 jours. Les résultats montrent que le système peut être utilisé pour résoudre des études de cas de grande taille et que les économies potentielles sont de l’ordre de 5 % à 30 %. [ABSTRACT FROM AUTHOR]

The forwarding of logs at harvest areas once the harvesting is done is planned manually by experienced operators. To improve their efficiency and simplify the planning we have developed and tested a decision support system at a major Swedish forest company. The system is based on a combination of a geographic information system (GIS), global positioning system (GPS), and optimization routines to solve the underlying vehicle routing problem. The routes for the forwarders are found by using a repeated matching algorithm. The solution time is short, and it is possible to find routes dynamically in a real-time environment. The geographic information required is found by using a GPS together with data obtained from the bucking software in the harvesters. To show the routes and location of the forwarder, we make use of a GIS that is connected to the GPS. We report on a study with savings in the distance travelled of 8% and numerical tests on the solution methodology. We also compare the proposed solution method with some well-known routing methods. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the periodic EEG patterns seen in healthy and sick full term neonates (tracé alternant and burst suppression, respectively) have different frequency characteristics.Methods: Burst episodes were selected from the EEGs of 9 healthy and 9 post-asphyctic full-term neonates and subjected to power spectrum analysis. Powers in two bands were estimated; 0–4 and 4–30 Hz, designated low- and high-frequency activity, respectively (LFA, HFA). The spectral edge frequency (SEF) was also assessed.Results: In bursts, the LFA power was lower in periods of burst suppression as compared to those of tracé alternant. The parameter that best discriminated between the groups was the relative amount of low- and high-frequency activity. The SEF parameter had a low sensitivity to the group differences. In healthy neonates, the LFA power was higher over the posterior right as compared to the posterior left region.Conclusions: Spectral power of low frequencies differs significantly between the burst episodes of healthy and sick neonates.Significance: These results can be used when monitoring cerebral function in neonates. [Copyright &y& Elsevier]

Background: Adverse effects may still limit the use of continuous epidural and intravenous analgesia in surgical wards. This study postulated that postoperative epidural analgesia was more efficient, and had fewer side-effects than intravenous morphine. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large patient population.Methods: During a five-year period 2696 patients undergoing major surgery, received either epidural or intravenous analgesia for postoperative pain relief. The patients were prospectively monitored in surgical wards. Pain was evaluated with a numeric rating scale (0-10) at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/nightmares/confusion, nausea/vomiting, pruritus, orthostatism/leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest.Results: Epidural analgesia was used in 1670 patients, and intravenous morphine in 1026 patients. Patients with epidural analgesia experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism/leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the intravenous group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements.Conclusion: In a large patient population the use of epidural and intravenous postoperative analgesia was considered safe in surgical wards, and the incidence of adverse effects was low. Patients with epidural analgesia experienced overall less pain, while opioid related side-effects were more common with intravenous morphine analgesia. [ABSTRACT FROM AUTHOR]

This report involves a 74-year-old-male who developed a thoracic epidural hematoma with paraparesis on the second postoperative day in conjunction with thoracic epidural anesthesia established before surgery for acute abdominal aortic dissection. The finding indicates that laminectomy can be performed successfully as late as three days after diagnosis of the hematoma, with a complete restitution of neurological function. High-dose steroid treatment may have been a contributing factor for the positive outcome. [ABSTRACT FROM AUTHOR]

Background: This clinical study aimed at investigating the impact of postoperative thoracic epidural analgesia on extracellular glycerol concentration and glucose metabolism in subcutaneous adipose tissue, using the microdialysis technique. The sympathetic nervous activity, which can be attenuated by epidural anesthesia, influences lipolysis and the release of glycerol.Methods: Fourteen patients who underwent major abdominal or thoraco-abdominal surgery were studied postoperatively over 3 days. For postoperative analgesia the patients were prospectively randomized to receive either thoracic epidural analgesia with a bupivacaine/morphine infusion (EPI-group, n=6) or a continuous i.v. infusion of morphine (MO-group, n=8). The concentration of glycerol, glucose and lactate in the abdominal and deltoid subcutaneous adipose tissue were measured using a microdialysis technique.Results: The abdominal glycerol levels were equal in both groups. In the deltoid region of the EPI-group, glycerol concentrations started to increase on Day 2, and reached significantly higher levels on Day 3 compared with the MO-group. The glucose and lactate levels showed no differences between groups in the two regions.Conclusion: The uniform glycerol levels in abdominal subcutaneous adipose tissue in conjunction with the difference in glycerol levels in the deltoid area indicate that the local lipolysis is different in the two study groups. This might be explained by a regional metabolic influence of thoracic epidural analgesia, possibly via the sympathetic nervous system. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate postoperative breathing patterns with a new monitoring device in patients given bupivacaine-morphine epidural analgesia.Design: Open explorative study.Setting: Inpatient anesthesia in a university hospital setting.Patients: 15 ASA physical status I and II patients aged 28 to 87 years and scheduled for major abdominal surgery.Interventions: All patients underwent abdominal surgery with epidural anesthesia combined with general anesthesia. Postoperatively, they continued with epidural analgesia consisting of bupivacaine and morphine. On the first postoperative night, the breathing pattern was studied with a new noninvasive monitoring device measuring respiratory frequency and apnea. Arterial blood gas analysis was performed in case of apnea or low respiratory frequency.Measurements and Main Results: A total of 84 alarm events were registered in 11 patients. Twenty-one percent (18/84) of the alarms were associated with arterial carbon dioxide tension (PaCO2) levels greater than 48.8 mmHg. Three of the four patients with PaCO2 levels greater than 48.8 mmHg were older than 80 years of age.Conclusion: The tested noninvasive monitoring device may detect abnormal respiratory breathing patterns in patients at risk for respiratory depression during epidural analgesia with bupivacaine-morphine. [Copyright &y& Elsevier]

There is a need to decrease the costs of cut-to-length operations. The harwarder, a one-machine system with the potential to reduce the costs, has been compared to the two-machine system (TMS) at the stand and regional levels but not at the national level, which is important as basis for decision to implement. The objective was therefore to analyze its potential on a large scale in Swedish final fellings. It was evaluated using two modeling approaches in conjunction with data representing around 30% of Sweden's yearly final fellings from five forestry organizations. The analyses revealed that total costs could be reduced by around 3% if up to 50% of the total volume was logged using harwarders rather than the TMS. This would require the introduction of up to 250 harwarders into machine fleets that currently use only the TMS. The two modeling approaches gave similar results. It was concluded that the harwarder may need to demonstrate greater potential to justify a full-scale implementation in Swedish forestry, but the machine could be improved through technological development, especially through automation. [ABSTRACT FROM AUTHOR]

High productivity in forest harvesting requires efficient forwarding. Planning is complicated by multiple choices of routes and their order, the number and types of assortments, the loading sequence, and pile organization at the landing. This paper develops and tests a decision support tool for forwarder routing with sequential co-loading of assortments. Input data are the harvester production file (including Global Navigation Satellite Systems tracking), placement of landing, and machine specifications. The trail network is generated from the harvester production data when devising routes to pick up all log piles, including specific assortments and volumes. Multiple assortments can be loaded along each route, and a certain loading sequence of assortments is preferred and (or) required. Sorting time during co-loading varies, depending on the assortment combinations and bunk loading pattern. Route planning is modeled using a set-partitioning problem, and the solution method is a metaheuristic based on repeated matching. In addition to routes and loading sequences, solutions include the organization of assortment piles at the landing, depending on the total volume of each assortment. The tool produces similar results to those attained by skilled forwarder operators on five clearcuts (3–11 ha) in northern Sweden, when the results are compared with data from actual forwarder production files. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented the early warning signs of complications of epidural anesthesia.

Background: Epidural anaesthesia and analgesia are indicated for oesophageal surgery. A rare but serious complication is spinal haematoma, which can occur on insertion, manipulation or withdrawal of catheters. Evidence and guidelines are vague regarding which tests are appropriate and how to interpret their results. We aimed to describe how routine coagulation test results change during oesophagectomy's perioperative course. Methods: Following ethical approval, we retrospectively identified patients who had undergone oesophagectomy between 2002 and 2012. Blood test results and details of operations, haemorrhage and complications were recorded and analysed with Excel and R. A literature search was conducted using the PubMed terms 'epidural' AND 'coagulation' AND English language. Relevant articles published in 2000 and after were included. Results: Three hundred and seven patients received a thoracic epidural infusion with bupivacaine and morphine while 51 received an intravenous morphine infusion. Tests taken preoperatively and before the planned withdrawal of the epidural catheter demonstrated increases in all three measures: aPTT (activated partial thromboplastin time), PT-INR (prothrombin international normalised ratio) and platelet count (Plc). Postoperative thrombocytopenia was almost non-existent while aPTT or PT-INR was elevated above the reference range in 129/307 patients: aPTT was elevated in 116/307 while PT-INR was elevated in 32/307. This is too small a sample to allow meaningful estimation of risk of spinal haematoma: it may be as high as 2.3%. The literature search returned 275 articles, of which 57 were relevant. Twenty-one concerned the natural history of postoperative coagulation; 16, the incidence of and risk factors for spinal haematoma; and 5, evaluation of specific blood tests. Postoperative coagulation is characterised by thrombocytosis and transient moderately abnormal routine coagulation test results. Viscoelastic tests are not validated in the stable postoperative setting. Conclusions: Screening for coagulopathy before removal of epidural catheters is of unclear benefit since elevated aPTT and PT-INR are usual and may not indicate hypocoagulation. A thorough clinical assessment is important. We nevertheless recommend caution when being presented with elevated routine tests of coagulation before withdrawing an epidural catheter: viscoelastic haemostatic tests may have a role in testing before withdrawal of epidural catheters but they are so far not validated. Future research should include advanced coagulation analysis as soon as a patient is unfortunate enough to have a spinal haematoma. [ABSTRACT FROM AUTHOR]

When a company is integrated vertically, it can manage and plan its overall value chain in one direct and integrated approach. However in many cases, companies follow a decoupled approach where forests and production plants optimize separately their processes in a supply-driven strategy. In Chile, the two largest forest companies are vertically integrated (i.e., they own forest and mills that produce logs, lumber, plywood, pulp, paper, and bioenergy, etc.). Historically, they have coordinated their value chains using a make-to-stock strategy, for which the forest is the main driver of the value chain activities. In this paper, we propose an integrated planning approach to show the impacts of a demand-driven integration of the value chain in the forest industry. To compare this strategy with the decoupled strategy, we propose a mixed integer programming (MIP) model for the integrated strategy. To illustrate our proposal, we use forest and production information from a Chilean forest company. The decoupled strategy, where the forest and industry planning are planned separately, uses two models. The first model deals with the forest management and harvesting decisions and maximizes the expected net present value (NPV) of logs. In this model, the planning horizon covers one full forest rotation, which in Chile corresponds to about 25 years. The second model maximizes the NPV of the downstream operations for a shorter business planning horizon (five years) constrained by the availability of the logs from the first model. In the integrated approach, all parts of the value chain (forest, transportation, and mills) are driven by final product demand and where the objective is to maximize the profit of the company (NPV of the entire value chain). The demand is only given for the shorter business planning horizon. The two strategies are evaluated using the MIP model, and NPV is used to determine the best practice. According to the results, the NPV can increase up to 5.0% when the proposed integrated strategy is implemented compared to a decoupled strategy. Moreover, the profit for the business period increases up to 8.5%. [ABSTRACT FROM AUTHOR]

Purpose: Adverse effects by night-call duty have become an important occupational health issue. The aim of this study was to investigate whether the heart rate variability (HRV) differed during recovery from day work and night-call duty between distinct physician specialities. Methods: We studied the impact of a 16-h night-call duty on autonomic balance, measured by HRV, among two physician groups differing with respect to having to deal with life-threatening conditions while on call. Nineteen anaesthesiologists (ANEST) and 16 paediatricians and ear, nose and throat surgeons (PENT) were monitored by ambulatory digital Holter electrocardiogram (ECG). Heart rate variability was analysed between 21:00 and 22:00 after an ordinary workday, on night call and in the evening post-call. Absolute and normalized high-frequency power (HF, HFnu) were the main outcome variables, expressing parasympathetic influence on the heart. Results: ANEST had lower HF power than PENT while on night call and post-daytime work ( p < 0.05), but not at post-night call. In the whole group of physicians, HFnu was lower on call and post-daytime work compared with post-night-call duty ( p < 0.05). Conclusions: The physiological recovery after night duty seemed sufficient in terms of HRV patterns for HFnu, reflecting autonomic balance and did not differ between specialities. However, the less dynamic HRV after daytime work and during night-call duty in the ANEST group may indicate a higher physiological stress level. These results may contribute to the improvement of night-call schedules within the health care sector. [ABSTRACT FROM AUTHOR]

Background: A controversy exists whether beneficial analgesic effects of epidural analgesia over intravenous analgesia influence the rate of post-operative complications and the length of hospital stay. There is some evidence that favours epidural analgesia following major surgery in high-risk patients. However, there is a controversy as to whether epidural analgesia reduces the intensive care resources following major surgery. In this study, we aimed at comparing the post-operative costs of intensive care in patients receiving epidural or intravenous analgesia. Methods: Clinical data and rates of post-operative complications were extracted from a previously reported trial following thoraco-abdominal oesophagectomy. Cost data for individual patients included in that trial were retrospectively obtained from administrative records. Two separate phases were defined: costs of pain treatment and the direct cost of intensive care. Results: Higher calculated costs of epidural vs. intravenous pain treatment, 1,037 vs. 410 Euros/patient, were outweighed by lower post-operative costs of intensive care 5,571 vs. 7,921 Euros/patient (NS). Conclusion: Higher costs and better analgesic effects of epidural analgesia compared with intravenous analgesia do not reduce total costs for post-operative care following major surgery. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate whether very low EEG frequency activity can be recorded from post asphyctic full term neonates using EEG equipment where the high pass filter level was lowered to 0.05Hz. Methods: The time constant of the amplifier hardware was set to 3.2s in order to enable recordings that equal to a high pass filter cut off at 0.05Hz. Burst episodes were selected from the EEGs of 5 post asphyctic full term neonates. The episodes were analysed visually using different montages and subjected to power spectrum analysis. Powers in two bands were estimated; 0–1 and 1–4Hz, designated very low- and low-frequency activity, respectively (VLFA, LFA). Results: In all infants, VLFA coinciding with the burst episodes could be detected. The duration of the VLFA was about the same as that of the burst episode i.e. around 4s. The activity was most prominent over the posterior regions. In this small material, a large amount of VLFA neonatally seemed to possibly be related to a more favourable prognosis. Conclusions: VLFA can be recorded from post asphyctic full term neonates using EEG equipment with lowered cut off frequency for the high pass filter. Significance: VLFA normally disregarded due to filtering, is present in the EEG of sick neonates and may carry important clinical information. [Copyright &y& Elsevier]

Each year, more than three million animals are transported from farms to abattoirs in Sweden. Animal transport is related to economic and environmental costs and a negative impact on animal welfare. Time and the number of pick-up stops between farms and abattoirs are two key parameters for animal welfare. Both are highly dependent on efficient and qualitative transportation planning, which may be difficult if done manually. We have examined the benefits of using route optimization in cattle transportation planning. To simulate the effects of various planning time windows and transportation time regulations and number of pick-up stops along each route, we have used data that represent one year of cattle transport. Our optimization model is a development of a model used in forestry transport that solves a general pick-up and delivery vehicle routing problem. The objective is to minimize transportation costs. We have shown that the length of the planning time window has a significant impact on the animal transport time, the total driving time and the total distance driven; these parameters that will not only affect animal welfare but also affect the economy and environment in the pre-slaughter logistic chain. In addition, we have shown that changes in animal transportation regulations, such as minimizing the number of allowed pick-up stops on each route or minimizing animal transportation time, will have positive effects on animal welfare measured in transportation hours and number of pick-up stops. However, this leads to an increase in working time and driven distances, leading to higher transportation costs for the transport and negative environmental impact. [ABSTRACT FROM AUTHOR]

Background: It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call. Methods: Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons. Results: Recovery patterns over the days after night call did not differ between groups, but between days. Mean night sleep for all physicians was 3 hours when on call, 7 h both nights post-call and Saturday, and 6 h after daytime work (p < 0.001). Scores for mental fatigue and feeling well rested were poorer post-call, but returned to Sunday morning levels after two nights' sleep. Conclusions: Despite considerable sleep loss during work on night call, and unexpectedly short sleep after ordinary day work, the physicians' self-reports indicate full recovery after two nights' sleep. We conclude that these 16-hour night duties were compatible with a short-term recovery in both physician groups, but the limited sleep duration in general still implies a long-term health concern. These results may contribute to the establishment of safe working hours for night-call duty in physicians and other health-care workers. [ABSTRACT FROM AUTHOR]

Background: Several studies have shown impaired mental well-being and performance in physicians work on call, but knowledge of the physiological effects is scarce. The aims of the present study were to investigate if there was a metabolic stress response in the restitutional phase after night-call duty, indicating potential negative health effects, and determine whether there were differences between physician specialities. Methods: Anaesthesiologists ( n = 19) were compared with paediatricians/ear, nose and throat (ENT) surgeons ( n = 18). On an ordinary workday, 1 and 3 days after work on night call, blood samples were taken for analysis of glucose, thyroid-stimulating hormone (TSH), free thyroxine, testosterone, insulin growth factor-1 (IGF-1), high- and low-density lipoprotein cholesterol (HDL and LDL), triglycerids (TG) and insulin. Saliva cortisol was sampled on an ordinary working day, a day including 16-h night call, the third day following, and for anaesthesiologists also on a day off work. Results: TSH differed significantly between days in both groups, with a 26% lower level 1 day after on-call duty ( P < 0.001). A 48% cortisol rise in the morning preceding night duty was found for paediatricians/ENT surgeons ( P < 0.01). Conclusion: The significant dip in TSH level 24 h after night-call duty indicates a metabolic effect of working on night call and should be studied further. However, the levels were within the normal range and the overall results do not imply any serious metabolic changes and only minor differences were seen between specialist groups. [ABSTRACT FROM AUTHOR]

Analbuminemia is a rare autosomal recessive disorder manifested by the absence or severe reduction of circulating serum albumin in homozygous subjects. In this report we describe a new molecular defect that caused the analbuminemic trait in a newborn of Iraqi origin. When the parents’ DNA was analyzed, both subjects were found to be heterozygous for the same mutation found in the infant. All the 14 exon and flanking intron sequences of the albumin gene were amplified via PCR and screened for mutations by SSCP and heteroduplex analysis. A mutation in the DNA region encoding exon 1 and its flanking intron was revealed by the presence of a heteroduplex. The fragment, which was directly DNA sequenced, contains a previously unreported single nucleotide change, consisting in a G to A substitution at nucleotide 118 in the structural gene of the human protein. This mutation, involving the first base of intron 1, destroys the GT dinucleotide consensus sequence found at the 5′ end of most intervening sequences and causes the defective pre-mRNA splicing responsible for the analbuminemic trait. [Copyright &y& Elsevier]