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SUMMARY: Objectives: To assess a multimodal physician‐to‐physician communication initiative that is low in cost and impact to daily workflow to reduce blood product wastage. Background: Blood product stewardship is an important issue in all hospital systems. Previous studies have proposed low‐cost interventions to reduce blood product wastage, but few have evaluated improvements in communication between the blood bank and providers. We undertook a prospective quality improvement project focusing on improving communication to reduce blood product wastage. Methods: We conducted a prospective quality improvement project over the first quarter of 2017, identifying patients with issued but unused blood products. Each service overseeing the care of patients identified on the unit status report was contacted through two possible methods: (i) phone or (ii) proprietary Health Insurance Portability and Accountability Act of 1996 compliant digital messaging application. Collected variables included reserved blood product type and participant time spent. Outcomes included the rate of blood product release and changes in wastage compared with historical data tracked by the blood bank. Results: Eight hundred and forty products were reserved during the study period, of which 436 (52%) were released. Average participant times ranged from 2 ± 1 min to 15 ± 4 min with no significant differences in time spent between participants (P = 0·194). Compared with the average product wastage 10 months prior to project initiation, there were significant reductions in the average wastage for platelets (5·3 ± 2·5 units vs 2·5 ± 1·5 units, P = 0·05), RBCs (6·1 ± 3·7 units vs 0 ± 0 units, P = 0·01) and overall wastage (58·3 ± 14·9 units vs 40 ± 15·7 units, P = 0·05). Conclusion: Efforts focusing on improving provider‐to‐provider communication can reduce blood product wastage. [ABSTRACT FROM AUTHOR]

Reduced tillage, with more crop residue remaining on the soil surface, is believed to conserve water, especially in arid and semi-arid climates. However, the magnitude of water conservation is not clear. An experiment was conducted to study the effect of crop residue removal on soil water content, soil quality, and crop yield at North Platte, Nebraska. The same field plots were planted to soybean (Glycine max) in 2009 and 2010. There were two treatments: residue-covered soil and bare soil. Residue (mostly corn residue in 2009 and mostly soybean residue in 2010) was removed every spring from the same plots using a flail chopper and subsequent hand-raking. The experiment consisted of eight, 12.2 m X 12.2 m, plots (two treatments with four replications each). Soybeans were sprinkler-irrigated, but purposely water-stressed, so that any water conservation in the residue-covered plots might translate into higher yields. After four years of residue removal, soil organic matter content and soil residual nitrate nitrogen were significantly smaller, and soil pH was significantly greater, in the bare-soil plots compared to the residue-covered plots. The residue-covered soil held approximately 90 mm more water in the top 1.83 m compared to the bare soil near the end of the 2009 growing season. In addition, mean soybean yield was 4.5 Mg ha-1 in the residue-covered plots, compared to 3.9 Mg ha-1 in the bare-soil plots. Using two crop production functions, it is estimated that between 74 and 91 mm of irrigation water would have been required to produce this extra 0.6 Mg ha-1. In 2010, mean soybean yield was 3.8 Mg ha-1 in the residue-covered plots, compared to 3.3 Mg ha-1 in the bare-soil plots. Between 64 and 79 mm of irrigation water would have been required to produce this extra 0.5 Mg ha-1. In both years, several processes may have contributed to the differences observed: (1) greater evaporation of water from the soil in the bare-soil treatment, and (2) greater transpiration by plants in the bare-soil treatment in the beginning of the growing season as a result of more vegetative growth due to higher soil temperatures in the bare-soil treatment. [ABSTRACT FROM AUTHOR]

Competition for water is becoming more intense in many parts of the U.S., including west-central Nebraska. It is believed that reduced tillage, with more crop residue on the soil surface, conserves water, but the magnitude of water conservation is not clear. A study was initiated on the effect of residue on soil water content and corn yield at North Platte, Nebraska. The experiment was conducted in 2007 and 2008 on plots planted to field corn (Zea mays L.). In 2005 and 2006, soybean was grown on these plots. There were two treatments: residue-covered soil and bare soil. Bare-soil plots were created in April 2007. The residue plots were left untreated. In April 2008, bare-soil plots were recreated on the same plots as in 2007. The experiment consisted of eight plots (two treatments with four replications each). Each plot was 12.2 m X 72.2 m. During the growing season, soil water content was measured several times in each of the plots at six depths, down to a depth of 1.68 m, using a neutron probe. The corn crop was sprinkler-irrigated but purposely water-stressed, so that any water conservation in the residue-covered plots might translate into higher yields. In 2007, mean corn yield was 12.4 Mg ha-1 in the residue-covered plots, which was significantly (p = 0.0036) greater than the 10.8 Mg ha-1 in the bare-soil plots. Other research has shown that it takes 65 to 100 mm of irrigation water to grow this extra 1.6 Mg ha-1, which may be considered water conservation due to the residue. In 2008, the residue-covered soil held approximately 60 mm more water in the top 1.83 m compared to the bare soil toward the end of the growing season. In addition, mean corn yield was 11.7 Mg ha-1 in the residue-covered plots, which was significantly (p = 0.0165) greater than the 10.6 Mg ha-1 in the bare-soil plots. It would take 30 to 65 mm of irrigation water to produce this additional 1.1 Mg ha-1 of grain yield. Thus, the total amount of water conservation due to the residue was 90 to 125 mm in 2008. Water conservation of such a magnitude will help irrigators to reduce pumping cost. With deficit irrigation, water saved by evaporation is used for transpiration and greater yield, which may have even greater economic benefits. In addition, with these kinds of water conservation, more water would be available for competing needs. [ABSTRACT FROM AUTHOR]

The taxonomy of termites of the genus Odontotermes is poorly resolved. We used partial sequences from the mitochondrial 16S ribosomal RNA gene, combined with field and laboratory observations, to differentiate among populations of Odontotermes from four localities in Kenya. Three morphologically and behaviourally distinct forms from Kajiado ( O. tanganicus (Sjöstedt), O. anceps (Sjöstedt) and O. zambesiensis (Sjöstedt)) have distinct mitochondrial haplotypes, confirming that these are separate biological species. In contrast, a form from Kasarani and Karen ( O. stercorivorus (Sjöstedt)) shares almost identical mitochondrial haplotypes with the morphologically and behaviourally distinct O. montanus Harris at Embakasi. O. montanus at Embakasi and at Kinangop are fairly similar in behaviour, and at present are morphologically indistinguishable, but they have quite distinct mitochondrial haplotypes. We present a phylogeny of these mtDNA sequences and discuss it. We conclude that molecular sequence data provide a practical means of resolving ill-defined morphospecies in this genus. [ABSTRACT FROM AUTHOR]

Most patients with cancer prefer to die at home but the majority die in institutions. To determine place of death for patients with cancer in Belfast, to examine changes over time and identify factors associated with place of death. A survey of deaths registered in Belfast over a six-month period for 1977, 1987 and 1997 identified patients dying from cancer. Epidemiological data included age, gender, malignancy, social class, marital status, area of residence and place of death. Home deaths fell from 35% in 1977 to 28% in 1997. Hospital deaths fell from 50% in 1977 to 40% in 1987 rising to 42% in 1997. Hospice deaths rose from 13% in 1977 to 25% in 1987 falling to 23% in 1997. There was an association between place of death and age, marital status, type of cancer and area of residence, but not with social class or gender. The majority of people fail to achieve a home death. Resources need to be targeted to those most at risk of an institutional death; females, the elderly, the unmarried, those with haematological malignancies and residents of South Belfast. [ABSTRACT FROM AUTHOR]

Twenty recreational drug users were asked to describe the psychological and physiological effects they experienced under MDMA (3,4-methylenedioxymethamphetamine). The subjects comprised 11 males and nine females, in the age range 18–31 years. Five subjects had taken MDMA once, nine had taken it 2–9 times, while six subjects had taken it +10 times. Each subject completed a modified Profile of Mood States Questionnaire (POMS), an Ecstasy Effect Questionnaire, and a structured interview, covering past experience with MDMA. Increased feelings of elation, agreeableness, energy, and mental confusion were reported on-drug (p < 0·001), together with faster heart rate, feeling hot, increased sweating and dehydration, dilated pupils, and tight jaw (trismus). Coming off-Ecstasy led to feelings of lethargy, moodiness, insomnia, depression, irritability, and paranoia. Bad MDMA trips were reported by 25 per cent of the sample, following a variety of unpleasant experiences. Chronic pharmacodynamic tolerance was not apparent, since although regular users all described their first MDMA experience as ‘the most intense’, later trips were affected by knowledge and expectancy, rather than any diminution in drug response. Acute pharmacodynamic tolerance was, however, evident, with a period between drugs being described as necessary in order to maintain drug effectiveness. This may help explain the low addiction potential of MDMA. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Talks about the possible role of pharmacogenomics, the functional linkage of the science of human pharmacology, toxicology and genomics, in antibiotic therapy. Areas of pharmacogenomics potential; Key to the successful application of antimicrobial pharmacogenomics; Significance of pharmacogenomics.

Background: Base deficit (BD), anion gap (AG), and albumin corrected anion gap (ACAG) are used by clinicians to assess the presence or absence of hyperlactatemia (HL). We set out to determine if these tools can diagnose the presence of HL using cotemporaneous samples.Methods: We conducted a chart review of ICU patients who had cotemporaneous arterial blood gas, serum chemistry, serum albumin (Alb) and lactate(Lac) levels measured from the same sample. We assessed the capacity of AG, BD, and ACAG to diagnose HL and severe hyperlactatemia (SHL). HL was defined as Lac > 2.5 mmol/L. SHL was defined as a Lac of > 4.0 mmol/L.Results: From 143 patients we identified 497 series of lab values that met our study criteria. Mean age was 62.2 +/- 15.7 years. Mean Lac was 2.11 +/- 2.6 mmol/L, mean AG was 9.0 +/- 5.1, mean ACAG was 14.1 +/- 3.8, mean BD was 1.50 +/- 5.4. The area under the curve for the ROC for BD, AG, and ACAG to diagnose HL were 0.79, 0.70, and 0.72, respectively.Conclusion: AG and BD failed to reliably detect the presence of clinically significant hyperlactatemia. Under idealized conditions, ACAG has the capacity to rule out the presence of hyperlactatemia. Lac levels should be obtained routinely in all patients admitted to the ICU in whom the possibility of shock/hypoperfusion is being considered. If an AG assessment is required in the ICU, it must be corrected for albumin for there to be sufficient diagnostic utility. [ABSTRACT FROM AUTHOR]