Development,implementation and impact of simple patient safety interventions in a university teaching hospital

ObjectiveTo determine the incidence of anesthesia patient safety incidents at a university teaching hospital, develop interventions to address the most common incidents, and determine the effectiveness of these interventions.Study designPre-post intervention observational.AnimalsFour thousand, one hundred forty dogs and cats anesthetized by the anesthesia service.MethodsThe study was divided into two 11.5 month periods. During each period, incidents were logged (e.g. closed adjustable pressure limiting (APL) valve, esophageal intubation, and medication error). At the end of the first period, four countermeasures were incorporated into the service’s protocols: 1) prior to any drug injection, the individual would read out aloud the drug name, patient name, and route of administration; 2) use of a uniquely colored occlusive wrap over arterial catheters; 3) a check box on the anesthesia record labeled “Technician Confirmed Intubation”; 4) a check box on the anesthesia record labeled “Technician Checked OR (operating room)”. The number of patient safety incidents during period 1 and period 2 were compared using Fisher’s Exact Test.ResultsDuring Period 1, there were 74 incidents documented in 2028 patients (3.6%) including 25 medication errors, 20 closed APL valves, and 16 of esophageal intubation. During Period 2, there were 30 incidents documented in 2112 patients (1.4%) including 14 medication errors, 5 closed APL valves, and 4 of esophageal intubation. The proportion of events during Period 2 was significantly smaller than during Period 1 (p < 0.0001).Conclusions and Clinical relevanceImplementation of four simple interventions was associated with a significant decrease in the number of incidents.     

Antinociceptive and selected physiological effects of morphine and xylazine on tiletamine‐zolazepam anesthesia in llamas

ObjectiveEvaluate antinociception, anesthesia, and recovery in llamas given tiletamine-zolazepam (TZ) with either morphine, xylazine, morphine and xylazine, or saline.Study designRandomized crossover experimental study.AnimalsSix healthy, adult intact male llamas.MethodsLlamas were given each of four treatments intramuscularly with a 1-week washout: TZ (2 mg kg^?1) combined with either morphine (0.5 mg kg^?1; M), xylazine (0.15 mg kg^?1; X), morphine (0.5 mg kg^?1) and xylazine (0.15mg kg^?1) (MX), or saline (C). Llamas breathed room air during the experiment. Characteristics of anesthesia, recovery, and selected cardiopulmonary variables were recorded. Antinociception was assessed by clamping a claw at 5-minute intervals. Data were analyzed using a mixed-model anova and Tukey-Kramer test, and are expressed as least squares mean ± SEM. Significance was set at p < 0.05.ResultsNo llama in the control group demonstrated antinociception. Antinociception was longest with treatment MX, followed by treatments X and M, respectively. Heart rates in llamas given treatments X and MX were significantly lower than with other treatments. The respiratory rate in llamas given treatment C was greater (p < 0.05) than for all other treatments, however, the respiratory rate was not significantly different among treatments X, M and MX. The PaO₂ for llamas given MX remained <60 mmHg throughout the 20 minute period of blood gas analysis. Mean arterial blood pressure in llamas in treatment MX was less than for treatments M or C.Conclusion and clinical relevanceThe combination of morphine (0.5 mg kg^?1) and xylazine (0.15 mg kg^?1) increased the duration of antinociception compared with xylazine alone, in TZ-anesthetized llamas. Treatments X, M and MX were associated with hypoxemia (PaO₂ < 60 mmHg).     

Poor maternal nutrition inhibits muscle development in ovine offspring

Background

Maternal over and restricted nutrition has negative consequences on the muscle of offspring by reducing muscle fiber number and altering regulators of muscle growth. To determine if over and restricted maternal nutrition affected muscle growth and gene and protein expression in offspring, 36 pregnant ewes were fed 60%, 100% or 140% of National Research Council requirements from d 31 ± 1.3 of gestation until parturition. Lambs from control-fed (CON), restricted-fed (RES) or over-fed (OVER) ewes were necropsied within 1 d of birth (n = 18) or maintained on a control diet for 3 mo (n = 15). Semitendinosus muscle was collected for immunohistochemistry, and protein and gene expression analysis.

Results

Compared with CON, muscle fiber cross-sectional area (CSA) increased in RES (58%) and OVER (47%) lambs at 1 d of age (P < 0.01); however at 3 mo, CSA decreased 15% and 17% compared with CON, respectively (P < 0.01). Compared with CON, muscle lipid content was increased in OVER (212.4%) and RES (92.5%) at d 1 (P < 0.0001). Muscle lipid content was increased 36.1% in OVER and decreased 23.6% in RES compared with CON at 3 mo (P < 0.0001). At d 1, myostatin mRNA abundance in whole muscle tended to be greater in OVER (P = 0.07) than CON. Follistatin mRNA abundance increased in OVER (P = 0.04) and tended to increase in RES (P = 0.06) compared with CON at d 1. However, there was no difference in myostatin or follistatin protein expression (P > 0.3). Phosphorylated Akt (ser473) was increased in RES at 3 mo compared with CON (P = 0.006).

Conclusions

In conclusion, maternal over and restricted nutrient intake alters muscle lipid content and growth of offspring, possibly through altered gene and protein expression.     

Excavating sponges that are destructive to farmed pearl oysters in Western and Northern Australia

Species of the family Clionaidae (Porifera: Demospongiae) that excavate shell of the silver‐lip pearl oyster, Pinctada maxima, in north Western and Northern Australia are described. Two species belong to the genus Cliona and one species to the closely related genus Pione. Cliona orientalis has only recently been reported from Australia in living and dead coral on the Great Barrier Reef, and this is the first report of this species from north Western and Northern Australia. Cliona dissimilis is reported from Australia for the first time. Pione velans was first described from Shark Bay, Western Australia and this study extends its distribution from Albany, south Western Australia to Port Bremer in the Northern Territory. The most common species found was C. dissimilis. Pione velans and C. orientalis were also present, although the latter species was rare. Cliona dissimilis and P. velans were found to be sexually reproductive in some shells with specimens of C. dissimilis with oocytes in May and P. velans in September 1999. Egg development was synchronous, indicating that the sponges were oviparous and would broadcast gametes in a spawning event.     

Changes in soil organic carbon in a clay loam soil following ploughing and reseeding of permanent grassland under temperate moist climatic conditions

This study investigated changes in soil organic carbon (SOC) in a poorly drained clay loam soil under (i) permanent grassland (PG) over 7 years and (ii) after PG renovation over 2·5 years. The experimental area was divided into four blocks with four paddocks per block. Composite soil samples from each PG block were taken to 30‐cm depth on five occasions between 2004 and 2011. In June 2008, one paddock per block was renovated by ploughing and reseeding and sampled as above on the latter four occasions. Renovation decreased SOC (P < 0·05) by 32·2 t ha^?1 in the 2·5 years following ploughing; the difference developed almost entirely (86%) in the first four months. Renovation had no effect on above‐ground productivity, standing root and stubble phytomass or on dissolved organic matter leaching. Therefore, soil respiration was considered to be a single potential pathway responsible for the SOC loss from renovated grassland. Although a simple linear regression indicated a tendency for PG to accumulate SOC, there was no evidence of recovery in SOC to previous levels following renovation during the study period. These results could have implications for greenhouse gas inventories in countries where PG is an important land‐use type.     

Wisconsin’s “Happy Cows”? Articulating heritage and territory as new dimensions of locality

In this article, we suggest that attending to the roles of heritage and territory could help reshape local food systems in the US: first, by incorporating more producer voices and visions into the conversation; and second, by considering more deeply the characteristics of the places where food is produced. Using the Wisconsin artisanal cheese network as a case study, we have traced how artisanal producers frame their collective heritage and links to their territory. They describe a heritage that includes a cultivation of embedded, “situated” agricultural knowledge(s) and a commitment to specific quality practices as well as a connection to terroir—the specific ecologies and social contexts of their farm or region. We argue that their articulation of this heritage and terroir is both an emergent, ongoing process of adapting to changing market, cultural, and geographic conditions and an effort to recover valued traditions and practices and (re)connect to specific places.     

Evidence for long‐term spatial displacement of breeding and pupping harbour seals by shellfish aquaculture over three decades

• 1. Shellfish mariculture is increasing worldwide and often occurs adjacent to marine mammal breeding and feeding habitat. To better understand breeding pinniped vulnerability to potential shellfish mariculture disturbance and displacement effects in a US National Park, potential mechanisms were explored that may affect the proportion of harbour seals (Phoca vitulina) selecting high quality haul‐out sites near shellfish aquaculture within a large colony, and overall seal utilization of that colony in relation to other regional colonies.
• 2. Seal haul‐out sites isolated from the mainland (no predator access) had higher pup:adult ratios, indicating they are generally more important for pupping. Short‐term human disturbance did not have a significant effect on spatial use, but rather spatial use was pre‐determined by general sandbar isolation. Using multiple competing hypothesis and an information‐theoretic approach, it was found that within the estuary, after removing effects of El Niño, the proportion of seals (total seals and pups only) hauled out near mariculture sites was 8 ± 2% lower during years of higher oyster harvest. Annual oyster harvest was used as a measure of aquaculture activity that could result in direct disturbance or indirect displacement of harbour seals.
• 3. At the regional scale, oyster harvest, seal counts at a nearby colony, and loss of a major haul‐out site within the estuary, best explained pup and total seal use compared with the region. Regional population size, short‐term human disturbance rate, and other factors were not important. Concurrent with higher oyster harvest, the proportion of regional seals using the estuary declined by 7 ± 2% for seal pups (–65 ± 18 total pups), and 5 ± 2% for total counts ( ? 192 ± 58 total seals). These findings (both within the estuary and at the regional scale) were essentially identical whether modelling oyster harvest as either a continuous or categorical (low/high) variable and when using either frequentist or Bayesian statistical analyses.
• 4. Marine reserves set aside for wildlife may be less effective when the highest quality breeding and pupping sites are adjacent to regular aquaculture activities. These effects may not be detectable until additional natural variation lowers the quality of nearby habitats. Published in 2011. This article is a US Government work and is in the public domain in the USA.

     

Investigation on redox status and gene expression related to larval cryopreservation in the Pacific oyster Crassostrea gigas

This study evaluated the effects of larval cryopreservation on redox status of post-thaw trochophore larvae and on gene expression in post-thaw trochophore larvae, D-larvae, umbo larvae, eyed larvae and spat, with the aim to understand the effects of cryodamage in the Pacific oyster Crassostrea gigas. The results showed that total antioxidant capacity was significantly higher in the cryopreserved larvae than in the control group (P?<?0.05), with no significant difference in the production of reactive oxygen species between these two groups (P?>?0.05). The expressions of FADD, Bax1, Baxlike, Bcl2, CASP7 and CAT were significantly downregulated in post-thaw trochophore larvae, whereas the expression of the SOD gene was significantly upregulated. However, the expressions of all of these genes did not significantly differ at later developmental stages. In the cryopreserved group, the expressions of GPX and ATG6 were downregulated in trochophore larvae and upregulated in D-larvae, while there were no signficant changes in the expressions of BI-1, Caspase 3 and ATG8 at all developmental stages investigated. Taken together, these results suggest that the larval cryopreservation technique developed for the Pacific oyster may compromise the survival of post-thaw trochophore larvae by modifying the redox status and gene expression patterns, but that they have limited effects, if any effect at all, after the umbo stage, indicating that the umbo stage should be used for assessing post-thaw larval performance in this species.

     

Multimycotoxin UPLC-MS/MS for tea, herbal infusions and the derived drinkable products

In recent years the consumption of tea and herbal infusions has increased. These hot drinks are consumed as daily drinks as well as for medicinal purposes. All tea varieties (white, yellow, green, oolong, black and puerh) originate from the leaves of the tea plant, Camellia sinensis. All extracts made of plant or herbal materials which do not contain Camellia sinensis are referred as herbal infusions or tisanes. During processing and manufacturing fungal contamination of the plant materials is possible, enabling contamination of these products with mycotoxins. In this study a multimycotoxin UPLC-MS/MS method was developed and validated for the analysis of the raw tea and herbal infusion materials as well as for their drinkable products. The samples were analyzed by ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), with a mobile phase consisting of variable mixtures of water and methanol with 0.3% formic acid. The limits of detection for the different mycotoxins varied between 2.1 μg/kg and 121 μg/kg for raw materials and between 0.4 μg/L and 46 μg/L for drinkable products. Afterward 91 different tea and herbal infusion samples were analyzed. Only in one sample, Ceylon melange, 76 μg/kg fumonisin B(1) was detected. No mycotoxins were detected in the drinkable products.