790 resultados para anaesthetic nurse specialist, leading and facilitating


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Lini Richarda Grol was originally born in Nijmegen, Netherlands in 1913 and immigrated to Canada in 1954 after working as a nurse in South America for three years from 1951 to 1954. She was granted her first Canadian passport in 1961 and worked full-time as nurse at the Welland County Hospital. While nursing she would enroll in writing courses at McMaster University and Ryerson Polytechnical Institute, now Ryerson University. Eventually she decided to dedicate herself to her writing and artwork and began to only work as a nurse part-time and then later opened the Fonthill Studio to devote herself to her writing and artwork full-time. Her status as an immigrant and career as a nurse provided inspiration for much of her writing and she frequently tackles the experience of the female immigrant in her works. Her first publication was in 1938 in a small literary and women’s magazines in Holland and Belgium and her first work of poetry was entitled Stive Gedachten. None of these publications exist in this archive. Her most well-known publication, Liberation, centers around her experiences leading up to and after the liberation of Holland during World War II. Grol was, and continues to be a prolific writer in the Niagara Region and has been published in the Welland Tribune, Pelham Herald, Thorold News, Parent Magazine, Dunville Chronicle, and various Christian publications and literary newsletters and journals. Grol also started her own poetry magazine entitled Canadian Poets Pen Club to help aspiring writers get published. Perhaps her most recognized achievement was the inclusion of one of her poems and the recognition of her novel Liberation into the Thank You Canada Day celebration in May 1970. Grol participated in many local writers’ groups such as the Welland Writer’s Club, and the Canadian Author’s Association. Grol was membership secretary for the Canadian Author’s Association in 1984. She also founded a writer’s club in 1995 in her retirement home, Holland Christian Homes where members meet to talk about their poems and short stories either in English or Dutch. Participating in and creating a writers’ community is integral to Grol’s identity as an author and can be related to the feelings of isolation she felt as an immigrant to Canada. Grol also hosted her own television shows entitled Discovery with Lini Grol which featured guests, usually local artists and writers, and Holland en Hollanders a cultural program for Dutch immigrants. Grol’s most recent activities include the publication of a one act play entitled Peppermint Problems [1996] and a short story entitled “When our War started in Rotterdam” [2004]. In 1994, she moved to Brampton, Ontario into a Christian retirement center called Holland Christian Homes. For further biographical information about Grol see two books contained within this collection Women of Action [1976] and Something About the Author [1976].

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INTRODUCTION: Il existe peu d’évidences sur l’association entre le taux de chômage dans le milieu résidentiel (CR) et le risque de maladies cardiovasculaires parmi les résidents de milieux urbains. De plus, on ne sait pas si ce lien diffère entre les deux sexes. Cette thèse a pour objectif de déterminer la direction et la taille de l’association entre le CR et le risque de maladies cardiovasculaires, et d’examiner si cette association varie en fonction du sexe. MÉTHODES: Un sous-échantillon de 342 participants de l’Étude sur les habitudes de vie et la santé dans les quartiers montréalais a rapporté ses habitudes de vie et sa situation socio-économique. Des mesures biologiques et anthropométriques ont été recueillies par une infirmière. Le CR a été opérationnalisé en fonction d’une zone-tampon d’un rayon de 250 m centrée sur la résidence de chacun des participants à l’aide d’un Système d’Information Géographique (SIG). Des équations d’estimation généralisées ont été utilisées afin d’estimer l’association entre le CR et l’Indice de Masse Corporelle (IMC) et un score cumulatif de Risque Cardio-métabolique (RC) représentant la présence de valeurs élevées de cholestérol total, de triglycérides, de lipoprotéines de haute densité et d’hémoglobine glyquée. RÉSULTATS: Après ajustement pour l’âge, le sexe, le tabagisme, les comportements de santé et le statut socio-économique, le fait de vivre dans un endroit classé dans le 3e ou 4e quartile de CR était associé avec un IMC plus élevé (beta pour Q4 = 2.1 kg/m2, IC 95%: 1.02-3.20; beta pour Q3 = 1.5 kg/m2, IC 95%: 0.55-2.47) et un taux plus élevé de risque cardiovasculaires Risque Relatif [RR pour Q4 = 1.82 (IC 95 %: 1.35-2.44); RR pour Q3 = 1.66 (IC 95%: 1.33-2.06)] par rapport au 1er quartile. L'interaction entre le sexe et le CR révèle une différence absolue d’IMC de 1.99 kg/m2 (IC 95%: 0.00-4.01) et un risque supérieur (RR=1.39; IC 95%: 1.06-1.81) chez les femmes par rapport aux hommes. CONCLUSIONS: Le taux de chômage dans le milieux résidentiel est associé à un plus grand risque de maladies cardiovasculaires, mais cette association est plus prononcée chez les femmes.

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Contexte : Les médecins spécialistes peuvent participer aux soins ambulatoires des personnes atteintes de maladies chroniques (MCs) et comorbidité comme co-gestionnaire ou consultant selon qu’ils sont responsables ou non du suivi du patient. Il y a un manque d’évidences sur les déterminants et l’impact du type d’implication du médecin spécialiste, ainsi que sur la façon optimale de mesurer la comorbidité pour recueillir ces évidences. Objectifs : 1) déterminer chez les patients atteints de MCs les facteurs associés à la cogestion en spécialité, dont les caractéristiques des organisations de première ligne et la comorbidité; 2) évaluer si le type d’implication du spécialiste influence le recours à l’urgence; 3) identifier et critiquer les méthodes de sélection d’un indice de comorbidité pour la recherche sur l’implication des spécialistes dans le suivi des patients. Méthodologie : 709 adultes (65 +/- 11 ans) atteints de diabète, d’arthrite, de maladie pulmonaire obstructive chronique ou d’insuffisance cardiaque furent recrutés dans 33 cliniques de première ligne. Des enquêtes standardisées ont permis de mesurer les caractéristiques des patients (sociodémographiques, comorbidité et qualité de vie) et des cliniques (modèle, ressources). L’utilisation des services de spécialistes et de l’urgence fut mesurée avec une base de données médico-administratives. Des régressions logistiques multivariées furent utilisées pour modéliser les variables associées à la cogestion et comparer le recours à l’urgence selon le type d’implication du spécialiste. Une revue systématique des études sur l’utilisation des services de spécialistes, ainsi que des revues sur les indices de comorbidité fut réalisée pour identifier les méthodes de sélection d’un indice de comorbidité utilisées et recommandées. Résultats : Le tiers des sujets a utilisé les services de spécialistes, dont 62% pour de la cogestion. La cogestion était associée avec une augmentation de la gravité de la maladie, du niveau d’éducation et du revenu. La cogestion diminuait avec l’âge et la réception de soins dans les cliniques avec infirmière ayant un rôle innovateur. Le recours à l’urgence n’était pas influencé par l’implication du spécialiste, en tant que co-gestionnaire (OR ajusté = 1.06, 95%CI = 0.61-1.85) ou consultant (OR ajusté = 0.97, 95%CI = 0.63-1.50). Le nombre de comorbidités n’était pas associé avec la cogestion, ni l’impact du spécialiste sur le recours à l’urgence. Les revues systématiques ont révélé qu’il n’y avait pas standardisation des procédures recommandées pour sélectionner un indice de comorbidité, mais que 10 critères concernant principalement la justesse et l’applicabilité des instruments de mesure pouvaient être utilisés. Les études sur l’utilisation des services de spécialistes utilisent majoritairement l’indice de Charlson, mais n’en expliquent pas les raisons. Conclusion : L’implication du spécialiste dans le suivi des patients atteints de MCs et de comorbidité pourrait se faire essentiellement à titre de consultant plutôt que de co-gestionnaire. Les organisations avec infirmières ayant un rôle innovateur pourraient réduire le besoin pour la cogestion en spécialité. Une méthode structurée, basée sur des critères standardisés devrait être utilisée pour sélectionner l’indice de comorbidité le plus approprié en recherche sur les services de spécialistes. Les indices incluant la gravité des comorbidités seraient les plus pertinents à utiliser.

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Introduction. L’ostéoporose est une maladie chronique habituellement asymptomatique jusqu’à ce qu’il y ait fracture de fragilisation (FF). Ces fractures engendrent des coûts importants dont une partie pourrait être évitée par la prise en charge de ces patients pour l’ostéoporose. L’implantation d’un programme de prévention des fractures subséquentes géré par des infirmières en orthopédie pourrait permettre de parer à ces problèmes. Objectifs. L’objectif principal de ce projet était de déterminer si une infirmière peut gérer de façon efficace et sécuritaire un service de liaison pour fracture. Méthode. Les décisions cliniques d’infirmières entre 2010 et 2012 pour 525 patients d’un service de liaison pour fracture à l’étude ont été évaluées par deux médecins spécialistes indépendants avec expertise dans les soins pour l’ostéoporose. Résultats. Les infirmières ont pu identifier la totalité des sujets à risque et référer 26.7% de ceux-ci à un spécialiste. L’accord entre chacun des évaluateurs et les infirmières était de >97%. Les évaluateurs ont donné les mêmes réponses à >96% pour chaque type de décision et le niveau d’accord inter-juge était presque parfait (AC1 >0.960). Aucune référence n’a été jugée inutile. Les comorbidités majeures ont toutes été prises en charge. Conclusion. L’accord élevé entre les décisions cliniques des infirmières et des médecins évaluateurs démontre que la prise en charge par une infirmière est sécuritaire et recommandable pour les patients avec FF. Ce type d’intervention pourrait contribuer à résoudre les problèmes d’accessibilité aux soins chez les patients avec fragilité osseuse, ainsi qu’à diminuer le fardeau économique que représente le traitement des FF pour la société.

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PowerPoint presentation that showcases: • Research Objectives • Strategic Value of the Lean Enterprise • Multi-Stakeholder Value Optimization • Lean Enterprise Self-Assessment Tool (LESAT) • Leading and Lagging Indicators of Lean Enterprise Transformation • Empirical Results in the Aerospace Industry • Accelerating the Lean Transformation - Linking LESAT to Strategic Objectives • Summary and Questions

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In the last twenty years, in most Western countries, kinship foster care has become an integral part of childcare systems, growing progressively with regard to the numbers of children involved and relative weight as a care resource within the system; indeed, in some countries it is even more common than other placement options, such as non-kinship foster care and residential care. Research on this phenomenon is still recent and scarce, and there are few programmes targeting this population. In this article we present the results of a descriptive study on kinship foster care in the city of Barcelona, including information and data from the different stakeholders involved. From a quality of life research perspective we analyze the perceptions, evaluation and expressed satisfaction of caregivers, children and practitioners from the specialist Child and Adolescent Teams (EAIAs) responsible for the study and follow-up of kinship foster care cases. The research presented results are in line with those of current research in this field, and lays the basis for the future development of kinship foster care programmes

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The principal objective of this paper is to identify the relationship between the re­sults of the Canadian policies implemented to protect female workers against the impact of globalization on the garment industry and the institutional setting in which this labour market is immersed in Winnipeg. This research paper begins with a brief summary of the institutional theory appro­ach that sheds light on the analysis of the effects of institutions on the policy options to protect female workers of the Winnipeg garment industry. Next, this paper identi­fies the set of beliefs, formal procedures, routines, norms and conventions that cha­racterize the institutional environment of the female workers of Winnipeg’s garment industry. Subsequently, this paper descri­bes the impact of free trade policies on the garment industry of Winnipeg. Afterward, this paper presents an analysis of the ba­rriers that the institutional features of the garment sector in Winnipeg can set to the successful achievement of policy options addressed to protect the female workforce of this sector. Three policy options are considered: ethical purchasing; training/retraining programs and social engage­ment support for garment workers; and protection of migrated workers through promoting and facilitating bonds between Canada’s trade unions and trade unions of the labour sending countries. Finally, this paper concludes that the formation of isolated cultural groups inside of factories; the belief that there is gender and race discrimination on the part of the garment industry management against workers; the powerless social conditions of immi­grant women; the economic rationality of garment factories’ managers; and the lack of political will on the part of Canada and the labour sending countries to set effective bilateral agreements to protect migrate wor­kers, are the principal barriers that divide the actors involved in the garment industry in Winnipeg. This division among the prin­cipal actors of Winnipeg’s garment industry impedes the change toward more efficient institutions and, hence, the successful achievement of policy options addressed to protect women workers. 

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This book is aimed primarily at students for whom the study of building or civil engineering contracts forms part of a construction-based course. We have had in mind the syllabus requirements for first degrees in Building, Civil Engineering, Architecture, Quantity Surveying and Building Surveying, as well as those of postgraduate courses in Construction Management and Project Management. We have also assumed that such students will already have been introduced to the general principles of English law, especially those relating to contract and tort. As a result, while aspects of those subjects that are of particular relevance to construction are dealt with here, the reader must look elsewhere for the general legal background. In producing this third edition, we have again been greatly assisted by the many helpful comments made by reviewers and users of its predecessor. Nonetheless, our basic aim is identical to that which underpinned the first edition: to provide an explanation of the fundamental principles of construction contract law, rather than a clause-by-clause analysis of any particular standard-form contract. As a result, while we draw most frequently upon JCT 98 for our illustrations of particular points, this merely reflects the pre-eminent position occupied by that particular form of contract in the UK construction industry. We conclude by repeating our previous warning as to the dangers inherent in a little learning. Neither this book, nor the courses for which it is intended, seek to produce construction lawyers. The objective is rather to enable those who are not lawyers to resolve simple construction disputes before they become litigious, and to recognize when matters require professional legal advice. It should be the aim of every construction student to understand the legal framework sufficiently that they can instruct and brief specialist lawyers, and this book is designed to help them towards that understanding.

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While only about 1-200 species are used intensively in commercial floriculture (e.g. carnations, chrysanthemums, gerbera, narcissus, orchids, tulips, lilies, roses, pansies and violas, saintpaulias, etc.) and 4-500 as house plants, several thousand species of herbs, shrubs and trees are traded commercially by nurseries and garden centres as ornamentals or amenity species. Most of these have been introduced from the wild with little selection or breeding. In Europe alone, 12 000 species are found in cultivation in general garden collections (i.e. excluding specialist collections and botanic gardens). In addition, specialist collections (often very large) of many other species and/or cultivars of groups such as orchids, bromeliads, cacti and succulents, primulas, rhododendrons, conifers and cycads are maintained in several centres such as botanic gardens and specialist nurseries, as are 'national collections' of cultivated species and cultivars in some countries. Specialist growers, both professional and amateur, also maintain collections of plants for cultivation, including, increasingly, native plants. The trade in ornamental and amenity horticulture cannot be fully estimated but runs into many billions of dollars annually and there is considerable potential for further development and the introduction of many new species into the trade. Despite this, most of the collections are ad hoc and no co-ordinated efforts have been made to ensure that adequate germplasm samples of these species are maintained for conservation purposes and few of them are represented at all adequately in seed banks. Few countries have paid much attention to germplasm needs of ornamentals and the Ornamental Plant Germplasm Center in conjunction with the USDA National Plant Germplasm System at The Ohio State University is an exception. Generally there is a serious gap in national and international germplasm strategies, which have tended to focus primarily on food plants and some forage and industrial crops. Adequate arrangements need to be put in place to ensure the long- and medium-term conservation of representative samples of the genetic diversity of ornamental species. The problems of achieving this will be discussed. In addition, a policy for the conservation of old cultivars or 'heritage' varieties of ornamentals needs to be formulated. The considerable potential for introduction of new ornamental species needs to be assessed. Consideration needs to be given to setting up a co-ordinating structure with overall responsibility for the conservation of germplasm of ornamental and amenity plants.

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Information provision to address the changing requirements can be best supported by content management. The Current information technology enables information to be stored and provided from various distributed sources. To identify and retrieve relevant information requires effective mechanisms for information discovery and assembly. This paper presents a method, which enables the design of such mechanisms, with a set of techniques for articulating and profiling users' requirements, formulating information provision specifications, realising management of information content in repositories, and facilitating response to the user's requirements dynamically during the process of knowledge construction. These functions are represented in an ontology which integrates the capability of the mechanisms. The ontological modelling in this paper has adopted semiotics principles with embedded norms to ensure coherent course of actions represented in these mechanisms. (C) 2008 Elsevier B.V. All rights reserved.

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Colon cancer is a leading and expanding cause of death worldwide. A major contributory factor to this disease is diet composition; some components are beneficial (e.g. dietary fibre) whilst others are detrimental (e.g. alcohol). Garlic oil is a prominent dietary constituent that prevents the development of colorectal cancer. This effect is believed to be mainly due to diallyl disulphide (DADS), which selectively induces redox stress in cancerous (rather than normal) cells which leads to apoptotic cell death. However, the detailed mechanism by which DADS causes apoptosis remains unclear. We show that DADS-treatment of colonic adenocarcinoma cells (HT-29) initiates a cascade of molecular events characteristic of apoptosis. These include a decrease in cellular proliferation, translocation of phosphatidylserine to the plasma-membrane outer-layer, activation of caspase-3, genomic-DNA fragmentation and G2/M phase cell-cycle arrest. Short-chain fatty acids (SCFAs), particularly butyrate (abundantly produced in the gut by bacterial fermentation of dietary polysaccharides), enhance colonic cell integrity but, in contrast, inhibit colonic-cancer cell growth. Combining DADS with butyrate augmented the effect of butyrate on HT-29 cells. These results suggest that the anti-cancerous properties of DADS afford greater benefit when supplied with other favourable dietary factors (SCFA/polysaccharides) that likewise reduce colonic tumour development.

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LaFe(1-x)CO(x)O(3) perovskites were conventionally or nanocasting synthesized. The nanocasting involved the preparation of a micro-mesoporous carbon mould using a Silica Aerosil 200 and a carbon source. Then, perovskites were carbon cast at 800 degrees C. The solids were characterized by XRD, N(2) sorption, FTIR, TGA/DTG, SEM and TEM. N(2) sorption evidenced that the nanocast perovskites did not show significant intraparticle porosity in despite of their enhanced (30-50 m(2)/g) specific surface area (SSA). Nevertheless, TEM images, XRD and Rietveld refinement data showed that the solids are constituted at least by 97 wt% of perovskite phase and by agglomerates smaller than 100 nm constituted by crystallites of about 6 nm. TGA/DTG results demonstrated carbon oxidation during the perovskite formation, thus eliminating the template effect and facilitating the occurrence of sintering, which limited the SSA increase. The nanocast perovskites were more active in the reduction of NO than the uncast ones, behavior that was attributed to the increase in their SSA that allows the exposure of a higher number of accessible active sites. However, the perovskite composition and the presence of impurities can reduce the effect of the improvement of the textural properties. The nanocast perovskites also showed high thermal and catalytic stability, corroborating their potential as catalysts for the studied reaction. (C) 2009 Elsevier B.V. All rights reserved.

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A produção de etanol e a dominação da indústria, historicamente, tem sido uma fonte de discórdia para seus dois principais produtores. Os EUA com seu etanol de milho e o Brasil com sua etanol de cana, são os dois maiores produtores mundiais de etanol (1º EUA; 2º Brasil) e tem competido pela participação de mercado mundial há décadas. A partir de Dezembro de 2011, os EUA levantaram as tarifas e os subsídios que foram instalados para proteger sua indústria de etanol, o que muda o campo de jogo da produção mundial de etanol para o futuro. Atualmente em todo o mundo, o etanol é usado em uma proporção muito menor comparativamente a outros combustíveis. Esta pesquisa analisa o nível potencial de colaboração entre os EUA e o Brasil, facilitando um diálogo entre os stakeholders em etanol. A pesquisa consiste principalmente de conversas e entrevistas, com base em um conjunto de perguntas destinadas a inspirar conversas detalhadas e expansivas sobre os temas de relações Brasil-EUA e etanol. Esta pesquisa mostra que o etanol celulósico, que é também conhecido como etanol de segunda geração, oferece mais oportunidades de parceria entre os EUA e o Brasil, como há mais oportunidades para pesquisa e desenvolvimento em conjunto e transferência de tecnologia nesta área. Enquanto o etanol de cana no Brasil ainda é uma indústria próspera e crescente, o milho e a cana são muito diferentes geneticamente para aplicar as mesmas inovações exatas de um etanol de primeira geração, por outro. As semelhanças entre os processos de fermentação e destilação entre as matérias-primas utilizadas nos EUA e no Brasil para o etanol de segunda geração torna o investimento conjunto nesta área mais sensível. De segunda geração é uma resposta para a questão "alimentos versus combustíveis". Esta pesquisa aplica o modelo de co-opetição como um quadro de parceria entre os EUA e o Brasil em etanol celulósico. A pesquisa mostra que enquanto o etanol pode não ser um forte concorrente com o petróleo no futuro imediato, ele tem melhores perspectivas de ser desenvolvido como um complemento ao petróleo, em vez de um substituto. Como os EUA e o Brasil tem culturas de misturar etanol com petróleo, algo da estrutura para isso já está em vigor, a relação de complementaridade seria fortalecido através de uma política de governo clara e de longo prazo. A pesquisa sugere que apenas através desta colaboração, com toda a partilha de conhecimentos técnicos e estratégias econômicas e de desenvolvimento, o etanol celulósico será um commodity negociado mundialmente e uma alternativa viável a outros combustíveis. As entrevistas com os interessados em que esta pesquisa se baseia foram feitas ao longo de 2012. Como a indústria de etanol é muito dinâmica, certos eventos podem ter ocorrido desde esse tempo para modificar ou melhorar alguns dos argumentos apresentados.

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The desire to research on this subject arisen from the experience as nursing in the indigenous health, where I observed that many professionals from all regions of Brazil chose to work within this zone. It was notorious the nurse s difficult to settle in only one place for a long length of time. Probably due to health care in indigenous zones happens from a cultural confront. This confront materialize because both sides are imbued with their own culture: in one hand the nurse professional with its scientific knownledgment on the other the indigenous with their rituals and peculiars habits. In this context nurses should delineate and negotiate the reality through symbolic representations of life, and then make questions on the new reality. In this way, this study set out with the aim of apprehends the nurse s social representations of transcultural care in indigenous health. This knownledgment is important to avoid possible conflicts, shocks, difficulties and health care incongruence within this context. The data collect was carried out on a range of non structured interview guided by a pre-elaborated questionnaire with four questions and a hand drawing related to nurse s health care in the indigenous health. This research had a sample of 17 nurses from the Indigenous Sanitary District of Manaus in the Amazon State. To interpret data we used the Discourse of the Collective Subject, which findings were presented in three chapters: characterization of participants, discussion on themes prevalent in discourse; social representation of nursing care through infographics. The analysis revealed that the care in the indigenous health is challenging because the native people imbued in its world are perceived and processed according to the nurse s cultural lens, leading to materialize of some strangeness and adaptation difficulties, especially in the first contacts. The Social Representation on nursing practice, in many cases, is projected and contrived on the basis of scattered believes and on perception derived from common sense. The findings shows that representions are essential to mitigating the initial strangeness and help nurses to better situate themselves in the new universe. The nurse s practice in the indigenous health care should merge into each other. From the Social Representations is possible to perceive that assimilation, also comprehension on indigenous health system and its traditional knowledge are important to developing strategies to improve access and quality of care for indigenous peoples. After analysis the nurse s discourses and drawings, it is possible to represent the nurse s practice in the indigenous health as anthropophagism, since nurses should literally consuming its patients culture, digesting it and seize it as means to provide culturally congruent care. We highlight the urgent need for preparation and training of professionals to work more effectively with indigenous peoples

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Halothane depresses cardiorespiratory function and activates the pituitary-adrenal axis, increasing beta endorphin. In horses, beta endorphin may enhance the anaesthetic-associated cardiorespiratory depression and mortality risk. The authors studied endogenous opioid effects on cardiorespiratory function and pituitary-adrenal activity in halothane-anaesthetised ponies by investigating opioid antagonism by naloxone. Six ponies were anaesthetised three times (crossover design). Anaesthesia was induced with thiopentone and maintained with 1.2 per cent halothane for 2 hours. Immediately after induction, naloxone was administered either intra venously (0.5 mg kg(-1) bolus then 0.25 mg kg(-1) hour(-1) for 2 hours) or intrathecally (0.5 mg) or was replaced by saline as control. Pulse and respiratory rates, arterial blood gases, cardiac output and plasma cortisol and adrenocorticotrophic hormone (ACTH) concentrations were measured. All groups developed cardiorespiratory depression (40 per cent decrease in cardiac output) and plasma cortisol increased. Plasma ACTH concentration was higher in ponies treated with intrathecal naloxone. Endogenous opioids may inhibit ACTH Secretion, attenuating the stress response to halothane anaesthesia in equidae. (C) 2001 Harcourt Publishers Ltd.