SHORT-TERM EFFECTS OF PHENYLEPHRINE ON SYSTEMIC AND REGIONAL HEMODYNAMICS IN PATIENTS WITH SEPTIC SHOCK: A CROSSOVER PILOT STUDY

Clinical studies evaluating the use of phenylephrine in septic shock are lacking. The present study was designed as a prospective, crossover pilot study to compare the effects of norepinephrine (NE) and phenylephrine on systemic and regional hemodynamics in patients with catecholamine-dependent septic shock. In 15 septic shock patients, NE (0.82 +/- 0.69 mug.kg.min) was replaced with phenylephrine (4.39 +/- 5.23 mug.kg.min) titrated to maintain MAP between 65 and 75 mmHg. After 8 h of phenylephrine infusion treatment was switched back to NE. Data from right heart catheterization, acid-base balance, thermo-dye dilution catheter, gastric tonometry, and renal function were obtained before, during, and after replacing NE with phenylephrine. Variables of systemic hemodynamics, global oxygen transport, and acid-base balance remained unchanged after replacing NE with phenylephrine except for a significant decrease in heart rate (phenylephrine, 89 +/- 18 vs. NE, 93 +/- 18 bpm; P < 0.05). However, plasma disappearance rate (phenylephrine, 13.5 +/- 7.1 vs. NE, 16.4 +/- 8.7%.min) and clearance of indocyanine green (phenylephrine, 330 +/- 197 vs. NE, 380 +/- 227mL.min.m), as well as creatinine clearance (phenylephrine, 81.3 +/- 78.4 vs. NE, 94.3 +/- 93.5 mL.min) were significantly decreased by phenylephrine infusion (each P < 0.05). In addition, phenylephrine increased arterial lactate concentrations as compared with NE infusion (1.7 +/- 1.0 vs. 1.4 +/- 1.1 mM; P < 0.05). After switching back to NE, all variables returned to values obtained before phenylephrine infusion except creatinine clearance and gastric tonometry values. Our results suggest that for the same MAP, phenylephrine causes a more pronounced hepatosplanchnic vasoconstriction as compared with NE.

Late Pleistocene glaciation in the Central Andes: Temperature versus humidity control A case study from the eastern Bolivian Andes (17°S) and regional synthesis

A glacier–climate model was used to calculate climatic conditions in a test site on the east Andean slope around Cochabamba (17°S, Bolivia) for the time of the maximum Late Pleistocene glaciation. Results suggest a massive temperature reduction of about − 6.4 °C (+ 1.4/− 1.3 °C), combined with annual precipitation rates of about 1100 mm (+ 570 mm/− 280 mm). This implies no major change in annual precipitation compared with today. Summer precipitation was the source for the humidity in the past, as is the case today. This climate scenario argues for a maximum advance of the paleo-glaciers in the eastern cordillera during the global Last Glacial Maximum (LGM, 20 ka BP), which is confirmed by exposure age dates. In a synthesized view over the central Andes, the results point to an increased summer precipitation-driven Late Glacial (15–10 ka BP) maximum advance in the western part of the Altiplano (18°S–23°S), a temperature-driven maximum advance during full glacial times (LGM) in the eastern cordillera, and a pre- and post-LGM (32 ka BP/14 ka BP) maximum advance around 30°S related to increased precipitation and reduced temperature on the western slope of the Andes. The results indicate the importance of understanding the seasonality and details of the mass balance–climate interaction in order to disentangle drivers for the observed regionally asynchronous past glaciations in the central Andes.

A STUDY ON REGIONAL CIRCULAR ECONOMY SYSTEM AND ITS CONSTRUCTION, OPERATION AND SUGGESTION FOR SHANGHAI

The characteristics of the traditional linear economic model are high consumption, high emission and low efficiency. Economic development is still largely at the expense of the environment and requires a natural resource investment. This can realize rapid economic development but resource depletion and environmental pollution become increasingly serious. In the 1990's a new economic model, circular economics, began to enter our vision. The circular economy maximizes production and minimizes the impact of economic activities on the ecological environment through organizing the activities through the closed-loop feedback cycle of "resources - production - renewable resource". Circular economy is a better way to solve the contradictions between the economic development and resource shortages. Developing circular economy has become the major strategic initiatives to achieving sustainable development in countries all over the world. The evaluation of the development of circular economics is a necessary step for regional circular economy development. Having a quantitative evaluation of circular economy can better monitor and reveal the contradictions and problems in the process of the development of recycling economy. This thesis will: 1) Create an evaluation model framework and new types of industries and 2) Make an evaluation of the Shanghai circular economy currently to analyze the situation of Shanghai in the development of circular economy. I will then propose suggestions about the structure and development of Shanghai circular economy.

Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study

BACKGROUND Many orthopaedic surgical procedures can be performed with either regional or general anesthesia. We hypothesized that total hip arthroplasty with regional anesthesia is associated with less postoperative morbidity and mortality than total hip arthroplasty with general anesthesia. METHODS This retrospective propensity-matched cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database included patients who had undergone total hip arthroplasty from 2007 through 2011. After matching, logistic regression was used to determine the association between the type of anesthesia and deep surgical site infections, hospital length of stay, thirty-day mortality, and cardiovascular and pulmonary complications. RESULTS Of 12,929 surgical procedures, 5103 (39.5%) were performed with regional anesthesia. The adjusted odds for deep surgical site infections were significantly lower in the regional anesthesia group than in the general anesthesia group (odds ratio [OR] = 0.38; 95% confidence interval [CI] = 0.20 to 0.72; p < 0.01). The hospital length of stay (geometric mean) was decreased by 5% (95% CI = 3% to 7%; p < 0.001) with regional anesthesia, which translates to 0.17 day for each total hip arthroplasty. Regional anesthesia was also associated with a 27% decrease in the odds of prolonged hospitalization (OR = 0.73; 95% CI = 0.68 to 0.89; p < 0.001). The mortality rate was not significantly lower with regional anesthesia (OR = 0.78; 95% CI = 0.43 to 1.42; p > 0.05). The adjusted odds for cardiovascular complications (OR = 0.61; 95% CI = 0.44 to 0.85) and respiratory complications (OR = 0.51; 95% CI = 0.33 to 0.81) were all lower in the regional anesthesia group. CONCLUSIONS Compared with general anesthesia, regional anesthesia for total hip arthroplasty was associated with a reduction in deep surgical site infection rates, hospital length of stay, and rates of postoperative cardiovascular and pulmonary complications. These findings could have an important medical and economic impact on health-care practice.

Urban sprawl and city compactness. A proposal for regional sustainability indicators. Case study of the towns of Alcorcon and Majadahonda (Comunidad de Madrid, Spain)

The main contribution of this research paper is to display a range of figures and values which could help urban planners to quantify the urban phenomenon of sprawl. In this way, after a rigorous analysis and comparison between a scattered urban fabric (Majadahonda) and a compact urban fabric (Alcorcón), several possible indexes are established and characterized in order to verify the main hypothesis: in what extent land consumption and exploitation of energy resources are higher in a scattered urban fabric than in a compact one.

Case study of the effects of atmospheric aerosols and regional haze on agriculture: An opportunity to enhance crop yields in China through emission controls?

The effect of atmospheric aerosols and regional haze from air pollution on the yields of rice and winter wheat grown in China is assessed. The assessment is based on estimates of aerosol optical depths over China, the effect of these optical depths on the solar irradiance reaching the earth’s surface, and the response of rice and winter wheat grown in Nanjing to the change in solar irradiance. Two sets of aerosol optical depths are presented: one based on a coupled, regional climate/air quality model simulation and the other inferred from solar radiation measurements made over a 12-year period at meteorological stations in China. The model-estimated optical depths are significantly smaller than those derived from observations, perhaps because of errors in one or both sets of optical depths or because the data from the meteorological stations has been affected by local pollution. Radiative transfer calculations using the smaller, model-estimated aerosol optical depths indicate that the so-called “direct effect” of regional haze results in an ≈5–30% reduction in the solar irradiance reaching some of China’s most productive agricultural regions. Crop-response model simulations suggest an ≈1:1 relationship between a percentage increase (decrease) in total surface solar irradiance and a percentage increase (decrease) in the yields of rice and wheat. Collectively, these calculations suggest that regional haze in China is currently depressing optimal yields of ≈70% of the crops grown in China by at least 5–30%. Reducing the severity of regional haze in China through air pollution control could potentially result in a significant increase in crop yields and help the nation meet its growing food demands in the coming decades.

The Universality of Civil War Definitions: A Study of How Regional Considerations Impact Civil War in Somalia, Colombia, and Angola

Civil war is a socially intimate phenomenon. The viability of the conflict hinges on recruitment for the cause, military strategy, community support, and a variety of other conditional factors. Despite this dependence on local society, many researchers approach civil war from a global perspective, attempting to discover universal truths about this kind of conflict. This capstone project focuses on restricting the operating parameters of civil war research projects to the span of a single continent, hoping to achieve deeper insight by focusing the research using a more culturally sensitive set of parameters. By using cultural data to guide civil war research, conflict indicators can tailor conflict prevention to escalating violent scenarios.

Russian gas industry - current condition and prospects; New regional 'in-security' system in Central Asia; Caspian oil and gas: the facts at the end of the year 2000. OSW Study 1/2001

Russian gas industry: The current condition of the gas industry is one of the most crucial factors influencing the Russian state·s functioning, internal situation and international position. Not only is gas the principal energy resource in Russia, it also subsidises other sectors of the economy. Status of the main European gas exporter strengthens also Russia's importance in the international arena. New regional in-security: Ten years have passed since the Central Asian states declared their independence, but their relationship with Russia still remains close, and the latter treats them as its exclusive zone of influence. A crucial reason for keeping Central Asia within the orbit of Moscow·s influence is the fact that Russia exercises control over the most important transport routes out of the region of raw materials for the power industry, on which the economic development of Asia depends on. But this is the only manifestation of Central Asia·s economic dependence on Russia. Moscow lacks solid economic instruments (i.e. investment input or power industry dependence) to shape the situation in the region. Caspian oil and gas: Caspian stocks of energy resources are not, and most probably will not be, of any great significance on the world scale. Nevertheless it is the Caspian region which will have the opportunity to become an oil exporter which will reduce the dependence of the European countries on Arabian oil, and which will guarantee Russia the quantities of gas which are indispensable both for meeting its internal demands and for maintaining its current level of export. For Azerbaijan, Kazakhstan and Turkmenistan, the confirmation of the existence of successive oil strata is not only an opportunity to increase income, but also an additional bargaining chip in the game for the future of the whole region. The stake in this game is the opportunity to limit the economic, and by extension the political influences of Russia in the region.

Kazakhstan: the regional success story; Tajikistan: a trial period; Uzbekistan: the major source of instability in Central Asia? OSW Study 15/2004

Kazakhstan: Kazakhstan can boast economic development like no other country in Central Asia. In contrast to other countries of the region, which have rich natural resources, Kazakhstan has managed to use its economic potential in a way that yields concrete benefits now and, at the same time, creates prospects for further sustainable economic growth. Tajikistan: Tajikistan in its present state has been built on the civil war experiences and provisions of the peace accords signed in 1997. These have had a great impact on the present form of the state, its political scene and power mechanisms. President Emomali Rakhmonov is the central figure in the state. The political system, which he has cocreated, is based on - unique in this region - political pluralism (the existence of the Islamic party), decentralisation (far-going independence of the regions and relatively limited potential of the central structures) and compromise as the basic way of resolving conflicts. Such a system has so far guaranteed stabilisation and normalisation of the country. Uzbekistan: With its geographic location, potential, ambitions and political priorities, Uzbekistan could play a leading role in Central Asia. The international community has perceived the country as the pillar of stability in the region. This perception was further reinforced after 11th September 2001 and was certainly among the factors that inspired the United States to start closer political and military cooperation with Tashkent. The administration in Washington had expected that closer contacts might galvanise political, economic and social change in Uzbekistan, thus reinforcing positive trends in other countries of the region as well. But the relations between Washington and Tashkent are in crisis (which the United States will certainly try to overcome), and we have seen rapprochement between Uzbekistan and Russia and China.