RESUMO
On-farm decision support in animal health management requires a tailor-made failure costs (FCs) assessment of production disorders for the individual farm. In our study we defined a generic framework to estimate the FC of production disorders in dairy cows. We converted the framework to a practical tool in which the farm-specific FC of mastitis, ketosis, lameness and metritis were estimated for 162 organic dairy farms in four European countries. Along with the structure of the framework, the FC estimation required three distinct types of model input: performance input (related to herd performance parameters), consequential input (related to the consequences of the disorders) and economic input (related to price levels). Input was derived from official herd recordings (e.g. test-day records and animal health recordings) and farmers' responses (e.g. questionnaire replies). The average FC of mastitis, ketosis, lameness and metritis amounted to 96, 21, 43 and 10 per cow per year, respectively. The variation in FC outcomes was high among farmers and countries. Overall ranking of the disorders based on absolute values was the same for all countries, with mastitis being the costliest disorder followed in order by lameness, ketosis, and metritis. Farm specific estimates can be used to rank production related disorders in terms of their associated failure costs and thus provide valuable insights for herd health management. The practical calculation tool developed in this study should be considered by farmers or herd health advisors to support their animal health practices or advice.
Assuntos
Doenças dos Bovinos/economia , Indústria de Laticínios/economia , Agricultura Orgânica/economia , Bem-Estar do Animal , Animais , Bovinos , Europa (Continente) , Feminino , LeiteRESUMO
The purpose of this study was to investigate whether storing mobilized peripheral blood progenitor cell (PBPC) collections overnight before CD34+ selection may delay platelet count recovery after high-dose chemotherapy and CD34+-enriched PBPC re-infusion. Lymphoma patients underwent PBPC mobilization with cyclophosphamide 4 g/m2 i.v. and G-CSF 10 microg/kg/day subcutaneously. Patients were prospectively randomized to have each PBPC collection enriched for CD34+ cells with the CellPro CEPRATE SC System either immediately or after overnight storage at 4 degrees C. Thirty-four patients were randomized to overnight storage and 34 to immediate processing of PBPC; 15 were excluded from analysis due to tumor progression or inadequate CD34+ cell mobilization. PBPC from 23 patients were stored overnight, while 30 subjects underwent immediate CD34+ selection and cryopreservation. Median yield of CD34+ enrichment was 43.6% in the immediate processing group compared to 39.1% in the overnight storage group (P = 0.339). Neutrophil recovery >500 x 10(9)/l occurred a median of 11 days (range 9-16 days) in the overnight storage group compared to 10.5 days (range 9-21 days) in the immediate processing group (P = 0.421). Median day to platelet transfusion independence was 13 (range 7-43) days in the overnight storage group vs 13.5 (range 8-35) days in those assigned to immediate processing (P = 0.933). We conclude that storage of PBPC overnight at 4 degrees C allows pooling of consecutive-day collections resulting in decreased costs and processing time without compromising neutrophil and platelet engraftment after infusion of CD34+-selected progenitor cells. Bone Marrow Transplantation(2000) 25, 559-566.
Assuntos
Antígenos CD34/sangue , Preservação de Sangue , Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/métodos , Leucaférese/economia , Linfoma/terapia , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Antineoplásicos/toxicidade , Plaquetas/imunologia , Contagem de Células , Criopreservação , Feminino , Sobrevivência de Enxerto , Mobilização de Células-Tronco Hematopoéticas , Humanos , Linfoma/economia , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Contagem de Plaquetas , Transfusão de Plaquetas , Estudos Prospectivos , Transplante Autólogo/economiaRESUMO
UNLABELLED: We tested whether crystalliod solutions could be used instead of colloid solutions for partial exchange transfusions (PET) in polycythaemic neonates because crystalloid solutions are cheap, carry no risk of anaphylactic reactions and can be sterilized. We randomly assigned 20 term neonates with venous haematocrit (Hct) > 0.65 l/l to PET with either a serum preparation (BISEKO) or Ringer solution. Plasma volume (PV) was measured with Evans blue dilution. Blood volume (BV) and red cell mass were calculated from PV and venous Hct. Before PET both serum and Ringer groups had the same Hct (0.69 (0.66-0.76) vs 0.69 (0.66-0.71) l/l; median (range)) and BV (108 (81-116) versus 96 (68-121) ml/kg. During PET an equivalent amount of blood was withdrawn stepwise (19 (14-26) versus 17 (13-25) ml/kg and replaced by either serum or Ringer solution. More of the Ringer solution (median 77%) than of the serum (median 36%) given left the intravascular space within 4 h after PET (P = 0.016); but there was no significant difference in Hct after Ringer-PET compared to serum-PET (median 0.58 vs 0.56 l/l). No infant required repeat PET. Ringer-PET reduced BV from high to normal values (from median 96 to 83 ml/kg; P = 0.005), whereas after serum-PET BV remained high (from median 108 to 98 ml/kg; not significant). CONCLUSION: PET with Ringer solution resulted in a haemodilution comparable to PET with serum and a correction of hypervolaemia.
Assuntos
Transfusão de Componentes Sanguíneos , Hemodiluição/métodos , Soluções Isotônicas/uso terapêutico , Policitemia/terapia , Transfusão de Componentes Sanguíneos/efeitos adversos , Viscosidade Sanguínea , Volume Sanguíneo , Hematócrito , Hemodiluição/economia , Humanos , Recém-Nascido , Infusões Intravenosas , Soluções Isotônicas/administração & dosagem , Policitemia/sangueRESUMO
The multi-center study presented reveals that 76% of the conventionally performed X-ray investigations of the skull can be avoided without any relevance concerning the non-diagnosis of severe injuries. Only in 3.2% of all patients investigated a skull X-ray had instantaneous therapeutically consequences. Thus routinely performed skull X-rays are no longer acceptable in the light of cost reduction and radiation load. The clinical-neurological investigations however are inevitable to perform the state of the art treatment of patients with head injuries today, leading to computerized tomography if necessary. A check-list of clinical findings is presented to get the indications for conventional X-rays of the skull and to manage an effective use of such investigations in appropriate clinical situations.
Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Crânio/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Controle de Custos , Feminino , Mau Uso de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia/economia , Radiografia/estatística & dados numéricos , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
With some ingenuity, a transformation of our attitudes toward preservation of the environment will take place fairly soon. We will recognize the symbolic and social meanings of environments, not just their economic utility; we will emphasize their historical significance as well as the future generations that will use them. At the same time, we must realize that there are things we may not want to trade at all, except in the sense of letting someone else have his share of the environment also. As environments become more differentiated, smaller areas will probably be given greater significance, and it may be possible for more groups to have a share. It is likely that we shall want to apply our technology to the creation of artificial environments. It may be possible to create environments that are evocative of other environments in other times and places. It is possible that, by manipulating memory through the rewriting of history, environments will come to have new meaning. Finally, we may want to create proxy environments by means of substitution and simulation. In order to create substitutes, we must endow new objects with significance by means of advertising and by social practice. Sophistication about differentiation will become very important for appreciating the substitute environments. We may simulate the environment by means of photographs, recordings, models, and perhaps even manipulations in the brain (48). What we experience in natural environments may actually be more controllable than we imagine (49). Artificial prairies and wildernesses have been created, and there is no reason to believe that these artificial environments need be unsatisfactory for those who experience them. Rare environments are relative, can be created, are dependent on our knowledge, and are a function of policy, not only tradition. It seems likely that economic arguments will not be sufficient to preserve environments or to suggest how we can create new ones. Rather, conscious choice about what matters, and then a financial and social investment in an effort to create significant experiences and environments, will become a policy alternative available to us. What's wrong with plastic trees? My guess is that there is very little wrong with them. Much more can be done with plastic trees and the like (50) to give most people the feeling that they are experiencing nature. We will have to realize that the way in which we experience nature is conditioned by our society-which more and more is seen to be receptive to responsible interventions. Bentham, the father of utilitarianism, was very concerned about the uses of the dead to the living and suggested (51): If a country gentleman have rows of trees leading to his dwelling, the autoicons [embalmed bodies in an upright position] of his family might alternate with the trees; copal varnish would protect the face from the effects of rain-caoutchouc [rubber] the habiliments.