Handling injectable medications in anaesthesia: Guidelines from the Association of Anaesthetists.

Peri-operative medication safety is complex. Avoidance of medication errors is both system- and practitioner-based, and many departments within the hospital contribute to safe and effective systems. For the individual anaesthetist, drawing up, labelling and then the correct administration of medications are key components in a patient's peri-operative journey. These guidelines aim to provide pragmatic safety steps for the practitioner and other individuals within the operative environment, as well as short- to long-term goals for development of a collaborative approach to reducing errors. The aim is that they will be used as a basis for instilling good practice.

Phytoplankton communities of the west coast of Florida - multiyear and seasonal responses to nutrient enrichment.

Blooms of the harmful algae species Karenia brevis are frequent off the southwest coast of Florida despite having relatively slow growth rates. The regional frequency of these harmful algal blooms led to the examination of the dominant estuarine outflows for effects on both K. brevis and the phytoplankton community in general. There is comparatively little information on the growth rates of non-Karenia taxonomic groups other than diatoms. A seasonally based series (Fall, Winter, and Spring) of bioassay experiments were conducted to determine the nutrient response of the coastal phytoplankton community. Treatments included estuarine waters (Tampa Bay, Charlotte Harbor, and the Caloosahatchee River) applied in a 1:25 dilution added to coastal water to mimic the influence of estuarine water in a coastal environment. Other treatments were 5-15 µM additions of nitrogen (N), phosphorus (P), and silica (Si) species, amino acids, and N (urea) + P added to coastal water. Incubations were conducted under ambient conditions with shading for 48 h. Analyses of dissolved and particulate nutrients were coupled with HPLC analysis of characteristic photopigments and taxonomic assignments of biomass via CHEMTAX. The coastal phytoplankton community, dominated by diatoms, cyanophytes and prasinophytes, was significantly different both by bioassay and by season, indicating little seasonal fidelity in composition. Specific growth rates of chlorophyll a indicated no significant difference between any controls, any estuarine treatment, P, or Si treatments. Conditions were uniformly N-limited with the highest growth rates in diatom biomass. Despite differing initial communities, however, there were seasonally reproducible changes in community due to the persistent growth or decline of the various taxa, including haptophytes, cyanophytes, and cryptophytes. For the one bioassay in which K. brevis was present, the slow growth of K. brevis relative to diatoms in a mixed community was evident, indicating that identifying the seasonally based behavior of other taxa in response to nutrients is critical for the simulation of phytoplankton competition and the successful prediction of the region's harmful algal blooms.

Red tides in the Gulf of Mexico: Where, when, and why?

[1] Independent data from the Gulf of Mexico are used to develop and test the hypothesis that the same sequence of physical and ecological events each year allows the toxic dinoflagellate Karenia brevis to become dominant. A phosphorus-rich nutrient supply initiates phytoplankton succession, once deposition events of Saharan iron-rich dust allow Trichodesmium blooms to utilize ubiquitous dissolved nitrogen gas within otherwise nitrogen-poor sea water. They and the co-occurring K. brevis are positioned within the bottom Ekman layers, as a consequence of their similar diel vertical migration patterns on the middle shelf. Upon onshore upwelling of these near-bottom seed populations to CDOM-rich surface waters of coastal regions, light-inhibition of the small red tide of ~1 ug chl l(-1) of ichthytoxic K. brevis is alleviated. Thence, dead fish serve as a supplementary nutrient source, yielding large, self-shaded red tides of ~10 ug chl l(-1). The source of phosphorus is mainly of fossil origin off west Florida, where past nutrient additions from the eutrophied Lake Okeechobee had minimal impact. In contrast, the P-sources are of mainly anthropogenic origin off Texas, since both the nutrient loadings of Mississippi River and the spatial extent of the downstream red tides have increased over the last 100 years. During the past century and particularly within the last decade, previously cryptic Karenia spp. have caused toxic red tides in similar coastal habitats of other western boundary currents off Japan, China, New Zealand, Australia, and South Africa, downstream of the Gobi, Simpson, Great Western, and Kalahari Deserts, in a global response to both desertification and eutrophication.

Innovative techniques for harmful algal toxin analysis.

The global increase in frequency and intensity of harmful algal blooms (HABs) has led to more frequent incidence of seafood-borne illnesses and adverse impacts on natural resources. In response, public health agencies worldwide have mobilized to initiate HAB monitoring programs. To meet this demand, innovative analytical techniques are being developed that provide rapid and reliable detection of the causative organisms and the toxins produced. Modifications to conventional chromatography and mass spectrometry have greatly improved sensitivity and selectivity of these methods toward naturally occurring phycotoxins. Bioassay techniques using live organisms are giving way to molecular and cellular methods that measure the toxicologically significant activity of the toxin molecules. Molecular probes are being applied to distinguish species-specific RNA and DNA sequences for rapid identification of HAB-causing organisms. The direction of this new technology is to develop rapid and reliable screening methods for phycotoxins and the causative organisms to provide protection for public health, aquaculture, and natural resources. New methods also are being developed for detecting minute amounts of toxin molecules in microenvironments, leading to understanding the toxicokinetics and toxicological functions of the toxins.

The common cold.

The common cold is characterized by symptoms of rhinorrhea, nasal obstruction, sneezing, throat clearing, postnasal drip, and cough. Some of the many viruses that cause colds may cause mild additional symptoms such as sore throat, weakness, dizziness, and tearing. This article presents data concerning the cause, pathogenesis, and treatment of the common cold as well as discussion of the available diagnostic tests and their use in formulating differential diagnoses.

Evaluation of two ankle appliances using ground reaction force data.

The purpose of this study was to evaluate, using ground reaction force data, two ankle stabilizing techniques commonly used by athletic trainers; the closed Gibney taping procedure and the boot type ankle stabilizer. Each condition was examined in a pre- and postexercise bout. In addition, a no appliance condition was also tested. Eight healthy female athletes were required to perform ten satisfactory trials in each of the five conditions. Ten trial mean values of 34 descriptors of ground reaction force components for each subject/condition were evaluated using multivariate analyses of variance. No significant differences in any of the force or impulse variables were found across conditions. However, significant differences were found in three variables describing the relative timing of events in the footfall (p < 0.05). No significant differences were found between the pre- and postexercise conditions. The variability in the measured parameters. of the no appliance condition was consistently higher than the ankle appliance conditions. The implication of the study was that, in normal running, the ankle appliances did not appear to moderate or change foot function. J Orthop Sports Phys Ther 1986;7(5):244-249.