Postneonatal mortality impacts following grants from the Gavi Vaccine Alliance: an econometric analysis from 2000 to 2014.

We completed a retrospective multivariate panel study to evaluate the effect of Gavi Vaccine Alliance grants on vaccine-preventable disease (VPD) postneonatal mortality. We separately tested a composite VPD mortality rate and five vaccine-preventable mortality rates: pertussis, meningitis, measles, diarrhea, and pneumonia (lower-respiratory infection) as dependent variables. All 77 countries eligible for Gavi assistance from 2000 to 2014 were included in the study. To isolate the effect of Gavi funding in our primary model, we controlled for known and likely predictors of child mortality. We found evidence that, among other factors, Gavi investment, antenatal care access, and girls' primary education are important elements to reduce vaccine-preventable mortality rates. For every $1 per capita invested by the Gavi Vaccine Alliance, there are statistically significant effects decreasing the VPD postneonatal mortality rate by 1.848 per 1000 live births. We also found Gavi investments to be significantly associated with reductions in three VPD-specific rates: pertussis, meningitis, and pneumonia. We conclude that Gavi investments in developing country immunization programs have measurably contributed to reductions in postneonatal VPD mortality rates.

Drivers for animal welfare policies in Asia, the Far East and Oceania.

The complex and diverse nature of the World Organisation for Animal Health (OIE) region for Asia, the Far East and Oceania presents both challenges and opportunities in implementing improved approaches to animal welfare. Drivers for improvements include social values, culture, religion, political interest, trade, an increasing global awareness of animal welfare issues, an increasing demand for meat and dairy products, the interest of non-governmental organisations, and the mandate given to the OIE to develop science-based standards for animal welfare. The outcomes-based OIE standards can be amended in the light of new scientific knowledge and implemented by countries in a manner best suited to meet their needs. A number of regional initiatives are described, including a regional strategy, examples of national activities, projects run by the OIE Collaborating Centre for Animal Welfare Science and Bioethical Analysis, and trade measures. Although the overall outlook for improvements in the region looks promising, implementation of standards over the longer-term will require ongoing political commitment, resources and cultural change to ensure sustained improvements.

Arrested blood flow during false aneurysm formation in the carotid arteries of cattle slaughtered with and without stunning.

The time to onset of arrested blood flow and the size of false aneurysms in the severed carotid arteries were assessed in 126 cattle during halal slaughter without stunning. Thirty six cattle (29%) showed early arrest of blood flow. In 6%, both the left and right carotid arteries in the same animal stopped bleeding before 60s had elapsed following the neck cut. The time to early arrested blood flow was on average 21s, and this was accompanied by enlargement with false aneurysms which occluded the arteries. In the arteries which were still bleeding at 60s after the neck was cut the artery size was normal. Based on comparative data from different slaughter premises it appeared that making the cut in the neck at the first cervical vertebra instead of the second to fourth cervical vertebrae reduced the frequency of false aneurysm formation and early arrested blood flow. This was confirmed in a separate controlled trial where 100 cattle were stunned with a captive bolt and the arteries were examined following neck cutting at either the C1 or C3 positions.

Oral clonidine reduces postoperative PCA morphine requirements.

PURPOSE: The purpose of this study was to evaluate the effect of perioperative oral clonidine on postoperative analgesia and PCA morphine requirements in adult patients after major orthopaedic knee surgery. METHODS: In this prospective, double blind, placebo-controlled study 44 patients undergoing either total knee replacement or hemiarthroplasty of the knee were randomly assigned to receive oral placebo or clonidine (5 micrograms . kg-1) 1.5 hr before surgery, and at 12 hr, and 24 hr after the initial dose. Five patients were subsequently withdrawn from study. No other preoperative drugs were given. Preoperative sedation score was recorded. A standardized general anaesthetic was administered to all patients. Postoperative blood pressure, heart rate, PCA morphine use, visual analogue score (VAS) for pain, sedation, nausea, and pruritus were recorded for 36 hr postoperatively. RESULTS: The cumulative PCA morphine used was 37% lower after clonidine 57.3 +/- 26.8 mg (mean +/- SD) compared with placebo 91 +/- 31.6 mg (P = 0.031). There was no difference in pain or sedation scores postoperatively but patients who received clonidine were more sedated preoperatively (P < 0.001) and had a lower mean arterial blood pressure throughout the period of study by 10 to 26 mmHg (P < 0.0001). Clonidine reduced the incidence of postoperative nausea (25% vs 74%) (P < 0.01) and vomiting compared with placebo (10% vs 53%) (P < 0.01) and required less antiemetic (dimenhydrinate 37.5 +/- 20.9 mg vs 82.1 +/- 49.4 mg) but not statistically significant (P = 0.065). CONCLUSIONS: Oral clonidine is a useful component to postoperative balanced analgesia as it decreases PCA morphine requirements and decreases the incidence of nausea and vomiting.

Intracoronary propofol does not decrease myocardial contractile function in the dog.

The intravenous administration of propofol is associated with a considerable decrease in arterial blood pressure. The present study was undertaken to test the hypothesis that myocardial function is not affected by propofol and therefore does not contribute to the hypotensive effect of this anaesthetic agent. Propofol was administered in anaesthetized, open-chest dogs by direct arterial infusion into the left anterior descending coronary artery (LAD). Mean arterial blood pressure, heart rate, left ventricular pressure, dP/dt, regional lactate and oxygen extraction, as well as coronary blood flow were measured. Diastolic function was determined by calculation of the time constant of isovolumetric relaxation from the left ventricular pressure measurement and dP/dt. Contractility was evaluated by measuring regional systolic shortening in an area of the myocardium supplied by the LAD. This was compared with systolic shortening in the distribution of the circumflex (CIRC) artery and with the effects obtained with the intracoronary administration of thiopentone. Intracoronary infusions of propofol and thiopentone did not produce any change in systemic arterial blood pressure, heart rate, or left ventricular end diastolic pressure. Propofol, at a concentration of 5 or 10 micrograms.ml-1 did not decrease systolic shortening in the area perfused by the LAD while thiopentone (40 micrograms.ml-1) reduced systolic shortening by 33% (P < or = 0.05). Neither drug had an effect on systolic shortening in the CIRC area, LAD blood flow or diastolic function. The results of this study suggest that propofol does not have an effect on myocardial contractility. The hypotension associated with the intravascular administration of propofol is more likely due to either a direct vascular or a central effect.

Mortality experience of employees with occupational exposure to DBCP.

Concern about the carcinogenic potential of 1,2-dibromo-3-chloropropane(DBCP) has arisen recently, focusing on six organ sites: stomach, liver, kidney, lung, testes, and skin. To examine the mortality experience of persons potentially exposed, a cohort of 550 employees involved in production and formulation from 1957 to 1976 was defined. A total of 35 deaths was observed through 1979 (39.2 expected). No statistically significant excess was observed for any cause of death. No cancer deaths were noted for five of the hypothesized sites. For the lung cancer category, five deaths were observed (2.7 expected, P greater than .135), two of which occurred in a subgroup directly exposed for at least 1 yr (0.5 expected, P greater than .077). Aside from arsenicals exposure, potential confounding resulting from smoking or multiple chemical exposures could not be evaluated.

A cross-sectional study of ethylene glycol monomethyl ether process employees.

Human exposures to ethylene glycol monomethyl ether have been associated with hematological and neurological abnormalities. Recent animal toxicology studies have also reported testicular atrophy. To determine whether employees potentially exposed to ethylene glycol monomethyl ether during manufacturing and packaging had a higher prevalence of anemia, leukopenia, or sterility than an in-plant comparison group, a cross-sectional study was conducted at the Michigan Division of Dow Chemical U.S.A. Blood samples on 65 of 97 potentially exposed and control white males, and semen samples from a subset of 15 were analyzed. With the possible exception of smaller testicular size, no gross abnormalities or clinically meaningful differences in hematological or fertility indices were noted. Results of regression modeling suggested that white blood cells and hemoglobin might be decreased at higher exposure levels.

A mortality survey of employees engaged in the development or manufacture of styrene-based products.

The authors examined the mortality experience of employees whose work assignments involved development or production of styrene-based products. To investigate potential relationships between mortality and work exposure in the diverse chemical operations under study, a multiple agent approach to exposure categorization was adopted. Mortality was less than that of the corresponding U.S. white male population and was consistent with that of an industrial comparison group. Although deaths due to malignant neoplasms were fewer than expected for the total cohort, an increase in lymphatic leukemia was observed among a subgroup of employees who had exposure to polymer extrusion fumes, solvents, and colorants. However, no relationship was found with duration or intensity of exposures experiences by these employees, and the etiology of the lymphatic leukemias was not established. The approach used to characterize exposure in this study may have application in other epidemiologic investigations involving complex work environments.