Ketamine for the difficult-to-sedate ER patient

-For the small segment of the emergency population whose acute behavioral disturbance does not respond to traditional sedation, ketamine appears to be effective and safe, according to an Australian study published online in Annals of Emergency Medicine (“Ketamine for Difficult to Sedate Severe Acute Behavioral Disturbance in the Emergency Department”).

“Difficult to sedate patients with behavioral disturbances are highly problematic for emergency department staff,” said Geoff Isbister, MD, of the Clinical Toxicology Research Group at the University of Newcastle in Newcastle, Australia. “Although such patients are uncommon, they cause significant disruption and danger to emergency department staff and consume time and resources required for other patients. Ketamine is a reasonable third-line agent to use on these patients once other sedation options have been exhausted.”

Of 49 emergency patients who were treated with ketamine to achieve sedation for acute behavioral disturbances, only 10 percent either did not achieve sedation within 2 hours or required additional sedation within 1 hour. Patients were treated with ketamine only after sedation was attempted with droperidol in the majority of cases. Average time to sedation after ketamine was 20 minutes.

Police were involved with 20 of the 49 subjects, of whom 57 percent were male.

“Most agitated and aggressive patients in the emergency department will either respond to verbal de-escalation or oral sedation, or be rapidly sedated with droperidol” said Dr. Isbister. “For the small number who don’t, we have ketamine.”

Journal Reference:

Geoffrey Kennedy Isbister, Leonie A. Calver, Michael A. Downes, Colin B. Page. Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department. Annals of Emergency Medicine, 2016; DOI: 10.1016/j.annemergmed.2015.11.028

View the original article here

Advertisements

Hulk Hogan’s NSFW Gawker Lawsuit Is a Free-Speech Battle Royale

Caption: Then One/WIRED

Skip Article Header. Skip to: Start of Article. Web Then One/WIRED

Asia-Pacific’s most advanced datacentre coming to Asean

Thailand will have the first Tier IV Gold datacentre, as rated by the Uptime Institute, in Asia in the first quarter of 2017. This will make it the most advanced datacentre in the Asia-Pacific and the largest in Thailand, with capacity for more than 6,000 data server racks.

The Uptime Institute’s datacentre tier certification is awarded at four levels, and Tier IV represents a certification for a fault-tolerant site infrastructure.

Located in Hemmaraj Industrial Estate in Thailand’s eastern province Chonburi, the 11bn THB (US$300m) Supernap datacentre is being developed by Supernap International, together with a group of leading Thai organisations, including CPB Equity, Kasikorn Bank, Siam Commercial Bank and True IDC.

“The Supernap Thailand datacentre is a mirror of Switch Supernap US facilities, which are the first Tier IV Gold carrier-neutral colocation datacentres. This cutting-edge datacentre will meet the global demand for innovation in Asia-Pacific,” said Khaled Bichara, CEO of Supernap International.

Te datacentre will generate “intense competition” in the industry for customers in Thailand, said Tuang Cheevatadavirut, senior market analyst at IDC.

“This will create a huge impact in the Thailand ICT/IT industry, as the datacentre supply will grow significantly and an international player such as Supernap will cater mostly to the premium customer segment in the Asian or Asean region. The local operators will need to compete with a new standard for quality, security and innovation to differentiate their services,” added Cheevatadavirut.

IDC expects the existing local operators to initially compete on price. Enterprises are expected to be attracted to their lower price points and may try outsourcing non-core business processes.

Later, these local operators will realise that enterprises are willing to pay a premium for datacentre services that drive business growth through systems of engagement, insight and action, rather than maintain existing systems of record,” said Cheevatadavirut.

He said the datacentre is a result of a partnership between five different entities, which means some of the datacentre’s capacity will be utilised by the partners, with the remainder of the capacity being rented out to customers.

The Supernap datacentre is likely to be the most technologically advanced datacentre in the region, as there is no record of any Uptime Institute rated Tier IV datacentres in Japan, Singapore, India, South Korea or China, said Cheevatadavirut.

“These countries may use different standards or they may build to match Tier IV standard, but are not certified and registered with Uptime Institute.”

The Supernap datacentre will cover an area of nearly 12 hectares and will be built outside the flood zone, 110 meters above sea level. It is built 27km away from the international submarine cable landing station, which links the facility to national and international telecoms and IT carriers. 

View the original article here

Airbnb’s Diversity Worries Aren’t Just About Who Works There

Caption: David King III. Christie Hemm Klok/WIRED

Skip Article Header. Skip to: Start of Article. David King III. David King III. Christie Hemm Klok/WIRED

Ad Blockers Are Making Money Off Ads (And Tracking, Too)

Caption: Then One/WIRED

Skip Article Header. Skip to: Start of Article. Web Then One/WIRED

AT&T Will Let You Get Cable TV Without Having Cable—Or a TV

Skip Article Header. Skip to: Start of Article.

Better technology could take agriculture halfway towards climate targets

Unless greenhouse gas emissions from food consumption are reduced substantially, EU climate targets will not be met, according to a new study from Swedish researchers. Currently accounting for about 25 percent of greenhouse gas emissions, emissions from food and agriculture need to be cut by about three-quarters by 2050 to meet the targets.

Researchers at Chalmers University of Technology and SP Technical Research Institute of Sweden studied a range of measures for cutting food-related emissions. Besides reductions in beef and dairy consumption, they found that technology improvements will be crucial. Under favorable conditions, better technology could cut these emissions by as much as 50 percent.

“Emissions from manure storage can all but be eliminated if the facilities are covered and waste gases are flared, says David Bryngelsson, lead author of the study. And emissions from fertilizer production can largely be avoided by using the latest technology. However, far more ambitious climate policies for agriculture are needed to make these technology improvements happen.”

The technological prospects for cattle are less promising, according to the researchers. This is a critical finding, since cattle account for a very large share of the emissions. The study therefore concludes that reductions in beef consumption are necessary for meeting the climate targets.

“But we don’t have to give up meat entirely,” says Stefan Wirsenius, co-author of the study. “Poultry and pork cause rather low emissions, in a range equivalent to 10 to 30 kilos of carbon dioxide per kilo of protein, while beef cause 200 kilos per kilo protein. So we can continue to eat large quantities of poultry and pork — provided that we cut back on beef.”

Cheese and other dairy products are also serious climate problems, according to the study:

“EU and US consumption of cheese and other dairy products is among the highest in the world and causes a climate impact equal to that of their pork and chicken consumption” says Stefan Wirsenius. “If we were to replace some of the dairy products with vegetable products, such as oat milk, we would have a better chance of meeting our climate targets.”

The scientists have also looked at the effect of reducing food waste. The results may be surprising:

“Although wasting less food is good for the climate, the impact of reducing waste is small compared to what’s required to meet the targets,” says David Bryngelsson. “Reducing the amount of food that goes to waste can only cut emissions from food and agriculture by five to ten percent. Reducing beef and dairy consumption is much more important.”

The findings are reported in the article How can the EU climate targets be met? A combined analysis of technological and demand-side changes in food and agriculture, in the journal Food Policy. Study authors are David Bryngelsson, Stefan Wirsenius, Fredrik Hedenus, and Ulf Sonesson.

Journal Reference:

David Bryngelsson, Stefan Wirsenius, Fredrik Hedenus, Ulf Sonesson. How can the EU climate targets be met? A combined analysis of technological and demand-side changes in food and agriculture. Food Policy, 2016; 59: 152 DOI: 10.1016/j.foodpol.2015.12.012

View the original article here