New ways of working releasing general practitioner capacity with pharmacy prescribing support: a cost-consequence analysis.

Background: General practice in the United Kingdom is experiencing a workforce crisis. Greater multidisciplinary working, including more general practice pharmacists, is seen as part of the solution. However, it is unknown what impact and cost-consequences that pharmacists may have in freeing general practitioner (GP) capacity.

Analytical Representations for Characterizing the Global Aviation Radiation Environment Based on Model and Measurement Databases.

The climatological model and the (ARMAS) statistical database are presented as polynomial fit equations. Using equations based on altitude, shell, and geomagnetic conditions an effective dose rate for any location from a galactic cosmic ray (GCR) environment can be calculated. A subset of the ARMAS database is represented by a second polynomial fit equation for the GCR plus probable relativistic energetic particle (REP; Van Allen belt REP) effective dose rates within a narrow band of shells with altitudinal and geomagnetic dependency.

Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study.

Background: General practice in the UK is experiencing a workforce crisis. However, it is unknown what impact prescribing support teams may have on freeing up GP capacity and time for clinical activities.

Aim: To release GP time by providing additional prescribing resources to support general practices between April 2016 and March 2017.

Metabolism, temperature, and ventilation.

In mammals and birds, all oxygen used (VO2) must pass through the lungs; hence, some degree of coupling between VO2 and pulmonary ventilation (VE) is highly predictable. Nevertheless, VE is also involved with CO2 elimination, a task that is often in conflict with the convection of O2. In hot or cold conditions, the relationship between VE and VO2 includes the participation of the respiratory apparatus to the control of body temperature and water balance.

Airway distensibility in normal and asthmatic subjects and partitioning of the Fowler dead space.

Anatomical dead space measured by the Fowler method (VDF) is the sum of 2 serial volume compartments (VDF = VDp1 + VDp2). VDF has been shown to increase linearly with end-inspiratory lung volume (EILV) and the gradient of the relationship (DeltaVDF) has been used as an index of airway distensibility. The aim of this study was to partition VDF into its serial compartments VDp1 and VDp2 to test the hypothesis that, given the greater distensibility of distal airways, VDp2 would demonstrate greater volume dependence than VDp1.

Decreased lung capillary blood volume post-exercise is compensated by increased membrane diffusing capacity.

The diffusing capacity of the lung for carbon monoxide (DLCO) decreases to below the pre-exercise value in the hours following a bout of intense exercise. Two mechanisms have been proposed: (1) development of pulmonary oedema and (2) redistribution of central blood volume to peripheral muscles causing a reduction in pulmonary capillary blood volume ( V(c)). In the present study DLCO, V(c) and the membrane diffusing capacity ( D(m)) were measured in nine healthy females using a rebreathing method, in contrast to the single breath technique employed in previous studies.

Exercise-induced oxyhaemoglobin desaturation, ventilatory limitation and lung diffusing capacity in women during and after exercise.

Arterial haemoglobin saturation during exercise in healthy young women [eight subjects mean (SEM) age 20.8 (1.8) years] was measured to confirm the theory that young women experience exercise-induced arterial hypoxaemia (EIAH) at a lower relative percentage of maximal oxygen uptake (VO(2max)) than has been documented in their male counterparts.

Behavioral thermoregulation in obese and lean Zucker rats in a thermal gradient.

Genetically obese Zucker (Z) rats have been reported to display a body core temperature (Tb) that is consistently below that of their lean littermates. We asked the question whether the lower Tb was a result of deficits in thermoregulation or a downward resetting of the set point for Tb. For a period of 45 consecutive hours, lean and obese Z rats were free to move within a thermal gradient with an ambient temperature (T(a)) range of 15-35 degrees C, while subjected to a 12:12-h light-dark cycle.

Effect of changing body temperature on the ventilatory and metabolic responses of lean and obese Zucker rats.

We measured body temperature (Tb) and ventilatory and metabolic variables in lean (n = 8) and obese (n = 8) Zucker rats. Measurements were made while rats breathed air, 4% CO2, and 10% O2. Under control conditions, Tb in obese rats was always less than that of their lean counterparts.

Ventilatory and metabolic responses to cold and hypoxia in conscious rats with discrete hypothalamic lesions.

We tested the hypothesis that hypothalamic nuclei involved in thermoregulatory control could represent a site of integration of the metabolic and ventilatory response to cold and hypoxia. Electrolytic lesions were performed bilaterally under stereotaxic guide, either within the anterior or posterior hypothalamic areas of adult rats. One week later, oxygen consumption (VO2) and ventilation (VE) were measured in the conscious animals during warm (27 degrees C) or cold (12 degrees C) conditions, in normoxia (21% O2) or hypoxia (10% O2), and compared to measurements obtained in control rats, which were either intact or sham-operated.

Ventilatory response to asphyxia in conscious rats: effect of ambient and body temperatures.

In many mammals the ventilatory response to hypoxia depends on ambient temperature (Ta), largely because of the hypometabolic effects of hypoxia below thermoneutrality. We questioned whether the ventilatory response to asphyxia also depends upon Ta, and the role played by metabolism and body temperature (Tb). Oxygen consumption (VO2) and pulmonary ventilation (VE) were measured in conscious rats at Ta = 27 degrees C (warm) and 11 degrees C (cold), breathing air or two levels of asphyxic gases, moderate (10% O2-4% CO2), or severe (10% O2-8% CO2), for approximately 30 min each.

Influence of body temperature on responses to hypoxia and hypercapnia: implications for SIDS.

1. This paper reviews current knowledge regarding interactions between body temperature and the respiratory responses to hypoxia and/or hypercapnia, with special emphasis on how these interactions might predispose towards sudden infant death syndrome (SIDS). 2.

Ventilatory and metabolic responses to hypoxia during moderate hypothermia in anesthetized rats.

In resting euthermic mammals, hypoxia elicits a hyperventilation that results from a combination of hyperpnea and hypometabolism. Often accompanying the hypoxia-induced hypometabolism is a drop in body temperature. To separate the synergic effects of hypothermia per se from the direct effects of hypoxia on metabolic rate, ventilation (VE), and O2 consumption (VO2) were measured in anesthetized rats fitted with abdominal heat exchangers and maintained at either normothermic (37.

Dual effect of aminophylline on the ventilatory response to hypoxia in the rat.

Male Hooded Wistar rats were exposed to three five-minute periods of hypoxia in which they breathed a gas mixture comprising 7% O2 and 93% N2. Before the second and third hypoxic exposures rats were injected (i.m.

Respiratory responses to combined hypoxia and hypothermia in rats after posterior hypothalamic lesions.

Urethane-anaesthetised rats were exposed to hypoxia (7% O2 in N2) for 5 min periods while body core temperature (Tbc) was maintained within the normal range (37-38 degrees C) using an abdominal heat exchanger. Animals were exposed to hypoxia and after placement of electrolytic lesions in either the anterior (n = 6) or posterior hypothalamus (n = 6). Neither lesion altered respiration while rats breathed air at either Tbc.

Phrenicotomy in the rat: acute changes in blood gases, pH and body temperature.

Adult male rats were used to compare blood gases, pH and body temperature (Tb) before and after acute bilateral phrenicotomy. Under anaesthesia a femoral artery was catheterised and ties were placed round the phrenic nerves of seven rats (PNX group), while in five rats the ties were placed in the vicinity of the phrenic nerves (SHAM group). Twenty-four hours after surgery arterial blood samples were collected during quiet wakefulness (QW) and grooming (G), before and 1 h after the ties were pulled, and analysed for PO2, PCO2 and pH.

Body temperature effects on hypoxic and hypercapnic responses in awake rats.

During surgery under pentobarbital sodium anesthesia, 20 rats had heat exchange devices implanted into their abdominal cavity. After recovery, 14 rats underwent two sets of trials, one in which body core temperature (Tbc) was lowered to 34.5-35.

Alteration in breathing of the awake rat after laryngeal and diaphragmatic muscle paralysis.

The respiratory rate (f), tidal volume (VT) and ventilation (V) were measured in 3 groups of rats: 10 rats before and after cutting both recurrent laryngeal nerves (RLNX), 10 rats before and after bilateral phrenicotomy (PNX) and 5 sham transected (SHAMX) rats. All rats were exposed to air and gas mixtures, deficient in O2 and/or enriched with CO2. The barometric method was used to measure ventilatory parameters.

A vagally mediated response to metabolic acidosis in anesthetized rabbits.

Pentobarbital sodium-anesthetized rabbits received 10-min infusions of acetic, lactic, or propionic acid delivered via a catheter to the right atrium at a rate of 1 mmol/min (n = 14). Arterial [H+] increased by 35.8 +/- 7.

Changes in ventilation, breathing pattern and acid-base balance of conscious rabbits following intravenous almitrine.

Five conscious rabbits each received a single injection of almitrine bismesylate via a marginal ear vein. Measurements were made of ventilation and breathing pattern using a barometric method, and blood gases, pH and lactate concentration ([Lac]) were measured from arterial blood samples throughout the hour following the injection. Almitrine caused an immediate increase in ventilation through an increase in tidal volume (VT), frequency (f) showing a small decline.

Ventilation and acid-base balance in awake dogs exposed to heat and CO2.

Some awake quiet dogs pant at cool ambient temperature (Ta) and some do not pant even when acutely exposed to heat. The purpose of the study was to determine whether this puzzling variability in respiratory behavior diminished during prolonged heat. The contributions of thermal and CO2 drives to respiratory adaptations were also examined.

Effects of decortication and carotid sinus nerve section on ventilation of the rat.

The effect on ventilation of exposure to hypoxic, hypercapnic and hypoxic/hypercapnic gas mixtures was studied before and after functional decortication of intact rats and rats in which the carotid chemoreceptors had been disconnected. Unanaesthetized rats responded to both hypoxia and hypercapnia with an increase in minute ventilation (V) through increases in both frequency (f) and tidal volume (VT). Decortication led to a greater V response to CO2.

Effect of a constant arterial CO2 tension on respiratory pattern in hear-stressed sheep.

Sheep were exposed in a climate chamber to a hot humid environment under two conditions: breathing atmospheric air and breathing air enriched with CO2. Measurements were made of rectal temperature (Tre), respiratory frequency (fR), mean arterial pressure (BP), heart rate (fH), and arterial O2 tension (PO2), CO2 tension (PCO2), and pH; depth of breathing was also estimated. Tre increased at a similar rate under both conditions.

The respiratory frequency response to carbon dioxide inhalation in conscious rabbits.

1. The respiratory responses to CO(2) inhalation were measured in New Zealand White rabbits. Prior to testing, the rabbits either received drinking water ad libitum (C), or were subjected to 72 hr water deprivation (WD).

Responses of conscious rabbits to CO2 at ambient temperatures of 5, 20, and 35 degrees C.

Conscious rabbits were exposed to atmospheric air or to 6% CO2 in air at ambient temperatures (Ta) of 5, 20 and 35 degrees C. Measurements were made of rectal temperature (Tre), metabolic rate (MR), respiratory frequency (f), tidal volume (VT), and minute volume (VE). CO2 exposure did not affect Tre at any Ta and only affected MR at 35 degrees C when it caused an increase.