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Haibin Zou,1 Fangfang Xi,1 Yuanyuan Fu,1 Jinhui Xu,1 Ping Zhang,1 Dongge Li,2 Heguo Luo1 1Department of Anesthesiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330006, People’s Republic of China; 2The Third Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of ChinaCorrespondence: Heguo Luo, Department of Anesthesiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330006, People’s Republic of China, Tel +86 13807035516, Email ddjy121@163.comPurpose: Ciprofol, a new sedative anesthetic developed in China, offers rapid onset and recovery, reduced injection pain, and stable circulation. However, its effect on blood pressure during anesthesia induction in older adults remains unclear. To compare the effects of propofol and ciprofol on hypotension induced by general anesthesia in older adults.Patients and Methods: This prospective, single-center, double-blind, randomized, controlled clinical study enrolled 117 older adults undergoing surgery. Patients in the ciprofol group (group C) received an intravenous injection of ciprofol (0.3 mg/kg, n=57), while the propofol group (group P) received an intravenous injection of propofol (1.5 mg/kg, n=58). The primary outcome was the incidence of hypotension (mean arterial pressure (MAP) decreased by > 30% from baseline or MAP< 65 mmHg). Secondary outcomes included induction success rate (bispectral index (BIS) value ≤ 60 and Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) score ≤ 1), injection pain, number of drug additions, time to BIS 60, time to eyelash reflex disappearance, blood pressure changes, incidence of hypertension, tachycardia and BIS values before and after administration.Results: The incidence of induced hypotension was 26.3% (15/57) in group C and 48.3% (28/58) in group P (OR=0.383, 95% CI:175– 0.837, P =0.015). Group C had significantly lower injection pain incidence (5.3% vs 20.7%, OR=0.213, 95% CI: 0.057– 0.801, p=0.014). Both groups had a 100% induction success rate, with no significant difference in the number of additional doses. Post-intubation hypertension and tachycardia incidence were not significantly different. Group C showed less blood pressure decrease during induction and a deeper anesthesia level.Conclusion: Compared to propofol, ciprofol reduces the incidence of induced hypotension in older adults and maintains more stable blood pressure during induction. Additionally, ciprofol reduces injection pain and provides a good depth of anesthesia, making it a safe and effective option for anesthesia induction in older adults.Trial Registration ClinicalTrials.gov Identifier: ChiCTR2200066053.Keywords: ciprofol, propofol, bispectral index, BIS, hypotension

Groundwater is an essential source of drinking as well as irrigation water. It has recently become a significant challenge to maintain good and safe drinking water for all living beings. The continuous supply of arsenic detected in groundwater poses a severe health problem and has adverse effects on humans and the ecosystem. Researchers also identified arsenic contamination globally across various regions. However, a few studies also identified that the groundwater of Patna, Saran, and Vaishali districts of Bihar is intoxicated by arsenic. To assess the toxic level of arsenic in groundwater, samples from various GPS-based pointed locations were collected from the study area using a GARMIN GPS device. The total concentration of arsenic in drinking water (mostly traces of arsenic, level of μg L−1 or less) can be detected only by sophisticated analytical techniques such as ICP-MS, GF-AAS, and HG-AAS. The standard procedures were followed to determine quality attributes in groundwater. Arsenic contamination persists in most areas and exceeds the permissible limits prescribed by the World Health Organization (WHO), negatively impacting the health of more than 10 million people in the state. The 90.47% and 85.71% groundwater samples of the study area exceeded the permissible limit of the WHO (0.01 mg L−1) and Bureau of Indian Standards (BIS (0.05 mg L−1), respectively. The analyzed data was obtained, and variability was noticed in total arsenic concentrations ranging from 0.002 to 7.801 mg L−1, with a mean value of 0.87 mg L−1. Similarly, the water quality attribute like total dissolved solids were identified in 14.28% of samples, which crossed 201 to 1026 mg L−1, with a mean value of 375.33 mg L−1. [ABSTRACT FROM AUTHOR]

Background: Breast cancer-related lymphedema (BCRL) profoundly impacts patients' quality of life, causing heightened depression, anxiety, and physical limitations. Surgical removal of the axillary nodes, combined with radiation therapy, is a significant risk factor for BCRL. Smarter axillary surgery, coupled with early detection and fostering lymphedema education, significantly improves BCRL management, promoting timely diagnosis and treatment. A lymphedema prevention program encompassing all these factors can significantly aid in preventing, treating, and reducing the severity of BCRL cases. Therefore, our study aims to share our insights and experiences gained from implementing a lymphedema prevention program at our institution. Methods & Results: At our institution, axillary reverse mapping (ARM) is performed on all patients undergoing axillary surgery. We surveil these patients with pre- and postoperative SOZO® measurements using bioimpedance spectroscopy to detect sub-clinical lymphedema. Concerning education, we use a 3-pronged approach with surgeons, nurse practitioners, and video representation for patients. We have had 212 patients undergo the ARM procedure since 2019, with three (1.41%) developing persistent lymphedema. Conclusion: Our study underscores the significance of a comprehensive lymphedema prevention program, integrating smarter axillary surgery, early detection, and patient education. The lymphedema rate of 1.41% not only validates the success rate of these interventions but also advocates for their widespread adoption to enhance the holistic care of breast cancer survivors. As we continue to refine and expand our program, further research, and long-term follow-up are crucial to improve prevention strategies continually and enhance the overall well-being of individuals at risk of BCRL. [ABSTRACT FROM AUTHOR]

Insomnia disorder is a subjective complaint of sleep dissatisfaction including both night-time and daytime symptoms. Currently there are three commonly used diagnostic manuals each with their own set of criteria, which is often credited for the wide range in insomnia prevalence reported by population-based studies, especially those with self-reported insomnia. However, there are limited studies directly comparing different criteria and little is known about associations with health outcomes. Thus, the aim of this study was to compare the most commonly used diagnostic criteria for insomnia from the literature and to explore the associations with a range of physical and mental health outcomes. We used data from 21,083 women and men from the seventh survey of the population-based Tromsø Study which included adults aged 40–99 years. A revised version of the Bergen Insomnia Scale was used to define insomnia based on the 4th (revised) and 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM5), the 10th edition of the International Classification of Diseases (ICD-10), and the 3rd edition of the International Classification of Sleep Disorders (ICSD-3). We found the following prevalence of insomnia: DSM-IV-TR 23.6 %, DSM5 8.5 %, ICD-10 9.9 % and ICSD-3 20.0 %. When looking at each symptom, we found over half the participants classified as having insomnia using the DSM-IV-TR and ICSD-3 criteria did not report having impaired daytime functioning at least three days per week. Overall, participants with DSM5 and ICD-10 insomnia appeared to have worse health profiles, based on a higher percentage meeting the cut-off for possible anxiety or depression, reporting a psychological problem or chronic pain, and using antidepressants, painkillers or sleeping pills. However logistic regression models showed largely the same health factors had the same association with the odds for being classified as having insomnia disorder from each set of criteria. Overall, this study suggests that insomnia prevalence may be overestimated if daytime symptoms are not adequately included in accordance with current guidelines. • Insomnia prevalence range widely likely due to different diagnostic criteria. • Criteria were compared in over 20,000 individuals from a general population sample. • Insomnia prevalence ranged from 8.5 % to 23.6 % from the same population. • The lowest prevalence's were associated with worse health profiles. [ABSTRACT FROM AUTHOR]

This study investigates the incorporation of accounting and informatics in contemporary company management, with a specific emphasis on the influence of information technology on corporate governance and its effects on firm management. This evaluates the significance of ICT in business and the function of economic information systems in corporate management. The study used a qualitative methodology, using academic literature, industry reports, and case studies. The studies seek to improve comprehension of the correlation between accounting and informatics in contemporary corporate management. The study highlights the pivotal significance of information technologies in creating corporate settings and promoting innovation.

Objective: The course of sedation during drug‐induced sleep endoscopy (DISE) depends on the application pattern of the sedative drug. The depth of sedation should imitate light and deep sleep as well. Moreover, there should be as many breathing cycles as possible available for observation during light and deep sedation. The aim of the study was to evaluate different rates of propofol application with respect to the achieved depth and length of the course of sedation. Methods: Sixty‐three consecutive patients with obstructive sleep apnea and/or snoring undergoing DISE were randomly sedated by propofol perfusion at seven different application patterns: 14, 16, 18, 19, 20, 22 mg/kg/h (0.233, 0.267, 0.3, 0.317, 0.333, 0.367 mg/kg/min) per perfusor and individual bolus application 10 mg each. Sedation depth was monitored by BiSpectral Index™ (BIS). The influence of baseline parameters and the courses of sedation were analyzed. Results: The application rate was the only factor that influenced the depth of sedation. Basic parameters (gender, age, body mass index, apnea‐hypopnea index) had no influence on the depth of sedation. The sedation depth was dependent on the rate of propofol application. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50 representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases of sedation levels below deep sleep niveau. Propofol rates between 18 and 20 mg/kg/h enable BIS levels below 50 representing deep sleep and providing enough breathing cycles for observation. Conclusion: Lower application rates of propofol provide slower courses of sedation and shallower depths of sedation. A rate of 14 mg/kg/h might be appropriate to reach a sedation plateau at light sleep. A rate of 18 mg/kg/h leads to a sedation, corresponding to deep sleep. The combination of both rates might be a suitable pattern for performing sedation‐controlled DISE. Level of evidence: 2: Randomized trial.Establishment of a dose–response relationship between applied sedative and achieved sedation during sleep endoscopy. And proposal to perform a sedation‐depth guided sleep endoscopy. [ABSTRACT FROM AUTHOR]

BackgroundBreast cancer-related lymphedema (BCRL) profoundly impacts patients’ quality of life, causing heightened depression, anxiety, and physical limitations. Surgical removal of the axillary nodes, combined with radiation therapy, is a significant risk factor for BCRL. Smarter axillary surgery, coupled with early detection and fostering lymphedema education, significantly improves BCRL management, promoting timely diagnosis and treatment. A lymphedema prevention program encompassing all these factors can significantly aid in preventing, treating, and reducing the severity of BCRL cases. Therefore, our study aims to share our insights and experiences gained from implementing a lymphedema prevention program at our institution.Methods & ResultsAt our institution, axillary reverse mapping (ARM) is performed on all patients undergoing axillary surgery. We surveil these patients with pre- and postoperative SOZO® measurements using bioimpedance spectroscopy to detect sub-clinical lymphedema. Concerning education, we use a 3-pronged approach with surgeons, nurse practitioners, and video representation for patients. We have had 212 patients undergo the ARM procedure since 2019, with three (1.41%) developing persistent lymphedema.ConclusionOur study underscores the significance of a comprehensive lymphedema prevention program, integrating smarter axillary surgery, early detection, and patient education. The lymphedema rate of 1.41% not only validates the success rate of these interventions but also advocates for their widespread adoption to enhance the holistic care of breast cancer survivors. As we continue to refine and expand our program, further research, and long-term follow-up are crucial to improve prevention strategies continually and enhance the overall well-being of individuals at risk of BCRL.

Abstract Background Clinical insight (i.e., impaired insight into illness) is increasingly recognized by the scientific community as a significant contributor to an array of psychological and clinical outcomes in schizophrenia. Therefore, its assessment using a reliable, rapid, easy and economic tool is important for clinical practice. This study proposes to investigate the psychometric properties of an Arabic translation of the Birchwood Insight Scale (BIS) in Arabic-speaking chronic patients with schizophrenia. Our objectives were to identify the most adequate factor structure of the BIS among the several measurement models previously proposed in the literature, verify the reliability and measurement invariance of the BIS across sex groups, and explore the concurrent validity of the BIS through examining its patterns of correlations with psychotic symptoms. Method One hundred seventeen Arabic-speaking chronic, remitted patients with schizophrenia took part in this study. An Arabic translated version of the BIS and the Positive and Negative Syndrome Scale (PANSS) were administered to participants. Results Confirmatory factor analyses (CFA) showed that, after omitting two items with low loadings (items 1 and 2), the unidimensional factor model of the BIS showed good fit indices and a reliability of α = 0.68 and ω = 0.68. However, analyses failed to show good fit for the full-length one-, two-, and three-factor models of the BIS in its Arabic version. Measurement invariance of the Arabic 6-item one-factor BIS was established between males and females at the configural, metric and scalar levels; no statistically significant difference between males and females was found in terms of BIS scores. Finally, BIS scores correlated significantly with the PANSS scores in our sample, thus demonstrating adequate concurrent validity. Conclusion This study offers valuable additional psychometric information about the BIS based on results of CFA and other analyses in schizophrenia from a non-Western cultural environment. We believe that making the BIS available in Arabic might benefit clinicians working with Arabic-speaking patients with schizophrenia, open new avenues of research and gain a better knowledge into the nature of clinical insight and its relevance to psychopathology.

This study investigates the incorporation of accounting and informatics in contemporary company management, with a specific emphasis on the influence of information technology on corporate governance and its effects on firm management. This evaluates the significance of ICT in business and the function of economic information systems in corporate management. The study used a qualitative methodology, using academic literature, industry reports, and case studies. The studies seek to improve comprehension of the correlation between accounting and informatics in contemporary corporate management. The study highlights the pivotal significance of information technologies in creating corporate settings and promoting innovation. [ABSTRACT FROM AUTHOR]

Overhydration (OH) is a prevalent medical problem that occurs in patients with kidney failure, but a specific marker has still not been found. Patients requiring kidney replacement therapy suffer from a water imbalance, which is correlated with mortality rates in this population. Currently, clinicians employ techniques such as bioimpedance spectroscopy (BIS) and ultrasound (USG) markers of overhydration or markers of heart and kidney function, namely NT-pro-BNP, GFR, or creatinine levels. New serum markers, including but not limited to Ca-125, galectin-3 (Gal-3), adrenomedullin (AMD), and urocortin-2 (UCN-2), are presently under research and have displayed promising results. Ca-125, which is a protein mainly used in ovarian cancer diagnoses, holds great potential to become an OH marker. It is currently being investigated by cardiologists as it corresponds to the volume status in heart failure (HF) and ventricular hypertrophy, which are also associated with OH. The need to ascertain a more precise marker of overhydration is urgent mainly because physical examinations are exceptionally inaccurate. The signs and symptoms of overhydration, such as edema or a gradual increase in body mass, are not always present, notably in patients with chronic kidney disease. Metabolic disruptions and cachexia can give a false picture of the hydration status. This review paper summarizes the existing knowledge on the assessment of a patient's hydration status, focusing specifically on kidney diseases and the role of Ca-125. [ABSTRACT FROM AUTHOR]

This research work deals with the TDS and physiochemical parameters of RO purified drinking water in Raipur region. Current pollution trends taught us that it is necessary to drink RO purified water but we must have to know the quality of RO purified drinking water because many peoples used RO water for consumption. This paper deals about RO water with special reference to TDS, but another physical parameter viz. pH, EC, Salt, Temperature and chemical parameter viz. Hardness (total hardness, calcium hardness & magnesium hardness) and Total alkalinity and NA+, K+ of RO purified water also tested and studied. We are able to know about the correlation between TDS and many physiochemical parameter after study about this research paper. 20 water samples collected from different places of Raipur city. The purpose of the research paper is to ensure the quality of RO purified water that people using for drinking purpose. Many samples of RO purified waters TDS level is below the permissible limit of BIS guidelines in the part of result and discussion the samples are mentioned properly in this present paper. Peoples should aware about the consequences which can occur after long term consumption of RO purified drinking water. [ABSTRACT FROM AUTHOR]

Abstract Objective The course of sedation during drug‐induced sleep endoscopy (DISE) depends on the application pattern of the sedative drug. The depth of sedation should imitate light and deep sleep as well. Moreover, there should be as many breathing cycles as possible available for observation during light and deep sedation. The aim of the study was to evaluate different rates of propofol application with respect to the achieved depth and length of the course of sedation. Methods Sixty‐three consecutive patients with obstructive sleep apnea and/or snoring undergoing DISE were randomly sedated by propofol perfusion at seven different application patterns: 14, 16, 18, 19, 20, 22 mg/kg/h (0.233, 0.267, 0.3, 0.317, 0.333, 0.367 mg/kg/min) per perfusor and individual bolus application 10 mg each. Sedation depth was monitored by BiSpectral Index™ (BIS). The influence of baseline parameters and the courses of sedation were analyzed. Results The application rate was the only factor that influenced the depth of sedation. Basic parameters (gender, age, body mass index, apnea‐hypopnea index) had no influence on the depth of sedation. The sedation depth was dependent on the rate of propofol application. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50 representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases of sedation levels below deep sleep niveau. Propofol rates between 18 and 20 mg/kg/h enable BIS levels below 50 representing deep sleep and providing enough breathing cycles for observation. Conclusion Lower application rates of propofol provide slower courses of sedation and shallower depths of sedation. A rate of 14 mg/kg/h might be appropriate to reach a sedation plateau at light sleep. A rate of 18 mg/kg/h leads to a sedation, corresponding to deep sleep. The combination of both rates might be a suitable pattern for performing sedation‐controlled DISE. Level of evidence 2: Randomized trial.

Abstract Background Postoperative delirium (POD) is an important complication for older patients and recent randomised controlled trials have showed a conflicting result of the effect of deep and light anesthesia. Methods We included randomised controlled trials including older adults that evaluated the effect of anesthetic depth on postoperative delirium from PubMed, Embase, Web of Science and Cochrane Library. We considered deep anesthesia as observer’s assessment of the alertness/ sedation scale (OAA/S) of 0–2 or targeted bispectral (BIS) 50. The primary outcome was incidence of POD within 7 days after surgery. And the secondary outcomes were mortality and cognitive function 3 months or more after surgery. The quality of evidence was assessed via the grading of recommendations assessment, development, and evaluation approach. Results We included 6 studies represented 7736 patients aged 60 years and older. We observed that the deep anesthesia would not increase incidence of POD when compared with the light anesthesia when 4 related studies were pooled (OR, 1.40; 95% CI, 0.63–3.08, P = 0.41, I2 = 82%, low certainty). And no significant was found in mortality (OR, 1.12; 95% CI, 0.93–1.35, P = 0.23, I2 = 0%, high certainty) and cognitive function (OR, 1.13; 95% CI, 0.67–1.91, P = 0.64, I2 = 13%, high certainty) 3 months or more after surgery between deep anesthesia and light anesthesia. Conclusions Low-quality evidence suggests that light general anesthesia was not associated with lower POD incidence than deep general anesthesia. And High-quality evidence showed that anesthetic depth did not affect the long-term mortality and cognitive function. Systematic review registration CRD42022300829 (PROSPERO).

Internet addiction (IA), one of the behavioral addictions, is also related to impulsivity. Although studies on its etiology and risks continue, the number of studies is limited. In this study, we aimed to assess the roles of behavioral systems, emotional regulation (ER), and impulsivity in the development of IA in adolescents and also to assess the relationship between all these clinical parameters and brain-derived neurotrophic factor (BDNF) and neuropeptide Y (NPY). Forty-two adolescents with IA and 30 healthy controls (ages 12 –17) were included in the study. Self-reported measures included the Internet Addiction Scale. (IAS), Behavioral Activation and Behavioral Inhibition Scale (BAS/BIS), Barratt. Impulsiveness Scale-11 (BIS-11), and Difficulties in Emotion Regulation Scale-16 (DERS-16) were used for the assessment of the participants. The levels of plasma brain BDNF and NPY were evaluated with the ELISA method. BAS/BIS subscale scores, BIS-11, and DERS-16 scale total scores were found to be statistically significantly higher, while BDNF and NPY levels were found to be lower in adolescents with IA compared to the healthy controls. IA severity was not found to correlate with both BDNF and NPY. IA was found to be more related to BIS than to BAS. There is a need for further studies evaluating developmental features and possible diagnostic biomarkers that may be associated with IA in adolescents. [ABSTRACT FROM AUTHOR]

Variability is high in predicted propofol concentrations during clinical anaesthesia titrated by target-controlled infusion (TCI) to maintain a processed EEG parameter (bispectral index [BIS]) within a specified range. We have shown that the potential for improving the pharmacokinetic model is minimal. The drug titration paradox revealed that titration challenges the classical relationship between drug dose and effect in both individuals and the population. We hypothesised that dynamic factors during surgery beyond the static genetic, epigenetic, and other factors such as age, height, and weight affect the necessary dose. We compared the variability of measured end-tidal sevoflurane concentrations with predicted effect-site propofol concentrations when titrated to a BIS range of 40–60, with the hypothesis that the variability in measured sevoflurane concentrations would not be less than the variability in estimated propofol concentrations. Clinical data from 2280 surgical procedures >1 h in duration were included in the analysis. Anaesthesia with sevoflurane or propofol was based on an institutional protocol. The titration performance for both drugs was assessed by comparing BIS values 30 min after skin incision. The variability of the required concentrations at the same time point was calculated and compared. The achieved 30-min post-incision BIS ranges were not significantly different for sevoflurane or propofol TCI (30 [99% CI: 28–33] and 31 [99% CI: 27–36], respectively). The variability of sevoflurane concentrations was not significantly different from measured predicted propofol concentrations during BIS-guided anaesthesia (normalized concentration range of 0.89 [99% CI: 0.78–0.99] and 0.93 [99% CI 0.87–1.02). Improvements in prediction accuracy of pharmacokinetic models beyond that of those already in clinical use are unlikely to reduce variability in target anaesthetic concentrations across patients in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background The Bispectral Index (BIS) and the Patient State Index (PSI) are commonly used measures to assess intraoperative sedation depth. However, model differences lead to different results, which in turn interferes with clinicians’ judgment on the depth of anesthesia. Remimazolam tosilate (RT) for injection is a new benzodiazepine used in sedation. In its clinical application, there are few effective indicators for sedation depth monitoring. To close this gap, this study aims to compare BIS and PSI in measuring the sensitivity and specificity of intraoperative RT and to explore the safety of RT for intraspinal anesthesia in elderly patients. Methods This study included 40 patients undergoing elective electro-prostatectomy with intraspinal anesthesia, who were monitored by BIS and PSI simultaneously during operation. Remimazolam tosylate 0.1 mg/kg was intravenously administered after the intraspinal anesthesia when patients were in a completely painless status. Then BIS, PSI, the Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scores and vital signs were observed and recorded per minute for 10 min. Pearson’s correlation analysis and linear regression model were used to compare BIS and PSI sedation scores, and to test their associations with the MOAA/S score, respectively. ROC curves were drawn to compare the sensitivity and specificity of BIS and PSI. Changes of vital signs were presented as mean ± standard deviation. Perioperative liver and kidney function indicators were analyzed using a paired t-test to evaluate the safety of RT for intraspinal anesthesia in the elderly patients. Results According to Pearson’s correlation analysis, a significant (P

The article examines the current state of implementation of one of the largest regulatory projects in to examine the role of international cross-border payment regulation in the context of global financial architecture and to see how a modernized national payment infrastructure could be optimally embedded in the global payment infrastructure. To achieve this purpose, this article systematizes the standard setting documents and analyzes doctrinal sources. Special attention is paid to BIS Innovation Hub projects. The study analyses area E of the G20 Roadmap, which covers the development of new means of payment, including CBDCs and stablecoins. In particular, the paper provides an overview of analytics and specific projects pertaining to the introduction of central bank digital currencies (CBDC). The article also analyzes how the issuance of CBDCs relates to the international framework being created for regulating crypto assets. The authors conclude that global financial regulation is becoming more payment-centric since the issue of regulating cross-border payments lies at the intersection of several important policies and international legal regimes. In particular, this involves international policies pertaining to the regulation of financial services, macroprudential regulation, regulation of the global monetary system, regulation of crypto assets, countering illicit financial flows in the global economy, and ESG regulation. The article systematizes the features and risks of the payment-centric model for global financial regulation. It concludes that international cooperation and coordination are necessary if cross-border projects related to payments are to be successfully implemented.

Background: Insomnia is a very common and yet challenging condition encountered in clinical practice. Clinical evaluation, often with the help of questionnaires is used to diagnose and quantify this condition. However, the questionnaires are highly heterogeneous in their scope and outlook and give varying information on different aspects of insomnia. Research questionnaires on insomnia abound in clinical literature but are not useful in the clinical setting to help in therapeutic decision-making. This paper is a review of the scope and limitations of some of the commonly used questionnaires in the diagnosis and evaluation of insomnia in the clinical setting. Methods: A thorough literature search of studies evaluating diagnosis and evaluation of insomnia were included. The studies were selected on basis of their utility in clinical settings and the quality of the research reporting the results of their use. The usefulness and scope of the questionnaire and voids in their utility were discussed. Out of a total of 3872 articles, a final of 11 studies were taken up for final study as per the guidelines of reporting of systematic reviews PRISMA statement, 2020. Results: The included articles showed great heterogeneity in their scope as well as outcome measures. The older studies were of low methodological quality and limited clinical utility. Administration in a clinical setting was difficult for many while scoring questionnaires was complex and cumbersome. Conclusion: There is an unmet need for a holistic and easily administrable assessment measure of insomnia remains.

This research involved measuring the concentration of chloride in the water of the Ami River, selected sites, in water produced from plant liquidation, and in the water used in residential areas in GIDA Gorakhpur. The results illustrate that the highest chloride concentration was found in the water of River Ami in different seasons (rainy, winter, and summer). In the Year 2020-2021, the recorded chloride concentrations in the rainy season (325 mg/l), winter (275 mg/l), and summer (350 mg/l). In the year 2021-2022, the rainy season (375 mg/l), winter (325 mg/l), and summer (400 mg /l) were recorded in the year 2021-2022. The level of chloride in the water of the Ami River was consistent with the BIS standard specification. [ABSTRACT FROM AUTHOR]

Background and Aims: The return of consciousness (ROC) after general anesthesia (GA) is by stopping the administration of anesthetic agents. At present, no drug is given to reverse the loss of consciousness produced by general anesthetic agents. This study is conducted to find whether caffeine and aminophylline hasten the ROC. Material and Methods: This study was conducted on 75 American Society of Anesthesiologists (ASA) I and II female patients undergoing laparoscopic hysterectomy, aged between 18 and 60 years. The patients were divided into three equal groups (Group C: caffeine citrate, Group A: aminophylline, and Group S: saline) of 25 each by a computer-generated random number table. GA was induced with propofol, fentanyl, and maintained with propofol infusion. On completion of the surgery, the neuromuscular blocking agent was reversed and then the infusion of propofol was stopped. The study drug was administered intravenously when the BIS 60 was achieved. Time to achieve BIS 90, return of first gag reflex, eye-opening on verbal command, and extubation after study drug administration were noted. Hemodynamic parameters and SpO2 were also monitored. Results: The time for BIS 60 to 90 was 10 (4.25) min in the caffeine group, 13 (4.25) min in the aminophylline group, and 26 (9.0) min in the saline group. The time to return of gag reflex and time to extubation were shorter in the caffeine and aminophylline group compared to the saline group. The time to eye-opening on verbal command was shorter in the aminophylline group compared to the saline group. Hemodynamic parameters after infusion of the study drug were comparable in all three groups. Conclusion: Caffeine hastens the recovery from total intravenous anesthesia with propofol and fentanyl in laparoscopic hysterectomy as effectively as aminophylline. [ABSTRACT FROM AUTHOR]

Introduction: Since body image constitutes a cross-sectional axis in the quality of life of oncology patients, it is of great relevance to identify its impact on it, recognize its importance within the health-disease process, and include it in the approach and follow-up, to improve their quality of life. Methodology: An extensive literature review was carried out in freely accessible databases such as PubMed, BVS, Dialnet, and ClinicalKey, between August and September 2022; for this, MeSH terms such as "breast cancer", "body image", and "quality of life", in both English and Spanish, were used and related to the Boolean operator "and", in English, and "y", in Spanish. Results: 35 articles were selected, of which 2 used the EORTC QLQ C30, 7 used the EORTC QLQ-BR23 survey, 4 used BIS as the sole scale. On the other hand, 17 used the QLQ-BR23 and QLQ C30, one article used QLQ-BR23 and BIS, and only 4 used all three scales. Conclusions: It is important to carry out individualized management in patients with breast cancer, considering that their body image is negatively affected, which influences their quality of life. Regarding surgical management, it was determined that patients undergoing mastectomy have a greater impact on the perception of their body image. Finally, in patients managed with chemotherapy, deterioration of body image is evident as the treatment progresses, and hair loss represents a major concern for them. [ABSTRACT FROM AUTHOR]

Introduction: Hemodialysis is life‐sustaining in kidney failure. However, proper regulation of body fluids depends on an accurate estimate of target weight. This trial aims to compare clinical endpoints between target weight estimation guided by bioimpedance spectroscopy and usual care in hemodialysis patients. Methods: This is an open‐label, parallel‐group, controlled trial that randomized, through a table of random numbers, adult patients on maintenance hemodialysis to target weight estimation based on monthly clinical evaluation alone or added to evaluation by bioimpedance twice a year. The primary outcome was survival, and the secondary outcomes were the rate of hospital admissions, change in blood pressure (BP), and antihypertensive drugs load. Participants were followed for 2 years. Survival analysis was performed using Kaplan–Meier estimator and Log‐rank test, and hospital admissions were analyzed by the incidence‐rate ratio. Findings: One hundred and ten patients were randomized to the usual care (52) or bioimpedance (58) groups, with a mean age of 57.4 (15.4) years, 64 (58%) males. There was no difference between the groups at baseline. Survival was not significantly different between groups (log‐rank test p = 0.68), but the trial was underpowered for this outcome. There was also no difference between the groups in the change in systolic or diastolic BP or in the number of antihypertensive drugs being used. The incidence rate of hospital admissions was 3.1 and 2.1 per person‐year in usual care and bioimpedance groups, respectively, with a time‐adjusted incidence rate ratio of 1.48 (95% CI: 1.20–1.82, p = 0.0001) and attributable fraction of risk among exposed individuals of 0.32 (95% CI: 0.17–0.45). Discussion: The inclusion of bioimpedance data to guide the estimation of target weight in hemodialysis patients had no detectable impact on survival or BP control, but significantly reduced the incidence rate of hospital admissions. The study was registered at ClinicalTrials.gov Identifier: NCT05272800. [ABSTRACT FROM AUTHOR]

Background: Postoperative delirium (POD) is the most common postoperative complication in elderly patients, especially in older aged patients (aged 75 years or over). The development of electroencephalography analysis could provide indicators for early detection, intervention, and evaluation. If there are pathophysiological changes in the brain, the BIS value will also change accordingly. In this study, we investigated the predictive value of the preoperative bispectral (BIS) index in POD for patients aged over 75 years. Methods: In this prospective study, patients (≥ 75 years) undergoing elective non-neurosurgery and non-cardiac surgery under general anesthesia were included (n = 308). Informed consent was obtained from all involved patients. Before the operation and during the first 5 postoperative days, delirium was assessed with the confusion assessment method by trained researchers twice every day. Thereafter, the preoperative bedside BIS of each patient was dynamically acquired by the BIS VISTA monitoring system and the BIS monitoring of electrodes. A series of evaluation scales were assessed before and after surgery. A preoperative predictive score was generated according to the results of multivariable logistic regression. The receiver operating characteristic curves were drawn and the area under the curves was estimated to evaluate the perioperative diagnostic values of BIS and preoperative predictive score for POD. The specificity, sensitivity, positive predictive value (PPV), and negative predictive (NPV) value were calculated. Results: Delirium occurred in 50 of 308 (16.2%) patients. The median BIS of delirious patients was 86.7 (interquartile range [IQR] 80.0–94.0), lower than that of the non-delirious 91.9 (IQR 89.7–95.4, P < 0.001). According to the ROC curve of the BIS index, the optimal cut-off value was 84, with a sensitivity of 48%, specificity of 87%, PPV 43%, NPV 89% for forecasting POD and the area under curves was 0.67. While integrating BIS, mini-mental state examination, anemia, activities of daily living, and blood urea nitrogen, the model had a sensitivity of 78%, specificity of 74%, PPV of 0.37%, and NPV of 95% for forecasting POD, and the area under curves was 0.83. Conclusions: Preoperative bedside BIS in delirium patients was lower than that in non-delirium patients when undergoing non-neurosurgery and non-cardiac surgery in patients aged over 75. The model of integrating BIS, mini-mental state examination, anemia, activities of daily living, and blood urea nitrogen is a promising tool for predicting postoperative delirium in patients aged over 75. [ABSTRACT FROM AUTHOR]

The domain of SEPs is highly engrossed with multitude of issues, as it is generally understood. Most of the issues come from patent holders' anti-competitive behavior, which includes unilateral rejection to license, patent ambushes, patent holdups, strategic injunctive relief, royalty staking, and breach of F/RAND Commitments, both inside and outside of SSOs (national & international). One of the key tenets of standards is that they be universally recognized and applied once they have been approved. Suppliers view standards as a way to meet consumer needs while also offering a chance to pave the way for innovation through compatibility, complementarily and interoperability. Standards thus have an impact on both innovation and the dissemination of technology since they create a technological infrastructure with a significant public benefit component. The previous article provided the readers with a comprehensive introduction to SEPs and their implications in the modern intellectual property landscape. This issue of this yearlong series will take the baton further to dwell on the issues circumventing around this domain of SEPs. [ABSTRACT FROM AUTHOR]

Ping Wang,1,2 Lei Zhao,1 Tianlong Wang,1 Wei Mei,3 Jingsheng Li,1 Yi An,1 Lixia Li,1 Zhongjia Li1 1Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of China; 2Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210000, People’s Republic of China; 3Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, People’s Republic of ChinaCorrespondence: Lei Zhao, Email zhaoalei@sina.comObjective: This study aimed to compare the half-effective concentration (EC50) of propofol required for the bispectral index (BIS) 50 in patients with Parkinson’s disease (PD) and non-PD (NPD) during induction by the Dixon’s improved sequential method.Methods: This prospective study recruited 20 patients with PD undergoing deep brain stimulation and 20 patients with NPD accompanied by meningioma or glioma undergoing intracranial surgery from March 2018 to March 2019. The patients were induced by propofol via target-controlled infusion. The target effect-site concentration of propofol was determined by the Dixon’s improved sequential method. The results of the pilot experiment showed that the target effect-site concentration for the first patient with PD and NPD was 3.5 μg/mL and 2.8 μg/mL, respectively. BIS values were recorded after achieving a constant effect-site concentration of propofol. The increment or decrement of the target effect-site concentration of the next patient was 0.1 μg/mL.Results: Demographic data, general physical condition, and hemodynamic values were similar between the PD and the NPD groups. The target effect-site concentration of propofol induction doses was significantly higher in the PD group than in the NPD group. The EC50 of propofol required for BIS 50 was 3.213 μg/mL [95% confidence interval (CI), 3.085– 3.287 μg/mL] in the PD group and 2.77 μg/mL (95% CI, 2.568– 2.977 μg/mL) in the NPD group.Conclusion: The EC50 of propofol required for BIS 50 was higher in patients with PD than in patients with NPD.Keywords: BIS, effect-site concentration, Parkinson’s disease, propofol, sequential method, TCI

Background and Aims: The return of consciousness (ROC) after general anesthesia (GA) is by stopping the administration of anesthetic agents. At present, no drug is given to reverse the loss of consciousness produced by general anesthetic agents. This study is conducted to find whether caffeine and aminophylline hasten the ROC. Material and Methods: This study was conducted on 75 American Society of Anesthesiologists (ASA) I and II female patients undergoing laparoscopic hysterectomy, aged between 18 and 60 years. The patients were divided into three equal groups (Group C: caffeine citrate, Group A: aminophylline, and Group S: saline) of 25 each by a computer-generated random number table. GA was induced with propofol, fentanyl, and maintained with propofol infusion. On completion of the surgery, the neuromuscular blocking agent was reversed and then the infusion of propofol was stopped. The study drug was administered intravenously when the BIS 60 was achieved. Time to achieve BIS 90, return of first gag reflex, eye-opening on verbal command, and extubation after study drug administration were noted. Hemodynamic parameters and SpO2 were also monitored. Results: The time for BIS 60 to 90 was 10 (4.25) min in the caffeine group, 13 (4.25) min in the aminophylline group, and 26 (9.0) min in the saline group. The time to return of gag reflex and time to extubation were shorter in the caffeine and aminophylline group compared to the saline group. The time to eye-opening on verbal command was shorter in the aminophylline group compared to the saline group. Hemodynamic parameters after infusion of the study drug were comparable in all three groups. Conclusion: Caffeine hastens the recovery from total intravenous anesthesia with propofol and fentanyl in laparoscopic hysterectomy as effectively as aminophylline.

This study re-examines the relationships between the five mindfulness facets of observing, describing, acting-with-awareness, non-judging, and non-reactivity, and the affective personality measures inspired by the revised Reinforcement Sensitivity Theory (rRST). The rRST measures assess behavioural inhibition sensitivity, fight-flight-freeze sensitivity, and the behavioural approach sensitivity components of reward interest, goal-drive-persistence, reward reactivity, and impulsivity. Research has suggested that relationships exist between specific mindfulness facets and specific rRST constructs. However, some non-significant relationships were reported, possibly due to the small sample used. Also included in the analyses is (self-reported) attentional control, a variable that has not been accounted for in rRST and mindfulness research, but is inter-correlated with mindfulness and anxiety. In a sample of 641 participants, behavioral inhibition sensitivity shared a negative relationship with the describing, acting with awareness, non-judging, and non-reactivity components of mindfulness, and the impulsivity component of behavioural approach sensitivity shared a negative relationship with the acting with awareness facet of mindfulness. This is consistent with previous research. Attentional control shared a positive relationship with the describing, acting with awareness. and non-judging facets of mindfulness. In conclusion, specific reinforcement sensitivity personality constructs and attentional control relate to specific mindfulness components. Trait mindfulness and/or the efficacy of mindfulness interventions could be affected by variations in reinforcement sensitivity and attentional control ability.

Background: The Bispectral Index (BIS) and the Patient State Index (PSI) are commonly used measures to assess intraoperative sedation depth. However, model differences lead to different results, which in turn interferes with clinicians' judgment on the depth of anesthesia. Remimazolam tosilate (RT) for injection is a new benzodiazepine used in sedation. In its clinical application, there are few effective indicators for sedation depth monitoring. To close this gap, this study aims to compare BIS and PSI in measuring the sensitivity and specificity of intraoperative RT and to explore the safety of RT for intraspinal anesthesia in elderly patients. Methods: This study included 40 patients undergoing elective electro-prostatectomy with intraspinal anesthesia, who were monitored by BIS and PSI simultaneously during operation. Remimazolam tosylate 0.1 mg/kg was intravenously administered after the intraspinal anesthesia when patients were in a completely painless status. Then BIS, PSI, the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scores and vital signs were observed and recorded per minute for 10 min. Pearson's correlation analysis and linear regression model were used to compare BIS and PSI sedation scores, and to test their associations with the MOAA/S score, respectively. ROC curves were drawn to compare the sensitivity and specificity of BIS and PSI. Changes of vital signs were presented as mean ± standard deviation. Perioperative liver and kidney function indicators were analyzed using a paired t-test to evaluate the safety of RT for intraspinal anesthesia in the elderly patients. Results: According to Pearson's correlation analysis, a significant (P < 0.01) correlation between BIS and PSI was found when used to monitor intraoperative sedation of RT (r = 0.796). Significant associations between BIS and MOAA/S (r = 0.568, P < 0.01), and between PSI and MOAA/S (r = 0.390, P < 0.01) were also found. The areas under the ROC curves of BIS and PSI were 0.801 ± 0.022 and 0.734 ± 0.026, respectively, suggesting that both measures may predict patients' state of consciousness and BIS was more accurate than PSI. Vital signs remained stable throughout the study. No abnormal changes of clinical significance were found based on laboratory test results of liver and kidney function. Conclusion: BIS and PSI are strongly associated for monitoring the sedation of RT intraoperatively. Both methods can accurately reflect sedation depth. According to correlation analyses with MOAA/S scale and ROC curves, BIS is more accurate than PSI during such intraoperative monitoring. In addition, RT can be safely used in elderly patients under intraspinal anesthesia for supportive sedation, with stable vital signs and sound kidney and liver safety profiles. Trial registration: http://www.chictr.org.cn (ChiCTR2100051912). [ABSTRACT FROM AUTHOR]

'Depth of anaesthesia' monitors claim to measure hypnotic depth during general anaesthesia from the EEG, and clinicians could reasonably expect agreement between monitors if presented with the same EEG signal. We took 52 EEG signals showing intraoperative patterns of diminished anaesthesia, similar to those that occur during emergence (after surgery) and subjected them to analysis by five commercially available monitors. We compared five monitors (BIS, Entropy-SE, Narcotrend, qCON, and Sedline) to see if index values remained within, or moved out of, each monitors' recommended index range for general anaesthesia for at least 2 min during a period of supposed lighter anaesthesia, as observed by changes in the EEG spectrogram obtained in a previous study. Of the 52 cases, 27 (52%) had at least one monitor warning of potentially inadequate hypnosis (index above range) and 16 of the 52 cases (31%) had at least one monitor signifying excessive hypnotic depth (index below clinical range). Of the 52 cases, only 16 (31%) showed concordance between all five monitors. Nineteen cases (36%) had one monitor discordant compared with the remaining four, and 17 cases (33%) had two monitors in disagreement with the remaining three. Many clinical providers still rely on index values and manufacturer's recommended ranges for titration decision making. That two-thirds of cases showed discordant recommendations given identical EEG data, and that one-third signified excessive hypnotic depth where the EEG would suggest a lighter hypnotic state, emphasizes the importance of personalised EEG interpretation as an essential clinical skill. [ABSTRACT FROM AUTHOR]

Impulsive personality traits are complex heritable traits that are governed by frontal-subcortical circuits and are associated with numerous neuropsychiatric disorders, particularly drug abuse and attention-deficit/hyperactivity disorder (ADHD). In collaboration with the genetics company 23andMe, we performed 10 genome-wide association studies on measures of impulsive personality traits [the short version of the UPPS-P Impulsive Behavior Scale, and the Barratt Impulsiveness Scale (BIS-11)] and drug experimentation (the number of drug classes an individual had tried in their lifetime) in up to 22,861 male and female adult human research participants of European ancestry. Impulsive personality traits and drug experimentation showed single nucleotide polymorphism heritabilities that ranged from 5 to 11%. Genetic variants in the CADM2 locus were significantly associated with UPPS-P Sensation Seeking (p = 8.3 × 10-9, rs139528938) and showed a suggestive association with Drug Experimentation (p = 3.0 × 10-7, rs2163971; r2 = 0.68 with rs139528938). Furthermore, genetic variants in the CACNA1I locus were significantly associated with UPPS-P Negative Urgency (p = 3.8 × 10-8; rs199694726). The role of these genes was supported by single variant, gene- and transcriptome-based analyses. Multiple subscales from both UPPS-P and BIS showed strong genetic correlations (>0.5) with Drug Experimentation and other substance use traits measured in independent cohorts, including smoking initiation, and lifetime cannabis use. Several UPPS-P and BIS subscales were genetically correlated with ADHD (rg = 0.30-0.51), supporting their validity as endophenotypes. Our findings demonstrate a role for common genetic contributions to individual differences in impulsivity. Furthermore, our study is the first to provide a genetic dissection of the relationship between different types of impulsive personality traits and various psychiatric disorders.SIGNIFICANCE STATEMENT Impulsive personality traits (IPTs) are heritable traits that are governed by frontal-subcortical circuits and are associated with neuropsychiatric disorders, particularly substance use disorders. We have performed genome-wide association studies of IPTs to identify regions and genes that account for this heritable variation. IPTs and drug experimentation were modestly heritable (5-11%). We identified an association between single nucleotide polymorphisms in CADM2 and both sensation seeking and drug experimentation; and between variants in CACNA1I and negative urgency. The role of these genes was supported by single variant, gene- and transcriptome-based analyses. This study provides evidence that impulsivity can be genetically separated into distinct components. We showed that IPT are genetically associated with substance use and ADHD, suggesting impulsivity is an endophenotype contributing to these psychiatric conditions.

Structural equation modelling (SEM) is a statistical technique used in the field of Information Systems amongst others. The technique has been paid attention thanks to its flexibility and predictive power. However, there is a paucity of guidelines in the application of the technique in the field of Behavioural Information Security. Hence, this paper aims to provide a comprehensive guide of using PLS-SEM in disclosure and privacy studies on Social Network Sites (SNSs). Data has been gathered using papers (n=21) published between 2006 and 2022 from scholarly databases such as Google Scholar, Association for Information Systems eLibrary (AISeL), IEEE Xplore and Science Direct. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) was used to analyse and synthesize the status of the field. Our systematic review covers data characteristics, reasons for using PLS-SEM, the evaluation of measurement models, the evaluation of the structural model and reporting best practices. The review proposed guidelines for the use of PLS-SEM in the discipline of Behavioural Information Security with a focus on disclosure and privacy on SNSs studies and other fields as well.

Background: Renewed interest in regional anaesthesia during the recent COVID-19 pandemic has inspired application of neuraxial anaesthesia for previously unconventional indications, such as awake abdominal surgeries. These patients needed little sedation, since studies demonstrate that neuraxial anaesthesia causes sedation as measured by the bispectral index (BIS). In contrast, no published study has investigated the possible sedative effects of non-neuraxial regional anaesthesia. This pilot randomised controlled trial (RCT) was designed as a template for, and to test the feasibility of, performing a definitive RCT to establish if nonneuraxial regional anaesthesia has any sedative effect. Methods: Forty participants presenting for forearm surgery were randomly allocated to two treatment groups (supraclavicular block and control). Their level of sedation was monitored with BIS prior to surgery for 60 minutes. Specific feasibility outcomes were planned and data were collected according to CONSORT 2010 recommendations. Results: Out of 48 patients screened, 41 (85.42%) were invited to participate. Forty patients (97.56%) consented and 100% of these completed the study. In four participants (10%), BIS electrodes needed replacement, while inadequate contact was shown in three participants (7.50%). Data collection and form completion were deemed "easy" and block success rate was 100%. Differences in mean BIS between groups were < 5 and a difference of 10% between groups in incidence of BIS < 80 (85% block group, 75% control group) was shown. Conclusion: We propose that progression to formal RCT is feasible only with specific modifications to the study design. The decrease in BIS value from baseline should be measured per patient and a clinically significant decrease should be estimated; emergency patients should be excluded; the sample size should be 500 patients; and multiple trial sites should be used. Further consideration should be given to whether such a trial would provide clinically useful information, and would justify the risks, patient discomfort and the considerable financial cost. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the chemical and physical aspects of Vizag's water quality in a few key regions. Materials and Method: In order to conduct the study, water samples were taken from the Vishakhapatnam neighbourhoods A, B, C, and D, and sent to Spectra Environment Tech Pvt Ltd for analysis. Result: The World Health Organisation standard for drinking water (WHO) and BIS standard were found to be met by the drinking water of the chosen study area from Vishakhapatnam in all physico-chemical parameters in all 4 areas, namely A, B, C, and D drinking water sampling sites. The samples were examined using widely renowned and well-established analytical procedures for the intended water quality indicators. It is clear that all of the chosen parameters were deemed to be within the organization's standards. Conclusion: Conclusion: The water quality in the chosen sites is suitable for human consumption. Dissemination of the water quality status in government reports via social media, print media, and television can increase public satisfaction. [ABSTRACT FROM AUTHOR]