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BACKGROUND: During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes.METHODS: Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).RESULTS: The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=-0.72 days; 95% CI, -1.10 to -0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence.CONCLUSIONS: Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.

Among the earliest signs of degradation in cellulose triacetate cinematographic films is the generation of acetic acid due to hydrolytic deacetylation of the polymer, marked by an increase in the acidity of the films and emissions of acetic acid leading to a characteristic vinegar odour. We propose a mathematical model for predicting the onset of the vinegar syndrome which accounts for the autocatalytic effect of acetic acid on the deacetylation reaction. Model parameters are estimated from previously published experimental data from other research groups. These show free acidity changes in cellulose triacetate films subjected to accelerated ageing at temperatures of 70–100 °C. The model is validated against a different set of previously published experimental data of cellulose triacetate films aged at 21 °C and 35 °C, at 20, 35 and 50% relative humidity. The model demonstrates good quantitative agreement with the published experimental data. Predictions of film permanence at lower temperatures, similar to those present in the archives in which the films are typically stored, are made and compared with the predictions of film conservation guidelines. The results indicate that film permanence may be overestimated by existing guidelines, which do not account for autocatalysis in their modelling of the deacetylation rate. Our results suggest that cold storage, a common film conservation strategy, may be less effective at inhibiting degradation than previously thought. As cold storage typically requires film to be kept in confined spaces with limited air movement, conditions which promote autocatalysis, the inclusion of autocatalysis in our model is highly applicable to simulating this environment.

The anti-inflammatory activity of the citrus pectins, CU701 and CU201, with low and high degrees of methylesterification (LM and HM), respectively, was studied after oral administration in mice using three models of inflammation: acetic acid-induced colitis, cytokine production by blood leukocytes in response to lipopolysaccharide (LPS) and endotoxin shock. Oral administration of either CU701 or CU201 24 h before the infusion of acetic acid into the colon was found to prevent the progression of colitis. However, CU701 was found to decrease the adhesion of peritoneal granulocytes and their production of reactive oxygen species in colitic mice, whereas CU201 had no effect on granulocyte activity. Only CU701 was found to decrease tumour necrosis factor-α (TNF-α) release and to increase production of the anti-inflammatory cytokine interleukin-10 (IL-10) 24 h after oral administration in mice. CU201 had no effect on cytokine production. CU701, but not CU201, was found to improve the survival rate in mice that were subjected to a lethal dose of LPS. The present study demonstrates that LM pectin would be a more efficient anti-inflammatory agent than HM pectin upon oral administration. LM pectin was found to inhibit both local and systemic inflammation, whereas HM pectin was shown to prevent intestinal inflammation.

Background Although adults with developmental disabilities are at high risk for obesity and its sequelae, few community-based lifestyle interventions targeting those with developmental disabilities exist. Design The study was a single group, community-based demonstration project with pre–post test evaluation conducted from December 2005 to June 2006. Setting/participants Eligible participants were 431 community-dwelling adults with developmental disabilities, aged 18–65 years, who were overweight/obese (BMI ≥25) with another risk factor for diabetes or metabolic syndrome or who had a diagnosis of diabetes, and received services from a community agency. Eighty-five signed up (20% of those eligible), 68 participated in an initial class, and 44 completed the program (35% attrition rate). Intervention The Healthy Lifestyle Change Program (HLCP) is a community-based health intervention developed and implemented using community-based participatory research methods by members of the developmental disabilities community, in collaboration with academic researchers. The HLCP was a 7-month, twice-weekly education and exercise program to increase knowledge, skills, and self-efficacy regarding health, nutrition, and fitness among adults with developmental disabilities. Peer mentors served as participant leaders and primary motivators. Measures Changes in weight, BMI, abdominal girth, access to care, and self-reported nutrition, physical activity, and life satisfaction were each measured. Results Two thirds of participants maintained or lost weight, with a mean weight loss of 2.6 pounds and a median weight loss of 7 lbs (range: 2–24 lbs). Average BMI decreased by 0.5 kg/m 2 ( p =0.04). Abdominal girth decreased in 74% of participants (mean= –1.9 inches). Sixty-one percent of participants reported increased physical activity. Mean exercise frequency increased from 3.2 times to 3.9 times per week ( p =0.01). Mean exercise duration increased from 133 minutes to 206.4 minutes per week ( p =0.02). Significant improvements in nutritional habits and self-efficacy were reported. Over half (59%) of participants showed improvements in life satisfaction. Participants received 206 referrals for needed medical care. The HLCP and its dissemination increased participants' and peer mentors' ability to act as community advocates and partners in research. Conclusions The HLCP resulted in improved lifestyles, weight loss success, and increased community capacity, indicating that a community-based program with significant participation of those with developmental disabilities is feasible. This program should be expanded and evaluated with larger populations with developmental disabilities.

Can we study the future “rationally” and “scientifically”? This paper examines the methods now in use and finds the assumptions shaky, the tools faulty, and the implications dangerous. With data as the driver, analysis the watchword, quantification the rule, and model-building the prime preoccupation, futurology rests heavily on two key pillars, the information base and cost/benefit calculations. Because these are shown to rest on quicksand, the elaborate methodological structure based on them totters precariously.

Despite earnest admonitions in most technology assessments that institutional arrangements, social impacts, and societal implications be taken into account, the methodology commonly used not only systematically and systematically excludes these very dimensions but often creates a distorted focus. The paradigm dominating structural modeling in technology assessment is technically-oriented; the techniques, lineal descendants of systems analysis, are no more reliable for “assessing” the uncertain future than have been their ancestors in “managing” the present.

Drawing on case materials from completed and ongoing systems analyses, this paper presents an empirical assessment of the current and growing trend toward the utilization of this and related quantitative techniques, such as cost/benefit measures and program budgeting, in social planning. The first section is devoted to examination of the bases for and assumptions underlying the general acceptance and ubiquitous application of the systems approach; the second deals with the concepts of systems analysis and related techniques; and the third with that technique throught which systems management capability is transferred from the private to the public sector. The final section contains a critical appraisal of systems techniques as currently applied to social problems.

Unorthodox thought it may seem, this paper starts with its conclusion, viz., that, given the present state-of-the-art of “future research,” the classic example of the Greek sibyls (i.e., deliberate ambiguity) may be the most desirable. As for criteria for “good futures research,” there are none identifiable now; it is doubtful that there can be any; it might be better for the future if there were none. Using veracity and accuracy as possible criteria, the paper explores the past and finds considerable lack of agreement among historians and historiographers. Current sources of information are then scrutinized, and although there is no dearth of data, reliability as to source and interpretation is generally suspect, in both the public and private sector. As for the future, technological and social forecasting are still paper-and-pencil games, with the outcome only as good as the forecasters. This puts the onus on the professional “futurologists,” whose credibility and credentials are yet to be established.