Search

Background: Spouses of persons living with dementia face intense strains on their well‐being compared with similarly aged adults and spouses of partners with no dementia. This strain can impact spouses' health and healthcare needs, and therefore affect their healthcare utilization and expenditures. Methods: Using data from the Health and Retirement Study linked with Medicare claims, we matched dyads of spouses and their partners with dementia (SPWD) to a comparison group of similar spouses and their partners with no dementia (SPWND). We then examined Medicare expenditures for spouses in the 5 years following their partner's dementia onset month using a two‐part regression model. Results: SPWD cumulative total Medicare expenditures were, on average, $60,043 in the 5 years post dementia onset, compared to $56,068 for SPWND. This difference ($3974, 95% CI = [−$3,199; $11,477]) was not significant. However, there were significant differences in the 5th year's total expenditures (+$2,748 [$321; $5,447]), driven by inpatient expenditures ($1,562 [$22; $3,277]). Conclusions: Despite the differences in partner's dementia status, we found no significant difference in the 5‐year cumulative Medicare expenditures between SPWD and SPWND. Compared to previous studies, we likely captured an earlier stage of dementia more consistently for a broader population which may be less straining on spouses. Further research should examine patterns of expenditures in later years and around critical timepoints in caregiving, such as partner transitions to formal long‐term care settings and death, to better understand healthcare expenditures for spouses of persons living with dementia. See related editorial by Horstman. [ABSTRACT FROM AUTHOR]

Approximately 50 million Americans suffer from chronic pain, and nearly a quarter of chronic pain patients have reported misusing opioid prescriptions. Repeated drug seeking is associated with reactivation of an ensemble of neurons sparsely scattered throughout the dorsomedial prefrontal cortex (dmPFC). Prior research has demonstrated that chronic pain increases intrinsic excitability of dmPFC neurons, which may increase the likelihood of reactivation during drug seeking. We tested the hypothesis that chronic pain would increase oxycodone‐seeking behaviour and that the pain state would differentially increase intrinsic excitability in dmPFC drug‐seeking ensemble neurons. TetTag mice self‐administered intravenous oxycodone. After 7 days of forced abstinence, a drug‐seeking session was performed, and the ensemble was tagged. Mice received spared nerve injury (SNI) to induce chronic pain during the period between the first and second seeking session. Following the second seeking session, we performed electrophysiology on individual neurons within the dmPFC to assess intrinsic excitability of the drug‐seeking ensemble and non‐ensemble neurons. SNI had no impact on sucrose seeking or intrinsic excitability of dmPFC neurons from these mice. In females, SNI increased oxycodone seeking and intrinsic excitability of non‐ensemble neurons. In males, SNI had no impact on oxycodone seeking or neuron excitability. Data from females are consistent with clinical reports that chronic pain can promote drug craving and relapse and support the hypothesis that chronic pain itself may lead to neuroadaptations which promote opioid seeking. [ABSTRACT FROM AUTHOR]

Copyright of Risk, Hazards & Crisis in Public Policy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An abundance of unstructured and loosely structured data on disasters exists and can be analysed using network methods. This paper overviews the use of qualitative data in quantitative social network analysis in disaster research. It discusses two types of networks, each with a relevant major topic in disaster research—that is, (i) whole network approaches to emergency management networks and (ii) personal network approaches to the social support of survivors—and four usable forms of qualitative data. This paper explains five opportunities afforded by these approaches, revolving around their flexibility and ability to account for complex network structures. Next, it presents an empirical illustration that extends the authors' previous work examining the sources and the types of support and barrier experienced by households during long‐term recovery from Hurricane (Superstorm) Sandy (2012), wherein quantitative social network analysis was applied to two qualitative datasets. The paper discusses three challenges associated with these approaches, related to the samples, coding, and bias. [ABSTRACT FROM AUTHOR]

This article explores the use of stable isotopes in studying fish biology. It focuses on four main themes: understanding isotopic discrimination patterns, determining energy distribution in fish communities, assessing the impact of human activity on fish foraging and fitness, and exploring nontraditional stable isotope systems. The article presents various studies that investigate these themes, including the influence of maternal provisioning on young fish tissues, the use of non-lethal tissues for analysis, and the effects of environmental factors on fish communities. It also discusses the implications of human disturbance on fish diet, habitat use, and overall fitness. The article emphasizes the importance of stable isotopes in understanding fish ecology and physiology in a changing world. Additionally, the document discusses the advancements in analytical technology that have made non-traditional isotope systems more accessible to fish biologists, such as Calcium and Zinc. It also highlights the potential of stable isotope analysis in uncovering the functional roles of ancient fish lineages. The document concludes by stating that the continued development of isotopic tools will contribute to the management and conservation of global fish populations. [Extracted from the article]

The qualitative study was part of a sub-analysis of a randomised controlled trial in which 133 patients were allocated to one of two groups receiving a thoracic epidural or rectus sheath catheters [[3]]. Continuing Education in Anaesthesia Critical Care and Pain 2004; 4: 16 - 19. 5 Rucklidge M, Beattie E. Rectus sheath catheter analgesia for patients undergoing laparotomy. The other group of patients had bilateral rectus sheath catheters inserted using ultrasound guidance after induction of anaesthesia. Keywords: expectations; outcomes; patients EN expectations outcomes patients 1199 1202 4 09/08/23 20231001 NES 231001 Brearley et al. have published a qualitative study "nested" within a randomised controlled trial. [Extracted from the article]

Identifying potential links between food web structure and animal body condition is fundamental for predicting the long‐term persistence of populations under rapidly changing environments. Northern lakes, and the cold‐water adapted species that inhabit them, are particularly vulnerable to a warming climate.We explored relationships among body condition and energy channel use in lake trout (Salvelinus namaycush) and seasonal variation in food‐chain length in the Lake of Two Rivers, Ontario, Canada. Bayesian mixing models using carbon isotope values (δ13C) of essential amino acids showed that individuals utilising multiple energy channels had higher gonad mass, suggesting that dietary diversity has reproductive fitness benefits.Amino acid nitrogen isotope (δ15N) analysis revealed seasonal variation in food chain length, with extension of the food web during winter and spring and truncation of the food web during summer. Although these findings illustrate increased omnivory of lake trout during summer, there was no clear evidence that seasonal changes in food chain length had an impact on trout condition.These findings provide new insight into potential relationships between food web structure, energy flow and consumer condition in freshwater ecosystems, thereby revealing potential responses of species to shifting ecosystem states under intensifying climate change at high latitudes. [ABSTRACT FROM AUTHOR]

Premise: Although Boechera (Boechereae, Brassicaceae) has become a plant model system for both ecological genomics and evolutionary biology, all previous phylogenetic studies have had limited success in resolving species relationships within the genus. The recent effective application of sequence data from target enrichment approaches to resolve the evolutionary relationships of several other challenging plant groups prompted us to investigate their usefulness in Boechera and Boechereae. Methods: To resolve the phylogeny of Boechera and closely related genera, we utilized the Hybpiper pipeline to analyze two combined bait sets: Angiosperms353, with broad applicability across flowering plants; and a Brassicaceae‐specific bait set designed for use in the mustard family. Relationships for 101 samples representing 81 currently recognized species were inferred from a total of 1114 low‐copy nuclear genes using both supermatrix and species coalescence methods. Results: Our analyses resulted in a well‐resolved and highly supported phylogeny of the tribe Boechereae. Boechereae is divided into two major clades, one comprising all western North American species of Boechera, the other encompassing the eight other genera of the tribe. Our understanding of relationships within Boechera is enhanced by the recognition of three core clades that are further subdivided into robust regional species complexes. Conclusions: This study presents the first broadly sampled, well‐resolved phylogeny for most known sexual diploid Boechera. This effort provides the foundation for a new phylogenetically informed taxonomy of Boechera that is crucial for its continued use as a model system. [ABSTRACT FROM AUTHOR]

Summary: It is essential that academic publishing complies with the highest standards in terms of ethics, research conduct and manuscript preparation. This protects the rights and welfare of research participants, ensures the integrity of study results and aids the communication and dissemination of novel findings into clinical practice. This position statement outlines the current policies and practices of the Editors of Anaesthesia and Anaesthesia Reports in relation to academic medical publishing. [ABSTRACT FROM AUTHOR]

Summary: Human factors is an evidence‐based scientific discipline used in safety critical industries to improve safety and worker well‐being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high‐quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three‐stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non‐technical skills, such as teamwork and communication, human factors is a broad‐based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia. [ABSTRACT FROM AUTHOR]

Summary: Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in high‐pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety‐critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad‐based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which 'design out' the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non‐technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision‐making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date. [ABSTRACT FROM AUTHOR]

The authors found a dose-dependent surgical site infection risk in blood-transfused patients and hypothesised that those undergoing knee arthroplasty who receive multiple doses of TXA, but still required red cell transfusions, tended to be more susceptible to infection. Whilst Ling et al. [[13]] found that the combination of intravenous and intra-articular TXA was more efficacious than either alone, this is doubtless because there is a dose dependent effect of TXA, and 2 g is probably too high a dose to be administered in knee surgery. Even allowing for the increased use of TXA more recently, and other improvements in patient management that invariably occur with time, they found that the administration of TXA was associated with a 38% reduction in blood transfusion and was not associated with an excess incidence of thromboembolic events. Keywords: knee surgery; safety; tranexamic acid EN knee surgery safety tranexamic acid 275 278 4 02/08/23 20230301 NES 230301 When we administer any medication, it should be safe, effective and affordable. [Extracted from the article]

Objective: To assess the association between anatomical location of contamination and mortality in dogs with gastrointestinal and biliary origin of septic peritonitis. Methods: Medical records at two private referral hospitals between 2003 and 2020 were retrospectively reviewed. Cases were included if the origin of contamination was confirmed intraoperatively within the gastrointestinal or biliary tract. Cases were excluded if the dog died or was euthanized intraoperatively or where the data regarding the origin of contamination were not available. The association of anatomical origin with survival was assessed specifying the locations as stomach, small intestine, large intestine and biliary tract. The gastrointestinal tract origin was further subdivided into pylorus, nonpylorus, duodenum, jejunum, ileum, caecum and colon. Results: The overall survival rate was 75.9% (n = 44/58). There were no significant differences in survival among different anatomical origins of contaminations before or after subdivision (P = 0.349 and 0.832, respectively). Also, there was no association between isolated microorganism species in microbiological culture and the anatomical origin (P = 0.951) and the microorganism species was not associated with survival (P = 0.674). Conclusions: There was no association between anatomical location of leakage, microorganism species and survival although further studies are warranted to analyse the relationships between anatomical leakage site and microorganism species as well as microorganism species and mortality. [ABSTRACT FROM AUTHOR]

Portfolio effects (PEs) in ecology refer to the suite of phenomenon where the temporal variation of aggregate ecosystem properties (i.e., abundance) is lower than that of their ecosystem components. An example of this is where differential responses of species to environmental variation generate stability at higher levels of ecological organization (e.g., local community, metapopulation, metacommunity). Most of the research examining such PEs has focused on spatial or interannual variation of ecosystems; however, as global change continues to alter seasonality and ecosystem functioning, understanding the underlying food web structures that help maintain stability at multiple spatial and temporal scales is critical to managing ecological systems. Recent advances investigating diversity‐stability relationships has led to the development of frameworks that incorporate a metacommunity perspective which allows for the partitioning of PEs across organizational scales (i.e., local community, metapopulation, cross‐community, metacommunity) from local population dynamics (total). This partitioning yields insights into the mechanisms that generate observed PEs in nature. Here, we employed one of these recently developed frameworks on a temporally (1986–1999, 2008–2019) and spatially (five sampling stations, local communities) extensive data set of zooplankton abundance (e.g., density) within a large temperate lake to investigate how temporal (seasonal) and spatial (among site) PEs influence stability within the zooplankton metacommunity. We found that seasonal asynchrony of different zooplankton species within local communities and across communities generated the vast majority of stabilization, while spatial (i.e., metapopulation) dynamics were more synchronous and contributed little to overall system stability. Furthermore, significantly positive diversity‐asynchrony relationships at the total, local‐ and cross‐community scales were found as asynchrony was positively correlated with local Shannon diversity. Last, a comparison of PEs over the time periods, during which significant local and global changes (i.e., climate warming, invasive species) have occurred suggests that PEs may be eroding, as increasingly synchronous dynamics and declining diversity in recent years have led to a rise in metacommunity variability. We end by arguing for the critical importance of understanding seasonally driven stabilizing mechanisms as local and global changes threaten to fundamentally alter seasonal signals with potentially strong implications for the structures that lend stability to ecosystems. [ABSTRACT FROM AUTHOR]

Global change is fundamentally altering flows of natural and anthropogenic subsidies across space and time. After a pointed call for research on subsidies in the 1990s, an industry of empirical work has documented the ubiquitous role subsidies play in ecosystem structure, stability, and function. Here, we argue that physical constraints (e.g., water temperature) and species traits can govern a species' accessibility to resource subsidies, which has been largely overlooked in the subsidy literature. We examined the input of a high‐quality, point‐source anthropogenic subsidy (aquaculture feed) into a recipient freshwater lake food web. Using a combined bio‐tracer approach, we detect a gradient in accessibility of the anthropogenic subsidy within the surrounding food web driven by the thermal preferences of three constituent species, effectively rewiring the recipient lake food web. Because aquaculture is predicted to increase significantly in coming decades to support growing human populations, and global change is altering temperature regimes, then this form of food web alteration may be expected to occur frequently. We argue that subsidy accessibility is a key characteristic of recipient food web interactions that must be considered when trying to understand the impacts of subsidies on ecosystem stability and function under continued global change. [ABSTRACT FROM AUTHOR]

There is a need to prioritise equity, diversity and inclusion within anaesthesia and medicine as a whole. This position statement outlines the Anaesthesia Editors' current policies and practices aiming to achieve equity, represent the diversity of our specialty and actively include people engaged with this journal and beyond. We will define, promote and embed principles of equity, diversity and inclusion across all our work. We will monitor and report author and editor characteristics and ensure recruitment practices are transparent and adhere to our principles on equity, diversity and inclusion. We will attempt to remove systemic barriers restricting those from under-represented groups from progressing into leadership roles within anaesthesia. We will respond to threats and barriers to the principles and practices we set. With these principles and specific actions we undertake, we aim to be pro-active rather than reactive. We commit to embracing and embedding equity, diversity and inclusion in all our practices and regularly reviewing, improving and updating our policies and practices. [ABSTRACT FROM AUTHOR]

The bushmeat trade, or the trade in wild animals for meat, is a primary threat to wildlife and ecosystems in Sulawesi, Indonesia. Hunting for trade and consumption can hasten the local extirpation of vulnerable species, such as fruit bats and the protected babirusa and Sulawesi crested black macaque. This study provides a much‐needed step in understanding the bushmeat trade by describing longitudinal trends in the amount of bushmeat (animal carcasses) observed for sale in markets in North Sulawesi, a particularly biodiversity‐rich area. Surveys were conducted in 10 markets in 2011, 2015, 2018 and 2019. At each market, total counts of all taxa for sale were noted, and encounter rates per market sample were derived to account for variable sampling effort across years and markets. Generalized Linear Mixed Models were used to compare encounter rates across years, months and markets. Our results show that although animal carcasses are still sold in high numbers, there has been an overall decrease between 2011 and 2019, particularly between 2011 and 2018 (encounter rate fell by 99%). However, bats, rats and Sulawesi warty pigs were still present at high levels, indicating a persistent demand for bushmeat in North Sulawesi. The encounter rate of protected taxa for sale was low, but steady throughout the study period. We identified which markets sold the greatest amount of bushmeat to inform future conservation actions and management. Based on our results, the persistent demand for bushmeat in the region, and the continued presence of protected taxa in the markets, we recommend further research to establish the sustainability of the bushmeat trade at its current rate. [ABSTRACT FROM AUTHOR]

Summary: Ergonomics in relation to anaesthesia is the scientific study of the interaction between anaesthetists and their workspace environment in order to promote safety, performance and well‐being. The foundation for avoiding pain or discomfort at work is to adopt and maintain a good posture, whether sitting or standing. Anaesthetists should aim to keep their posture as natural and neutral as possible. The successful practice of anaesthesia relies on optimisation of ergonomics and lack of attention to detail in this area is associated with impaired performance. The anaesthetic team should wear comfortable clothing, including appropriately‐sized personal protective equipment where necessary. Temperature, humidity and light should be adequate at all times. The team should comply with infection prevention and control guidelines and monitoring as recommended by the Association of Anaesthetists. Any equipment or machinery that is mobile should be positioned where it is easy to view or reach without having to change the body or head position significantly when interacting with it. Patients who are supine should, whenever possible, be raised upwards to limit the need to lean towards them. Any item required during a procedure should be positioned on trays or trolleys that are close to the dominant hand. Pregnancy affects the requirements for standing, manually handling, applying force when operating equipment or moving machines and the period over which the individual might have to work without a break. Employers have a duty to make reasonable adjustments to accommodate disability in the workplace. Any member of staff with a physical impairment needs to be accommodated and this includes making provision for a wheelchair user who needs to enter the operating theatre and perform their work. [ABSTRACT FROM AUTHOR]

Keywords: intensive care unit; neuromuscular blocking drugs; neuromuscular function EN intensive care unit neuromuscular blocking drugs neuromuscular function 953 955 3 08/04/22 20220901 NES 220901 Whenever and wherever neuromuscular blocking (NMB) drugs are used, they should be administered and monitored safely. When NMB drugs are given to patients whose lungs are mechanically ventilated, it is particularly important to monitor their effects, because there are many conditions that co-exist in patients with critical illness that may affect the action of NMB drugs. While the use of NMB drugs is less prevalent in the intensive care unit (ICU), a large observational study found that >12% of patients whose lungs were mechanically ventilated received NMB drugs for at least one day [2]. The use of NMB drugs has also been questioned in acute respiratory distress syndrome (ARDS); while paralysis improves the mechanics of ventilation in patients, because this is accompanied by some form of sedation, this can lead to impaired recovery. [Extracted from the article]

Background: Sinusitis is a common outpatient diagnosis made by physicians and is a reason for referral to otolaryngologists. A foundation in basic sinonasal anatomy is critical in understanding sinus pathophysiology and avoiding complications. Our objective in this study was to develop and to validate a self‐directed surgical anatomy video for medical students. Methods: Two multimedia videos were developed highlighting sinonasal anatomy. In Video 1 we included audio narration and radiologic imaging. Video 2 incorporated highlighted images from a sinus surgery video. An assessment was developed to test sinonasal anatomy landmarks, spatial recognition of structures, and their clinical relevance. An expert panel of rhinologists scored face and content validity of the curriculum videos and assessment. Factor analysis was used to separate questions into face and content validity domains, and a one‐sample t test was performed. Results: The panel scored face validity (Videos 1 and 2: 4.4/5) and content validity (Video 1: 4.5/5, 0.83; Video 2: 4.3/5, 0.75) significantly higher than a neutral response. There were no statistical differences for face or content validity between videos. The assessment was rated suitable (29%) or very suitable (57%) for testing basic sinonasal surgical anatomy, and the majority (71%) of respondents agreed (14%) or strongly agreed (57%) that the assessment thoroughly covered the sinus anatomy content with which medical students should be familiar. Conclusion: We have developed two videos and an assessment that highlight and test sinonasal anatomy. Future studies will aim to identify whether the use of a self‐directed video curriculum improves sinonasal anatomy awareness and whether incorporation of surgical endoscopic videos augments training. [ABSTRACT FROM AUTHOR]

Teleost fishes occupy a range of ecosystem, and habitat types subject to large seasonal fluctuations. Temperate fishes, in particular, survive large seasonal shifts in temperature, light availability, and access to certain habitats. Mobile species such as lake trout (Salvelinus namaycush) can behaviorally respond to seasonal variation by shifting their habitat deeper and further offshore in response to warmer surface water temperatures during the summer. During cooler seasons, the use of more structurally complex nearshore zones by lake trout could increase cognitive demands and potentially result in a larger relative brain size during those periods. Yet, there is limited understanding of how such behavioral responses to a seasonally shifting environment might shape, or be shaped by, the nervous system.Here, we quantified variation in relative brain size and the size of five externally visible brain regions in lake trout, across six consecutive seasons in two different lakes. Acoustic telemetry data from one of our study lakes were collected during the study period from a different subset of individuals and used to infer relationships between brain size and seasonal behaviors (habitat use and movement rate).Our results indicated that lake trout relative brain size was larger in the fall and winter compared with the spring and summer in both lakes. Larger brains coincided with increased use of nearshore habitats and increased horizontal movement rates in the fall and winter based on acoustic telemetry. The telencephalon followed the same pattern as whole brain size, while the other brain regions (cerebellum, optic tectum, olfactory bulbs, and hypothalamus) were only smaller in the spring.These findings provide evidence that flexibility in brain size could underpin shifts in behavior, which could potentially subserve functions associated with differential habitat use during cold and warm seasons and allow fish to succeed in seasonally variable environments. [ABSTRACT FROM AUTHOR]

Summary: The need to evacuate an ICU or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: Not only is there a risk that patients may come to harm but also that staff may be injured and unable to work. Designing newly‐built or refurbished ICUs and operating theatre suites is an opportunity to incorporate mandatory fire safety features and improve the management and outcomes of such emergencies: These include well‐marked manual fire call points and oxygen shut off valves (area valve service units); the ability to isolate individual zones; multiple clear exit routes; small bays or side rooms; preference for ground floor ICU location and interconnecting routes with operating theatres; separate clinical and non‐clinical areas. ICUs and operating theatre suites should have a bespoke emergency evacuation plan and route map that is readily available. Staff should receive practical fire and evacuation training in their clinical area of work on induction and annually as part of mandatory training, including 'walk‐through practice' or simulation training and location of manual fire call points and fire extinguishers, evacuation routes and location and operation of area valve service units. The staff member in charge of each shift should be able to select and operate fire extinguishers and lead an evacuation. Following an emergency evacuation, a network‐wide response should be activated, including retrieval and transport of patients to other ICUs if needed. A full investigation should take place and ongoing support and follow‐up of staff provided. [ABSTRACT FROM AUTHOR]

In hospitals, green, amber and red pathways have been established, with vulnerable COVID-19 negative patients being shielded from COVID-19 positive patients in order to ensure they continued receiving vital treatment [6]. Keywords: COVID-19; resource utilisation; pandemic; staffing EN COVID-19 resource utilisation pandemic staffing 1151 1154 4 08/05/21 20210901 NES 210901 " I People are your most valuable asset. A sufficiently resourced ICU workforce will be less likely to require anaesthetists to staff intensive care, and thus allow elective surgery to continue even during times of increased ICU demand. A large-scale redeployment of hospital resources was therefore necessary during both the first and second pandemic waves to cope with the increased demand on general and acute hospital beds and critical care beds from COVID-19 admissions [13]. [Extracted from the article]

Summary: Case reports have fulfilled an important role in the development of anaesthesia and continue to be highly relevant to modern practice. Despite this, they are sometimes criticised for being insufficiently rigorous to meaningfully inform clinical practice or research design. Reporting checklists are a useful tool to improve rigour in research and, although case report checklists have previously been developed, no existing checklist focuses on the peri‐operative setting. In order to address the need for a case reports checklist that better accommodates peri‐operative care, we used an established tool as the basis for developing the 12‐item Anaesthesia Case Report checklist. This was refined using an iterative approach through feedback from journal editors with experience of handling case reports, patient and public involvement, and trialling its use on Anaesthesia Reports submissions. The Anaesthesia Case Report checklist differs from existing checklists by aligning with peri‐operative practice; it places less emphasis on making diagnoses and focuses on the way in which clinical challenges, for example, related to the patient's comorbidities or operative interventions, are addressed. Adopting a standardised approach to the content of case reports presents clear benefits to authors, editors and peer reviewers through streamlining the processes involved in writing and publication. The Anaesthesia Case Report checklist provides a pragmatic framework for comprehensive and transparent reporting. We hope it will facilitate the authorship of high‐quality case reports with the potential to further improve the quality and safety of peri‐operative care. [ABSTRACT FROM AUTHOR]

Understanding how information use contributes to uncertainties surrounding evacuation decisions is crucial during disasters. While literature increasingly establishes that people consult multiple information sources in disaster situations, little is known about the patterns in which multiple media and personal network sources are combined simultaneously and sequentially across decision‐making phases. We address this gap using survey data collected from households in Jacksonville, Florida affected by 2016's Hurricane Matthew. Results direct attention to perceived consistency of information as a key predictor of uncertainty regarding hurricane impact and evacuation logistics. Frequently utilizing National Weather Service, national and local TV channels, and personal network contacts contributed to higher perceived consistency of information, while the use of other local and online sources was associated with lower perceived consistency. Furthermore, combining a larger number of media and official sources predicted higher levels of perceived information consistency. One's perception of information amount did not significantly explain uncertainty. This study contributes to the theorizing of individuals' information environment from the perspective of media and network multiplexity and provides practical implications regarding the need of information coordination for improved evacuation decision‐making. [ABSTRACT FROM AUTHOR]

Premise: Researchers adopting target‐enrichment approaches often struggle with the decision of whether to use universal or lineage‐specific probe sets. To circumvent this quandary, we investigate the efficacy of a simultaneous enrichment by combining universal probes and lineage‐specific probes in a single hybridization reaction, to benefit from the qualities of both probe sets with little added cost or effort. Methods and Results: Using 26 Brassicaceae libraries and standard enrichment protocols, we compare results from three independent data sets. A large average fraction of reads mapping to the Angiosperms353 (24–31%) and Brassicaceae (35–59%) targets resulted in a sizable reconstruction of loci for each target set (x̄ ≥ 70%). Conclusions: High levels of enrichment and locus reconstruction for the two target sets demonstrate that the sampling of genomic regions can be easily extended through the combination of probe sets in single enrichment reactions. We hope that these findings will facilitate the production of expanded data sets that answer individual research questions and simultaneously allow wider applications by the research community as a whole. [ABSTRACT FROM AUTHOR]

The ice‐cover period in lakes is increasingly recognized for its distinct combination of physical and biological phenomena and ecological relevance. Knowledge gaps exist where research areas of hydrodynamics, biogeochemistry and biology intersect. For example, density‐driven circulation under ice coincides with an expansion of the anoxic zone, but abiotic and biotic controls on oxygen depletion have not been disentangled, and while heterotrophic microorganisms and migrating phytoplankton often thrive at the oxycline, the extent to which physical processes induce fluxes of heat and substrates that support under‐ice food webs is uncertain. Similarly, increased irradiance in spring can promote growth of motile phytoplankton or, if radiatively driven convection occurs, more nutritious diatoms, but links between functional trait selection, trophic transfer to zooplankton and fish, and the prevalence of microbial versus classical food webs in seasonally ice‐covered lakes remain unclear. Under‐ice processes cascade into and from the ice‐free season, and are relevant to annual cycling of energy and carbon through aquatic food webs. Understanding the coupling between state transitions and the reorganization of trophic hierarchies is essential for predicting complex ecosystem responses to climate change. In this interdisciplinary review we describe existing knowledge of physical processes in lakes in winter and the parallel developments in under‐ice biogeochemistry and ecology. We then illustrate interactions between these processes, identify extant knowledge gaps and present (novel) methods to address outstanding questions. Plain Language Summary: Winter is an important but poorly understood period for lake ecosystems at high latitudes. Incoming solar radiation is diminished by ice and (often) snow, flows of oxygen and substrates such as organic matter or nutrients from outside the lake are limited, and wind no longer causes turbulent mixing of the water column. The sediments become a source of heat as well as of solutes which drive denser water toward the bottom. The resulting density stratification creates a template for the development of winter ecosystems. Distinct oxygenated and oxygen‐depleted zones will affect microbial community structure and the habitat and behavior of zooplankton and fish. Conditions can rapidly change in spring with increased irradiance and incoming snowmelt. This paper reviews how physical, biogeochemical and biological processes act together to shape aquatic ecosystems in winter and in spring. In addition, we present an overview of the unknowns regarding the interactions between the different processes, which can now be posed due to improved understanding of under‐ice hydrodynamics and the nature of lake ice, of biogeochemistry, and of ecology. However, work to date has largely been conducted within distinct disciplines. We therefore outline interdisciplinary approaches that can bridge current knowledge gaps in winter limnology. Key Points: Ecosystems of seasonally ice‐covered lakes are governed by poorly understood interactions between abiotic and biotic processesDensity‐driven currents enable gradients in redox potential, create niche habitats and redistribute substrates and organisms under iceWinter limnology has tended to progress within disciplines; an interdisciplinary approach is necessary to resolve extant knowledge gaps [ABSTRACT FROM AUTHOR]

Surgery leads to a reduction in circulating natural killer cells as well as other lymphocytes, and, in a breast cancer study, serum was collected from patients undergoing surgery randomly allocated to propofol-based total intravenous anaesthesia (TIVA) or inhalational anaesthesia. Anaesthesia 2019; 74: 560 - 3. 11 Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthetic technique In the study by Pirie et al., the type of anaesthesia was decided by individual clinicians and, ideally, a pragmatic approach to anaesthetic technique should be undertaken in any future trials in colorectal cancer surgery. Keywords: colorectal cancer surgery; ERAS; patient outcomes; spinal anaesthesia EN colorectal cancer surgery ERAS patient outcomes spinal anaesthesia 748 750 3 06/09/22 20220701 NES 220701 Enhanced recovery after surgery (ERAS) was developed around 20 years ago and refers to patient-centred, evidence-based pathways developed by multidisciplinary teams in order to reduce the patient's surgical stress response, optimise their physiological function and facilitate recovery. [Extracted from the article]

Lakes are traditionally classified based on their thermal regime and trophic status. While this classification adequately captures many lakes, it is not sufficient to understand seasonally ice‐covered lakes, the most common lake type on Earth. We describe the inverse thermal stratification in 19 highly varying lakes and derive a model that predicts the temperature profile as a function of wind stress, area, and depth. The results suggest an additional subdivision of seasonally ice‐covered lakes to differentiate underice stratification. When ice forms in smaller and deeper lakes, inverse stratification will form with a thin buoyant layer of cold water (near 0°C) below the ice, which remains above a deeper 4°C layer. In contrast, the entire water column can cool to ∼0°C in larger and shallower lakes. We suggest these alternative conditions for dimictic lakes be termed "cryostratified" and "cryomictic." Plain Language Summary: Most mid and high latitude lakes are seasonally ice‐covered and have only been classified based on the thermal structure and trophic status during the open‐water season in summer. However, limited temperatures observations in these ice‐covered lakes suggest that there is a wide range of thermal structures over winter. We developed an analytical model to predict the average water temperature at the time of ice formation based on the strength of the surface winds, the area of the lake, and the maximum depth of the lake. Using both the analytical model and water temperature data from 19 different lakes in North America, Europe, and Asia, we found that the time of ice formation in lakes that are large or experience strong winds were later compared to lakes that are small or experience weak winds. The larger and windier lakes are also colder (0°C∼2°C) than smaller and calmer lakes (2°C∼4°C) at the time of ice formation. This suggests that these seasonally ice‐covered lakes can be subdivided into two additional classes during winter. The analytical model and the new categorization have important consequences for understanding fish habitat under the ice and the potential effects of climate change on these seasonally ice‐covered lakes. Key Points: Standard classifications of dimictic lakes do not consider how variable the initial thermal stratification can be under winter lake iceLakes that are shallow or windy can cool to near 0°C–1°C before ice forms and are weakly stratified, which we term "cryomictic"Deeper lakes or those with calmer winds, result in ice forming just above deeper waters of 3°C–4°C, which we term "cryostratified" [ABSTRACT FROM AUTHOR]

The ecological consequences of winter in freshwater systems are an understudied but rapidly emerging research area. Here, we argue that winter periods of reduced temperature and light (and potentially oxygen and resources) could play an underappreciated role in mediating the coexistence of species. This may be especially true for temperate and subarctic lakes, where seasonal changes in the thermal environment might fundamentally structure species interactions. With climate change already shortening ice‐covered periods on temperate and polar lakes, consideration of how winter conditions shape biotic interactions is urgently needed. Using freshwater fishes in northern temperate lakes as a case study, we demonstrate how physiological trait differences (e.g. thermal preference, light sensitivity) drive differential behavioural responses to winter among competing species. Specifically, some species have a higher capacity for winter activity than others. Existing and new theory is presented to argue that such differential responses to winter can promote species coexistence. Importantly, if winter is a driver of niche differences that weaken competition between, relative to within species, then shrinking winter periods could threaten coexistence by tipping the scales in favour of certain sets of species over others. [ABSTRACT FROM AUTHOR]

For many ectothermic animals, the acquisition, storage and depletion of lipids is integral to successfully coping with reduced metabolic rates and activity levels associated with cold, winter periods. In fish, lipids are crucial for overwinter survival and successful reproduction. The timing and magnitude of seasonal lipid storage should therefore vary predictably among fish with different thermal preferences and spawn times. Small‐ and large‐bodied fish should also face different constraints associated with season that influence lipid cycling. However, much work to date has been species‐ and location‐specific and a general conceptual model for the seasonal energy budgets of freshwater fish is lacking. Here, we conducted a comprehensive literature review of seasonal lipid levels in freshwater fishes. We predicted that warm and cool water species would be more likely to demonstrate peak lipid levels during warm months than cold water species, and expected a larger magnitude of annual lipid cycling in warm and cool water compared to cold water fish. We also expected dampened lipid cycling in larger fish due to their lower mass‐specific metabolic rates. Observed patterns in the timing and magnitude of lipid storage contradicted our prediction because lipid cycling was widespread across species, despite thermal guild, with peak lipid levels commonly occurring during warmer months, even in cold water fish. For body size effects, larger bodied fish species had dampened seasonal lipid cycling, as predicted. We developed a conceptual framework describing how the 'scope' for variation in annual lipid cycling changes with body size both among and within species in order to guide future work. Together, our findings suggest that energy acquired during warm months is broadly important for overwinter survival and reproduction in fishes, and provide a new perspective on the differential constraints and physiological responses to seasonality among freshwater fish. Improving our understanding of these dynamics is especially pressing given that a changing global climate is anticipated to alter existing seasonal signals. [ABSTRACT FROM AUTHOR]

More than 50% of medical students and 45% of practising doctors are female in the UK. In the specialty of anaesthesia, 32% of consultants are female. However, compared with males, females are under-represented as authors of articles published in high-impact journals. We investigated the proportion of female first authors by examining the case reports submitted to Anaesthesia Cases since its inception in 2013. We defined authors by their sex (male or female), that is, biological characteristics, rather than their gender. There were a total of 802 submissions to Anaesthesia Cases over 4.5 years. Sixteen submissions were excluded and of the remaining 786 submissions, 279 were accepted and 507 rejected, an acceptance rate of 35.5%. Twenty (2.5%) authors' sex could not be identified. The overall proportion of female first authors was 37.1%. The proportion of female first authors of accepted case reports was 42.1% and females were first authors of rejected case reports in 34.4%. We found that, compared with previous studies on female sex and gender bias in publishing, there was a relatively high proportion of female first authors publishing in Anaesthesia Cases and female first authors were more likely to be accepted than male first authors. Authorship is considered to reflect career success and there continues to be sex/gender inequity that must be tackled at all levels, from application to medical school, through research funding, journals and Editorial Boards. [ABSTRACT FROM AUTHOR]

Guidelines are presented for the organisational and clinical management of anaesthesia for day-case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion. [ABSTRACT FROM AUTHOR]

The article offers information on the effect of pre-operative intravenous iron compared with oral iron on quality of life (QoL) in patients with anaemia and colorectal cancer undergoing curative surgery. It mentions patient-reported experience measures (PREMs) evaluate the patient's perception of the healthcare experience; and also mentions that QoL improvements have still been observed in anaemic patients with cancer-related fatigue.

Summary: The Brassicaceae family comprises c. 4000 species including economically important crops and the model plant Arabidopsis thaliana. Despite their importance, the relationships among major lineages in the family remain unresolved, hampering comparative research.Here, we inferred a Brassicaceae phylogeny using newly generated targeted enrichment sequence data of 1827 exons (> 940 000 bases) representing 63 species, as well as sequenced genome data of 16 species, together representing 50 of the 52 currently recognized Brassicaceae tribes. A third of the samples were derived from herbarium material, facilitating broad taxonomic coverage of the family.Six major clades formed successive sister groups to the rest of Brassicaceae. We also recovered strong support for novel relationships among tribes, and resolved the position of 16 taxa previously not assigned to a tribe. The broad utility of these phylogenetic results is illustrated through a comparative investigation of genome‐wide expression signatures that distinguish simple from complex leaves in Brassicaceae.Our study provides an easily extendable dataset for further advances in Brassicaceae systematics and a timely higher‐level phylogenetic framework for a wide range of comparative studies of multiple traits in an intensively investigated group of plants. [ABSTRACT FROM AUTHOR]

The relationship between food‐web structure (i.e., trophic connections, including diet, trophic position, and habitat use, and the strength of these connections) and ecosystem functions (i.e., biological, geochemical, and physical processes in an ecosystem, including decomposition, production, nutrient cycling, and nutrient and energy flows among community members) determines how an ecosystem responds to perturbations, and thus is key to understanding the adaptive capacity of a system (i.e., ability to respond to perturbation without loss of essential functions). Given nearly ubiquitous changing environmental conditions and anthropogenic impacts on global lake ecosystems, understanding the adaptive capacity of food webs supporting important resources, such as commercial, recreational, and subsistence fisheries, is vital to ecological and economic stability.Herein, we describe a conceptual framework that can be used to explore food‐web structure and associated ecosystem functions in large lakes. We define three previously recognised broad habitat compartments that constitute large lake food webs (nearshore, pelagic, and profundal). We then consider, at three levels, how energy and nutrients flow: (a) into each basal resource compartment; (b) within each compartment; and (c) among multiple compartments (coupling). Flexible shifts in food‐web structures (e.g., via consumers altering their diet or habitat) that sustain these flows in the face of perturbations provide evidence for adaptive capacity.We demonstrate the conceptual framework through a synthesis of food‐web structure and ecosystem function in the Laurentian Great Lakes, with emphasis on the upper trophic levels (i.e., fishes). Our synthesis showed evidence of notable adaptive capacity. For example, fishes increased benthic coupling in response to invasion by mussels and round gobies. However, we also found evidence of loss of adaptive capacity through species extirpations (e.g., widespread collapse in the abundance and diversity of ciscoes, Coregonus spp., except in Lake Superior).In large freshwater lakes, fishery managers have traditionally taken a top‐down approach, focusing on stocking and harvest policy. By contrast, water quality managers have focused on nutrient effects on chemical composition and lower trophic levels of the ecosystem. The synthesised conceptual model provides resource managers a tool to more systematically interpret how lower food‐web dynamics influence harvestable fish populations, and vice versa, and to act accordingly such that sustainable resource practices can be achieved.We identify key gaps in knowledge that impede a fuller understanding of the adaptive capacities of large lakes. In general, we found a greater uncertainty in our understanding of processes influencing energy and nutrient flow within and among habitats than flows into the system. [ABSTRACT FROM AUTHOR]

There are approximately 8.5 million Jehovah's Witnesses and around 150,000 live in Great Britain and Ireland. Based on their beliefs and core values, Jehovah's Witnesses refuse blood component transfusion (including red cells, plasma and platelets). They regard non-consensual transfusion as a physical violation. Consent to treatment is at the heart of this guideline. Refusal of treatment by an adult with capacity is lawful. The reasons why a patient might refuse transfusion and the implications are examined. The processes and products that are deemed acceptable or unacceptable to Jehovah's Witnesses are described. When a team is faced with a patient who refuses transfusion, a thorough review of the clinical situation is advocated and all options for treatment should be explored. After discussion, a plan should then be made that is acceptable to the patient and appropriate consent obtained. When agreement cannot be reached between the doctor and the patient, referral for a second opinion should be considered. When the patient is a child, the same strategy should be used but on occasion the clinical team may have to obtain legal help. [ABSTRACT FROM AUTHOR]

The article discusses the sedative premedication for children who have learning disabilities and behavioral issues. It explains the aims of premedication in children and elements of an ideal sedative premedication. The factors to consider in the development of an oral pediatric drug formulation are also explained. The article also offers information on midazolam as the most commonly prescribed preoperative sedative in pediatric anesthesia and alternatives including ketamine and clonidine.

Keywords: children; dexmedetomidine; paediatrics; sedation EN children dexmedetomidine paediatrics sedation 309 311 3 02/08/21 20210301 NES 210301 Dexmedetomidine is an 2-adrenergic receptor agonist with an eight-fold greater affinity for the 2-adrenergic receptor than its sister drug clonidine. Whereas there have been no studies specifically examining whether dexmedetomidine affects implicit memory, we do know that explicit memory is impaired at low-dose midazolam sedation yet preserved at low-dose dexmedetomidine sedation. Sedation Dexmedetomidine has been most successfully used as the sole agent for sedation in children requiring non-painful procedures such as MRI and transthoracic echocardiography [17]. Dexmedetomidine is excellent as a sedative premedication in uncooperative children and as a sole agent for sedation, but current evidence suggests that it does not confer significant advantages when routinely added as an adjunct to general anaesthesia in children undergoing simple day case procedures. [Extracted from the article]

The article considers circumstances when peri-operative cell salvage should be used. It examines the appropriate use of peri-operative cell salvage to lessen the chances of allogeneic red blood cell transfusion or severe postoperative anemia. It recommends cell salvage use in hospitals undertaking surgery when there is a likelihood of blood loss complication outside of day case procedures.

There is a widely acknowledged need to explicitly include humans in our conceptual and mathematical models of food webs. However, a simple and generalized method for incorporating humans into fisheries food webs has yet to be established. We developed a simple graphical framework for defining whole‐system inland fishery food webs that includes a continuum of fishery behaviors. This range of behaviors mimics those of generalist to specialist predators, which differentially influence ecosystem diversity, sustainability, and functioning. Fishery behaviors in this food‐web context are predicted to produce a range of “fishery types” – from targeted (ie specialist) to multispecies (ie generalist) inland fisheries – and relate to the socioeconomic status of fishery participants. Fishery participants in countries with low Human Development Index (HDI) values are highly connected through fisheries food webs relative to humans in more developed countries. Our framework shows that fisheries can occupy a variety of roles within a food‐web model and may thereby affect food‐web stability in different ways. This realization could help to improve sustainable fisheries management at a global scale. [ABSTRACT FROM AUTHOR]

The author focuses on throat packs inserted by anaesthetists. Topics discussed include surveys showing that throat pack insertion is common, the change in protocol regarding throat packs, incidence of retained throat packs and raising awareness that retained throat packs remain a serious risk within the everyday practice of anaesthetists.

Summary: The International Committee of Medical Journal Editors recommends the prospective registration of interventional clinical trials. We aimed to assess the compliance with these guidelines for manuscripts submitted to and published by a single anaesthetic journal. We examined the rates of prospective trial registration, the incidence of discrepancies in primary outcome measure(s) and sample sizes, and the citation metrics of all randomised controlled trials published in Anaesthesia over a 3‐year period (2014–2016). Of the 422 randomised controlled trials submitted during the study period, 115 (27.3%) were accepted for publication, of which 90 (78.3%) were patient studies, with the remaining 25 comprising manikin, simulation, volunteer, bench, cadaver and other non‐patient intervention studies. Of the accepted patient studies, 64 (71.1%) were prospectively registered with a clinical trials registry, 20 (22.2%) were not registered and 6 (6.7%) were retrospectively registered after manuscript submission. There was no difference in the frequency of registration between accepted and rejected manuscripts (77.8% vs. 84.5%, respectively, p = 0.143). The median (IQR [range]) time from registration of accepted manuscripts to journal submission was 701 (331–1341 [99–2436]) days. There was no correlation between number of patients recruited to a study and time to submission. Fifty‐two (81.3%) of the prospectively registered studies reported the same primary outcomes in both registration and submission, and 34 (53.1%) studies were published with the same powered sample size as that described in the registry. Eleven (12.2%) studies recruited more patients and 19 (21.1%) recruited fewer patients than described in the registration protocol. There was no difference in the median (IQR [range]) number of citations per month since publication between prospectively (0.27 (0.15–0.46 [0.00–1.59]), and retrospectively (0.39 (0.15–0.62 [0.10–0.67]); p = 0.502) or unregistered (0.33 (0.10–0.52 [0.00–0.67]); p = 0.867) studies. Our results suggest that prospective clinical trial registration has no influence on acceptance for publication by Anaesthesia or subsequent citation metrics. The international recommendation for prospective trial registration appears to have not been universally incorporated into anaesthetic‐related research practice. [ABSTRACT FROM AUTHOR]

The article focuses on the controversies related to stop using uncuffed tracheal tubes in children. It mentions that it is the part of a child's airway which is below the vocal cords at the level of the cricoid cartilage. It mentions that the uncuffed tracheal tube that can seal the cricoid ring. It states that the tube enable positive pressure ventilation without excessive pressure on the tracheal mucosa.

Abstract: Proliferative kidney disease (PKD) of salmonids caused by Tetracapsuloides bryosalmonae causes high mortalities of wild brown trout (Salmo trutta fario) and farmed rainbow trout (Oncorhynchus mykiss) at elevated water temperatures. Here the aim was to compare the temperature‐dependent modulation of T. bryosalmonae in the two salmonid host species, which display different temperature optima. We used a novel experimental set‐up in which we exposed brown trout and rainbow trout to an identical quantified low concentration of T. bryosalmonae for a short time period (1 hr). We followed the development of the parasite in the fish hosts for 70 days. PKD prevalence and parasite kinetics were assessed using qPCR. Exposures were performed at temperatures (12°C and 15°C) that reflect an environmental scenario that may occur in the natural habitat of salmonids. T. bryosalmonae infection was confirmed earliest in brown trout kept at 15°C (day 7 post‐exposure) while, in all other groups, T. bryosalmonae was not confirmed until day 15 post‐exposure. Moreover, significantly greater infection prevalence and a faster increase of parasite intensity were observed in brown trout kept at 15°C than in all other groups. These results indicate that PKD is differentially modulated by water temperature in related host species. [ABSTRACT FROM AUTHOR]