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Objective: To estimate the potential economic burden of long COVID in Australia. Design: A stock‐and‐flow model of weekly estimated numbers of people with long COVID (January 2021 to June 2023); application of proxy cost estimates from people living with myalgic encephalomyelitis/chronic fatigue syndrome; time series analysis of labour market and social security datasets. Setting: The working age Australian population. Main outcome measures: The likely number of Australians severely impacted by long COVID; the economic cost of long COVID; and the impacts of long COVID, determined by analysis of labour market data. Results: At its peak in late 2022, between 181 000 and 682 000 Australians may have experienced some long COVID symptoms, of whom 40 000–145 000 may have been severely affected. Severe cases potentially decreased to affecting 10 000–38 000 people by June 2023. The likely economic burden of long COVID in Australia during 2022 was between $1.7 billion and $6.3 billion (some 0.07% to 0.26% of gross domestic product). Labour market data suggest that between 25 000 (February 2023) and 103 000 (June 2023) more working age Australians reported being unable to work due to long term sickness than would have been predicted based on pre‐COVID‐19 trends. This does not appear to have translated into increased claims for Disability Support Pensions, but numbers of working age Carer Allowance recipients have grown markedly since 2022. Conclusions: Long COVID likely imposed a small but significant aggregate toll on the Australian economy, while exposing tens of thousands of Australians to substantial personal economic hardship and contributing to labour market supply constraints. Yet while some signal from long COVID is discernible in the labour force data, Australia lacks adequate direct surveillance data to securely guide policy making. [ABSTRACT FROM AUTHOR]

Aims: To estimate the direct costs during the prenatal, delivery and postpartum periods in mothers with diabetes in pregnancy, compared to those without. Methods: This study used a population‐based dataset from 2004 to 2017, including 57,090 people with diabetes and 114,179 people without diabetes in Tasmania, Australia. Based on diagnostic codes, delivery episodes with gestational diabetes mellitus (GDM) were identified and matched with delivery episodes without diabetes in pregnancy. A group of delivery episodes with pre‐existing diabetes was identified for comparison. Hospitalisation, emergency department and pathology costs of these groups were calculated and adjusted to 2020–2021 Australian dollars. Results: There were 2774 delivery episodes with GDM, 2774 delivery episodes without diabetes and 237 delivery episodes with pre‐existing diabetes identified. Across the 24‐month period, the pre‐existing diabetes group required the highest costs, totalling $23,536/person. This was followed by the GDM ($13,210/person), and the no diabetes group ($11,167/person). The incremental costs of GDM over the no diabetes group were $890 (95% CI 635; 1160) in the year preceding delivery; $812 (616; 1031) within the delivery period and $341 (110; 582) in the year following delivery (p < 0.05). Within the year preceding delivery, the incremental costs in the prenatal period were $803 (579; 1058) (p < 0.05). Within the year following delivery, the incremental costs in the postpartum period were $137 (55; 238) (p < 0.05). Conclusions: Our results emphasised the importance of proper management of diabetes in pregnancy in the prenatal and postpartum periods and highlighted the significance of screening and preventative strategies for diabetes in pregnancy. [ABSTRACT FROM AUTHOR]

The literature on responsive regulation argues that citizens should be involved in regulatory practices to avoid capture between regulator and regulatee. It also argues that including citizens can add an important perspective to regulatory practices. However, we know little about how citizens' perspectives are brought into regulatory practices. This paper draws on existing qualitative research to compare and analyze four cases of experimental participatory regulation in Dutch health care, focusing on the theoretical assumptions that citizen involvement (a) prevents capture, and (b) stimulates the inclusion of new perspectives. Our results show that involving citizens in regulation can increase transparency and trust in regulatory practices and familiarizes regulators with other perspectives. It is, however, up to the regulator to work on deriving benefits from that involvement—not only the practical work of organizing participatory regulation, but also the conceptual work of reflecting on their own assumptions and standards. We do find evidence for weak forms of capture and argue for the need to extend capture to involve multiple actors. We reflect on these results for theory development and regulatory practice. [ABSTRACT FROM AUTHOR]

Organization of healthcare strongly differs between European countries and results in country‐specific requirements in postgraduate medical training. Within the European Union (EU), the European Board of Anaesthesiology has set recommendations of training for the Specialty of Anaesthesiology including standards for Postgraduate Medical Specialist training including a description for providing service in pediatric anesthesia. However, these standards are advisory and not mandatory. Here we aimed to review the current state and associated challenges of pediatric anesthesia training in Europe. We report an important country‐specific variability both in training and regulations of practice of pediatric anesthesia in the EU and in the United Kingdom. The requirements for training in pediatric anesthesia varies between nothing specified (Belgium) or providing anesthesia with direct supervision to a minimum of 50 cases below 5 years of age (Germany) to 3–6 month clinical practice in a specialized pediatric hospital (France). Likewise, the regulations for providing anesthesia to children varies from no regulations at all (Belgium) to age specific requirements and centralization of all children below 4 years of age to specified centers (United Kingdom). Officially recognized pediatric anesthesia fellowship programs are not available in most countries of Europe. It remains unclear if and how country‐specific differences in pediatric anesthesia training are associated with clinical outcomes in pediatric perioperative care. There is converging interest and support for the establishment of a European pediatric anesthesia curriculum. [ABSTRACT FROM AUTHOR]

Community‐type conversions, such as replacement of perennials by exotic annual grasses in semiarid desert communities, are occurring due to plant invasions that often create positive plant–soil feedbacks, which favor invaders and make restoration of native perennials difficult. Exotic annual grass control measures, such as pre‐emergent herbicides, can also alter soil ecosystems directly or indirectly (i.e. via the plant community), yet there are few studies on the topic in natural, non‐cropped landscapes. We asked how spray treatments applied to soil post‐fire with the intention of inhibiting invasive annual grasses (such as Bromus tectorum L.) and releasing existing native perennial grasses affected soil resources, a microbial process, and invertebrates in three climatically varied sagebrush steppe sites. Spray treatments included chemical herbicides (imazapic and rimsulfuron) that strongly affected plant communities and a bioherbicide (Pseudomonas fluorescens strain D7) that did not. Chemical herbicides increased soil mineral nitrogen in proportion to their negative effects on plant cover for 2 years after treatments in all sites and increased soil water and net N mineralization (measured at one site) but did not affect total carbon, nitrogen, or organic matter. Invertebrate responses to herbicides varied by site, and invertebrates increased with chemical herbicides at the highest, wettest site. We show that herbicide treatments can exacerbate pulses of mineral nutrients, which previous studies have shown can weaken ecosystem resistance to invasion. Thus, restoration strategies that increase the likelihood that desired plants can capture mineralized nutrients after herbicide application will likely be more successful. [ABSTRACT FROM AUTHOR]

Background: The role of patient participation and representation during crises, such as the COVID‐19 pandemic, has been under‐researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID‐19 pandemic. Methods: The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands. Results: We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision‐making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision‐making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered. Conclusions: The struggle for patient representation during pandemic decision‐making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision‐making offer lessons for future representation activities. However, adaptations to the crisis decision‐making structure are also needed to enable patient representatives to play their role. Patient Contribution: We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co‐authored this paper. [ABSTRACT FROM AUTHOR]

A large body of empirical literature considers the productive advantages of cities, or "agglomeration economies." We present a meta‐analysis of this literature that draws on 6684 agglomeration elasticities from 294 studies spanning 54 countries and six decades. We find that elasticities are likely to lie in the range 0.015–0.039 and, like earlier reviews, that the controls enabled by detailed data are associated with smaller estimates. We make five main contributions: First, we find evidence that publication selection imparts a positive bias to the literature; second, we adopt novel methods that tend to yield more precise parameter estimates than conventional approaches; third, unlike earlier reviews, we do not find large differences between most countries nor an association with national income; fourth, we report new associations, for example between elasticities and the spatial scope of agglomeration, which may reflect underlying microeconomic channels; and fifth, we find evidence that elasticities for manufacturing sectors have fallen in recent decades, possibly due to lower freight costs and stricter environmental regulations. [ABSTRACT FROM AUTHOR]

Background: Uncertainty concerning anesthetic procedures and risks in children requiring anesthesia may cause concerns in parents and caregivers. Aims: To explore parental expectations and experiences regarding their child's anesthesia using questionnaires designed with parental input. Methods: This observational cross‐sectional cohort study included parents (including caregivers) of children undergoing anesthesia in a tertiary pediatric referral university hospital. The study consisted of two phases. In Phase 1, we developed three questionnaires with parental involvement through a focus group discussion and individual interviews. The questionnaires focused on parental satisfaction, knowledge, concerns, and need for preparation regarding their child's anesthesia. In Phase 2, independent samples of parents completed the questionnaires at three time points: before the preanesthesia assessment (T1), 2 days after the preanesthesia assessment (T2), and 4 days after the anesthetic procedure (T3). Results: In Phase 1, 22 parents were involved in the development of the questionnaires. The three questionnaires contained 43 questions in total, of which 10 had been proposed by parents. In Phase 2, 78% (474 out of 934) parents participated at T1, 36% (610 out of 1705), at T2 and 34% (546 out of 1622) at T3. Parental satisfaction scores were rated on a visual analogue scale for the preanesthesia assessment with a median of 87/100, and with a median of 90/100 for the anesthetic procedure (0: not satisfied and 100: satisfied). Parental concerns were rated with a median of 50/100 (0: no concerns and 100: extremely concerned). Parental answers from the questionnaire at T2 revealed significant knowledge deficits, with only 73% reporting that the anesthesiologist was a physician. Parents preferred to receive more information about the procedure, especially regarding the intended effects and side effects of anesthesia. Conclusions: Overall, parental satisfaction scores regarding the pediatric anesthesiology procedure were high, with a minority expressing concerns. Parents indicated a preference for their child's anesthesiologist to visit them both before and after the anesthetic procedure. Parental expectations regarding anesthesia did not completely correspond with the information provided; more information from the clinician about the intended effects and side effects of anesthesia was desired. [ABSTRACT FROM AUTHOR]

Background and Objective: Little is known about the association between ambient air pollution and idiopathic pulmonary fibrosis (IPF) in areas with lower levels of exposure. We aimed to investigate the impact of air pollution on lung function and rapid progression of IPF in Australia. Methods: Participants were recruited from the Australian IPF Registry (n = 570). The impact of air pollution on changes in lung function was assessed using linear mixed models and Cox regression was used to investigate the association with rapid progression. Results: Median (25th–75th percentiles) annual fine particulate matter (<2.5 μm, PM2.5) and nitrogen dioxide (NO2) were 6.8 (5.7, 7.9) μg/m3 and 6.7 (4.9, 8.2) ppb, respectively. Compared to living more than 100 m from a major road, living within 100 m was associated with a 1.3% predicted/year (95% confidence interval [CI] −2.4 to −0.3) faster annual decline in diffusing capacity of the lungs for carbon monoxide (DLco). Each interquartile range (IQR) of 2.2 μg/m3 increase in PM2.5 was associated with a 0.9% predicted/year (95% CI −1.6 to −0.3) faster annual decline in DLco, while there was no association observed with NO2. There was also no association between air pollution and rapid progression of IPF. Conclusion: Living near a major road and increased PM2.5 were both associated with an increased rate of annual decline in DLco. This study adds to the evidence supporting the negative effects of air pollution on lung function decline in people with IPF living at low‐level concentrations of exposure. [ABSTRACT FROM AUTHOR]

Background: The New Zealand (NZ) Ministry of Health ethnicity data protocols recommend that people of South Asian (SAsian) ethnicity, other than Indian, are combined with people of Japanese and Korean ethnicity at the most commonly used level of aggregation in health research (level two). This may not work well for perinatal studies, as it has long been observed that women of Indian ethnicity have higher rates of adverse pregnancy outcomes, such as perinatal death. It is possible that women of other SAsian ethnicities share this risk. Aims: This study was performed to identify appropriate groupings of women of SAsian ethnicity for perinatal research. Materials and Methods: National maternity and neonatal data, and singleton birth records between 2008 and 2017 were linked using the Statistics NZ Integrated Data Infrastructure. Socio‐demographic risk profiles and pregnancy outcomes were compared between 15 ethnic groups. Recommendations were made based on statistical analyses and cultural evaluation with members of the SAsian research community. Results: Similarities were observed between women of Indian, Fijian Indian, South African Indian, Sri Lankan, Bangladeshi and Pakistani ethnicities. A lower‐risk profile was seen among Japanese and Korean mothers. Risk profiles of women of combined Indian‐Māori, Indian‐Pacific and Indian‐New Zealand European ethnicity more closely represented their corresponding non‐Indian ethnicities. Conclusions: Based on these findings, we suggest a review of current NZ Ministry of Health ethnicity data protocols. We recommend that researchers understand the risk profiles of participants prior to aggregation of groups in research, to mitigate risks associated with masking differences. [ABSTRACT FROM AUTHOR]

The corresponding absolute number of complications reported by these hospitals ranged from <11 to 20. 1 TABLE Incidence of not present on admission anesthesia-related complications - State Inpatient Databases (SID) Q4 2015-2018. Incidence and between-center heterogeneity of anesthesia-related complications in pediatric populations documented in administrative data: A retrospective study Only 59 of 568 hospitals (representing 76.2% of cases in the dataset) reported at least one anesthesia complication; of the 59 hospitals reporting complications, rates varied widely (independent of the number of cases), with the majority reporting complication rates of less than 0.3%: median: 0.3% (IQR 0.1% to 0.8%), range 0.03% to 10.0% (Figure 1). [Extracted from the article]

The reaction of magnesium turnings and 6,6‐di‐para‐tolylpentafulvene was investigated. Under mild conditions, the magnesium dissolves, forming the MgII complex 1 with a π‐η5 : σ‐κ1 coordinating ligand of the dimerized pentafulvene, analyzed by NMR and XRD investigations. As a magnesium pentafulvene complex was a possible intermediate, amines were employed as intercepting agents. Thereby, the amines were formally deprotonated by elemental magnesium, yielding the first examples of Cp'Mg(THF)2NR2 complexes. This reaction competes with the formation of 1 and a consecutive formal [1,5]‐H‐shift forming an ansa‐magnesocene. Employing amines with low basicity gave quantitative conversion to the amide complexes. [ABSTRACT FROM AUTHOR]

The benzene ligand at CpV(η6--C6H6) (1) is exchanged for pentafulvenes. Using sterically demanding pentafulvenes gives a clean exchange reaction, yielding vanadium pentafulvene (2a and 2b) and benzofulvene complexes (3a and 3b). The molecular structures of the target compounds suggest a π-η5:σ-η¹ coordination mode with a vanadiumIII center. With the sterically low demanding 6,6-dimethylpentafulvene, a C--H activation at the leaving ligand is observed, yielding the ring-substituted vanadoceneII 4. The reactivity of the pentafulvene complexes was investigated. A series of unprecedented vanadoceneIII compounds were synthesized: Under mild conditions, E--H splitting of 4- tert-butylphenol, diphenylamine, and 2,6-diisopropylaniline yield well characterized examples of rare vanadoceneIII phenolate and amide complexes. Insertion reactions into the V--Cexo bond of the pentafulvene complexes by multiple bond containing substrates were found for acetone, 4-chlorobenzonitril and N,N'-dicyclohexylcarbodiimide. [ABSTRACT FROM AUTHOR]

Recent studies have indicated that the C4 perennial bioenergy crops switchgrass (Panicum virgatum) and big bluestem (Andropogon gerardii) accumulate significant amounts of soil carbon (C) owing to their extensive root systems. Soil C accumulation is likely driven by inter‐ and intraspecific variability in plant traits, but the mechanisms that underpin this variability remain unresolved. In this study we evaluated how inter‐ and intraspecific variation in root traits of cultivars from switchgrass (Cave‐in‐Rock, Kanlow, Southlow) and big bluestem (Bonanza, Southlow, Suther) affected the associations of soil C accumulation across soil fractions using stable isotope techniques. Our experimental field site was established in June 2008 at Fermilab in Batavia, IL. In 2018, soil cores were collected (30 cm depth) from all cultivars. We measured root biomass, root diameter, specific root length, bulk soil C, C associated with coarse particulate organic matter (CPOM) and fine particulate organic matter plus silt‐ and clay‐sized fractions, and characterized organic matter chemical class composition in soil using high‐resolution Fourier‐transform ion cyclotron resonance mass spectrometry. C4 species were established on soils that supported C3 grassland for 36 years before planting, which allowed us to use differences in the natural abundance of stable C isotopes to quantify C4 plant‐derived C. We found that big bluestem had 36.9% higher C4 plant‐derived C compared to switchgrass in the CPOM fraction in the 0–10 cm depth, while switchgrass had 60.7% higher C4 plant‐derived C compared to big bluestem in the clay fraction in the 10–20 cm depth. Our findings suggest that the large root system in big bluestem helps increase POM‐C formation quickly, while switchgrass root structure and chemistry build a mineral‐bound clay C pool through time. Thus, both species and cultivar selection can help improve bioenergy management to maximize soil carbon gains and lower CO2 emissions. [ABSTRACT FROM AUTHOR]

Bis(η5:η1‐(di‐para‐tolyl)pentafulvene)niobium chloride (1) reacts with methyl lithium via salt metathesis to the methylated bis(pentafulvene)niobium complex 2, and with lithium 2,6‐diisopropylanilide addition and subsequent N−H bond activation to the imido mono(pentafulvene)niobium complex 3. Avoiding the competing protonation of the chloride, bis(pentafulvene)niobium complex 2 reacts with primary aromatic and aliphatic amines to form terminal niobocene imido complexes, and with water to form the analog terminal oxo complex. Secondary methyl amines undergo a simultaneous N−H and C−H activation to form niobaaziridines under mild conditions. In contrast to other reported examples, 3 can be employed to investigate the uncontested reactivity of mono(pentafulvene)niobium complexes. Reaction with 4‐tert‐butylphenol selectively yields a niobocene phenolate complex. Unprecedented for mono(pentafulvene)niobium complexes, treating 3 with multiple‐bond‐containing substrates (nitriles, isocyanates) smoothly results the insertion into the Nb‐Cexo σ‐bond, forming the corresponding alkylidene amido and imidato complexes. [ABSTRACT FROM AUTHOR]

Introduction: High flow nasal cannula (HFNC) reduces the need for intubation in patients with hypoxaemic acute respiratory failure (ARF), but its added value in patients with severe coronavirus disease 2019 (COVID‐19) and a do‐not‐intubate (DNI) order is unknown. We aimed to assess (variables associated with) survival in these patients. Materials and methods: We described a multicentre retrospective observational cohort study in five hospitals in the Netherlands and assessed the survival in COVID‐19 patients with severe acute respiratory failure and a DNI order who were treated with high flow nasal cannula. We also studied variables associated with survival. Results and discussion: One‐third of patients survived after 30 days. Survival was 43.9% in the subgroup of patients with a good WHO performance status and only 16.1% in patients with a poor WHO performance status. Patients who were admitted to the hospital for a longer period prior to HFNC initiation were less likely to survive. HFNC resulted in an increase in ROX values, reflective of improved oxygenation and/or decreased respiratory rate. Conclusion: Our data suggest that a trial of HFNC could be considered to increase chances of survival in patients with ARF due to COVID‐19 pneumonitis and a DNI order, especially in those with a good WHO performance status. [ABSTRACT FROM AUTHOR]

The structure and composition of plant communities in drylands are highly variable across scales, from microsites to landscapes. Fine spatial resolution field surveys of dryland plants are essential to unravel the impact of climate change; however, traditional field data collection is challenging considering sampling efforts and costs. Unoccupied aerial systems (UAS) can alleviate this challenge by providing standardized measurements of plant community attributes with high resolution. However, given widespread heterogeneity in plant communities in drylands, and especially across environmental gradients, the transferability of UAS imagery protocols is unclear. Plant functional types (PFTs) are a classification scheme that aggregates the diversity of plant structure and function. We mapped and modeled PFTs and fractional photosynthetic cover using the same UAS imagery protocol across three dryland communities, differentiated by a landscape‐scale gradient of elevation and precipitation. We compared the accuracy of the UAS products between the three dryland sites. PFT classifications and modeled photosynthetic cover had highest accuracies at higher elevations (2241 m) with denser vegetation. The lowest site (1101 m), with more bare ground, had the least agreement with the field data. Notably, shrub cover was well predicted across the gradient of elevation and precipitation (~230–1100 mm/year). UAS surveys captured the heterogeneity of plant cover across sites and presented options to measure leaf‐level composition and structure at landscape levels. Our results demonstrate that some PFTs (i.e., shrubs) can readily be detected across sites using the same UAS imagery protocols, while others (i.e., grasses) may require site‐specific flight protocols for best accuracy. As UAS are increasingly used to monitor dryland vegetation, developing protocols that maximize information and efficiency is a research and management priority. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 patients were often transferred to other intensive care units (ICUs) to prevent that ICUs would reach their maximum capacity. However, transferring ICU patients is not free of risk. We aim to compare the characteristics and outcomes of transferred versus non‐transferred COVID‐19 ICU patients in the Netherlands. Methods: We included adult COVID‐19 patients admitted to Dutch ICUs between March 1, 2020 and July 1, 2021. We compared the patient characteristics and outcomes of non‐transferred and transferred patients and used a Directed Acyclic Graph to identify potential confounders in the relationship between transfer and mortality. We used these confounders in a Cox regression model with left truncation at the day of transfer to analyze the effect of transfers on mortality during the 180 days after ICU admission. Results: We included 10,209 patients: 7395 non‐transferred and 2814 (27.6%) transferred patients. In both groups, the median age was 64 years. Transferred patients were mostly ventilated at ICU admission (83.7% vs. 56.2%) and included a larger proportion of low‐risk patients (70.3% vs. 66.5% with mortality risk <30%). After adjusting for age, APACHE IV mortality probability, BMI, mechanical ventilation, and vasoactive medication use, the hazard of mortality during the first 180 days was similar for transferred patients compared to non‐transferred patients (HR [95% CI] = 0.99 [0.91–1.08]). Conclusions: Transferred COVID‐19 patients are more often mechanically ventilated and are less severely ill compared to non‐transferred patients. Furthermore, transferring critically ill COVID‐19 patients in the Netherlands is not associated with mortality during the first 180 days after ICU admission. [ABSTRACT FROM AUTHOR]

Aims: To quantify the incremental direct medical costs in people with diabetes from the healthcare system perspective; and to identify trends in the incremental costs. Methods: This was a matched retrospective cohort study based on a linked data set developed for investigating chronic kidney disease in Tasmania, Australia. Using propensity score matching, 51,324 people with diabetes were matched on age, sex and residential area with 102,648 people without diabetes. Direct medical costs (Australian dollars 2020–2021) due to hospitalisation, Emergency Department visits and pathology tests were included. The incremental costs and cost ratios between mean annual costs of people with diabetes and their controls were calculated. Results: On average, people with diabetes had healthcare costs that were almost double their controls ($2427 [95% CI 2322–2543]; ratio 1.87 [95% CI 1.85–1.91]; pooled from 2007–2017). While in the first year of follow‐up, the costs of a person with diabetes were $1643 (95% CI 1489–1806); ratio 1.83 (95% CI 1.76–1.92) more than their control, this increased to $2480 (95% CI 2265–2680); ratio 1.69 (95% CI 1.62–1.77) in the final year. Although the incremental costs were higher in older age groups (e.g., ≥70: $2498 [95% CI 2265–2754]; 40–49: $2117 [95% CI 1887–2384]), the cost ratios were higher in younger age groups (≥70: 1.52 [95% CI 1.48–1.56]; 40–49: 2.37 [95% CI 2.25–2.61]). Conclusions: Given the increasing burden that diabetes imposes, our findings will support policymakers in future planning for diabetes and enable targeting sub‐groups with higher long‐term costs for possible cost savings for the Tasmanian healthcare system. [ABSTRACT FROM AUTHOR]

Purpose: To compare the accuracy, inter- and intrarater reliability, and user-experience of manual and semi-automatic preoperative leg-alignment measurement planning software for high tibial osteotomy (HTO). Methods: Thirty patients (31 lower limbs) who underwent a medial opening wedge HTO between 2017 and 2019 were retrospectively included. The mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and planned correction angle were measured on preoperative long-leg full weight-bearing radiographs utilising PACS Jivex Review® v5.2 manual and TraumaCad® v2.4 semi-automatic planning software. Independent measurements were performed by four raters. Two raters repeated the measurements. Accuracy in the standard error of measurement (SEM), inter- and intrarater reliability, and user-experience were analysed. Additionally, measurements errors of more than 3° were remeasured and reanalysed. Results: The SEMs of all measured varus malalignment angles and planned correction angle were within 0.8° of accuracy for both software programs. Measurements utilising the manual software demonstrated moderate interrater intraclass correlation coefficient (ICC)-values for the mLDFA and mMPTA, and an excellent interrater ICC-value for the correction angle (0.810, 0.779, and 0.981, respectively). Measurements utilising the semi-automatic software indicated excellent interrater ICC-values for the mLDFA, mMPTA, and correction angle (0.980, 0.909, and 0.989, respectively). The intrarater reliability varied substantially per angle, presenting excellent intrarater agreements by both raters (ICC > 0.900) for the correction angle in each software program as well as poor-to-excellent ICC-values for the mLDFA (0.282–0.951 and 0.316–0.926) and mMPTA (0.893–0.934 and 0.594–0.941) in both the manual planning and semi-automatic software. Regarding user-experience, semi-automatic software was preferred by two raters, while the other two raters had no distinctive preference. After remeasurement of five outliers, excellent interrater ICC-values were found for the mLDFA (0.913) and mMPTA (0.957). Conclusions: Semi-automatic software outperforms the manual software when user-experience and outliers are considered. However, both software programs provide similar performance after remeasurement of the human-related erroneous outliers. For clinical practice, both programs can be utilised for HTO planning. Level of evidence: Diagnostic study, Level III. [ABSTRACT FROM AUTHOR]

Background and objective: Idiopathic pulmonary fibrosis (IPF) is one of the most common forms of interstitial lung diseases. While studies have been conducted in other countries to determine the epidemiological burden of IPF, there is limited information in Australia. Our study aimed to address this gap and generate the first estimates for the mortality, incidence and prevalence of IPF in Australia. Methods: Estimates were generated by utilizing the novel Mortality Incidence Analysis Model (MIAMOD) method and software based on the illness–death model. Data inputs included population estimates and mortality data from the Australian Bureau of Statistics (ABS) for the period 1997–2015 and participant data from the Australian IPF Registry (AIPFR). Projections were estimated for a 10‐year period up to 2025. Results: Overall crude and age‐standardized estimates for mortality were 5.9 and 6.3 per 100,000 population; incidence, 10.4 and 11.2 per 100,000 population; and prevalence, 32.6 and 35.1 per 100,000 population. Crude and age‐standardized mortality, incidence and prevalence increased over the study period; however, they demonstrated a decreasing trend over the projected period. Persons older than 70 years constituted 9% of the population; however, they accounted for approximately 82%–83% of all deaths, incident and prevalent cases. All estimates were higher in males than in females. Conclusion: Our study provides the first estimates for incidence, prevalence and mortality of IPF in Australia. By reporting national estimates for IPF, our study addresses an information gap important for policy, planning and to help optimize the allocation of resources for the management of patients with IPF. [ABSTRACT FROM AUTHOR]

Objective: Health state utility values (HSUVs) are a key input in health economic modeling, but HSUVs of people with osteoarthritis (OA)–related conditions have not been systematically reviewed and meta‐analyzed. Our objective was to systematically review and meta‐analyze the HSUVs for people with OA. Methods: Searches within health economic/biomedical databases were performed to identify eligible studies reporting OA‐related HSUVs. Data on study design, participant characteristics, affected OA joint sites, treatment type, HSUV elicitation method, considered health states, and the reported HSUVs were extracted. HSUVs for people with knee, hip, and mixed OA in pre‐ and posttreatment populations were meta‐analyzed using random effects models. Results: A total of 151 studies were included in the systematic review, and 88 in meta‐analyses. Of 151 studies, 56% were conducted in Europe, 75% were in people with knee and/or hip OA, and 79% were based on the EuroQoL 5‐dimension instrument. The pooled mean baseline HSUVs for knee OA core interventions, medication, injection, and primary surgery treatments were 0.64 (95% confidence interval [95% CI] 0.61–0.66), 0.56 (95% CI 0.45−0.68), 0.58 (95% CI 0.50–0.66), and 0.52 (95% CI 0.49–0.55), respectively. These were 0.71 (95% CI 0.59–0.84) for hip OA core interventions and 0.52 (95% CI 0.49–0.56) for hip OA primary surgery. For all knee OA treatments and hip OA primary surgery, pooled HSUVs were significantly higher in the post‐ than the pretreatment populations. Conclusion: This study provides a comprehensive summary of OA‐related HSUVs and generates an HSUV database for people with different affected OA joint sites undergoing different treatments to guide HSUV choices in future health economic modeling of OA interventions. [ABSTRACT FROM AUTHOR]

Objective: To comprehensively synthesize the evolution of health‐economic evaluation models (HEEMs) of all osteoarthritis (OA) interventions, including preventions, core treatments, adjunct nonpharmacologic interventions, pharmacologic interventions, and surgical treatments. Methods: The literature was searched within health‐economic/biomedical databases. Data extracted included OA type, population characteristics, model setting/type/events, study perspective, and comparators; the reporting quality of the studies was also assessed. The review protocol was registered at the International Prospective Register of Systematic Reviews (CRD42018092937). Results: Eighty‐eight studies were included. Pharmacologic and surgical interventions were the focus in 51% and 44% of studies, respectively. Twenty‐four studies adopted a societal perspective (with increasing popularity after 2013), but most (63%) did not include indirect costs. Quality‐adjusted life years was the most popular outcome measure since 2008. Markov models were used by 62% of studies, with increasing popularity since 2008. Until 2010, most studies used short‐to‐medium time horizons; subsequently, a lifetime horizon became popular. A total of 86% of studies reported discount rates (predominantly between 3% and 5%). Studies published after 2002 had a better coverage of OA‐related adverse events (AEs). Reporting quality significantly improved after 2001. Conclusion: OA HEEMs have evolved and improved substantially over time, with the focus shifting from short‐to‐medium‐term pharmacologic decision‐tree models to surgical‐focused lifetime Markov models. Indirect costs of OA are frequently not considered, despite using a societal perspective. There was a lack of reporting sensitivity of model outcome to input parameters, including discount rate, OA definition, and population parameters. While the coverage of OA‐related AEs has improved over time, it is still not comprehensive. [ABSTRACT FROM AUTHOR]

Chinese investments into Europe have been growing prodigiously in the past decade and are increasingly the subject of controversy. However, while a lot of empirical data and analysis are available on the flows and stocks of these investments, we still know very little about the loci of corporate power and control behind them. This article focuses on a domain where substantive power of decision making and control regarding these investments lies: corporate boards. The key aim is to assess how Chinese boards are relating to the existing European corporate elite networks by analysing the extent and nature of Sino–European corporate board interlocking by China's largest firms as a particular networking mode. Based on business listings and databases, and applying social network analysis in combination with qualitative analysis, the article highlights the contours of an emerging Sino–European corporate elite, revealing under‐exposed areas of ongoing Sino–European collaboration whilst at the same time indicating a sphere of potential influence by Chinese business elites at the top of Europe's corporations. [ABSTRACT FROM AUTHOR]

In recent years Europe has become a primary focus for Chinese investment. In the context of the rolling out of Chinese government plans such as its Belt and Road Initiative and 'Made in China 2025' industrial strategy, and the fact that many Chinese companies are either controlled or influenced by the Communist Party, major consequences for Europe's economic development — and its social, political and geopolitical corollaries — are now in train. The analyses presented in this special issue significantly advance our understanding of the dynamics and consequences of China's deepening economic engagements in Europe. They do so particularly in relation to the contentious issues surrounding corporate acquisitions by Chinese companies, the security problems associated with some investments and the impact of China's investment finance. This introductory article offers an institutional framework for comprehending the other articles that constitute the special issue and provides summaries of their contents. Additionally, it provides an assessment of how the special issue's contribution advances our understanding of China's externalization and its implications for European economic development. [ABSTRACT FROM AUTHOR]

The IODP‐ICDP Expedition 364 drilling recovered a 829 m core from Hole M0077A, sampling ˜600 m of near continuous crystalline basement within the peak ring of the Chicxulub impact structure. The bulk of the basement consists of pervasively deformed, fractured, and shocked granite. Detailed geochemical investigations of 41 granitoid samples, that is, major and trace element contents, and Sr–Nd isotopic ratios are presented here, providing a broad overview of the composition of the granitic crystalline basement. Mainly granite but also granite clasts (in impact melt rock), granite breccias, and aplite were analyzed, yielding relatively homogeneous compositions between all samples. The granite is part of the high‐K, calc‐alkaline metaluminous series. Additionally, they are characterized by high Sr/Y and (La/Yb)N ratios, and low Y and Yb contents, which are typical for adakitic rocks. However, other criteria (such as Al2O3 and MgO contents, Mg#, K2O/Na2O ratio, Ni concentrations, etc.) do not match the adakite definition. Rubidium–Sr errorchron and initial 87Sr/86Srt=326Ma suggest that a hydrothermal fluid metasomatic event occurred shortly after the granite formation, in addition to the postimpact alteration, which mainly affected samples crosscut by shear fractures or in contact with aplite, where the fluid circulation was enhanced, and would have preferentially affected fluid‐mobile element concentrations. The initial (ɛNd)t=326Ma values range from −4.0 to 3.2 and indicate that a minor Grenville basement component may have been involved in the granite genesis. Our results are consistent with previous studies, further supporting that the cored granite unit intruded the Maya block during the Carboniferous, in an arc setting with crustal melting related to the closure of the Rheic Ocean associated with the assembly of Pangea. The granite was likely affected by two distinct hydrothermal alteration events, both influencing the granite chemistry: (1) a hydrothermal metasomatic event, possibly related to the first stages of Pangea breakup, which occurred approximately 50 Myr after the granite crystallization, and (2) the postimpact hydrothermal alteration linked to a long‐lived hydrothermal system within the Chicxulub structure. Importantly, the granites sampled in Hole M0077A are unique in composition when compared to granite or gneiss clasts from other drill cores recovered from the Chicxulub impact structure. This marks them as valuable lithologies that provide new insights into the Yucatán basement. [ABSTRACT FROM AUTHOR]

The presidency of Donald Trump – often framed as a result of a populist revolt against the elites of Washington and Wall Street – and his apparent break with the postwar liberal internationalist foreign‐policy elite consensus, has raised fundamental questions about the future of elite power in the USA and the implications for its global role. As established by previous research, America's foreign‐policy elite has in the past decades been closely connected to transnationally oriented corporate elite networks, the theme of this special issue. In this article, we address to what extent the Trump presidency represents a real rupture with these extant power structures in the American political system and its foreign‐policy establishment. We present the first systematic mapping and social network analysis of Trump, his cabinet and his White House advisers, which, based on a novel biographical data set, compares earlier findings on the elite networks of the Clinton, Bush and Obama administrations. While finding some strong continuities, the Trumpian foreign‐policy elite is shown to display some very distinctive characteristics, particularly with respect to a lack of previous political affiliations, ties with a different kind of corporate elite, and a disconnect with the policy‐planning networks that have been so central to the previous administrations. [ABSTRACT FROM AUTHOR]

Questions: Relative to a landscape with a mosaic of two sagebrush community types and increasing fire frequency, we asked: (a) do vegetation characteristics vary significantly with number of times burned for each sagebrush community; (b) how do vegetation responses to different fire frequencies compare between the two sagebrush communities? Location: Columbia Plateau Ecoregion, Washington, USA. Methods: We sampled vegetation across a landscape that burned three times over a 10‐year period in two sagebrush community types that are interspersed on unique land forms: big sagebrush (Artemisia tridentata) communities that occur on small "mounds" and scabland sagebrush (A. rigida) communities that occur on surrounding "flats." Spatially overlapping fires permitted a balanced sampling design to assess unburned and once‐, twice‐, and thrice‐burned locations for each land form/community type. We utilized a suite of statistical analyses to determine differences among plant functional groups and biomass among unburned/burned strata by land form and compared results between land forms. Results: Big sagebrush and scabland sagebrush communities responded uniquely to multiple fires, due to different fuel loadings, fire severities, succession and invasion dynamics. Big sagebrush experienced nearly complete shrub loss and conversion from exotic‐invaded shrubland to exotic annual grassland after only one fire. In contrast, scabland sagebrush retained a minor shrub component and higher relative cover of native herbaceous species, even after three fires. Both communities retained cover of native perennial grasses, including shallow‐ and deep‐rooted species, likely reflecting decreasing fire intensity with number of times burned. Conclusions: Despite different community‐level responses, increasing fire frequency is transforming the entire landscape to a non‐native/native grassland mix. Quantifying unique ecosystem responses to altered wildfire regimes is critical to understanding the relative resilience of communities to disturbance and their resistance to exotic species invasion (and community type conversion). Management actions may help to maintain spatial heterogeneity of ecosystems and fire‐tolerant native species. [ABSTRACT FROM AUTHOR]

Background: Cochlear implantation in children with sensorineural hearing loss is preferably performed at youngest age because early auditory input is essential to prevent neural plasticity decline. In contrast, the rate of anesthetic adverse events is increased during infancy. Therefore, to provide recommendations regarding an optimal pediatric implantation age, these possible anesthetic risks in infants need to be taken into account. Aims: This study aimed at assessing the relation between the age at cochlear implant surgery and anesthetic and surgical adverse events. Secondary aims were to evaluate anesthetic and surgical adverse events in relation to (a) the number of preoperative anesthesia‐related procedures for cochlear implant candidacy assessment and (b) the anesthetic maintenance agent (total intravenous anesthesia versus inhalation anesthesia) during implantation. Methods: We executed a retrospective cohort study to evaluate cochlear implantation performed in infants and toddlers between January 2008 and July 2015 in a tertiary pediatric center. We compared anesthetic and surgical adverse events between age‐at‐implantation (0‐12 and 12‐24 months of age) groups. Furthermore, we assessed whether anesthetic adverse events occurred during preoperative anesthesia‐related procedures for cochlear implant candidacy assessment. Results: Forty‐six cochlear implantations were performed in 43 patients requiring 42 preoperative anesthesia‐related procedures. Nineteen cochlear implantations (41.3%) were performed during infancy. During implantation, the maintenance agent was either sevoflurane (n = 22) or propofol (n = 24). None of the patients encountered major anesthetic adverse events, whereas minor adverse events occurred during 34 cochlear implantations. Those attributed to surgery occurred following six implantations. Neither the age at implantation nor the anesthetic maintenance agent was significantly related to the occurrence of both types of adverse events. Conclusions: Adverse events occur independent of the age at implantation, the number of anesthetic preoperative procedures, and the type of anesthetic maintenance agent in patients who received a cochlear implant before 24 months of age. [ABSTRACT FROM AUTHOR]

Robot-assisted radical prostatectomy causes discomfort in the immediate postoperative period. This randomised controlled trial investigated if intrathecal bupivacaine/morphine, in addition to general anaesthesia, could be beneficial for the postoperative quality of recovery. One hundred and fifty-five patients were randomly allocated to an intervention group that received intrathecal 12.5 mg bupivacaine/300 μg morphine (20% dose reduction in patients > 75 years) or a control group receiving a subcutaneous sham injection and an intravenous loading dose of 0.1 mg.kg-1 morphine. Both groups received standardised general anaesthesia and the same postoperative analgesic regimen. The primary outcome was a decrease in the Quality of Recovery-15 (QoR-15) questionnaire score on postoperative day 1. The intervention group (n = 76) had less reduction in QoR-15 on postoperative day 1; median (IQR [range]) 10% (1-8 [-60% to 50%]) vs. 13% (5-24 [-6% to 50%]), p = 0.019, and used less morphine during the admission; 2 mg (1-7 [0-41 mg]) vs. 15 mg (12-20 [8-61 mg]), p < 0.001. Furthermore, they perceived lower pain scores during exertion; numeric rating scale (NRS) 3 (1-6 [0-9]) vs. 5 (3-7 [0-9]), p = 0.001; less bladder spasms (NRS 1 (0-2 [0-10]) vs. 2 (0-5 [0-10]), p = 0.001 and less sedation; NRS 2 (0-3 [0-10]) vs. 3 (2-6 [0-10]), p = 0.005. Moreover, the intervention group used less rescue medication. Pruritus was more severe in the intervention group; NRS 4 (1-7 [0-10]) vs. 0 (0-1 [0-10]), p = 0.000. We conclude that despite a modest increase in the incidence of pruritus, multimodal pain management with intrathecal bupivacaine/morphine remains a viable option for robot-assisted radical prostatectomy. [ABSTRACT FROM AUTHOR]

Clinical outcomes are measurable changes in health, function, or quality of life that are important for evaluating the quality of care and comparing the efficacy of interventions. However, clinical outcomes and related measurement tools need to be well‐defined, relevant, and valid. In adults, Core Outcome Measures in Effectiveness Trials (COMET) methodology has been used to develop core outcome sets for perioperative care. Systematic literature reviews identified standardized endpoints (StEP) and valid measurement tools, and consensus across a broader range of relevant stakeholders was achieved via a Delphi process to establish Core Outcome Measures in Perioperative and Anaesthetic Care (COMPAC). Core outcome sets for pediatric perioperative care cannot be directly extrapolated from adult data. The type and weighting of endpoints within particular domains can be influenced by age‐dependent differences in the indications for and/or nature of surgery and medical comorbidities, and the validity and utility of many measurement tools vary significantly with developmental stage and age. The involvement of parents/carers is essential as they frequently act as surrogate responders for preverbal and developmentally delayed children, parental response may influence child outcome, and parental and/or child ranking of outcomes may differ from those of health professionals. Here, we describe the formation of the international Pediatric Perioperative Outcomes Group, which aims to identify and create validated, broadly applicable, patient‐centered outcome measures for infants, children, and young people. Methodologies parallel that of the StEP and COMPAC projects, and systematic literature searches have been performed within agreed age‐dependent subpopulations to identify reported outcomes and measurement tools. This represents the first steps for developing core outcome sets for pediatric perioperative care. [ABSTRACT FROM AUTHOR]

Background: Intraoperative blood pressure has been suggested as a key factor for safe pediatric anesthesia. However, there is not much insight into factors that discriminate between children with low and normal pre-incision blood pressure. Our aim was to explore whether children who have a low blood pressure during anesthesia are different than those with normal blood pressure. The focus of the present study was on the pre-incision period.Methods: This retrospective study included pediatric patients undergoing anesthesia for non-cardiac surgery at a tertiary pediatric university hospital, between 2012 and 2016. We analyzed the association between pre-incision blood pressure and patient- and anesthesia characteristics, comparing low with normal pre-incision blood pressure. This association was further explored with a multivariable linear regression.Results: In total, 20 962 anesthetic cases were included. Pre-incision blood pressure was associated with age (beta -0.04 SD per year), gender (female -0.11), previous surgery (-0.15), preoperative blood pressure (+0.01 per mm Hg), epilepsy (0.12), bronchial hyperactivity (-0.18), emergency surgery (0.10), loco-regional technique (-0.48), artificial airway device (supraglottic airway device instead of tube 0.07), and sevoflurane concentration (0.03 per sevoflurane %).Conclusions: Children with low pre-incision blood pressure do not differ on clinically relevant factors from children with normal blood pressure. Although the present explorative study shows that pre-incision blood pressure is partly dependent on patient characteristics and partly dependent on anesthetic technique, other unmeasured variables might play a more important role. [ABSTRACT FROM AUTHOR]

Summary: This Statistical Analysis Plan details the statistical procedures to be applied for the analysis of data for the multicenter electroencephalography study. It consists of a basic description of the study in broad terms and separate sections that detail the methods of different aspects of the statistical analysis, summarized under the following headings (a) Background; (b) Definitions of protocol violations; (c) Definitions of objectives and other terms; (d) Variables for analyses; (e) Handling of missing data and study bias; (f) Statistical analysis of the primary and secondary study outcomes; (g) Reporting of study results; and (h) References. It serves as a template for researchers interested in writing a Statistical Analysis Plan. [ABSTRACT FROM AUTHOR]

This paper explores the factors involved in determining the differential performance of firms in bear markets. Bear markets are identified at the industry level by employing the criterion of a 20 percent drop of the industrial value added index over a period of at least 3 years. Twenty-one matched pairs of Dutch firms which have experienced such bear markets (one successful, the other unsuccessful), are analyzed. The dominant finding is that successful firms follow market-oriented strategies, whereas their unsuccessful counterparts are distinguished by their focus on costs. Success, however, is a multifaceted phenomenon. Differences in initial conditions, in other types of strategic measures, in energy levels and in timing are also involved. The findings are related to the literatures on decline, failure, turnaround and transformation. [ABSTRACT FROM AUTHOR]

Summary: Background: Concern over potential neurotoxicity of anesthetics has led to growing interest in prospective clinical trials using potentially less toxic anesthetic regimens, especially for prolonged anesthesia in infants. Preclinical studies suggest that dexmedetomidine may have a reduced neurotoxic profile compared to other conventional anesthetic regimens; however, coadministration with either anesthetic drugs (eg, remifentanil) and/or regional blockade is required to achieve adequate anesthesia for surgery. The feasibility of this pharmacological approach is unknown. The aim of this study was to determine the feasibility of a remifentanil/dexmedetomidine/neuraxial block technique in infants scheduled for surgery lasting longer than 2 hours. Methods: Sixty infants (age 1‐12 months) were enrolled at seven centers over 18 months. A caudal local anesthetic block was placed after induction of anesthesia with sevoflurane. Next, an infusion of dexmedetomidine and remifentanil commenced, and the sevoflurane was discontinued. Three different protocols with escalating doses of dexmedetomidine and remifentanil were used. Results: One infant was excluded due to a protocol violation and consent was withdrawn prior to anesthesia in another. The caudal block was unsuccessful in two infants. Of the 56 infants who completed the protocol, 45 (80%) had at least one episode of hypertension (mean arterial pressure >80 mm Hg) and/or movement that required adjusting the anesthesia regimen. In the majority of these cases, the remifentanil and/or dexmedetomidine doses were increased although six infants required rescue 0.3% sevoflurane and one required a propofol bolus. Ten infants had at least one episode of mild hypotension (mean arterial pressure 40‐50 mm Hg) and four had at least one episode of moderate hypotension (mean arterial pressure <40 mm Hg). Conclusion: A dexmedetomidine/remifentanil neuraxial anesthetic regimen was effective in 87.5% of infants. These findings can be used as a foundation for designing larger trials that assess alternative anesthetic regimens for anesthetic neurotoxicity in infants. [ABSTRACT FROM AUTHOR]

Abstract: Transition‐metal carbene complexes and their reactivities are a key topic of chemistry. They are an integral part of researches in catalysis, organic synthesis, coordination chemistry, and numerous other areas. In this context, we report the synthesis of a low‐valent bis(η5:η1‐(di‐p‐tolyl)‐pentafulvene)niobium chloride. Owing to the π‐η5:σ‐η1 coordination mode of the pentafulvenes and the resulting high nucleophilic character of the exocyclic carbon atom of the ligand, the bis(η5:η1‐pentafulvene)niobium complex is able to achieve the umpolung of a coordinated vinyl unit and the resulting formation of the first η5:η1 cyclic niobium Schrock carbene complex. This new synthetic route is, in comparison to classical α‐hydrogen elimination reactions or thermolysis of diazo compounds, completely unprecedented. The reactivity of the cyclic carbene function and the remaining fulvene ligand is demonstrated by double N−H bond activation of primary amines to niobium imido complexes. [ABSTRACT FROM AUTHOR]

Summary: All commonly used general anesthetics have been shown to cause neurotoxicity in animal models, including nonhuman primates. Opinion, however, remains divided over how cumulative evidence from preclinical and human studies in this field should be interpreted and its translation to current practices in pediatric anesthesia and surgery. A group of international experts in laboratory and clinical sciences recently convened in Genoa, Italy, to evaluate the current state of both laboratory and clinical research and discuss future directions for basic, translational, and clinical studies in this field. This paper describes those discussions and conclusions. A central goal identified was the importance of continuing to pursue laboratory research efforts to better understand the biological pathways underlying anesthesia neurotoxicity. The distinction between basic and translational experimental designs in this field was highlighted, and it was acknowledged that it will be important for future animal research to try to causally link structural changes with long‐term cognitive abnormalities. While inherent limitations will continue to affect the ability of even large observational cohorts to determine if anesthesia impacts neurodevelopment or behavioral outcomes, the importance of conducting further large well‐designed cohort studies was also emphasized. Adequately powered cohorts could clarify which populations are at increased risk, provide information on environmental and healthcare‐related risk modifiers, and guide future interventional trials. If anesthetics cause structural or functional adverse neurological effects in young children, alternative or mitigating strategies need to be considered. While protective or mitigating strategies have been repeatedly studied in animals, there are currently no human data to support alternative anesthetic strategies in clinical practice. Lastly, it was noted that there is still considerable debate over the clinical relevance of anesthesia neurotoxicity, and the need to evaluate the impact of other aspects of perioperative care on neurodevelopment must also be considered. [ABSTRACT FROM AUTHOR]

Introduction: Between 9 and 44% of women experience giving birth as traumatic, and 3% of women develop a post-traumatic stress disorder following childbirth. Knowledge on risk factors is abundant, but studies on treatment are limited. This study aimed to present an overview of means to prevent traumatic birth experiences and childbirth-related post-traumatic stress disorder.Material and Methods: Major databases [Cochrane; Embase; PsycINFO; PubMed (Medline)] were searched using combinations of the key words and their synonyms.Results: After screening titles and abstracts and reading 135 full-text articles, 13 studies were included. All evaluated secondary prevention, and none primary prevention. Interventions included debriefing, structured psychological interventions, expressive writing interventions, encouraging skin-to-skin contact with healthy newborns immediately postpartum and holding or seeing the newborn after stillbirth. The large heterogeneity of study characteristics precluded pooling of data. The writing interventions to express feelings appeared to be effective in prevention. A psychological intervention including elements of exposure and psycho-education seemed to lead to fewer post-traumatic stress disorder symptoms in women who delivered via emergency cesarean section.Conclusions: No research has been done on primary prevention of traumatic childbirth. Research on secondary prevention of traumatic childbirth and post-traumatic stress disorder following delivery provides insufficient evidence that the described interventions are effective in unselected groups of women. In certain subgroups, results are inhomogeneous. [ABSTRACT FROM AUTHOR]