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Background Trauma patients requiring abdominal operation have considerable morbidity and mortality, yet no specific quality indicators are measured in the trauma systems of the UK. The aims of this study were to describe the characteristics and outcomes of patients undergoing emergency abdominal operation and key processes of care. Study Design A prospective multicenter service evaluation was conducted within all of the major trauma centers in the UK. The study was conducted during 6 months beginning in January 2019. Patients of any age undergoing laparotomy or laparoscopy within 24 hours of injury were included. Existing standards for related emergent conditions were used. Results The study included 363 patients from 34 hospitals. The majority were young men with no comorbidities who required operation to control bleeding (51%). More than 90% received attending-delivered care in the emergency department (318 of 363) and operating room (321 of 363). The overall mortality rate was 9%. Patients with blunt trauma had a greater risk of death compared with patients with penetrating injuries (16.6% vs 3.8%; risk ratio 4.3; 95% CI, 2.0 to 9.4). Patients in which the Major Hemorrhage Protocol (MHP) was activated and who received a blood transfusion (n = 154) constituted a high-risk subgroup, accounting for 45% of the study cohort but 97% of deaths and 96% of blood components transfused. The MHP subgroup had expedited timelines from emergency department arrival to knife to skin (MHP: median 119 minutes [interquartile range 64 to 218 minutes] vs no MHP: median 211 minutes [interquartile range 135 to 425 minutes]; p Conclusions The majority of trauma patients requiring emergency abdominal operation received a high standard of expedited care in a maturing national trauma system. Despite this, mortality and resource use among high-risk patients remains considerable.

In the present study on winter crop growth monitoring in different villages in Kapadvanj Taluka of Kheda district was carried out using multi-temporal Sentinel-2 multi-spectral data (spatial resolution 10-m). Multi-temporal Sentinel-2 data covering study area for the winter crop period from November-2018 to March-2019 was downloaded from https://earthexplorer.usgs.gov/. The major objective of this study was to monitor site-specific crop growth in different villages of Kapadvanj Taluka by generating Normalized Difference Vegetation Index (NDVI) profiles of major winter crops. The spectral behavior of wheat, potato, bajara and castor crops during active growth stages was studied and it was observed that the spectral response of wheat and potato crops have quite distinct spectral behavior. However, castor and bajara crops do not show distinct spectral behavior. In this study, from the NDVI profiles of different crops it was observed that very distinct growth stages like early growth stage to flag leaf emergence which correspondence to rising of NDVI, followed by flag leaf emergence to flowering and grain filling stages which corresponds to maximum NDVI and finally physiological maturity stages corresponding to declining of NDVI of all the winter crops.

Background: Acute pain management in patients on buprenorphine opioid agonist therapy (BOAT) can be challenging. It is unclear whether BOAT should be continued or interrupted for optimization of postoperative pain control. Objectives: To determine an evidence-based approach for pain management in patients on BOAT in the perioperative setting, particularly whether BOAT should be continued or interrupted with or without bridging to another mu opioid agonist and to identify benefits and harms of either perioperative strategy. Study Design: Systematic literature review with qualitative data synthesis. Setting: Hospital, perioperative. Methods: The study protocol was registered on PROSPERO (Registration number 9030276355). Medline via OVID, EMBASE, CINAHL, and the Cochrane CENTRAL register of trials were searched for prospective or retrospective observational or controlled studies, case series, and case reports that described perioperative or acute pain care for patients on BOAT. References of narrative and systematic reviews addressing acute pain management in patients on BOAT and references of included articles were hand-searched to identify additional original articles for inclusion. The full text of publications were reviewed for final inclusion, and data were extracted using a standardized data extraction form. Results were summarized qualitatively. Primary outcomes were postoperative pain intensity and total opioid use and identification of benefits and harms of perioperative strategies. Results: Eighteen publications presenting data on the perioperative management of patients on BOAT were identified: 10 case reports, 5 case series, and 3 retrospective cohort studies. Eleven articles reported continuation of BOAT, 2 concerned bridging BOAT, and 4 articles described stopping BOAT without planned bridging. In one retrospective cohort study, BOAT was continued in half and interrupted in half of patients. Patients on BOAT may have pain that is more difficult to treat than those who are not on OAT. There is no clear evidence that one particular strategy provides superior postoperative pain control, but interruption of BOAT may result in harm, including failure to return to baseline BOAT doses, continuing non-BOAT opioid use, or relapse of opioid use disorder. Limitations: There were a limited number of articles relevant to the study question consisting of case reports and retrospective observational studies. Some omitted relevant details. No prospective studies were found. Conclusions: There is no clear benefit to bridging or stopping BOAT but failure to restart it may pose concerns for relapse. We recommend continuing BOAT in the perioperative period when possible and incorporating an interdisciplinary approach with multimodal analgesia. Key words: Opioid use disorder, opiate substitution treatment, buprenorphine, buprenorphinenaloxone, buprenorphine opioid agonist therapy, postoperative pain, acute pain, multimodal analgesia

Preexisting cross-reactivity to SARS-CoV-2 occurs in the absence of prior viral exposure. However, this has been difficult to quantify at the population level due to a lack of reliably defined seroreactivity thresholds. Using an orthogonal antibody testing approach, we estimated that about 0.6% of nontriaged adults from the greater Vancouver, Canada, area between May 17 and June 19, 2020, showed clear evidence of a prior SARS-CoV-2 infection, after adjusting for false-positive and false-negative test results. Using a highly sensitive multiplex assay and positive/negative thresholds established in infants in whom maternal antibodies have waned, we determined that more than 90% of uninfected adults showed antibody reactivity against the spike protein, receptor-binding domain (RBD), N-terminal domain (NTD), or the nucleocapsid (N) protein from SARS-CoV-2. This seroreactivity was evenly distributed across age and sex, correlated with circulating coronaviruses' reactivity, and was partially outcompeted by soluble circulating coronaviruses' spike. Using a custom SARS-CoV-2 peptide mapping array, we found that this antibody reactivity broadly mapped to spike and to conserved nonstructural viral proteins. We conclude that most adults display preexisting antibody cross-reactivity against SARS-CoV-2, which further supports investigation of how this may impact the clinical severity of COVID-19 or SARS-CoV-2 vaccine responses.

The present study investigated the biofilm organisms growing on selected monuments of the Champaner Pavagadh complex (Gujarat, India), which is a UNESCO World Heritage Site. The cyanobacteria and microalgae were isolated from biofilms collected through non-destructive methods. The identification of these biological organisms was done using micro-morphological characters and confirmed by 16S rRNA gene sequencing. The exopolysaccharide of each of the isolated strains was extracted, hydrolysed and analysed by the HPTLC. Six isolated strains representing five cyanobacteria and one microalga belong to the genera Desmonostoc, Nostoc, Leptolyngbya, Chroococcidiopsis and Asterarcys. The relationships between substrates’ specificity of these isolated biofilm organisms and those identified globally were evaluated using maximum parsimony analysis to generate a consensus phylogenetic tree. The five strains of cyanobacteria isolated were closely clustered with cyanobacteria belonging to a tropical region. At the generic level, no relationship between the species and substratum specificity was recorded. The exopolysaccharide analysis of the isolated strains revealed the presence of seven monosaccharides. While glucose was present in all the analysed species, the concentration of either fucose or arabinose was high. The current study presents a novel HPTLC-based method for determination of monosaccharides composition from the extracellular polymeric substances.

BackgroundQuantifying antibody reactivity against multiple SARS-CoV-2 antigens at the population level may help understand individual differences in COVID-19 severity. Pre-existing low antibody cross-reactivity may be particularly prevalent among childcare providers, including pediatric health care workers (HCW) who may be more exposed to circulating coronaviruses.MethodsCross-sectional study that included adults in the Vancouver area in British Columbia (BC), Canada, between May 17 and June 19, 2020. SARS-CoV-2 seroprevalence was ascertained by measuring total SARS-CoV-2 IgG/M/A antibodies against a recombinant spike (S1) protein and adjusted for bias due to false-positive and false-negative test results. A novel, high sensitivity multiplex assay was also used to profile IgG against four SARS-CoV-2 antigens, SARS-CoV and four circulating coronaviruses.FindingsAmong 276 participants (71% HCW), three showed evidence of direct viral exposure, yielding an adjusted seroprevalence of 0.60% [95%CI 0% – 2.71%], with no difference between HCW and non-HCW, or between paediatric and adult HCW. Among the 273 unexposed individuals, 7.3% [95%CI 4.5% – 11.1%], 48.7 [95%CI 42.7% – 54.8%] and 82.4% [95%CI 77.4% – 86.7%] showed antibody reactivity against SARS-CoV-2 RBD, N or Spike proteins, respectively. SARS-CoV-2 reactivity did not significantly correlate with age, sex, did not significantly differ between HCW and non-HCW (prevalence 1.0% vs 1.0%; P=1.00) and between pediatric and adult HCW (0.7% vs 1.6%; P=0.54), and modestly correlated with reactivity to circulating coronaviruses (Spearman rho range: 0.130 to 0.224 for 7 significant (FDR 5%), out of 16 correlations, from 36 correlations tested).InterpretationA substantial proportion of individuals showed low, but detectable antibody reactivity against SARS-CoV-2 antigens in this population despite low evidence of direct SARS-CoV-2 exposure.FundingNIAID/NIH

Neurologic complications in the parturient related to both obstetrics or anesthesia are rare. Women who do not receive neuraxial anesthesia may also present with neurologic complaints. Risk is difficult to calculate due to inaccurate diagnosis, incomplete follow-up (due to resolution of symptoms after hospital discharge), lack of statistical power to assess rare outcomes, and inconsistency of skills of obstetricians and anesthesiologists. Bias also exists as women who received neuraxial techniques are more likely to have neurologic symptoms reported and investigated. Due to the performance of a neuraxial technique, the anesthesiologist is often the first physician contacted for assessment of the patient with such complaints, regardless of the cause of the deficit. Knowledge of risks and possible neurologic complications of anesthetic techniques, as well as other neuropathies related to pregnancy, labor, and delivery, is therefore very important. Anesthesiologists practicing obstetric anesthesia should be able to assess a patient with neurologic deficits and differentiate between obstetric- and anesthetic-related injuries to facilitate immediate diagnosis and treatment of complications that might lead to permanent sequelae.

Objective Microalbuminuria (MA), a marker of renal microvascular disease, is associated with brain atrophy and neurovascular changes in older adults with type 2 diabetes mellitus (DM). We evaluated the relationship between urine albumin-to-creatinine ratio (UACR) and regional brain volumes to determine whether subclinical albuminuria may indicate early structural brain changes in type 2 DM. Materials/Methods We studied UACR and brain volumes in 85 type 2 DM patients (64.8 ± 8.3 years) and 40 age-matched controls using 3D magnetization prepared rapid acquisition with gradient echo (MP-RAGE) MRI (magnetic resonance imaging) at 3 Tesla. The relationship between UACR and brain volumes was analyzed using the least square models. Results In DM patients, UACR ≥ 5 mg/g, UACR ≥ 10 mg/g and clinically significant MA (UACR ≥ 17 mg/g [males] and 25 mg/g [females]) were associated with lower gray matter (GM) volume in the frontal lobe (r 2 adj = 0.2–0.4, P = 0.01–0.05) and UACR ≥ 5 mg/g was also related to global GM atrophy (r 2 adj = 0.1, P = 0.04), independent of DM duration, glucose levels, HbA 1c and hypertension. For UACR ≥ 5 mg/g, a lower global GM volume was related to worse executive function ( P = 0.04) in the DM group. No associations were found for UACR ( Conclusions Subclinical albuminuria (UACR ≥ 5 mg/g) is associated with lower GM volume that has clinical impact on cognitive function in older diabetic patients, and these relationships are independent of DM control and hypertension. Therefore, UACR levels may serve as an additional marker of DM-related brain structural changes.

Summary Objectives: To compare the effects of droperidol and ondansetron on electrocardiographic indices of myocardial repolarization in children. Aim: To refine understanding of the torsadogenic risk to children exposed to anti-emetic prophylaxis in the perioperative period. Background: QT interval prolongation is associated with torsades des pointes (TdP), but is a poor predictor of drug torsadogenicity. Susceptibility to TdP arises from increased transmural dispersion of repolarization (TDR) across the myocardial wall, rather than QT interval prolongation per se. TDR can be measured on the electrocardiogram as the time interval between the peak and end of the T wave (Tp-e). Tp-e may therefore provide a readily available, noninvasive assay of drug torsadogenicity. The perioperative period is one of high risk for TdP in children with or at risk of long QT syndromes. Droperidol and ondansetron are two drugs commonly administered perioperatively, for prophylaxis of nausea and vomiting, which can prolong the QT interval. This study investigated their effects on myocardial repolarization. Methods: One hundred and eight ASA1-2 children undergoing elective day-case surgery were randomized to receive droperidol, ondansetron, both or neither. Pre- and post-administration 12-lead electrocardiogram (ECGs) were recorded. QT and Tp-e intervals were measured and compared within and between groups, for the primary endpoint of a 25 ms change in Tp-e. Results: Eighty children completed the study. There were no demographic or baseline ECG differences between groups. QT intervals lengthened by 10–17 ms after allocated treatments, with no between-group differences. Values remained within normal limits for all groups. Tp-e intervals increased by 0–7 ms, with no between-group differences. There were no instances of dysrhythmia. Conclusions: Droperidol and ondansetron, in therapeutic anti-emetic doses, produce equivalent, clinically insignificant QT prolongation and negligible Tp-e prolongation, suggesting that neither is torsadogenic in healthy children at these doses.

SummaryBackground Emergence delirium (ED) refers to a variety of behavioral disturbances commonly seen in children following emergence from anesthesia. Vapor-based anesthesia with sevoflurane, the most common pediatric anesthetic technique, is associated with the highest incidence of ED. Propofol has been shown to reduce ED, but these studies have been methodologically limited. Objective To conduct a randomized-controlled trial comparing the incidence of ED in children following sevoflurane (SEVO) anesthesia and propofol–remifentanil total intravenous anesthesia (TIVA). Methods One hundred and twelve children, ASA I-II, aged ≥2 and ≤6 years, undergoing strabismus repair, were assigned to receive TIVA (intravenous induction and maintenance of anesthesia with propofol and remifentanil) or SEVO (inhalational induction and maintenance of anesthesia with sevoflurane). Parent–child induction behavior was scored using the Perioperative Adult Child Behavior Interaction Scale (PACBIS). Postoperatively, ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) Scale and pain using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale every 5 min. Results Data are reported for 94 subjects. Incidence of ED was higher with SEVO (38.3% vs 14.9%, P = 0.018). There was no difference in the median PACBIS score. A higher FLACC score was seen with SEVO (median 3 vs 1, P = 0.033). Subjects experiencing ED had higher FLACC scores vs those unaffected by ED (median 7 vs 1, P

BACKGROUND Emergence following termination of a general anesthetic depends on the effect site concentration (C(e)) of the drug declining to an awakening value (C(e)-awake). C(e)-awake has been described in adults, but is unknown in children. OBJECTIVES To determine C(e)-awake in children following a target-controlled infusion (TCI) of propofol and to assess a C(e)-driven TCI system's ability to predict times to emergence from anesthesia. METHODS Subjects undergoing elective surgery, aged 3 months to

Summary Introduction: This study aimed to determine the age-specific bolus dose of remifentanil (ED50) to facilitate tracheal intubation without the use of neuromuscular blocking agents. Methods: ASA 1–2 subjects were recruited into three groups of 0–3 months (group I), 4–12 months (group II), and 1–3 years (group III) of age. A sequential up-and-down design determined the remifentanil bolus dose, which was initially started at 3 mcg·kg−1 and adjusted in 1 mcg·kg−1 increments (range 1–6 mcg·kg−1). Following pretreatment with glycopyrrolate 10 μg·kg−1 and an induction dose of propofol 5 mg·kg−1, remifentanil was administered with a blinded study investigator commencing tracheal intubation after 60 s. After tracheal intubation, the time to return of spontaneous ventilation was measured. Logistic regression was used to predict the ED50 and ED95 of remifentanil. Results: Sixty-four subjects were recruited. Tracheal intubation was successful at first attempt in over 90% of subjects in each age group. Satisfactory intubating conditions were achieved in 85%, 63%, and 75% of subjects in groups I, II, and III, respectively. The logistic regression results for ED50 (95% CI) were 3.1 (2.5–3.8), 3.7 (2.0–5.4), and 3.0 (2.1–3.9) mcg·kg−1, and ED95 (95% CI) were 5.0 (3.0–7.0), 9.4 (1.5–17.4), and 5.6 (2.9–8.4) mcg·kg−1 in groups I, II, and III, respectively. Infants aged 4–12 months (group II) showed a marked variability in dose response; however, the mean ED50 and ED95 were not different to groups I and III. Older children had a longer duration of apnea than infants, 331 vs 180 s (P

Target controlled infusion (TCI) for Kids is a computer controlled system designed to administer propofol for general anesthesia. A controller establishes infusion rates required to achieve a specified concentration at the drug's effect site (C(e)) by implementing a continuously updated pharmacokinetic-pharmacodymanic model. This manuscript provides an overview of the system's design, preclinical tests, and a clinical pilot study. In pre-clinical tests, predicted infusion rates for 20 simulated procedures displayed complete convergent validity between two software implementations, Labview and Matlab, at computational intervals of 5, 10, and 15s, but diverged with 20s intervals due to system rounding errors. The volume of drug delivered by the TCI system also displayed convergent validity with Tivatrainer, a widely used TCI simulation software. Further tests, were conducted for 50 random procedures to evaluate discrepancies between volumes reported and those actually delivered by the system. Accuracies were within clinically acceptable ranges and normally distributed with a mean of 0.08 +/- 0.01 ml. In the clinical study, propofol pharmacokinetics were simulated for 30 surgical procedures involving children aged 3 months to 9 years. Predicted C(e) values during standard clinical practice, the accuracy of wake-up times predicted by the system, and potential correlations between patient wake-up times, C(e), and state entropy (SE) were assessed. Neither Ce nor SE was a reliable predictor of wake-up time in children, but the small sample size of this study does not fully accommodate the noted variation in children's response to propofol. A C(e) value of 1.9 mug/ml was found to best predict emergence from anesthesia in children.