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Since initial experiments with nitrous oxide and ether in the nineteenth century, general anaesthesia has been near synonymous with inhaled agents. However, total intravenous anaesthesia may offer advantages in certain circumstances. Total intravenous anaesthesia can be defined as the induction and maintenance of general anaesthesia using agents given solely intravenously and in the absence of all inhalational agents including nitrous oxide. It may be necessary when volatile anaesthesia is contraindicated or infeasible or may be chosen for other benefits. This chapter provides an overview of the benefits and disadvantages of total intravenous anaesthesia, as well as describing the equipment and care required to use it safely.
A thoroughly revised second edition providing the knowledge and evidence-base needed for the perioperative practitioner, clarifying the underlying principles needed for an understanding of anaesthetic, surgical, and recovery practice. This book defines the level of knowledge required for perioperative practitioners and provides a comprehensive reference to the principles and practice of modern operating department practice. Featuring a diverse range of topics, it offers a multidisciplinary overview of new techniques and technologies, changes in medico-legal requirements, changes to professional accountability, and requirements for continuous professional development. Twelve new chapters cover healthcare ethics and professional regulation, health and safety, infection prevention and control, basic patient monitoring, human factors, and perioperative care of the paediatric patient. Incorporating a new focus on the provision of evidence-based practice and holistic care in all areas of perioperative care, this invaluable book is essential reading for anyone working in this sector, in both education and practice.
Background: Healthcare facilities have experienced many challenges during the COVID-19 pandemic, including limited personal protective equipment (PPE) supplies. Healthcare personnel (HCP) rely on PPE, vaccines, and other infection control measures to prevent SARS-CoV-2 infections. We describe PPE concerns reported by HCP who had close contact with COVID-19 patients in the workplace and tested positive for SARS-CoV-2. Method: The CDC collaborated with Emerging Infections Program (EIP) sites in 10 states to conduct surveillance for SARS-CoV-2 infections in HCP. EIP staff interviewed HCP with positive SARS-CoV-2 viral tests (ie, cases) to collect data on demographics, healthcare roles, exposures, PPE use, and concerns about their PPE use during COVID-19 patient care in the 14 days before the HCP’s SARS-CoV-2 positive test. PPE concerns were qualitatively coded as being related to supply (eg, low quality, shortages); use (eg, extended use, reuse, lack of fit test); or facility policy (eg, lack of guidance). We calculated and compared the percentages of cases reporting each concern type during the initial phase of the pandemic (April–May 2020), during the first US peak of daily COVID-19 cases (June–August 2020), and during the second US peak (September 2020–January 2021). We compared percentages using mid-P or Fisher exact tests (α = 0.05). Results: Among 1,998 HCP cases occurring during April 2020–January 2021 who had close contact with COVID-19 patients, 613 (30.7%) reported ≥1 PPE concern (Table 1). The percentage of cases reporting supply or use concerns was higher during the first peak period than the second peak period (supply concerns: 12.5% vs 7.5%; use concerns: 25.5% vs 18.2%; p Conclusions: Although lower percentages of HCP cases overall reported PPE concerns after the first US peak, our results highlight the importance of developing capacity to produce and distribute PPE during times of increased demand. The difference we observed among selected groups of cases may indicate that PPE access and use were more challenging for some, such as nonphysicians and nursing home HCP. These findings underscore the need to ensure that PPE is accessible and used correctly by HCP for whom use is recommended.
From 2014 to 2020, we compiled radiocarbon ages from the lower 48 states, creating a database of more than 100,000 archaeological, geological, and paleontological ages that will be freely available to researchers through the Canadian Archaeological Radiocarbon Database. Here, we discuss the process used to compile ages, general characteristics of the database, and lessons learned from this exercise in “big data” compilation.
This paper presents a compilation of atmospheric radiocarbon for the period 1950–2019, derived from atmospheric CO2 sampling and tree rings from clean-air sites. Following the approach taken by Hua et al. (2013), our revised and extended compilation consists of zonal, hemispheric and global radiocarbon (14C) data sets, with monthly data sets for 5 zones (Northern Hemisphere zones 1, 2, and 3, and Southern Hemisphere zones 3 and 1–2). Our new compilation includes smooth curves for zonal data sets that are more suitable for dating applications than the previous approach based on simple averaging. Our new radiocarbon dataset is intended to help facilitate the use of atmospheric bomb 14C in carbon cycle studies and to accommodate increasing demand for accurate dating of recent (post-1950) terrestrial samples.
The papers in this forum offer an interdisciplinary assessment of the state of the field of Anglican Studies and perspectives on future trajectories. The first three papers, on liturgy, history, and world Anglicanism, offer an assessment of the respective state of these areas of Anglican Studies. The second set, on theology, sociology of religion, and biblical studies, stake out positions on how these disciplines inform the work of Anglican Studies. A concluding essay offers a synthesis of these papers, focusing on the themes of local contexts for Anglicanism, a further complexification of decolonizing processes in Anglicanism, and the critical role of conversation in Anglican Studies regarding disciplines, languages, and power dynamics.
The Coronavirus Disease 2019 (COVID-19) pandemic has had substantial global morbidity and mortality. Clinical research related to prevention, diagnosis, and treatment of COVID-19 is a top priority. Effective and efficient recruitment is challenging even without added constraints of a global pandemic. Recruitment registries offer a potential solution to slow or difficult recruitment.
The purpose of this paper is to describe the design and implementation of a digital research recruitment registry to optimize awareness and participant enrollment for COVID-19-related research in Baltimore and to report preliminary results.
Planning began in March 2020, and the registry launched in July 2020. The primary recruitment mechanisms include electronic medical record data, postcards distributed at testing sites, and digital advertising campaigns. Following consent in a Research Electronic Data Capture survey, participants answer questions related to COVID-19 exposure, testing, and willingness to participate in research. Branching logic presents participants with studies they might be eligible for.
As of March 24, 2021, 9010 participants have enrolled, and 64.2% are female, 80.6% are White, 9.4% are Black or African American, and 6% are Hispanic or Latino. Phone outreach has had the highest response rate (13.1%), followed by email (11.9%), text (11.4%), and patient portal message (9.4%). Eleven study teams have utilized the registry, and 4596 matches have been made between study teams and interested volunteers.
Effective and efficient recruitment strategies are more important now than ever due to the time-limited nature of COVID-19 research. Pilot efforts have been successful in connecting interested participants with recruiting study teams.
Functional changes in the brain during ageing can alter learning and memory, gait and balance – in some cases leading to early cognitive decline, disability or injurious falls among older adults. Dietary interventions with strawberry (SB) have been associated with improvements in neuronal, psychomotor and cognitive functions in rodent models of ageing. We hypothesised that dietary supplementation with SB would improve mobility and cognition among older adults. In this study, twenty-two men and fifteen women, between the ages of 60 and 75 years, were recruited into a randomised, double-blind, placebo-controlled trial in which they consumed either freeze-dried SB (24 g/d, equivalent to two cups of fresh SB) or a SB placebo for 90 d. Participants completed a battery of balance, gait and cognitive tests at baseline and again at 45 and 90 d of intervention. Significant supplement group by study visit interactions were observed on tests of learning and memory. Participants in the SB group showed significantly shorter latencies in a virtual spatial navigation task (P = 0·020, ηp2 = 0·106) and increased word recognition in the California Verbal Learning test (P = 0·014, ηp2 = 0·159) across study visits relative to controls. However, no improvement in gait or balance was observed. These findings show that the addition of SB to the diets of healthy, older adults can improve some aspects of cognition, but not gait or balance, although more studies with a larger sample size and longer follow-up are needed to confirm this finding.
An interested and engaged electorate is widely believed to be an indicator of democratic health. As such, the aggregate level of political interest of an electorate – macrointerest – is an essential commodity in a democracy, and understanding the forces that change macrointerest is important for diagnosing the health of a democracy. Because being interested in politics requires time and effort, the article theorizes that the electorate's level of political interest will be highest when the electorate believes the government cannot be trusted or is performing poorly. To test hypotheses derived from a proposed theory against rival explanations, the study develops a measure of macrointerest using a quarterly time series of aggregated survey items (1973–2014) of political interest. The authors find support for the theory that the electorate responds as reasonable agents when determining how closely to monitor elected officials: interest is positively related to decreases in trust in government.
OBJECTIVES/GOALS: Access to pediatric subspecialty care varies by sociodemographic factors. Providers for gender diverse youth (GDY) are rare, and GDY face health disparities, stigma, and discrimination. We examined the association between GDY access to medical and mental health care and rurality, race, parental education, and other GDY-specific factors. METHODS/STUDY POPULATION: We surveyed parents of GDY (<18 years old) across the United States. Participants were recruited through online communities and listserves specific to parents of GDY. We determined associations between access to gender-specific medical or mental health providers and rurality, race, parental education, as well as other GDY-specific factors including age, time since telling their parent their gender identity, parent-adolescent communication, parent stress, and gender identity using chi-square or Fisher’s exact tests. We calculated adjusted odds ratios using logistic regression models. RESULTS/ANTICIPATED RESULTS: We surveyed 166 parents and caregivers from 31 states. The majority (73.2%) identified as white, 66.5% had earned a bachelor’s degree or higher, and 7.6% lived in a zip code designated rural by the Federal Office of Rural Health Policy. We found no evidence of association between reported GDY access to medical or mental health care and race, parental education, or rurality. We did find a significant univariate association between access to mental health care and feminine (either female or transfeminine/transfemale) gender identity (p = 0.033, OR 2.60, 95% CI 1.06 – 6.36). After controlling for parent-adolescent communication in a backwards elimination logistic regression model, it was no longer significant (p = 0.137, OR 2.05, 95% CI 0.80 – 5.25). DISCUSSION/SIGNIFICANCE OF IMPACT: Despite rurality, race, and parental education impacting access to pediatric subspecialty care, we failed to find these associations among GDY accessing gender care. There is a need to better understand structural and societal barriers to care for this population including the impact of stigma and discrimination.
Three of Thomas Pynchon’s novels – The Crying of Lot 49 (1966), Vineland (1990), and Inherent Vice (2009) – are set primarily in California in the 1960s, 1970s, and 1980s. These “California novels” are shorter and less structurally complex than the longer, encyclopedic, globe-trotting, and quasi-historical works that have established his literary reputation (though The Crying of Lot 49 is undoubtedly the most widely read and taught of his novels). Two of the longer novels, Gravity’s Rainbow (1973) and Against the Day (2006), also conclude with episodes set in Southern California, in the 1970s and 1920s respectively. Despite their formal differences, the California novels deal with many of the same concerns that animate the longer works, including perhaps most centrally, the struggles of individual human subjects to understand and liberate themselves from the varied but often obscured agents of determinacy – economic, political, psychological, and existential – arrayed against them. In order to situate the California fiction within the body of Pynchon’s work, it is worth exploring some of the meanings attached to the common setting that Pynchon chose for them.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
The Enenteridae Yamaguti, 1958 and Gyliauchenidae Fukui, 1929 exhibit an interesting pattern of host partitioning in herbivorous fishes of the Indo-West Pacific. Enenterids are known almost exclusively from fishes of the family Kyphosidae, a group of herbivorous marine fishes common on tropical and temperate reefs. In contrast, gyliauchenids are found in most of the remaining lineages of marine herbivorous fishes, but until the present study, had never been known from kyphosids. Here we report on the first species of gyliauchenid known from a kyphosid. Endochortophagus protoporus gen. nov., sp. nov. was recovered from the Western buffalo bream, Kyphosus cornelii (Whitley, 1944), collected off Western Australia. Kyphosus cornelii also hosts an enenterid, Koseiria allanwilliamsi Bray & Cribb, 2002, and is thus the first fish known in which enenterids and gyliauchenids co-occur. Molecular phylogenetic analyses place the new species close to those of Affecauda Hall & Chambers, 1999 and Flagellotrema Ozaki, 1936, but there is sufficient morphological evidence, combined with the unusual host, to consider it distinct from these genera. We discuss factors which may have contributed to the host partitioning pattern observed between enenterids and gyliauchenids.
This work describes exploration of mitigating the parasitic amorphous alumina (Al2O3) shell of aluminum nanoparticles (n-Al) and modifying the surface using different plasmas, leading to n-Al with thinner shell and different coatings including carbons and oxidizing salt called aluminum iodate hexahydrate (AIH), respectively. The approach exploits a prototype atmospheric non-thermal plasma reactor with dielectric barrier discharge (DBD) configuration for nanoparticle surface modifications using n-Al of 80 nm average diameter as an example. Preliminary results indicate that the amorphous Al2O3 shell surrounding the active aluminum core can be mitigated with inert plasmas by as much as 40% using either helium (He) or argon (Ar). The particle surface becomes carbon-rich with carbon monoxide (CO) / He plasmas. By immersing the plasma-treated n-Al in an iodic acid (HIO3) solution, AIH crystals can be formed on the n-Al surface. Transmission electron microscopy (TEM) is used as a major tool to study the details of the modified surface morphologies, diffraction patterns, and chemical composition of the modified n-Al. The results demonstrate effective surface passivation of n-Al via atmospheric plasma techniques.