The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were ...compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.
In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review the science and use expert ...consensus to produce best practice recommendations to address the issue of perioperative hemodynamic instability. After expert presentations, a modified Delphi process using discussions, voting, and feedback resulted in 17 recommendations regarding advancing the perioperative care of the patient at risk of, or with, hemodynamic instability. There were 17 high-level recommendations. These recommendations related to the following 7 domains: Current Knowledge (5 statements); Preventing Hemodynamic Instability-Related Harm During All Phases of Care (4 statements); Data-Driven Quality Improvement (3 statements); Informing Patients (2 statements); The Importance of Technology (1 statement); Launch a National Campaign (1 statement); and Advancing the Science (1 statement). A summary of the recommendations is presented in Table 1 .
COVID survivors frequently experience lingering neurological symptoms that resemble cancer therapy-related cognitive impairment, a syndrome for which white-matter microglial reactivity and consequent ...neural dysregulation is central. Here, we explored the neurobiological effects of respiratory SARS-CoV-2 infection and found white-matter-selective microglial reactivity in mice and humans. Following mild respiratory COVID in mice, persistently impaired hippocampal neurogenesis, decreased oligodendrocytes and myelin loss were evident together with elevated CSF cytokines/chemokines including CCL11. Systemic CCL11 administration specifically caused hippocampal microglial reactivity and impaired neurogenesis. Concordantly, humans with lasting cognitive symptoms post-COVID exhibit elevated CCL11 levels. Compared to SARS-CoV-2, mild respiratory influenza in mice caused similar patterns of white matter-selective microglial reactivity, oligodendrocyte loss, impaired neurogenesis and elevated CCL11 at early timepoints, but after influenza only elevated CCL11 and hippocampal pathology persisted. These findings illustrate similar neuropathophysiology after cancer therapy and respiratory SARS-CoV-2 infection which may contribute to cognitive impairment following even mild COVID.
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Technology utilizing human induced pluripotent stem cells (iPS cells) has enormous potential to provide improved cellular models of human disease. However, variable genetic and phenotypic ...characterization of many existing iPS cell lines limits their potential use for research and therapy. Here we describe the systematic generation, genotyping and phenotyping of 711 iPS cell lines derived from 301 healthy individuals by the Human Induced Pluripotent Stem Cells Initiative. Our study outlines the major sources of genetic and phenotypic variation in iPS cells and establishes their suitability as models of complex human traits and cancer. Through genome-wide profiling we find that 5-46% of the variation in different iPS cell phenotypes, including differentiation capacity and cellular morphology, arises from differences between individuals. Additionally, we assess the phenotypic consequences of genomic copy-number alterations that are repeatedly observed in iPS cells. In addition, we present a comprehensive map of common regulatory variants affecting the transcriptome of human pluripotent cells.
Genetic testing and family entanglements Dimond, Rebecca; Doheny, Shane; Ballard, Lisa ...
Social science & medicine,
April 2022, 2022-04-00, 20220401, Letnik:
298
Journal Article
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The development of the ‘new genetics’ in the early 1990's opened up a new space which required some patients and families to understand and navigate genetic testing. The social science literature ...that has grown alongside the ‘new genetics’, now spanning more than thirty years, has continued to explore and question assumptions about attitudes and responses towards genetic technologies. In this article we highlight how individual experience of genetic disease and personal responses towards genetic technologies can only be understood by considering their context. We focus on the rich literature on family within sociology, science and technology studies, anthropology, and family studies, to explore the myriad ways in which family is implicated in the patient experience of genetic testing. We explore these connections by drawing on a set of interviews held with individuals who have undergone a predictive test for a genetic condition, including Huntington's Disease and breast cancer. Five themes were developed: family disclosure, family gatekeeping, going for testing, individual and collective communication practices, and receiving a negative test result. To conclude, we highlight how these connections might be considered through the lens of entanglement, explaining the complex mechanisms through which family and genetics are intimately entwined.
We explored the early stages of decision making about predictive genetic testing.The concept of entanglement was used to explore the role of family in genetics.The family act as gatekeepers and communicators of genetic information.Barriers to family communication include the desire to protect and respect others.Family entanglements continue to shape communication and experience.
This study aimed to investigate the efficacy of private septic systems retrofitted into aerobic bioreactors with ‘SludgeHammer’ technology. In addition, the study attempted to characterize the ...strength of domestic wastewater released from ‘green’ households practicing water conservation strategies. Ten retrofitted onsite septic systems were studied in the Edmonton area, Alberta (AB) Canada during winter. These systems could remove BOD5 and TSS by 92 ± 5 and 92 ± 6% respectively which, according to Albertan regulatory standards, were characteristic removal efficiencies of the secondary treatment in the subsequent drain field. These removal efficiencies were remarkable given the strength of the influent wastewater. The raw wastewater carried significantly high pollutant concentrations (1160 ± 350 mg BOD5/L, 1653 ± 1174 mg TSS/L, 99 ± 19 mg NH4+-N/L, 100 ± 56 mg TN/L, and 39 ± 28 mg PO43−-P/L), characterizing it as high-strength domestic wastewater. Mixing provided by the aerator could only suspend 1/34th (3% m/m) of the solids in the bioreactor and consequently released significantly low solid concentrations (195 ± 206 mg TSS/L) into the final treatment component. As such, this technology did not impair the natural function of septic tanks or did not create any unintended excessive solid loading on drain field as a consequence of the added mixing energies provided by the active aeration. Nitrogen balance suggested the possibility of simultaneous nitrification and denitrification (SND) in the aerobic bioreactors. In some cases, PO43−-P removal efficiency was as high as that in enhanced biological phosphate removal (EBPR) process (81–97%). Phosphorus balance estimated that non-assimilative pathways (i.e., EBPR + biologically induced phosphate precipitation (BIPP)) contributed 50–99% to overall phosphorus removal in the system. Long HRTs, high influent BOD5 and anaerobic/aerobic zoning in the bioreactor most likely provided favorable conditions for SND and high phosphorus removal efficiencies in the retrofitted onsite wastewater treatment systems (OWTS).
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•Wastewater released from ‘green’ households was characterized as high strength.•Remarkable removal efficiencies were seen despite high influent concentrations.•High BOD5 and TSS removal % met the regulatory secondary treatment requirement.•Low aeration energy did not cause sludge migration to the drain field.•High influent BOD5 + long HRT + anaerobic/aerobic zoning → High P removal % + SND
Human disease phenotypes are driven primarily by alterations in protein expression and/or function. To date, relatively little is known about the variability of the human proteome in populations and ...how this relates to variability in mRNA expression and to disease loci. Here, we present the first comprehensive proteomic analysis of human induced pluripotent stem cells (iPSC), a key cell type for disease modelling, analysing 202 iPSC lines derived from 151 donors, with integrated transcriptome and genomic sequence data from the same lines. We characterised the major genetic and non-genetic determinants of proteome variation across iPSC lines and assessed key regulatory mechanisms affecting variation in protein abundance. We identified 654 protein quantitative trait loci (pQTLs) in iPSCs, including disease-linked variants in protein-coding sequences and variants with
regulatory effects. These include pQTL linked to GWAS variants that cannot be detected at the mRNA level, highlighting the utility of dissecting pQTL at peptide level resolution.
Identifying internal waves in complex flow fields is a long‐standing problem in fluid dynamics, oceanography and atmospheric science, owing to the overlap of internal waves temporal and spatial ...scales with other flow regimes. Lagrangian filtering—that is, temporal filtering in a frame of reference moving with the flow—is one proposed methodology for performing this separation. Here we (a) describe an improved implementation of the Lagrangian filtering methodology and (b) introduce a new freely available, parallelized Python package that applies the method. We show that the package can be used to directly filter output from a variety of common ocean models including MITgcm, Regional Ocean Modeling System and MOM5 for both regional and global domains at high resolution. The Lagrangian filtering is shown to be a useful tool to both identify (and thereby quantify) internal waves, and to remove internal waves to isolate the non‐wave flow field.
Plain Language Summary
Ocean flows are a superposition of many different flow phenomena including eddies, jets, currents, and waves. Quantifying a particular phenomenon therefore requires a method to identify and separate that phenomenon from others in the flow, in order to be able to assess the associated energy and energetic exchanges. Here we present a new implementation of a method to identify a particular phenomenon known as “internal waves”—hourly to daily oscillatory motions which propagate three‐dimensionally throughout the ocean, driving mixing and thereby supporting the global ocean circulation. The method involves a combination of a coordinate transformation and a high‐pass temporal filter. Here we describe a newly released, freely available, efficient and user‐friendly open‐source Python package that implements the method.
Key Points
A new open source parallelized Python package to perform Lagrangian filtering is now available
The package implements an improved method for filtering internal waves from high‐resolution numerical model output
The package may be applied to directly filter output from a number of common ocean models including MITgcm, Regional Ocean Modeling System and MOM5
During the production of offshore oil and gas, the cooling of hydrocarbons toward seafloor temperatures enables the formation of gas hydrates, which may restrict fluid flow and ultimately block the ...flowline. During the formation of a hydrate blockage, a hydrate film may grow between individual particles or between hydrate particles and the pipeline wall, respectively, resulting in a higher slurry viscosity or a reduced hydraulic diameter. This hydrate film growth rate has been previously studied as a function of pressure, temperature, and hydrate guest species, but limited data are available to guide whether naturally occurring surface active components in the oil may affect the hydrate film growth rate. In this study, we have used a micromechanical force (MMF) apparatus to quantify the film growth rate of cyclopentane hydrate at moderate subcooling. Naturally occurring surface active species were obtained from an Australian crude oil by solvent extraction to separate out asphaltenes, binding resins, and free resins. Each crude oil fraction was then added to a chemically inert hydrocarbon phase, and the impact of the hydrate film growth rate was measured. The results illustrate that, at mass fractions below 300 ppm, the hydrate film growth rate was reduced by at least 1 order of magnitude with asphaltenes and free resins being the most and least effective fractions, respectively, at suppressing hydrate film growth rate. The presence of each fraction also caused an increase in the wetting angle of the water droplet on the hydrate particle surface, which suggested that these naturally occurring components may adsorb to the hydrate particle surface. Measurements with the MMF revealed that each of the three fractions was able to reduce the hydrate particle cohesive force by 2 orders of magnitude.
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