Pre-operative gastric ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study.

Point-of-care gastric sonography offers an objective approach to assessing individual pulmonary aspiration risk before induction of general anaesthesia. We aimed to evaluate the potential impact of routine pre-operative gastric ultrasound on peri-operative management in a cohort of adult patients undergoing elective or emergency surgery at a single centre. According to pre-operative gastric ultrasound results, patients were classified as low risk (empty, gastric fluid volume ≤ 1.5 ml.kg-1 body weight) or high risk (solid, mixed or gastric fluid volume > 1.5 ml.kg-1 body weight) of aspiration. After sonography, examiners were asked to indicate changes in aspiration risk management (none; more conservative; more liberal) to their pre-defined anaesthetic plan and to adapt it if patient safety was at risk. We included 2003 patients, 1246 (62%) of which underwent elective and 757 (38%) emergency surgery. Among patients who underwent elective surgery, 1046/1246 (84%) had a low-risk and 178/1246 (14%) a high-risk stomach, with this being 587/757 (78%) vs. 158/757 (21%) among patients undergoing emergency surgery, respectively. Routine pre-operative gastric sonography enabled changes in anaesthetic management in 379/2003 (19%) of patients, with these being a more liberal approach in 303/2003 (15%). In patients undergoing elective surgery, pre-operative gastric sonography would have allowed a more liberal approach in 170/1246 (14%) and made a more conservative approach indicated in 52/1246 (4%), whereas in patients undergoing emergency surgery, 133/757 (18%) would have been managed more liberally and 24/757 (3%) more conservatively. We showed that pre-operative gastric ultrasound helps to identify high- and low-risk situations in patients at risk of aspiration and adds useful information to peri-operative management. Our data suggest that routine use of pre-operative gastric ultrasound may improve individualised care and potentially impact patient safety

First principles study of the multiferroics BiFeO3_{3}, Bi2_{2}FeCrO6_{6}, and BiCrO3_{3}: Structure, polarization, and magnetic ordering temperature

We present results of an {\it ab initio} density functional theory study of three bismuth-based multiferroics, BiFeO$_{3}$, Bi$_{2}$FeCrO$_{6}$, and BiCrO$_{3}$. We disuss differences in the crystal and electronic structure of the three systems, and we show that the application of the LDA+$U$ method is essential to obtain realistic structural parameters for Bi$_{2}$FeCrO$_{6}$. We calculate the magnetic nearest neighbor coupling constants for all three systems and show how Anderson's theory of superexchange can be applied to explain the signs and relative magnitudes of these coupling constants. From the coupling constants we then obtain a mean-field approximation for the magnetic ordering temperatures. Guided by our comparison of these three systems, we discuss the possibilities for designing a multiferroic material with large magnetization above room temperature.Comment: 8 Pages, 4 Figure

Superconductive "sodalite"-like clathrate calcium hydride at high pressures

Hydrogen-rich compounds hold promise as high-temperature superconductors under high pressures. Recent theoretical hydride structures on achieving high-pressure superconductivity are composed mainly of H2 fragments. Through a systematic investigation of Ca hydrides with different hydrogen contents using particle-swam optimization structural search, we show that in the stoichiometry CaH6 a body-centred cubic structure with hydrogen that forms unusual "sodalite" cages containing enclathrated Ca stabilizes above pressure 150 GPa. The stability of this structure is derived from the acceptance by two H2 of electrons donated by Ca forming a "H4" unit as the building block in the construction of the 3-dimensional sodalite cage. This unique structure has a partial occupation of the degenerated orbitals at the zone centre. The resultant dynamic Jahn-Teller effect helps to enhance electron-phonon coupling and leads to superconductivity of CaH6. A superconducting critical temperature (Tc) of 220-235 K at 150 GPa obtained from the solution of the Eliashberg equations is the highest among all hydrides studied thus far.Comment: 19 pages, 4 figure

Ferroelectricity induced by interatomic magnetic exchange interaction

Multiferroics, where two or more ferroic order parameters coexist, is one of the hottest fields in condensed matter physics and materials science[1-9]. However, the coexistence of magnetism and conventional ferroelectricity is physically unfavoured[10]. Recently several remedies have been proposed, e.g., improper ferroelectricity induced by specific magnetic[6] or charge orders[2]. Guiding by these theories, currently most research is focused on frustrated magnets, which usually have complicated magnetic structure and low magnetic ordering temperature, consequently far from the practical application. Simple collinear magnets, which can have high magnetic transition temperature, have never been considered seriously as the candidates for multiferroics. Here, we argue that actually simple interatomic magnetic exchange interaction already contains a driving force for ferroelectricity, thus providing a new microscopic mechanism for the coexistence and strong coupling between ferroelectricity and magnetism. We demonstrate this mechanism by showing that even the simplest antiferromagnetic (AFM) insulator MnO, can display a magnetically induced ferroelectricity under a biaxial strain

Magnetoelectric ordering of BiFeO3 from the perspective of crystal chemistry

In this paper we examine the role of crystal chemistry factors in creating conditions for formation of magnetoelectric ordering in BiFeO3. It is generally accepted that the main reason of the ferroelectric distortion in BiFeO3 is concerned with a stereochemical activity of the Bi lone pair. However, the lone pair is stereochemically active in the paraelectric orthorhombic beta-phase as well. We demonstrate that a crucial role in emerging of phase transitions of the metal-insulator, paraelectric-ferroelectric and magnetic disorder-order types belongs to the change of the degree of the lone pair stereochemical activity - its consecutive increase with the temperature decrease. Using the structural data, we calculated the sign and strength of magnetic couplings in BiFeO3 in the range from 945 C down to 25 C and found the couplings, which undergo the antiferromagnetic-ferromagnetic transition with the temperature decrease and give rise to the antiferromagnetic ordering and its delay in regard to temperature, as compared to the ferroelectric ordering. We discuss the reasons of emerging of the spatially modulated spin structure and its suppression by doping with La3+.Comment: 18 pages, 5 figures, 3 table

Reduction in greenhouse gas emissions from national climate legislation

The international response to climate change has been inadequate, but not zero. There are 1,800 climate change laws worldwide. We use panel data on legislative activity in 133 countries over the period 1999–2016 to identify statistically the short-term and long-term impact of climate legislation. Each new law reduces annual carbon dioxide (CO2) emissions per unit of gross domestic product by 0.78% nationally in the short term (during the first three years) and by 1.79% in the long term (beyond three years). The results are driven by parliamentary acts and by countries with a strong rule of law. In 2016, current climate laws were associated with an annual reduction in global CO2 emissions of 5.9 GtCO2, more than the US CO2 output that year. Cumulative CO2 emissions savings from 1999 to 2016 amount to 38 GtCO2, or one year’s worth of global CO2 output. The impact on other greenhouse gases is much lower

The 4Cs of adaptation tracking: consistency, comparability, comprehensiveness, coherency

Adaptation tracking seeks to characterize, monitor, and compare general trends in climate change adaptation over time and across nations. Recognized as essential for evaluating adaptation progress, there have been few attempts to develop systematic approaches for tracking adaptation. This is reflected in polarized opinions, contradictory findings, and lack of understanding on the state of adaptation globally. In this paper, we outline key methodological considerations necessary for adaptation tracking research to produce systematic, rigorous, comparable, and usable insights that can capture the current state of adaptation globally, provide the basis for characterizing and evaluating adaptations taking place, facilitate examination of what conditions explain differences in adaptation action across jurisdictions, and can underpin the monitoring of change in adaptation over time. Specifically, we argue that approaches to adaptation tracking need to (i) utilize a consistent and operational conceptualization of adaptation, (ii) focus on comparable units of analysis, (iii) use and develop comprehensive datasets on adaptation action, and (iv) be coherent with our understanding of what constitutes real adaptation. Collectively, these form the 4Cs of adaptation tracking (consistency, comparability, comprehensiveness, and coherency)

Discovery of long acting inhaled muscarinic M3 receptor antagonists

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