International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Factors associated with intraoperative intravenous catheter extravasation in children

Summary This retrospective study aimed to determine the incidence of and factors associated with peripheral intravenous extravasation in paediatric patients in the intraoperative setting. We conducted a retrospective study of 56,777 patients who underwent general anaesthesia and had peripheral intravenous catheter placement at Cincinnati Children’s Hospital between 1 January 2015 and 1 January 2017. Data collected included age, American Society of Anesthesiologists Physical Status Classification, catheter site, number of cannulation attempts, ultrasound use for cannulation, surgery duration, and surgery class. Primary outcome was peripheral intravenous extravasation using an extravasation assessment tool. Some 64,814 peripheral venous catheters were placed in patients undergoing general anaesthesia. Significant extravasation was documented in 40 catheters with an estimated incidence of 1 in 1620 venous catheters (0.06%). Of those 40 catheters, 47.5% ( n = 19) were placed using ultrasound and 37.5% ( n = 15) required more than one cannulation attempt. In multivariable analysis, peripheral intravenous catheter extravasation was associated with American Society of Anesthesiologists Physical Status Classification (3, 4, 5) versus (1, 2) (odds ratio 2.42 (95% CI 1.08 to 5.41)), inpatient versus outpatient surgeries (odds ratio 2.99 (95% CI 1.31 to 6.81)), and intravenous catheters placed with ultrasound guidance (odds ratio 8.01 (95% CI 4.12 to 15.57)). Our study identified factors associated with intraoperative peripheral intravenous extravasation, and will help develop mitigation strategies to minimise harm to patients. </jats:p

A rapidly evolved shift in life‐history timing during ecological speciation is driven by the transition between developmental phases

For insect species in temperate environments, seasonal timing is often governed by the regulation of diapause, a complex developmental programme that allows insects to weather unfavourable conditions and synchronize their life cycles with available resources. Diapause development consists of a series of distinct phases including initiation, maintenance, termination and post-diapause development. The evolution of insect seasonal timing depends in part on how these phases of diapause development and post-diapause development interact to affect variation in phenology. Here, we dissect the physiological basis of a recently evolved phenological shift inRhagoletis pomonella(Diptera: Tephritidae), a model system for ecological divergence. A recently derived population ofR. pomonellashifted from specializing on native hawthorn fruit to earlier fruiting introduced apples, resulting in a 3-4 week shift in adult emergence timing. We tracked metabolic rates of individual flies across post-winter development to test which phases of development may act either independently or in combination to contribute to this recently evolved divergence in timing. Apple and hawthorn flies differed in a number of facets of their post-winter developmental trajectories. However, divergent adaptation in adult emergence phenology in these flies was due almost entirely to the end of the pupal diapause maintenance phase, with post-diapause development having a very small effect. The relatively simple underpinnings of variation in adult emergence phenology suggest that further adaptation to seasonal change in these flies for this trait might be largely due to the timing of diapause termination unhindered by strong covariance among different components of post-diapause development

sj-pdf-1-aic-10.1177_0310057X211062614 - Supplemental material for Factors associated with intraoperative intravenous catheter extravasation in children

Supplemental material, sj-pdf-1-aic-10.1177_0310057X211062614 for Factors associated with intraoperative intravenous catheter extravasation in children by Mecoli Marc D Conceptualization Data curation Formal analysis Investigation Methodology Writing original draft Writing review editing Ding Lili Formal analysis Investigation Writing review editing Yang Gang Formal analysis Investigation Software Writing review editing McSoley Joseph W Investigation Visualization Writing review editing Doellman Darcy A Conceptualization Investigation Writing review editing Rineair Sylvia A Conceptualization Investigation Writing review editingSubramanyam Rajeev Conceptualization Formal analysis Investigation Methodology Supervision Writing review editing in Anaesthesia and Intensive Care</p

sj-jpg-2-aic-10.1177_0310057X211062614 - Supplemental material for Factors associated with intraoperative intravenous catheter extravasation in children

Supplemental material, sj-jpg-2-aic-10.1177_0310057X211062614 for Factors associated with intraoperative intravenous catheter extravasation in children by Mecoli Marc D Conceptualization Data curation Formal analysis Investigation Methodology Writing original draft Writing review editing Ding Lili Formal analysis Investigation Writing review editing Yang Gang Formal analysis Investigation Software Writing review editing McSoley Joseph W Investigation Visualization Writing review editing Doellman Darcy A Conceptualization Investigation Writing review editing Rineair Sylvia A Conceptualization Investigation Writing review editing Subramanyam Rajeev Conceptualization Formal analysis Investigation Methodology Supervision Writing review editing in Anaesthesia and Intensive Care</p