Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients

Background There are no guidelines on ventilation modes in morbidly obese patients. We investigated the effects of volume-controlled (VCV) and pressure-controlled ventilation (PCV) on gas exchange, respiratory mechanics, and cardiovascular responses in laparoscopic gastric banding procedures. Methods After Institutional Review Board approval, 24 adult consenting patients scheduled for laparoscopic gastric banding were studied. Anesthesia was standardized using remifentanil, propofol, rocuronium, and sevoflurane. All patients started with VCV with a tidal volume of 10 ml kg(-1) ideal body weight, respiratory rate adjusted to obtain an end-tidal carbon dioxide of 35-40 mmHg, positive end-expiratory pressure of 5 cmH(2)O, an inspiratory pause of 10% and an inspiratory/expiratory ratio of 1:2. Fifteen minutes after pneumoperitoneum, the patients were randomly allocated to two groups. In Group VCV (n=12), ventilation was with the same parameters. In Group PCV (n=12), the airway pressure was set to provide a tidal volume of 10 ml kg(-1) ideal body weight without exceeding 35 cm H2O. Respiratory rate was adjusted to keep an end-tidal carbon dioxide of 35-40 mmHg. Arterial blood samples were drawn after surgical positioning and 15 min after allocation. Analysis of variance (ANOVA) was used for statistical analysis. Results With constant minute ventilation, VCV generates equal airway pressures and cardiovascular effects with a lower Pa-CO2 as compared to PCV (42.5 (5.2) mmHg versus 48.9 (4.3) mmHg, p < 0.01 ANOVA). Arterial oxygenation remained unchanged. Conclusion VCV and PCV appear to be an equally suited ventilatory technique for laparoscopic procedures in morbidly obese patients. Carbon dioxide elimination is more efficient when using VCV

Influence of fruit turgidity and firmness on apple bruise susceptibility.

Bruise damage is a major cause of quality loss for apples. It would be very useful to establish a method of characterizing bruise susceptibility in order to improve fruit handling, sometimes Magness-Taylor firmness is used as an indirect guide to handling requirements. The objective of the present work was to achieve a better bruise susceptibility prediction

NATIONAL QUALIFICATIONS SYSTEM IN RUSSIA – AN EPISTEMOLOGICAL PERSPECTIVE

Introduction. The article offers an insight into an epistemological perspective of establishing the national qualifications system in Russia that is critical for creating a “market of qualifications in the country that would be adequate to the current context.The aim of the research was to examine the context and factors underpinning the formation and evolution of the structure of knowledge relating to the national qualification system in Russia.Methodology and research methods. The methods applied comprise a mixed-method approach that included: review and analysis of official documents, semi-structured background and individual interviews with key stakeholders (line ministries, experts from industry and qualifications awarding bodies etc.) and desk research.Results and scientific novelty. The performed analysis of documents and of research data has revealed that the process of generating and enhancing knowledge about the national qualifications system semantically and methodologically is in broad terms contingent on the needs and objectives of social and economic development, and in narrower terms – on the development of occupational standards that underpin the standards of vocational and higher education, as well as on the enhanced institutionalisation of employers’ involvement in the training of personnel and in the search of effective mechanisms and instruments of independent assessment of qualifications.It also offers an insight into current key paradigmatic gaps in the NQF-related epistemology in Russia that account for the specificity of the observed state of play and for the key conceptual epistemological contradiction that has been identified by the authors as the opposition of and conflict between occupational and education qualifications. The authors propose ways out of the situation based on international practices in this area starting from aligning the terminology and conceptual approaches with international ones. The performed epistemological research and the conclusions made by the authors contribute to the national qualifications system discourse. It is stressed that core principles underpinning the development of the national qualifications system should be adapted to the social and economic and local factors.Practical significance. The material of the article can be used by policy-makers dealing with the NQS development and implementation of the NQS.Введение. В статье рассматривается эпистемологическая перспектива становления в России национальной системы квалификаций, необходимой для появления в стране отвечающего современным реалиям «рынка квалификаций». Цель публикации – обсуждение содержания, факторов формирования и эволюции знаний об аспектах функционирования национальной системы квалификаций в российских условиях. Методология и методики. В ходе работы применялись комплексный подход к объекту изучения, включающий такие методы исследования, как обзор и анализ официальных документов, полуофициальные опросы и индивидуальные интервью с представителями наиболее заинтересованных сторон – руководителями и сотрудниками отраслевых министерств, отраслевыми экспертами, специалистами структур по присуждению квалификаций и т. д.Результаты и научная новизна. Проведенный анализ документальных и научных источников показал, что процесс генерирования и совершенствования знаний о системе национальных квалификаций семантически и методологически связан в широком понимании с потребностями и целями социально-экономического развития; в более узком – с разработкой профессиональных стандартов, которые должны служить основой стандартов профессионального и высшего образования, а также с усилением институционализации участия работодателей в подготовке кадров и поиске эффективных механизмов и инструментария независимой оценки квалификаций и компетенций. Вскрыты имеющиеся в настоящее время парадигматические пробелы в системе знаний о национальной рамке квалификаций, порождающие проблемы дальнейшего развития данного направления в России. В качестве узлового концептуального эпистемологического противоречия выделено неправомерное противопоставление профессиональных и образовательных квалификаций. С опорой на зарубежный практический опыт предложены пути выхода из сложившейся ситуации, в частности, рекомендуется прежде всего согласовать терминологию и концептуальные подходы с международными нормами. Предпринятое в контексте эпистемологии исследование и сделанные авторами выводы расширяют дискурс о национальной системе квалификаций; подчеркивается, что при соблюдении общих принципов разработки национальной системы квалификаций важно учитывать специфические внутригосударственные социально-экономические и территориальные факторы. Практическая значимость. Материалы статьи могут быть использованы в практике отечественных специалистов, ответственных за создание инфраструктуры и внедрение национальной системы квалификаций и формирующих политику в этой области

Optical properties–microstructure–texture relationships of dried apple slices: Spatially resolved diffuse reflectance spectroscopy as a novel technique for analysis and process control

The potential of spatially resolved diffuse reflectance spectroscopy in the 500–1000 nm range by means of a fiber-optics probe was investigated for acquiring scattering and absorption properties of air dried apple rings subjected to different pre-treatment conditions: without osmo-dehydration (TQ) and with osmo-dehydration for 1 (OSMO1) and 3 h (OSMO2). The fresh apple rings were produced from ‘Golden Delicious’ apples at harvest (H) and 5 month storage at 2 conditions: controlled atmosphere (CA) and normal atmosphere (NA). Microstructure properties of the dried apple rings were also obtained from X-ray micro-CT measurements. The TQ samples were found to have significantly higher scattering properties, thicker tissue, smaller pore sizes, were less crispy, and required higher snapping work or rupture energy than the OSMO1 and OSMO2 samples. On the other hand, no significant differences were observed between the scattering properties, microstructure, and textural quality of the OSMO1 and OSMO2 apple rings. From these results, it was concluded that there is a clear process–microstructure–quality relation in osmo-air-dried apples which can be measured non-destructively with spatially resolved diffuse reflectance spectroscopy. Therefore, this study confirmed the potential of spatially resolved diffuse reflectance spectroscopy for non-destructive quality assessment of air-dried apple slices, which provides perspectives for drying process optimization

Ventilation and outcomes following robotic-assisted abdominal surgery: an international, multicentre observational study

Background: International data on the epidemiology, ventilation practice, and outcomes in patients undergoing abdominal robotic-assisted surgery (RAS) are lacking. The aim of the study was to assess the incidence of postoperative pulmonary complications (PPCs), and to describe ventilator management after abdominal RAS. Methods: This was an international, multicentre, prospective study in 34 centres in nine countries. Patients ≥18 yr of age undergoing abdominal RAS were enrolled between April 2017 and March 2019. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to stratify for higher risk of PPCs (≥26). The primary outcome was the incidence of PPCs. Secondary endpoints included the preoperative risk for PPCs and ventilator management. Results: Of 1167 subjects screened, 905 abdominal RAS patients were included. Overall, 590 (65.2%) patients were at increased risk for PPCs. Meanwhile, 172 (19%) patients sustained PPCs, which occurred more frequently in 132 (22.4%) patients at increased risk, compared with 40 (12.7%) patients at lower risk of PPCs (absolute risk difference: 12.2% [95% confidence intervals (CI), 6.8–17.6%]; P&lt;0.001). Plateau and driving pressures were higher in patients at increased risk, compared with patients at low risk of PPCs, but no ventilatory variables were independently associated with increased occurrence of PPCs. Development of PPCs was associated with a longer hospital stay. Conclusions: One in five patients developed one or more PPCs (chiefly unplanned oxygen requirement), which was associated with a longer hospital stay. No ventilatory variables were independently associated with PPCs. Clinical trial registration: NCT02989415

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2&lt;90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (&gt;30% decrease in blood pressure) or reduced oxygenation (SpO2 &lt;85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants. Clinical trial registration: NCT02350348

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. RESULTS: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04–1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15–1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7–3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64–7.71) and mortality (RR=19.80; 95% CI, 5.87–66.7). CONCLUSIONS: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants