Evaluation of the variability of anesthetic practice in a single institution

Anesthetics are provided to millions of patients every year in the United States mostly by anesthesiologists. However, there is a lack of literature or documentation on how anesthetics are administered by various anesthesia providers. In order to have a better understanding on the pattern, we performed retrospective chart review on anesthetic practice for surgical atrial septal defect repair procedures performed in Boston Children's Hospital. Our collected data included: premedication, anesthesia induction methods, anesthesia maintenance methods, choice of vasoactive agents, analgesics, and intravenous accesses, extubation in the operating room, postoperative sedation, and choice of antiemetics and postoperative nausea and vomiting. In addition, the studied patients were divided into two groups based on the institutional initiation of the Fast-track protocol: before and after the implementation of the Fast-track protocol (the Non-fast-track group and the Fast-track group). Some results fell under expectation; for example, in the Non-fast-track group, all patients who were induced intravenously were older than 10 years old, and received propofol for induction, which is the most popular choice of intravenous induction drug. The Fast-track group showed a similar trend; 80% of all intravenously induced patients were 10 years or older and induced with propofol. Also, in both groups, anesthesia was maintained with the combination of IV and volatile anesthetics. An anticipated change in practice pattern was seen in the Fast-track group for the choice of analgesics and postoperative sedation for non-extubated patients; acetaminophen was introduced as an adjunct to other analgesics, and propofol infusion was introduced as a standard drug of postoperative sedation for non-extubated patients, both of which are part of the Fast-track protocol. Interestingly, however, overall intraoperative opioid doses did not show any change. The variation in the choice of intravenous access showed difference before and after the Fast-track implementation; in the Non-fast-track group, extra jugular vein was accessed as the most popular choice, whereas in the Fast-track group, central venous line was the most popular choice. Also, the incidence of postoperative nausea and vomiting was notably lower in patients who were not given anti-emetics after the Fast-track protocol implementation. This calls for a need for a future research on what part of the Fast-track protocol could have resulted this improvement without intraoperative administration of regular anti-emetics. Overall, our results provide future directions for researches on anesthetic practice that may help improve patient safety and efficiency beyond the practice in Boston Children's Hospital

How to Keep the Binary Compatibility of C++ Based Objects

This chapter proposes the binary compatibility object model for C++ (BiCOMC) to provide the binary compatibility of software components in order to share objects among C++ based executable files such as .exe, .dll, and .so. In addition, the proposed model provides the method overriding and overloading, multiple inheritance, and exception handling. This chapter illustrates how to use the proposed model via a simple example in the Windows and Linux environment. The proposed method is validated by application examples and comparisons with known object models such as C++, COM, and CCC in terms of the call time of a method during execution and the binary compatibility such as reusability due to interface version and the types of compilers. Also this chapter shows that BiCOMC-based components compiled with Microsoft Visual C++ and GCC can call each other and the interface version problems are resolved

Cyclic Sieving Phenomenon of Promotion on Rectangular Tableaux

Cyclic sieving phenomenon (CSP) is a generalization by Reiner, Stanton, White of Stembridge's q=-1 phenomenon. When CSP is exhibited, orbits of a cyclic action on combinatorial objects show a nice structure and their sizes can be encoded by one polynomial. In this thesis we study various proofs of a very interesting cyclic sieving phenomenon, that jeu-de-taquin promotion on rectangular Young tableaux exhibits CSP. The first proof was obtained by Rhoades, who used Kazhdan-Lusztig representation. Purbhoo's proof uses Wronski map to equate tableaux with points in the fibre of the map. Finally, we consider Petersen, Pylyavskyy, Rhoades's proof on 2 and 3 row tableaux by bijecting the promotion of tableaux to rotation of webs. This thesis also propose a combinatorial approach to prove the CSP for square tableaux. A variation of jeu-de-taquin move yields a way to count square tableaux which has minimal orbit under promotion. These tableaux are then in bijection to permutations. We consider how this can be generalized

Negative Thermal Hall Conductance in Two-Dimer Shastry-Sutherland Model with {\pi}-flux Dirac Triplon

We introduce an effective 2-dimer tight-binding model for the family of Shastry-Sutherland models with geometrically tunable triplon excitations. The Rashba pseudospin-orbit coupling induced by the tilted external magnetic field leads to elementary excitations having nontrivial topological properties with {\pi}-Berry flux. The interplay between the in-plane and out-of-plane magnetic field thus allows us to effectively engineer the band structure in this bosonic system. In particular, the in-plane magnetic field gives rise to Berry curvature hotspot near the bottom of the triplon band, and at the same time significantly increases the critical magnetic field for the topological triplon band. We calculate explicitly the experimental signature of the thermal Hall effect of triplons in SrCu2(BO3)2, and show a pronounced and tunabled transport signals within the accessible parameter range, particularly with a change of sign of the thermal Hall conductance. The tilted magnetic field is also useful in reducing the bandwidth of the lowest triplon band. We show it can thus be a flexible theoretical and experimental platform for the correlated bosonic topological system