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

An analysis of the FIR/RADIO Continuum Correlation in the Small Magellanic Cloud

The local correlation between far-infrared (FIR) emission and radio-continuum (RC) emission for the Small Magellanic Cloud (SMC) is investigated over scales from 3 kpc to 0.01 kpc. Here, we report good FIR/RC correlation down to ~15 pc. The reciprocal slope of the FIR/RC emission correlation (RC/FIR) in the SMC is shown to be greatest in the most active star forming regions with a power law slope of ~1.14 indicating that the RC emission increases faster than the FIR emission. The slope of the other regions and the SMC are much flatter and in the range of 0.63-0.85. The slopes tend to follow the thermal fractions of the regions which range from 0.5 to 0.95. The thermal fraction of the RC emission alone can provide the expected FIR/RC correlation. The results are consistent with a common source for ultraviolet (UV) photons heating dust and Cosmic Ray electrons (CRe-s) diffusing away from the star forming regions. Since the CRe-s appear to escape the SMC so readily, the results here may not provide support for coupling between the local gas density and the magnetic field intensity.Comment: 19 pages, 7 Figure

Characterizing the radio continuum emission from intense starburst galaxies

© 2016 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society.The intrinsic thermal (free-free) and non-thermal (synchrotron) emission components that comprise the radio continuum of galaxies represent unique, dust-free measures of star formation rates (SFR). Such high SFR galaxies will dominate the deepest current and future radio surveys. We disentangle the thermal and non-thermal emission components of the radio continuum of six ultraluminous infrared galaxies (LFIR > 1012.5 L?) at redshifts of 0.2 = z = 0.5 and 22 IR selected galaxies. Radio data over a wide frequency range (0.8 < ? <10 GHz) are fitted with a star-forming galaxy model comprising of thermal and non-thermal components. The luminosities of both radio continuum components are strongly correlated to the 60 µm luminosity across many orders of magnitude (consistent with the far-IR to radio correlation). We demonstrate that the spectral index of the radio continuum spectral energy distribution is a useful proxy for the thermal fraction. We also find that there is an increase in mean and scatter of the thermal fraction with FIR to radio luminosity ratio which could be influenced by different time-scales of the thermal and non-thermal emission mechanisms

An Expanding Shell of Neutral Hydrogen Associated with SN 1006: Hints for the Single-Degenerate Origin and Faint Hadronic Gamma-Rays

We report new HI observations of the Type Ia supernova remnant SN 1006 using the Australia Telescope Compact Array with an angular resolution of $4.5' \times 1.4'$ ($\sim$2 pc at the assumed SNR distance of 2.2 kpc). We find an expanding gas motion in position-velocity diagrams of HI with an expansion velocity of $\sim$4 km s$^{-1}$ and a mass of $\sim$1000 $M_\odot$. The spatial extent of the expanding shell is roughly the same as that of SN 1006. We here propose a hypothesis that SN 1006 exploded inside the wind-blown bubble formed by accretion winds from the progenitor system consisting of a white dwarf and a companion star, and then the forward shock has already reached the wind wall. This scenario is consistent with the single-degenerate model. We also derived the total energy of cosmic-ray protons $W_\mathrm{p}$ to be only $\sim$1.2-$2.0 \times 10^{47}$ erg by adopting the averaged interstellar proton density of $\sim$25 cm$^{-3}$. The small value is compatible with the relation between the age and $W_\mathrm{p}$ of other gamma-ray supernova remnants with ages below $\sim$6 kyr. The $W_\mathrm{p}$ value in SN 1006 will possibly increase up to several 10$^{49}$ erg in the next $\sim$5 kyr via the cosmic-ray diffusion into the HI wind-shell.Comment: 12 pages, 4 figures, 1 table, accepted for publication in The Astrophysical Journal (ApJ

On the Expansion Rate, Age, and Distance of the Supernova Remnant G266.2-1.2 (Vela Jr.)

An analysis of Chandra ACIS data for two relatively bright and narrow portions of the northwestern rim of G266.2-1.2 (a.k.a. RX J0852.0-4622 or Vela Jr.) reveal evidence of a radial displacement of 2.40 +/- 0.56 arcsec between 2003 and 2008. The corresponding expansion rate (0.42 +/- 0.10 arcsec/yr or 13.6 +/- 4.2%/kyr) is about half the rate reported for an analysis of XMM-Newton data from a similar, but not identical, portion of the rim over a similar, but not identical, time interval (0.84 +/- 0.23 arcsec/yr, Katsuda et al. 2008a). If the Chandra rate is representative of the remnant as a whole, then the results of a hydrodynamic analysis suggest that G266.2-1.2 is between 2.4 and 5.1 kyr old if it is expanding into a uniform ambient medium (whether or not it was produced by a Type Ia or Type II event). If the remnant is expanding into the material shed by a steady stellar wind, then the age could be as much as 50% higher. The Chandra expansion rate and a requirement that the shock speed be greater than or equal to 1000 km/s yields a lower limit on the distance of 0.5 kpc. An analysis of previously-published distance estimates and constraints suggests G266.2-1.2 is no further than 1.0 kpc. This range of distances is consistent with the distance to the nearer of two groups of material in the Vela Molecular Ridge (0.7 +/- 0.2 kpc, Liseau et al. 1992) and to the Vel OB1 association (0.8 kpc, Eggen 1982).Comment: 30 pages, 7 figure

Remifentanil does not impair left ventricular systolic and diastolic function in young healthy patients

Background Experimental studies and investigations in patients with cardiac diseases suggest that opioids at clinical concentrations have no important direct effect on myocardial relaxation and contractility. In vivo data on the effect of remifentanil on myocardial function in humans are scarce. This study aimed to investigate the effects of remifentanil on left ventricular (LV) function in young healthy humans by transthoracic echocardiography (TTE). We hypothesized that remifentanil does not impair systolic, diastolic LV function, or both. Methods Twelve individuals (aged 18-48 yr) without any history or signs of cardiovascular disease and undergoing minor surgical procedures under general anaesthesia were studied. Echocardiographic examinations were performed in the spontaneously breathing subjects before (baseline) and during administration of remifentanil at a target effect-site concentration of 2 ng ml−1 by target-controlled infusion. Analysis of systolic function focused on fractional area change (FAC). Analysis of diastolic function focused on peak early diastolic velocity of the mitral annulus (e′) and on transmitral peak flow velocity (E). Results Remifentanil infusion at a target concentration of 2 ng ml−1 did not affect heart rate or arterial pressure. There was no evidence of systolic or diastolic dysfunction during remifentanil infusion, as the echocardiographic measure of systolic function (FAC) was similar to baseline, and measures of diastolic function remained unchanged (e′) or improved slightly (E). Conclusion Continuous infusion of remifentanil in a clinically relevant concentration did not affect systolic and diastolic LV function in young healthy subjects during spontaneous breathing as indicated by TT

Building a well-balanced culture in the perioperative setting.

Healthcare institutions are currently under enormous financial, political and social pressure. Especially in the perioperative setting, various professional groups with differing agendas, dynamic teams, high-stress levels and diverging stakeholder interests are contributing to tension on a variety of levels. These players ask for guidance that goes beyond defined goals, clear structures or rules for process optimization. The impact of culture, which is influenced by core values, unspoken behaviours and practices, a shared purpose and implicit norms, has been often neglected. However, culture is a key factor in the search for optimal patient outcomes, quality of care, protection and long-time retention of staff, as well as economic success. In this review, we discuss important aspects to consider in building a great perioperative workplace, discuss indispensable adaptations in times of crisis and touch on urgently needed further investigations to optimize the art of developing, protecting, and cultivating a well-balanced culture

Shared Decision-Making in Acute Pain Services.

PURPOSE OF REVIEW The implementation of shared decision-making (SDM) in acute pain services (APS) is still in its infancies especially when compared to other medical fields. RECENT FINDINGS Emerging evidence fosters the value of SDM in various acute care settings. We provide an overview of general SDM practices and possible advantages of incorporating such concepts in APS, point out barriers to SDM in this setting, present common patient decisions aids developed for APS and discuss opportunities for further development. Especially in the APS setting, patient-centred care is a key component for optimal patient outcome. SDM could be included into everyday clinical practice by using structured approaches such as the "seek, help, assess, reach, evaluate" (SHARE) approach, the 3 "MAking Good decisions In Collaboration"(MAGIC) questions, the "Benefits, Risks, Alternatives and doing Nothing"(BRAN) tool or the "the multifocal approach to sharing in shared decision-making"(MAPPIN'SDM) as guidance for participatory decision-making. Such tools aid in the development of a patient-clinician relationship beyond discharge after immediate relief of acute pain has been accomplished. Research addressing patient decision aids and their impact on patient-reported outcomes regarding shared decision-making, organizational barriers and new developments such as remote shared decision-making is needed to advance participatory decision-making in acute pain services

Cultural Framing and the Impact On Acute Pain and Pain Services.

PURPOSE OF REVIEW Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management. RECENT FINDINGS The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training