General anesthesia soon after dialysis may increase postoperative hypotension - A pilot study.

IntroductionPilot study associating hemodialysis-to-general-anesthesia time interval and post-operative complications in hemodialysis patients to better define a more optimal pre-anesthetic waiting period.MethodsPre-anesthetic and 48-hours post-anesthetic parameters (age, gender, body-mass-index, pre-operative ultrafiltrate, potassium, renal disease etiology, hemodialysis sessions per week, Acute Physiology and Chronic Health Evaluation-II score, Portsmouth-Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity, American Society of Anesthesiologists physical status, Johns Hopkins Surgical Classification System Category, surgical urgency, intra-operative fluids, estimated blood loss, post-operative complications) were collected on chronic hemodialysis patients between 11/2009-12/2010. Continuous data were analyzed by Analysis of Variance or t-test. Bivariate data were analyzed by Fisher's Exact Test. Relative Risks/Confidence Intervals were calculated for statistically significant comparisons (p=0.05). Exclusion criteria were incomplete records, peritoneal dialysis, intra-operative hemodialysis, liver transplant, and cardiopulmonary bypass.ResultsPatients were grouped by dialysis to anesthesia time interval: Group 1 >24 hours, Group 2 7-23.9 hours, Group 3 < 7 hours. Among Surgical Category 3-5 patients, hypotension was more common in Group 3 than Group 1 (63.6% vs 9.2%, p<0.0001, relative risk=6.9, confidence interval=3.0-15.7) or Group 2 (63.6% vs 17.3%, p=0.0002, relative risk=3.7, confidence interval=1.9-7.2). Other complications rates were not statistically significant. Disease and surgical severity scores, preoperative ultrafiltrate, and intra-operative fluids were not different.ConclusionsPost-anesthetic hypotension within 48 hours was more common in those with < 7 hours interval between dialysis and anesthesia. Therefore, if surgical urgency permits, a delay of ≥7 hours may limit postoperative hypotension. More precise associations should be obtained through a prospective study

Current Local Anesthetic Applications in Regional Anesthesia

Complete anesthesia is often described using terminology that pertains to the pharmacodynamic effects of the medications administered. This vocabulary often includes akinesia, analgesia, amnesia and hypnosis. Local anesthesia is more specific and represents the administration of an amide or ester local anesthetic, to affect analgesia, at or around the site of administration. Anesthesiologists employ a breadth of different clinical techniques that utilize local anesthetic medications. These techniques include topical, mucosal, endotracheal, intravenous, peripheral nerve block, epidural, and intrathecal (spinal) administration. Unique to the fields of anesthesiology and pain medicine, however, is the administration of epidural and intrathecal local anesthetic. Together, these routes are jointly referred to as neuraxial anesthesia and are often utilized to facilitate surgical intervention, labor analgesia, or pain therapy. The history of neuraxial local anesthetic administration is rich and intriguing. The anatomy of the spinal cord and surrounding structures is complex and pertinent to the pharmacologic discussion of neuraxial local anesthetic administration. The pharmacodynamic and pharmacokinetic interactions of local anesthetics, when administered via the neuraxial route, are unique and worthy of continued investigation. Much has been studied, but there is still more to be discovered. These topics will be the focus of our discussion

Crystal energy functions via the charge in types A and C

The Ram-Yip formula for Macdonald polynomials (at t=0) provides a statistic which we call charge. In types A and C it can be defined on tensor products of Kashiwara-Nakashima single column crystals. In this paper we prove that the charge is equal to the (negative of the) energy function on affine crystals. The algorithm for computing charge is much simpler and can be more efficiently computed than the recursive definition of energy in terms of the combinatorial R-matrix.Comment: 25 pages; 1 figur

The Elderly Poor in the EU’s New Member States. ENEPRI Research Reports No. 60, November 2008

To what extent is the financial position of the elderly in the NMS more vulnerable than that of the old member states (or the EU-15), due to a rather unfavourable starting point and the possible impact of pension reforms? This is the main issue of the current research report. It tries to delineate the vulnerability of the income position of elderly people in the NMS, in relation to the demographic, socio-economic and institutional context of these countries. More specifically, the report focuses on: - the current level of income of the elderly in the NMS, and the degree of relative poverty; - the way this position is related to the educational and labour market status of the elderly in the NMS, their retirement behaviour, institutional arrangements (notably the pension system), and demographic developments; - specific problems regarding the income position of possibly ‘marginal’ elderly groups in the NMS (such as single elderly female pensioners)

Shaking up story time

While the Philosophy for Children (P4C) method has been adopted within classrooms by individual teachers and into some school systems by schoolboards, public and school libraries, the ideal users of this sort of programming, have been slow to recognise the benefits of this didactic methodology. This is particularly surprising given that the P4C method integrates perfectly with traditional story-time orientated programming. Not only is the integration of P4C into story-time sessions virtually seamless (as it does not aim to replace, but rather strives to enhance story-telling), but it might also help reinvigorate a well-established feature of library programming with an aim to develop 21st-century information literacy competencies. This paper examines the case for the P4C method, explains the process of integration of the P4C method with traditional story-time, and highlights the potential benefits of incorporating Philosophy for Children in public and school library programming

An Arp2/3 Nucleated F-Actin Shell Fragments Nuclear Membranes at Nuclear Envelope Breakdown in Starfish Oocytes

Animal cells disassemble and reassemble their nuclear envelopes (NEs) upon each division. Nuclear envelope breakdown (NEBD) serves as a major regulatory mechanism by which mixing of cytoplasmic and nuclear compartments drives the complete reorganization of cellular architecture, committing the cell for division. Breakdown is initiated by phosphorylation-driven partial disassembly of the nuclear pore complexes (NPCs), increasing their permeability but leaving the overall NE structure intact. Subsequently, the NE is rapidly broken into membrane fragments, defining the transition from prophase to prometaphase and resulting in complete mixing of cyto- and nucleoplasm. However, the mechanism underlying this rapid NE fragmentation remains largely unknown. Here, we show that NE fragmentation during NEBD in starfish oocytes is driven by an Arp2/3 complex-nucleated F-actin “shell” that transiently polymerizes on the inner surface of the NE. Blocking the formation of this F-actin shell prevents membrane fragmentation and delays entry of large cytoplasmic molecules into the nucleus. We observe spike-like protrusions extending from the F-actin shell that appear to “pierce” the NE during the fragmentation process. Finally, we show that NE fragmentation is essential for successful reproduction, because blocking this process in meiosis leads to formation of aneuploid eggs.MIT Faculty Start-up FundNational Science Foundation (U.S.). Graduate Research Fellowshi

Current and future role of instrumentation and monitoring in the performance of transport infrastructure slopes

Instrumentation is often used to monitor the performance of engineered infrastructure slopes. This paper looks at the current role of instrumentation and monitoring, including the reasons for monitoring infrastructure slopes, the instrumentation typically installed and parameters measured. The paper then investigates recent developments in technology and considers how these may change the way that monitoring is used in the future, and tries to summarize the barriers and challenges to greater use of instrumentation in slope engineering. The challenges relate to economics of instrumentation within a wider risk management system, a better understanding of the way in which slopes perform and/or lose performance, and the complexities of managing and making decisions from greater quantities of data

Asymmetric function theory

The classical theory of symmetric functions has a central position in algebraic combinatorics, bridging aspects of representation theory, combinatorics, and enumerative geometry. More recently, this theory has been fruitfully extended to the larger ring of quasisymmetric functions, with corresponding applications. Here, we survey recent work extending this theory further to general asymmetric polynomials.Comment: 36 pages, 8 figures, 1 table. Written for the proceedings of the Schubert calculus conference in Guangzhou, Nov. 201