What Is the Best Pain Control After Major Hepatopancreatobiliary Surgery?

In the modern era, hepato-pancreato-biliary (HPB) surgery has become safe with significant reductions in morbidity and mortality at high volume centers for both liver and pancreas surgery. While laparoscopic surgery has provided a safe approach with superior pain control laparotomy is still needed for the majority of HPB operations. Inadequate pain control is not only associated with poor patient experience but contributes to inferior outcomes. Specifically, inadequate pain control affects the neuroendocrine stress response, increases complication rates, and prolongs length of stay. Furthermore, there is an ongoing opioid epidemic and all fields of medicine should strive to reduce narcotic use to limit transformation into chronic opiate dependence. As such, successful pain control after HPB surgery continues to be a challenge and rigorous studies evaluating postoperative results are needed. The following article reviews the modalities debated to be the best strategies for pain control after major HPB surgery, as well as a discussion of other important considerations when executing these plans

Communicative Predictors of a Shared Family Identity: Comparison of Grandchildren’s Perceptions of Family-of-Origin Grandparents and Stepgrandparents

From an intergroup perspective on family relationships, the current study investigates family-of-origin grandparents and stepgrandparents to determine similarities and differences in communication and relational dimensions. Participants (N = 88) completed questionnaires on family-of-origin grandparents and stepgrandparent relationships. From the perspective of young adult grandchildren, the research explores the role of supportive communication, reciprocal self-disclosure, nonaccommodative communication, and parental encouragement in predicting a sense of shared family identity with each grandparent type. Results are discussed in terms of implications for intergroup research, grandparent-grandchild communication, and stepfamily relationships

“It's my language, my culture and it's personal!” Migrant mothers' experience of language use and identity change in their relationship with their children: an interpretative phenomenological analysis

The question of how migrants’ language use impacts their ethnic identity has received considerable attention in the literature. There is, however, little understanding of how this relationship manifests or is negotiated in interethnic families. This paper presents an in-depth exploration of Spanish mothers’ experiences of Spanish- and English-language interactions with their English-born children. Semi-structured interviews were conducted with Spanish mothers living in Britain in interethnic partnerships and transcripts were subjected to interpretative phenomenological analysis. Analysis reveals a process of identity change where participants’ shifting ethnic identifications with host and heritage culture is intimately related to their language use with their children. Pivotal to this process is the participants’ need to maintain their ‘Spanish mother’ identity, a desire that can only be fulfilled by transferring their heritage language to their children and speaking it with them. Findings reveal how this dynamic impacts perception of family roles, relationship quality and psychological well-being

Multiproxy summer and winter surface air temperature field reconstructions for southern South America covering the past centuries

We statistically reconstruct austral summer (winter) surface air temperature fields back to ad 900 (1706) using 22 (20) annually resolved predictors from natural and human archives from southern South America (SSA). This represents the first regional-scale climate field reconstruction for parts of the Southern Hemisphere at this high temporal resolution. We apply three different reconstruction techniques: multivariate principal component regression, composite plus scaling, and regularized expectation maximization. There is generally good agreement between the results of the three methods on interannual and decadal timescales. The field reconstructions allow us to describe differences and similarities in the temperature evolution of different sub-regions of SSA. The reconstructed SSA mean summer temperatures between 900 and 1350 are mostly above the 1901-1995 climatology. After 1350, we reconstruct a sharp transition to colder conditions, which last until approximately 1700. The summers in the eighteenth century are relatively warm with a subsequent cold relapse peaking around 1850. In the twentieth century, summer temperatures reach conditions similar to earlier warm periods. The winter temperatures in the eighteenth and nineteenth centuries were mostly below the twentieth century average. The uncertainties of our reconstructions are generally largest in the eastern lowlands of SSA, where the coverage with proxy data is poorest. Verifications with independent summer temperature proxies and instrumental measurements suggest that the interannual and multi-decadal variations of SSA temperatures are well captured by our reconstructions. This new dataset can be used for data/model comparison and data assimilation as well as for detection and attribution studies at sub-continental scale

Acompañamiento psicosocial en dos comunidades de Manabí tras el terremoto del 16 de abril: una perspectiva desde la salud colectiva y los derechos humanos (Tema Central)

This paper intends to present two experiences of psychosocial accompaniment that were carried out in the province of Manabí, Ecuador in the next months following the earthquake of April 16, 2016. The first one takes place in the neighborhood Ebony in Jama and the second in the neighborhood Los Cañonazos in Portoviejo. In both cases, the accompaniment is aimed to the strengthening of the community organization, which reveals the perverse effects associated with disasters, such as land concentration or environmental discrimination. The phases: contact establishment, activities, methodology and conclusions are described, from a perspective of collective health and human rights. Keywords: earthquake Ecuador, Manabí, psychosocial accompaniment, collective health, human rights.El artículo presenta dos experiencias de acompañamiento psicosocial que se realizaron en la provincia de Manabí en Ecuador en los meses posteriores al terremoto del 16 de abril de 2016. La primera transcurrió en el barrio Ébano en Jama, y la segunda en el barrio Los Cañonazos en Portoviejo. En ambos casos, el acompañamiento se orientó al fortalecimiento del tejido comunitario que pone de manifiesto los efectos perversos asociados a los desastres, tales como la concentración de tierras o la discriminación ambiental. Para esto, se describen las fases de puesta de contacto, las actividades realizadas, la metodología utilizada y las conclusiones sobre el acompañamiento realizado, bajo una perspectiva de la salud colectiva y derechos humanos

An agenda for creative practice in the new mobilities paradigm

Creative practices have made a standing contribution to mobilities research. We write this article as a collective of 25 scholars and practitioners to make a provocation: to further position creative mobilities research as a fundamental contribution and component in this field. The article explores how creative forms of research—whether in the form of artworks, exhibitions, performances, collaborations, and more—has been a foundational part of shaping the new mobilities paradigm, and continues to influence its methodological, epistemological, and ontological concerns. We tour through the interwoven history of art and mobilities research, outlining five central contributions that creativity brings. Through short vignettes of each author’s creative practice, we discuss how creativity has been key to the evolution and emergence of how mobilities research has expanded to global audiences of scholars, practitioners, and communities. The article concludes by highlighting the potency of the arts for lively and transdisciplinary pathways for future mobilities research in the uncertainties that lay ahead

Clasificación Internacional del Funcionamiento de la discapacidad y de la salud (CIF): algunas experiencias de su aplicación y usos en américa latina

Este artículo tiene corno objetivo dar a conocer cómo la implemen- tación de la Clasificación Interna- cional de Defic iencias, Discapa- cidades y Minusvalías CIDDM-2 o Clasificación Internacional de Funcionamiento (CIF) está siendo implementada en la América Lat ina . Por medio de descripciones breves de cómo los países de la región (Argentina. Chile. Hon- duras, Méx ico, Panamá) adoptan esa clasificación, podernos aprender más sobre cómo las personas con discapacidad pueden ser beneficiadas en su capacidad de acceso a servicis de salud y rehabilitación

Respiratory plasticity in response to changes in oxygen supply and demand

Aerobic organisms maintain O2 homeostasis by responding to changes in O2 supply and demand in both short and long time domains. In this review, we introduce several specific examples of respiratory plasticity induced by chronic changes in O2 supply (environmental hypoxia or hyperoxia) and demand (exercise-induced and temperature-induced changes in aerobic metabolism). These studies reveal that plasticity occurs throughout the respiratory system, including modifications to the gas exchanger, respiratory pigments, respiratory muscles, and the neural control systems responsible for ventilating the gas exchanger. While some of these responses appear appropriate (e.g., increases in lung surface area, blood O2 capacity, and pulmonary ventilation in hypoxia), other responses are potentially harmful (e.g., increased muscle fatigability). Thus, it may be difficult to predict whole-animal performance based on the plasticity of a single system. Moreover, plastic responses may differ quantitatively and qualitatively at different developmental stages. Much of the current research in this field is focused on identifying the cellular and molecular mechanisms underlying respiratory plasticity. These studies suggest that a few key molecules, such as hypoxia inducible factor (HIF) and erythropoietin, may be involved in the expression of diverse forms of plasticity within and across species. Studying the various ways in which animals respond to respiratory challenges will enable a better understanding of the integrative response to chronic changes in O2 supply and deman