Evaluating the Likelihood of Use of Bispectral Index Guided Anesthesia as a Strategy to Reduce Postoperative Delirium in Surgical Patients 65 Years of Age or Older

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two parts to this project. The goal of part 1 was to evaluate recent trends in BIS monitor use for patients 65 years of age or older through retrospective chart review. The goal of part 2 was to conduct a voluntary survey to assess anesthesia provider’s knowledge of current recommendations, opinions, barriers to use, and if there are plans for practice change related to BIS monitor use. Data collected during part 1 demonstrated the odds ratio of BIS use in this sample overall 0.078, indicating that the likelihood of BIS being used in this sample was 12.8 times lower than BIS not being used (n=281, p

[Capillary electrophoresis and immobilization strategies research]

During the past few decades, the development of chromatography and electrophoresis has been an essential factor for the significant advancements achieved in biotechnology. Today, efforts continue to improve upon the accuracy, speed, and precision of these methods. DNA analysis by capillary electrophoresis (CE) is a good example of how the best attributes of different methods can be brought together to develop analytical methodology that offers significant improvements over existing technology. Despite the many attributes of CE, method validation continues to be problematic. In order to reproducibly achieve high efficiency and good resolution of DNA fragments, deactivating the surface of the separation column is essential. There exist many variations to the original method first suggested in 1985 by Stellan Hjerten. In this work, scanning electron microscopy (SEM) was utilized to examine various columns coated with non cross-linked polyacrylamide. At very low concentrations of acrylamide (~2.5%), no noticeable polymer layer is present. However, as the concentration of acrylamide exceeds 2.5%, a noticeable thickness and non-uniformity is observed. The use of coated columns can then be employed for the size-, selective capillary electrophoresis (SSCE) separations of DNA fragments. Since the development of this method in the early 1990’s, several papers have discussed the theoretical aspects of utilizing aqueous solutions of soluble polymers for the separation of DNA fragments. However, the instrumentation required to directly evaluate fundamental processes such as variance in SSCE has been limited by the lack of novel instrumentation necessary to perform these experiments. In this work, experimental measurements of variance under static and dynamic conditions are reported. The determination of static diffusion coefficients and their contribution to total band variance is reported. The fact that diffusion accounts for less than half of the total variance observed led to the conclusion that other processes occurring during DNA fragments separations (i.e., DNA - polymer entanglement/disentanglement interactions) contribute significantly to band variance. Upon optimizing conditions for DNA analyses by SSCE, a novel class of cyanine intercalation dyes reported to offer superior fluorescence sensitivity relative to ethidium bromide was also evaluated in this work. Despite an improvement in sensitivity of DNA/dye complexes when employing the cyanine intercalation dyes, the labeling mechanisms and kinetics proved to be problematic in achieving appreciably lower detection limits by CE. In another area of research, the potential of utilizing modestly selective stationary phases on microsensors was evaluated. Phases commonly employed in gas chromatography (GC) and liquid chromatography (LC) were bonded onto prepared silicon substrates. The relative affinity and selectivity of these phases for semivolatile organic compounds was determined by exposing these “sensors” to solutions followed by analysis by gas chromatography/mass spectrometry (GC/MS). It was found that improving wettability of the substrate prior to phase deposition was essential to achieve uniform films. Although the relative affinity and selectivity of these films are modest, these phases may be suitable for part of a higher-order, generalized approach to sensing

Sexual Selection in Lekking Sage Grouse: Phenotypic Correlates of Male Mating Success

Mate choice cues in sage grouse were reinvestigated by analyzing relationships between male mating success and a range of suggested cues. Display cues were implicated by significant relationships between mating status (whether or not a male mated) and lek attendance, display rate (corrected for effects of female proximity and time of day) and an acoustic component related to temporal and frequency measures of a whistle emitted during the strut display. Although display rate and the acoustic component were intercorrelated, both exerted significant partial effects on mating success in multivariate analyses. These display measures also differed significantly between males. In contrast, mating success was not significantly related to measures of territory characteristics, including size and proximity to the lek center, or to body size. These results resolve discrepancies between previous studies and provide a basis for experimental analysis of the role of female choice in this lek system

Reliability of measures of lower body strength and speed in academy male adolescent soccer players:Test reliability in elite adolescent footballers

The Nordbord and ForceFrame represent a practical and time efficient means of assessing eccentric hamstring and isometric adductor strength in the large number of squads and players associated with youth soccer academies, yet measurement reliability in this population is unexamined. Therefore, over a period of four days, with no less than 24 hours and no more than 48 hours between trials, 37 players (age: 14.7 ± 0.8 years; stature: 168.7 ± 7.8 cm; mass: 57.7 ± 9.1 kg; maturity offset: 0.8 ± 0.9 years) were assessed for eccentric hamstring strength (force, torque), isometric adductor strength (long and short lever positions) and 30-m sprint (5 m, 10 m, and 20 m splits), using the Nordbord, ForceFrame and electronic timing gates, respectively on three separate occasions. Relative reliability (intraclass correlation coefficient, [ICC]) was rated good for all Nordbord (range: 0.86 to 0.89) and ForceFrame (0.78 to 0.85) measures and ranged from moderate (0.53) to excellent (0.93) for the speed measures, improving with increased distance. Absolute reliability (standard error of the measurement [%SEM]) ranged from 7% to 8% (Nordbord), 3% to 11% (ForceFrame), and 1% to 4% (sprints). Our data provide the first Nordbord and ForceFrame reliability estimates in adolescent soccer academy players. To interpret test sensitivity, practitioners are encouraged to interpret our estimates of absolute reliability against meaningful change values derived from personal experience and evidence-based knowledge and not against absolute or standardized thresholds

Using data from primary care to investigate the epidemiology of motor vehicle crashes

Background Motor Vehicle Crashes (MVCs) are a major cause of morbidity and mortality worldwide. This thesis explores the potential use of large databases of primary care medical records to investigate the epidemiology of MVCs in the United Kingdom and to supplement the data available from national statistics, which are believed to understate both the number of crashes, and the number of injuries which occur as a result. Methods Details of all individuals enrolled in The Health Improvement Network (THIN) database whose primary care records indicated involvement in a MVC were used to calculate a series of summary measures describing the burden and consequences of MVCs. These were compared with data available from police accident reports and from hospital admissions. Data from THIN were used to conduct a series of studies of the impact of health and healthcare-related factors on the risk of involvement in MVCs. Specifically: a case-control study of the impact of modifiable lifestyle factors on the risk of MVC; case-crossover and self-controlled case-series studies of the effect of exposure to prescribed medications on the risk of MVC; a case-control study investigating the impact of disordered sleep on the risk of MVC; a case-control study of the risk of involvement in MVC among individuals with diabetes relative to the general population; and; a cohort study assessing whether there is evidence to suggest that involvement in a MVC may indicate the presence of undiagnosed disease which may impair driving performance. Results The socio-demographic characteristics of individuals involved in MVCs recorded in THIN differ markedly from those recorded in police accident reports and hospital admissions data. There was no evidence of consistent trends in MVC incidence over time in the three data sources. Differences in data collection methodology and the severity and scope of crashes recorded may account for these variations. Evidence was found of an association between having a high Body Mass Index and involvement in MVCs, and between past (but not current) smoking and involvement in MVCs, however the recording of data on lifestyle-related exposures such as smoking and alcohol consumption in the age-groups most likely to be involved in MVCs was poor, complicating interpretation of these results. Current exposure to benzodiazepines and preparations containing opioid analgesics was found to increase the risk of involvement in MVCs, as was longer-term use of non-benzodiazepine hypnotics, selective serotonin reuptake inhibitors and antihistamines. No increased risk of MVC was observed with exposure to beta-blockers or tricyclic antidepressants. Individuals reporting insomnia or snoring to their primary care practitioner were found to be at increased risk of MVC, as were individuals with diagnosed sleep apnoea. This association was independent the use of sedative or antidepressant medications. Individuals with diabetes were not found to be at an increased risk of MVC compared with the general population, and there was no difference in risk between those receiving different forms of treatment. Involvement in a MVC was associated with an increased risk of being diagnosed with cardiac disease in the two years following the crash. Conclusions Current sources of data about MVCs in the UK use different data collection methodologies, none of which is likely to accurately describe the overall burden of MVCs in the population. Primary care data remain a useful resource for those wishing to study the epidemiology of MVCs, but care must be taken to ensure that the uses to which the data are put are appropriate. Studies investigating lifestyle-related exposures are unlikely to produce reliable results as primary care recording of such factors is poor in the age-groups most likely to be involved in MVCs. Primary care data are more useful when studying the time course of pharmacological effects, or the effects of diagnosed illness, and can successfully detect previously observed associations. Primary care data is currently of little use in the study of injuries associated with involvement in MVCs as it is rare for both an injury and its proximate cause to be recorded. The investigation of methods by which this problem might be resolved is an important avenue for future research