Anaesthesiology – the most attractive speciality also in 20 years

Asker and Bærum Hospital, Oslo, Norway, Education Committee, WFSA, European Board of Anaesthesiology, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009The development of our speciality has been fast, ever since the famous demonstration of ether anaesthesia by William TG Morton in 1846. We provide the sine qua non for the development of surgery. Although a lot of what we do is common, the development until today has taken varied courses throughout the world. We have one speciality, but the specialist training varies between 0 – 7 years. In some countries, physician anaesthesiologists do mainly anaesthetics, with or without helpers like nurses or technicians, but in others, we are also involved in intensive care medicine, emergency medicine and chronic pain treatment. Anaesthesiologists are also popular as managers and leaders. Our prestige and attractiveness by young colleagues also vary, sometimes leading to lack of manpower. Both lack of manpower and financial restraints may lead health authorities to create shortcuts, for instance by reducing the duration of training. At the same time, availability of private practices, working time regulations and the general development in society might lead to reduced duty time for doctors. All these developments could lead to impaired quality of services and reduced patient safety. Other specialities also have interests in “our” turf/parts of our speciality like emergency medicine and intensive care medicine. Meanwhile, new teaching methods are also emerging and will be incorporated in our daily practice. There has always been change/development in medicine. For those countries that experience a shortage with recruitment problems, it might be useful to look to the success factors in the countries where anaesthesiology is popular - eg, in Scandinavia, like in Norway, where we enjoy higher prestige than general surgeons. We believe that the introduction of helicopter emergency medical services, with anaesthesiologists the as “medical problem solvers” in the field has played a role in that. The same is true for our involvement in intensive care and pain medicine. Another factor is that nurse anaesthetists are a natural part of our daily work, but not replacing the doctors (US), but being supervised by us. Hence, doctors often run several theatres simultaneously, or if the case is complicated, there will be two competent persons available at any one time. It is equally important that we are able to demonstrate to the medical students that anaesthesiology is – applied physiology, rewarding for our brains, hands and hearts. Rather than leaving to others to decide how our future should be, anaesthesiologists must be in the driver’s seat to develop our own speciality. This should be done by listening to anaesthesiology organisations in involved countries, assess what works well to improve attractiveness and quality, what development would we like to see concerning supra- or subspecialities, training, etc. Anaesthesiological organisations should work together to outline a roadmap for the future, and we should work with health authorities in a positive, constructive way, taking into account not only the status quo, but also potential positive changes to maintain and improve the quality of the organisation of our speciality

Latitudinal gradients of galactic cosmic rays during the 2007 solar minimum

Ulysses, launched in 1990 October in the maximum phase of solar cycle 22, completed its third out-of-ecliptic orbit in 2008 February. This provides a unique opportunity to study the propagation of cosmic rays over a wide range of heliographic latitudes during different levels of solar activity and different polarities in the inner heliosphere. Comparison of the first and second fast latitude scans from 1994 to 1995 and from 2000 to 2001 confirmed the expectation of positive latitudinal gradients at solar minimum versus an isotropic Galactic cosmic ray distribution at solar maximum. During the second scan in mid-2000, the solar magnetic field reversed its global polarity. From 2007 to 2008, Ulysses made its third fast latitude scan during the declining phase of solar cycle 23. Therefore, the solar activity is comparable in 2007-2008 to that from 1994 to 1995, but the magnetic polarity is opposite. Thus, one would expect to compare positive with negative latitudinal gradients during these two periods for protons and electrons, respectively. In contrast, our analysis of data from the Kiel Electron Telescope aboard Ulysses results in no significant latitudinal gradients for protons. However, the electrons show, as expected, a positive latitudinal gradient of ~0.2% per degree. Although our result is surprising, the nearly isotropic distribution of protons in 2007-2008 is consistent with an isotropic distribution of electrons from 1994 to 1995

Buoyant Venus station mission feasibility study for 1972 and 1973 launch opportunities. Volume 3 - Configuration definition. Part 2 - Appendixes Final report

Buoyant Venus station mission study for 1972 - 1973 launch period - backup data including atmospheric models, heat shield requirements, etc

Iterated Binomial Sums and their Associated Iterated Integrals

We consider finite iterated generalized harmonic sums weighted by the binomial $\binom{2k}{k}$ in numerators and denominators. A large class of these functions emerges in the calculation of massive Feynman diagrams with local operator insertions starting at 3-loop order in the coupling constant and extends the classes of the nested harmonic, generalized harmonic and cyclotomic sums. The binomially weighted sums are associated by the Mellin transform to iterated integrals over square-root valued alphabets. The values of the sums for $N \rightarrow \infty$ and the iterated integrals at $x=1$ lead to new constants, extending the set of special numbers given by the multiple zeta values, the cyclotomic zeta values and special constants which emerge in the limit $N \rightarrow \infty$ of generalized harmonic sums. We develop algorithms to obtain the Mellin representations of these sums in a systematic way. They are of importance for the derivation of the asymptotic expansion of these sums and their analytic continuation to $N \in \mathbb{C}$. The associated convolution relations are derived for real parameters and can therefore be used in a wider context, as e.g. for multi-scale processes. We also derive algorithms to transform iterated integrals over root-valued alphabets into binomial sums. Using generating functions we study a few aspects of infinite (inverse) binomial sums.Comment: 62 pages Latex, 1 style fil

NNLO coefficient functions of Higgs and Drell--Yan cross sections in Mellin space

We calculate the Mellin moments of next-to-next-to-leading order coefficient functions of the Drell-Yan and Higgs production cross sections. The results can be expressed in term of finite harmonic sums which are maximally threefold up to weight four. Various algebraic relations among these finite sums reduce the complexity of the results suitable for fast numerical evaluations. It is shown that only five non--trivial functions occur besides Euler's $\psi$--function in the representation of these Wilson coefficients.Comment: 1 latex file, 1 style file, Contribution to the Proceedings of "Loops and Legs in Quantum Field Theory 2004", Zinnowitz, Usedom Island, Germany, April 200

A Comprehensive View of the 2006 December 13 CME: From the Sun to Interplanetary Space

The biggest halo coronal mass ejection (CME) since the Halloween storm in 2003, which occurred on 2006 December 13, is studied in terms of its solar source and heliospheric consequences. The CME is accompanied by an X3.4 flare, EUV dimmings and coronal waves. It generated significant space weather effects such as an interplanetary shock, radio bursts, major solar energetic particle (SEP) events, and a magnetic cloud (MC) detected by a fleet of spacecraft including STEREO, ACE, Wind and Ulysses. Reconstruction of the MC with the Grad-Shafranov (GS) method yields an axis orientation oblique to the flare ribbons. Observations of the SEP intensities and anisotropies show that the particles can be trapped, deflected and reaccelerated by the large-scale transient structures. The CME-driven shock is observed at both the Earth and Ulysses when they are separated by 74$^{\circ}$ in latitude and 117$^{\circ}$ in longitude, the largest shock extent ever detected. The ejecta seems missed at Ulysses. The shock arrival time at Ulysses is well predicted by an MHD model which can propagate the 1 AU data outward. The CME/shock is tracked remarkably well from the Sun all the way to Ulysses by coronagraph images, type II frequency drift, in situ measurements and the MHD model. These results reveal a technique which combines MHD propagation of the solar wind and type II emissions to predict the shock arrival time at the Earth, a significant advance for space weather forecasting especially when in situ data are available from the Solar Orbiter and Sentinels.Comment: 26 pages, 10 figures. 2008, ApJ, in pres

Critical Foundations for Civic Engagement: Reimagining Civic Learning for a University Honors Program

Scholars are calling attention to shortcomings of service-learning, including the development of civic skills and adoption of a social change framework. Informed by this literature, this article uses a mixed-methods case study to detail the development, and initial outcomes, of a civic engagement course intended to lay a critical foundation for future service. This study documents the process of reimagining the class, formerly organized as a service project, and course evaluations and reflections are used to assess outcomes. Initial assessment signals impact in challenging previous assumptions about service, understanding the multifaceted nature of civic engagement, and motivating future responsible engagement

Data processing for a cosmic ray experiment onboard the solar probes Helios 1 and 2: Experiment 6

The data processing system for the Helios experiment 6, measuring energetic charged particles of solar, planetary and galactic origin in the inner solar system, is described. The aim of this experiment is to extend knowledge on origin and propagation of cosmic rays. The different programs for data reduction, analysis, presentation, and scientific evaluation are described as well as hardware and software of the data processing equipment. A chronological presentation of the data processing operation is given. Procedures and methods for data analysis which were developed can be used with minor modifications for analysis of other space research experiments

The effects of climate change on the ecology of fishes

Ocean warming and acidification are set to reshuffle life on Earth and alter ecological processes that underpin the biodiversity, health, productivity, and resilience of ecosystems. Fishes contribute significantly to marine, estuarine, and freshwater species diversity and the functioning of marine ecosystems, and are not immune to climate change impacts. Whilst considerable effort has been placed on studying the effects of climate change on fishes, much emphasis has been placed on their (eco)physiology and at the organismal level. Fishes are affected by climate change through impacts at various levels of biological organisation and through a large variety of traits, making it difficult to make generalisations regarding fish responses to climate change. Here, we briefly review the current state of knowledge of climate change effects on fishes across a wide range of subfields of fish ecology and evaluate these effects at various scales of biological organisation (from genes to ecosystems). We argue that a more holistic synthesis of the various interconnected subfields of fish ecology and integration of responses at different levels of biological organisation are needed for a better understanding of how fishes and their populations and communities might respond or adapt to the multi-stressor effects of climate change. We postulate that studies using natural analogues of climate change, meta-analyses, advanced integrative modelling approaches, and lessons learned from past extreme climate events could help reveal some general patterns of climate change impacts on fishes that are valuable for management and conservation approaches. Whilst these might not reveal many of the underlying mechanisms responsible for observed biodiversity and community change, their insights are useful to help create better climate adaptation strategies for their preservation in a rapidly changing ocean

Arterial Stiffness in a Cohort of Young People Living With Perinatal HIV and HIV Negative Young People in England

Background: Antiretroviral therapy (ART) has increased life expectancy and consequently the risk of cardiovascular disease (CVD) in adults living with HIV. We investigated the levels and predictors of arterial stiffness in young people (YP) living with perinatal HIV (PHIV) and HIV negative YP in the Adolescents and Adults Living with Perinatal HIV (AALPHI) study. Methods: AALPHI was a prospective study evaluating the impact of HIV infection and exposure to ART on YP living with PHIV (aged 13-21 years) who had known their HIV status for at least 6 months, and HIV negative YP (aged 13-23 years) who either had a sibling, friend or parent living with HIV. Participants were enrolled from HIV clinics and community services in England. Two hundred and thirteen PHIV and 65 HIV negative YP (42% siblings of PHIV) had pulse wave velocity (PWV) measurements taken (Vicorder software) from the supra-sternal notch to the middle of the thigh cuff, at their second interview in the study between 2015 and 2017. Average PWV was calculated from the three closest readings (≥3 and ≤ 12 m/s) within 0.6 m/s of each other. Linear regression examined predictors of higher (worse) PWV, including age, sex, HIV status and height as a priori, ethnicity, born outside UK/Ireland, alcohol/nicotine/drug use, weight, waist-to-hip-ratio, mean arterial pressure (MAP), caffeine 2 h before PWV and nicotine on day of PWV. A separate PHIV model included CD4, viral load, years taking ART and ART regimen. Findings: One hundred and twenty eight (60%) PHIV and 45 (69%) HIV negative YP were female (p = 0.18), with median (IQR) age 18 (16, 20) and 18 (16, 21) years (p = 0.48) respectively. Most PHIV were taking a combination of three ART drugs from two classes. There was a trend toward higher (worse) mean PWV in the PHIV group than the HIV negative group [unvariable analysis 6.15 (SD 0.83) m/s vs. 5.93 (0.70) m/s, respectively, unadjusted p = 0.058], which was statistically significant in the multivariable analysis [adjusted p (ap) = 0.020]. In multivariable analysis being male (ap = 0.002), older age (ap < 0.001), higher MAP (ap < 0.001) and nicotine use on day of measurement (ap = 0.001) were also predictors of higher PWV. The predictors were the same in the PHIV model. Interpretation: By late adolescence PHIV had worse PWV in comparison to HIV negative peers, and traditional risk factors for CVD (higher arterial pressure, being male and older age) were associated with higher PWV values. Regular detailed monitoring of cardiovascular risk factors should become standard of care for every young person with PHIV worldwide