Risk of postoperative pulmonary complications in adult surgical patients with metabolic syndrome: a systematic review and meta-analysis protocol

Background: Metabolic syndrome (MetS) is defined as an accumulation of risk factors that include chronic hypertension, dyslipidaemia, insulin resistance and obesity and leads to an increased risk for diabetes, cardiovascular disease and stroke. MetS is widespread and estimated to affect up to a quarter of the global population. Patients with MetS who undergo surgery are associated with an increased risk of postoperative complications when compared with patients with a non-MetS profile. An emerging body of literature points to MetS being associated with a greater risk of postoperative pulmonary complications (PPC) in the surgical patient. PPC are associated with increased postoperative morbidity and mortality, Intensive care unit (ICU) admission, length of stay (ICU and hospital), health care costs, resource usage, unplanned re-intubation and prolonged ventilatory time. Methods/design: We will search for relevant studies in the following electronic bibliographic databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus as well as scan the reference lists of included studies for potential additional literature. Two authors will independently screen titles and abstracts to identify potentially relevant studies for inclusion based on predefined inclusion and exclusion criteria. The Cochrane Collaboration Review Manager (Review Manager 5) statistical software will be used to conduct this systematic review and meta-analysis and generate forest plots to demonstrate comparison of findings across studies included for meta analysis. Subgroup and sensitivity analysis will be performed to assess the heterogeneity of included studies. A descriptive synthesis of the statistical data will be provided to summarise the results and findings of the systematic review and meta-analysis. Discussion: This review will be the first to report and summarise the risk for and incidence of PPC in adult patients with MetS undergoing surgery across a range of surgical specialities. The results have the potential to inform the development of evidenced-based interventions to improve the management of PPC in the surgical patient with MetS. Findings from this systematic review and meta-analysis will inform a subsequent Delphi study on priorities and responses to PPC in patients with MetS. We will also disseminate our results through publication in scientific peerreviewed journals, conference presentations and promotion throughout our network of surgical safety champions in clinical settings

Economic Games Quantify Diminished Sense of Guilt in Patients with Damage to the Prefrontal Cortex

Damage to the ventromedial prefrontal cortex (VMPFC) impairs concern for other people, as reflected in the dysfunctional real-life social behavior of patients with such damage, as well as their abnormal performances on tasks ranging from moral judgment to economic games. Despite these convergent data, we lack a formal model of how, and to what degree, VMPFC lesions affect an individual's social decision-making. Here we provide a quantification of these effects using a formal economic model of choice that incorporates terms for the disutility of unequal payoffs, with parameters that index behaviors normally evoked by guilt and envy. Six patients with focal VMPFC lesions participated in a battery of economic games that measured concern about payoffs to themselves and to others: dictator, ultimatum, and trust games. We analyzed each task individually, but also derived estimates of the guilt and envy parameters from aggregate behavior across all of the tasks. Compared with control subjects, the patients donated significantly less and were less trustworthy, and overall our model found a significant insensitivity to guilt. Despite these abnormalities, the patients had normal expectations about what other people would do, and they also did not simply generate behavior that was more noisy. Instead, the findings argue for a specific insensitivity to guilt, an abnormality that we suggest characterizes a key contribution made by the VMPFC to social behavior

Noise-robust preparation contextuality shared between any number of observers via unsharp measurements

Multiple observers who independently harvest nonclassical correlations from a single physical system share the system's ability to enable quantum correlations. We show that any number of independent observers can share the preparation contextual outcome statistics enabled by state ensembles in quantum theory. Furthermore, we show that even in the presence of any amount of white noise, there exists quantum ensembles that enable such shared preparation contextuality. The findings are experimentally realised by applying sequential unsharp measurements to an optical qubit ensemble which reveals three shared demonstrations of preparation contextuality.Comment: H. A. and N. W. contributed equally to this wor

Impaired Emotional Declarative Memory Following Unilateral Amygdala Damage

Case studies of patients with bilateral amygdala damage and functional imaging studies of normal individuals have demonstrated that the amygdala plays a critical role in encoding emotionally arousing stimuli into long-term declarative memory. However, several issues remain poorly understood: the separate roles of left and right amygdala, the time course over which the amygdala participates in memory consolidation, and the type of knowledge structures it helps consolidate. We investigated these questions in eight subjects with unilateral amygdala damage, using several different measures. For comparison, our main task used stimuli identical to those used previously to investigate emotional declarative memory in patients with bilateral amygdala damage. Contrasts with both brain-damaged and normal control groups showed that subjects with left amygdala damage were impaired in their memory for emotional stimuli, despite entirely normal memory for neutral stimuli (because of a number of caveats, the findings from subjects with right amygdala damage were less clear). Follow-up experiments suggested that the normal facilitation of memory for emotional stimuli may develop over an extended time course (>30 min), consistent with prior findings, and that the specific impairment we report may depend in part on the lexical nature of the task used (written questionnaire). We stress the complex and temporally extended nature of memory consolidation and suggest that the amygdala may influence specific components of this process

Bolivia\u27s lithium frontier: Can public private partnerships deliver a minerals boom for sustainable development?

Lithium is central at least in the short term, for transitions to renewable energy. Substantial deposits reside in South America's 'lithium triangle' in Bolivia, Argentina and Chile. Bolivia has promoted lithium industrialization through vertically integrated mineral development under resource nationalism and public-private partnerships with foreign corporations. Central to the Bolivian vision is a desire to harness the most environmentally appropriate technologies for national development and to move away from exploitative extractive models so prevalent in developing countries. Bolivia has been at the forefront of Global South climate change arguments about carbon debt and resource rights for just and fair sustainable development. We discuss the debate on cleaner production for lithium, challenges of Bolivia's lithium industrialization under Indigenous President Morales, and investigate how the desire for cleaner technologies has cultivated unusual governance arrangements via public private partnerships (PPPs) between state enterprises and foreign-owned private corporations. We consider this model for developing remote mineral reserves for advanced cleaner production technologies that are necessary for the transition from a fossil fuel to a low carbon global economy, alongside addressing sustainable development goals. Lithium is vital for energy storage, renewable energy and the electric vehicle industry. To meet rising lithium demand with minimal environmental and social impacts, novel approaches are needed to international resource extraction partnerships that transcend ideological biases; with their efficacy evaluated. Our research aims to pave the way to such an evaluative framework, using Bolivia's lithium as a central case. Key research issues for developing the framework and initial criteria of evaluation are proposed, focused on how public private partnerships interface with the United Nations Sustainable Development Goals (SDGs)

The Relationship between Religiosity and Health-Promoting Behaviors in Pregnant Women at Pregnancy Resource Centers

Abstract available through the Annals of Behavioral Medicine

Physical assessment skills in nursing curricula: A scoping review protocol

Review objective:This review seeks to establish the current state of knowledge regarding physical assessment skills taught in nursing programs globally. It aims to explore the literature on physical assessment skills taught in nursing curricula globally, skills used by nurses in practice, skills used by students, and core physical assessment skills that are important to teach nursing students

Reactivation of Microbial Strains and Synthetic Communities After a Spaceflight to the International Space Station: Corroborating the Feasibility of Essential Conversions in the MELiSSA Loop

To sustain human deep space exploration or extra-terrestrial settlements where no resupply from the Earth or other planets is possible, technologies for in situ food production, water, air, and waste recovery need to be developed. The Micro-Ecological Life Support System Alternative (MELiSSA) is such a Regenerative Life Support System (RLSS) and it builds on several bacterial bioprocesses. However, alterations in gravity, temperature, and radiation associated with the space environment can affect survival and functionality of the microorganisms. In this study, representative strains of different carbon and nitrogen metabolisms with application in the MELiSSA were selected for launch and Low Earth Orbit (LEO) exposure. An edible photoautotrophic strain (Arthrospira sp. PCC 8005), a photoheterotrophic strain (Rhodospirillum rubrum S1H), a ureolytic heterotrophic strain (Cupriavidus pinatubonensis 1245), and combinations of C. pinatubonensis 1245 and autotrophic ammonia and nitrite oxidizing strains (Nitrosomonas europaea ATCC19718, Nitrosomonas ureae Nm10, and Nitrobacter winogradskyi Nb255) were sent to the International Space Station (ISS) for 7 days. There, the samples were exposed to 2.8 mGy, a dose 140 times higher than on the Earth, and a temperature of 22 degrees C +/- 1 degrees C. On return to the Earth, the cultures were reactivated and their growth and activity were compared with terrestrial controls stored under refrigerated (5 degrees C +/- 2 degrees C) or room temperature (22 degrees C +/- 1 degrees C and 21 degrees C +/- 0 degrees C) conditions. Overall, no difference was observed between terrestrial and ISS samples. Most cultures presented lower cell viability after the test, regardless of the type of exposure, indicating a harsher effect of the storage and sample preparation than the spaceflight itself. Postmission analysis revealed the successful survival and proliferation of all cultures except for Arthrospira, which suffered from the premission depressurization test. These observations validate the possibility of launching, storing, and reactivating bacteria with essential functionalities for microbial bioprocesses in RLSS

Study Protocol for a Randomised Controlled Trial on Pulmonary Metastasectomy vs. Standard of Care in Colorectal Cancer Patients With ≥ 3 Lung Metastases (PUCC-Trial)

This is a multicentre prospective randomised controlled trial for patients with 3 or more resectable pulmonary metastases from colorectal carcinoma. The study investigates the effects of pulmonary metastasectomy in addition to standard medical treatment in comparison to standard medical treatment plus possible local ablative measures such as SBRT. This trial is intended to demonstrate an overall survival difference in the group undergoing pulmonary metastasectomy. Further secondary and exploratory endpoints include quality of life (EORTC QLQ-C30, QLQ-CR29 and QLQ-LC29 questionnaires), progression-free survival and impact of mutational status. Due to the heterogeneity and complexity of the disease and treatment trajectories in metastasised colorectal cancer, well powered trials have been very challenging to design and execute. The goal of this study is to create a setting which allows treatment as close to the real life conditions as possible but under well standardised conditions. Based on previous trials, in which patient recruitment in the given setting hindered successful study completion, we decided to (1) restrict inclusion to patients with 3 or more metastases (since in case of lesser, surgery will probably be the preferred option) and (2) allow for real world standard of care (SOC) treatment options before and after randomisation including watchful waiting (as opposed to a predefined treatment protocol) and (3) possibility that patient can receive SOC externally (to reduce patient burden). Moreover, we chose to stipulate 12 weeks of systemic treatment prior to possible resection to further standardize treatment response and disease course over a certain period of time. Hence, included patients will be in the disease state of oligopersistence rather than primary oligometastatic. The trial was registered in the German Clinical Trials Register (DRKS-No.: DRKS00024727)