Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Diaspora and Self-Representation: The Case of Greek People’s Identity, Fifteenth-Nineteenth Centuries

In the long space-time between the late fifteenth and early nineteenth centuries Greek Orthodox people from Southeastern Europe have established communities / “colonies”/ paroikiai in various cities in central, northern Europe, at the Mediterranean and at the Black Sea. The reasons for this were political, cultural and economic. Their establishment in the host cities was a result of their interest and, of course, a consequence of the privileges granted to them by the local authorities, more or less because of their special economic interest. In these diaspora communities Greeks, Serbs, Albanians, Aromunians and Bulgarians, founded their Greek Orthodox churches, and organised their common communities. Very often and, particularly, during the eighteenth century, they conducted different forms of organisation, following their own forms of national identification. The common Orthodox dogma was not sufficient as a combining element. The Jus-nationis took the important place of the Jus religionis. The commercial and intellectual networks, built by these diaspora Greek Orthodox people, were another interesting phenomenon of this long space-time. The coexistence of Greek Orthodox with other Orthodox, Catholic, Protestant, Armenian, Jewish people in the diaspora led, from the mid-eighteenth century, to the more or less intense strengthening of the ‘us’ towards to the ‘others’. The formation of the nation states in Southeastern Europe (the first among them being the Greek one, in 1830) was also a result of this long and interesting process of national identification

Yearbook of the Society for 18th Century Studies on South Eastern Europe / Greek Enlightenment. Antiquity and Orthodoxy: An Ambivalent Relation concerning the Way to National Identity

Recent years have witnessed the emergence of an entire body of literature on Neohellenic Enlightenment (mid 18th \u2013 early 19th cent.) and its relationship with the Greek Orthodox Church. Scholars oriented respectively towards Enlightenment and the Church agree, differ and disagree violently on a wide range of subjects. Many Enlightenment intellectuals were clerics, but this was not an obstacle to their exploring new philosophical and scientific horizons. A shift towards Greek Antiquity was observed during the heyday of Neohellenic Enlightenment. This was the era which K.Th. Dimaras, the great Greek Enlightenment scholar, dubbed a \u2018Delayed Renaissance\u2019(\u39a\u3b1\u3b8\u3c5\u3c3\u3c4\u3b5\u3c1\u3b7\u3bc\u3ad\u3bd\u3b7 \u391\u3bd\u3b1\u3b3\u3ad\u3bd\u3bd\u3b7\u3c3\u3b7). The \u2018rediscovery\u2019 of antiquity through publications of ancient Greekliterature and philosophy, grammars etc. and courses taught in schools and academies in theOttoman empire and the Greek Diaspora was the new trend. And this trend led in turn to newideologies and ideological orientations. The era, combined with the spread of the ideology of theFrench Revolution and its conceptions of the \u2018nation\u2019, \u2018people/peuple\u2019, \u2018fatherland\u2019, human rights etc.,encouraged Greek scholars to follow new paths, as well. The Greek nation was not only the \u2018Genos\u2019(\u393\u3ad\u3bd\u3bf\u3c2) of the Church, meaning the followers of the Greek Orthodox faith; it was something new andbeyond that: a Nation descended from Antiquity, with secular cultural roots as well. This meant anew identity, one that was also influenced by Nationalism, the new ideology. My paper seeks tocontribute to the critical discussion with a focus on the literature on this ambivalent relationship

Income-Related Peripheral Artery Disease Treatment: A Nation-Wide Analysis from 2009–2018

Economic status has a measurable and significant effect on cardiovascular health. Socioeconomic- and income-related disparities worsen cardiovascular risk factors. Peripheral artery disease (PAD) remains a major risk factor for morbidity and mortality. Not all patients benefit equally from recent advances in outpatient healthcare. The implementation of guideline recommendations regarding treatment is inadequate. Income-related disparities for PAD treatment are unknown. We aimed to analyse income-stratified PAD prevalence, outpatient treatment and pharmacotherapy. Associations of statutory health insurance physicians at the regional level, income-stratified PAD prevalence and differences in outpatient care and pharmacotherapy were analysed in 70.1 million statutorily insured patients/year between 2009 and 2018. Analysis was based on claims data (§295 of the social code (SGB V)) and drug-prescription data (§300 SGB V). The diagnosis of PAD was defined by ICD I70.2-9. Regional income data were derived from the German Census Bureau. PAD prevalence was higher in low-income than in high-income areas. Low-income patients more often presented to angiology outpatient care and more frequently received guideline recommended pharmacotherapy. High-income patients more often presented to outpatient vascular surgery. This was true for statins, antiplatelets, intermittent claudication and critical limb ischemia alike. These data indicate that PAD and income are associated. Regional income is related to insufficiencies in guideline-recommended treatment and contact to vascular specialists. Our results aim to encourage medical professionals to implement PAD guideline recommendations, especially in high-income areas. Further studies on associations between spatial-level income and healthcare in PAD are needed