PONV Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance

Objectives: To compare postoperative nausea and vomiting (PONV) prophylaxis treatment and outcomes based on patients’ sex, using a retrospective cohort. The setting was the operating room and post-anesthesia care unit of a tertiary care university medical center. Patients: A total of 678 adult male and female patients with American Society of Anesthesiologist (ASA) scores of 1-4 underwent surgery with general anesthesia. All patients received preoperative PONV risk assessment. PONV prophylaxis was administered at the discretion of the anesthesia care team members with guidance from a computerized decision support system. Measurements: Adequacy of prophylaxis was retrospectively determined based on individual patient risk factors and the observed treatment received, compared with guideline-based prophylaxis recommendations. Patient outcome was measured by diagnosis of PONV in recovery. Results: Comparing patients who received fewer than the guideline-recommended number of prophylactic antiemetics by sex, 94.6% were female and 5.4% were males (p \u3c 0.001). Patients who received fewer than guideline-recommended number of antiemetics had significantly higher rates of nausea or vomiting in the post-anesthesia care unit (30.4% vs 17.5%, p \u3c 0.001). Conclusion: This retrospective cohort study shows that female patients receiving general anesthesia are disproportionately affected by failure to adhere to PONV prevention guidelines

A greve, o carnaval e os comícios: O mundo do trabalho portuário em Buenos Aires e a configuração de uma comunidade obreira, verão de 1904

Objetivo/contexto: El presente trabajo indaga sobre el proceso de configuración de una comunidad obrera en el puerto de Buenos Aires, resultado de la acción de los trabajadores y habitantes del barrio obrero a inicios del siglo XX. Originalidad: En el cruce de diversas historiografías (historia social, cultural y política), aquí se propone mirar de manera conjunta la dimensión laboral, la conflictividad obrera, el tiempo de la fiesta o carnaval y la participación electoral, para pensar, desde esta multiplicidad de eventos y experiencias, la aparición de una comunidad obrera radicalizada y con una particular identificación gestada en la movilización durante una época específica a comienzos del siglo XX. Metodología: A partir de una coyuntura significativa, como fueron los meses de fines de 1903 e inicios de 1904 en el barrio portuario, y basado en un variado conjunto de documentos (periódicos comerciales, barriales, gremiales, de las izquierdas, revistas de actualidad, informes policiales, fotografías, entre otros), el artículo reconstruye la experiencia obrera en los escenarios de la protesta, el carnaval y la votación para diputados celebrada durante ese verano. Al mismo tiempo, se ponderan aquí la dimensión territorial de la configuración comunitaria y los lugares centrales de la trama conformada por la protesta, la fiesta y las elecciones. Conclusiones: El análisis permite identificar que las sociabilidades obreras en el puerto consolidaron una comunidad, afincada en solidaridades familiares, corporativas, partidistas y vecinales obreras, en tiempos de movilización gremial, política y festiva, y de confrontación radicalizada con el Estado y las empresas.Objective/context: This paper inquires about the process of emergence of a working-class community in the port of Buenos Aires, resulting from actions by workers and inhabitants of the working-class neighborhood at the beginning of the 20th century. Originality: At the crossroads of diverse historiographies (social, cultural and political history), this paper proposes a joint regard at the labor dimension, worker disputes, carnival celebrations and electoral participation, and to use this multiplicity of events and experiences to think about the emergence of a radicalized worker community, with a particular identity gestated in the mobilization during a specific time at the beginning of the 20th century. Methodology: The months from late 1903 to early 1904 were an important juncture in the port district, and based on a diverse set of documents (commercial, neighborhood, trade and left-wing newspapers, news magazines, police reports, photographs, among others), this paper reconstructs the worker experience in three settings converging in the summer months: protest, carnival and legislative polls. At the same time, it ponders the territorial dimension of community configuration and the key places that formed the backdrop to a story of protest, celebration, and elections. Conclusions: This analysis shows us that worker sociabilities around the port consolidated a community based on family, corporate, partisan, neighborhood and worker solidarities, in times of labor, political and festive mobilization, and of radicalized confrontation with the State and with corporations.Objetivo/contexto: O presente trabalho indaga sobre o processo de configuração de uma comunidade obreira no porto de Buenos Aires, resultado da ação dos trabalhadores e habitantes do bairro obreiro no início do século XX. Originalidade: No cruzamento de diversas historiografias (história social, cultural e política), propõe-se aqui observar, de maneira conjunta, a dimensão laboral, a conflituosidade obreira, o tempo da festa ou carnaval e a participação eleitoral para pensar, a partir dessa multiplicidade de eventos e experiências, a aparição de uma comunidade obreira radicalizada e com uma identificação particular gestada na mobilização durante uma época específica no começo do século XX. Metodologia: A partir de uma conjuntura significativa, como foi o final de 1903 e início de 1904 no bairro portuário e baseado em um variado conjunto de documentos (jornais comerciais, de bairros, de grêmios, das esquerdas, revistas de atualidades, relatórios policiais, fotografias, entre outros), o artigo reconstrói a experiência obreira nos cenários do protesto, do carnaval e da votação para deputados celebrada nesse verão. Ao mesmo tempo, ponderam-se aqui a dimensão territorial da configuração comunitária e os lugares centrais da trama formada pelo protesto, pela festa e pelas eleições. Conclusões: A análise permite identificar que as sociabilidades obreiras no porto consolidaram uma comunidade, estabelecida em solidariedades familiares, corporativas, partidaristas e de vizinhanças obreiras, em tempos de mobilização gremial, política e festiva, e de confronto radicalizado com o Estado e com as empresas.Fil: Caruso, Laura Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de San Martin. Instituto de Altos Estudios Sociales. Centro de Estudios de Historia E Historia del Arte.; Argentin

Germline variation at 8q24 and prostate cancer risk in men of European ancestry

Chromosome 8q24 is a susceptibility locus for multiple cancers, including prostate cancer. Here we combine genetic data across the 8q24 susceptibility region from 71,535 prostate cancer cases and 52,935 controls of European ancestry to define the overall contribution of germline variation at 8q24 to prostate cancer risk. We identify 12 independent risk signals for prostate cancer (p < 4.28 × 10−15), including three risk variants that have yet to be reported. From a polygenic risk score (PRS) model, derived to assess the cumulative effect of risk variants at 8q24, men in the top 1% of the PRS have a 4-fold (95%CI = 3.62–4.40) greater risk compared to the population average. These 12 variants account for ~25% of what can be currently explained of the familial risk of prostate cancer by known genetic risk factors. These findings highlight the overwhelming contribution of germline variation at 8q24 on prostate cancer risk which has implications for population risk stratification

Fine-mapping of prostate cancer susceptibility loci in a large meta-analysis identifies candidate causal variants

Prostate cancer is a polygenic disease with a large heritable component. A number of common, low-penetrance prostate cancer risk loci have been identified through GWAS. Here we apply the Bayesian multivariate variable selection algorithm JAM to fine-map 84 prostate cancer susceptibility loci, using summary data from a large European ancestry meta-analysis. We observe evidence for multiple independent signals at 12 regions and 99 risk signals overall. Only 15 original GWAS tag SNPs remain among the catalogue of candidate variants identified; the remainder are replaced by more likely candidates. Biological annotation of our credible set of variants indicates significant enrichment within promoter and enhancer elements, and transcription factor-binding sites, including AR, ERG and FOXA1. In 40 regions at least one variant is colocalised with an eQTL in prostate cancer tissue. The refined set of candidate variants substantially increase the proportion of familial relative risk explained by these known susceptibility regions, which highlights the importance of fine-mapping studies and has implications for clinical risk profiling. © 2018 The Author(s).Prostate cancer is a polygenic disease with a large heritable component. A number of common, low-penetrance prostate cancer risk loci have been identified through GWAS. Here we apply the Bayesian multivariate variable selection algorithm JAM to fine-map 84 prostate cancer susceptibility loci, using summary data from a large European ancestry meta-analysis. We observe evidence for multiple independent signals at 12 regions and 99 risk signals overall. Only 15 original GWAS tag SNPs remain among the catalogue of candidate variants identified; the remainder are replaced by more likely candidates. Biological annotation of our credible set of variants indicates significant enrichment within promoter and enhancer elements, and transcription factor-binding sites, including AR, ERG and FOXA1. In 40 regions at least one variant is colocalised with an eQTL in prostate cancer tissue. The refined set of candidate variants substantially increase the proportion of familial relative risk explained by these known susceptibility regions, which highlights the importance of fine-mapping studies and has implications for clinical risk profiling. © 2018 The Author(s).Peer reviewe

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order

Background. Do-not-resuscitate (DNR) orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population.Methods. Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010) of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared themto age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality.Results. DNR status was not uncommon in cardiac (n = 2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years) and thoracic (n = 3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years) surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater inhospital mortality after cardiac (37.5% vs. 11.2%, p < 0.0001 and thoracic (25.4% vs. 6.4%) operations. DNR status remained an independent predictor of in-hospital mortality onmultivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21–5.41, p < 0.0001) and thoracic (OR 6.11, 95% confidence interval 5.37–6.94, p < 0.0001) cohorts.Conclusions. DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care