A seasonal dipolar eddy near Ras Al Hamra (Sea of Oman)

Trajectories and hydrological data from two Argo floats indicate that warm and salty water at 200–300-m depths was ejected from the coast of Oman, near Ras al Hamra, in spring 2008, 2011, and 2012. This warm and salty water, Persian Gulf Water (PGW), once ejected from the coast, recirculated cyclonically in the western Sea of Oman, but also flowed eastward along the Iranian and Pakistani coasts. There, it was expelled seaward by mesoscale eddies as shown by other float data. Seasonal maps of salinity were computed from all available Argo floats; they showed that, in spring, PGW is present in the middle and north of the Sea of Oman, contrary to fall, when the salinity maxima lie southeast of Ras al Hadd. The ejection of PGW from Ras al Hamra is related here to the influence of a mesoscale dipolar eddy which often appears near this cape in spring. The time-averaged and empirical orthogonal functions of altimetric maps over 11 years for this season confirm the frequent presence and the persistence of this feature. From surface currents and hydrology, deep currents were computed via thermal wind balance, and the associated shear and strain fields were obtained. This deformation field is intense near Ras al Hamra, with an offshore direction. This flow structure associated with the mesoscale dipole explains PGW ejection from the coast. This observation suggests that PGW distribution in the Northern Arabian Sea can be strongly influenced by seasonal mesoscale eddies

Pre-operative peripheral intravenous cannula insertion failure at the first attempt in adults: Development of the VENSCORE predictive scale and identification of risk factors

STUDY OBJECTIVE: Our objective was to develop a clinical scale (the VENSCORE) to predict pre-operative peripheral intravenous cannula (PIVC) insertion failure at the first attempt in adults. DESIGN: This was a prospective multicenter cohort study that included internal validation with bootstrapping. SETTING: The operating rooms of 14 hospitals in southern France from June 2016 to June 2018. PATIENTS: Consecutive adult patients aged 18 years or older were recruited upon arrival to the operating room, regardless of American Society of Anaesthesiology (ASA) physical status. INTERVENTIONS: PIVC insertion on arrival to the OR. MEASUREMENTS: PIVC insertion failure at the first attempt was the outcome of interest. Data collected included the number of PIVC insertion attempts and potential predictors of the risk of failure (including pre-operative patient characteristics and data relative to the procedure). Uni- and multivariable logistic analyses were performed. Based on these results, the VENSCORE scale was developed to predict the risk of failure of the first PIVC insertion. MAIN RESULTS: In total, 3394 patients were included, and 27 were excluded because of protocol violations. The PIVC insertion failure rate at the first attempt was 20.3%. Based on multivariable analysis, a history of difficult PIVC insertions, high-risk surgery, poor vein visibility, and moderate to poor vein palpability were identified as risk factors for insertion failure at the first attempt. The area under the curve of the predictive model was 0.82 (95% confidence interval: 0.80-0.84). A VENSCORE value of 0 points was associated with a failure rate of 7%, versus 97% for a score of 6. CONCLUSIONS: The four-item VENSCORE scale could be useful for prospectively identifying adults at risk of first PIVC insertion attempt failure

Management of bleeding and invasive procedures in haemophilia A patients with inhibitor treated with emicizumab (Hemlibra®): Proposals from the French network on inherited bleeding disorders (MHEMO), the French Reference Centre on Haemophilia, in collaboration with the French Working Group on Perioperative Haemostasis (GIHP)

Emicizumab (Hemlibra®) recently became available and requires an adaptation for managing bleeding, suspected bleeding and emergency or scheduledinvasive procedures in haemophilia A patients with inhibitor. This implicates a multi‐disciplinary approach and redaction of recommendations for care that must be regu‐larly adapted to the available data. The following text aims to provide a guide for the management of people with haemophilia A with inhibitor treated with emicizumab in case of bleeding or invasives procedures

Intraoperative measurement of the respiratory exchange ratio predicts postoperative complications after liver transplantation

Abstract Background During surgery, any mismatch between oxygen delivery (DO2) and consumption (VO2) can promote the development of postoperative complications. The respiratory exchange ratio (RER), defined as the ratio of carbon dioxide (CO2) production (VCO2) to VO2, may be a useful noninvasive tool for detecting inadequate DO2. The primary objective of this study was to test the hypothesis that RER measured during liver transplantation may predict postoperative morbidity. Secondary objectives were to assess the ability of other variables used to assess the DO2/VO2 relationship, including arterial lactate, mixed venous oxygen saturation, and veno-arterial difference in the partial pressure of carbon dioxide (VAPCO2gap), to predict postoperative complications. Methods This retrospective study included consecutive adult patients who underwent liver transplantation for end stage liver disease from June 27th, 2020, to September 5th, 2021. Patients with acute liver failure were excluded. All patients were routinely equipped with a pulmonary artery catheter. The primary analysis was a receiver operating characteristic (ROC) curve constructed to investigate the discriminative ability of the mean RER measured during surgery to predict postoperative complications. RER was calculated at five standardized time points during the surgery, at the same time as measurement of blood lactate levels and arterial and mixed venous blood gases, which were compared as a secondary analysis. Results Of the 115 patients included, 57 developed at least one postoperative complication. The mean RER (median [25–75] percentiles) during surgery was significantly higher in patients with complications than in those without (1.04[0.96–1.12] vs 0.88[0.84–0.94]; p < 0.001). The area under the ROC curve was 0.87 (95%CI: 0.80–0.93; p < 0.001) with a RER value (Youden index) of 0.92 giving a sensitivity of 91% and a specificity of 74% for predicting the occurrence of postoperative complications. The RER outperformed all other measured variables assessing the DO2/VO2 relationship (arterial lactate, SvO2, and VAPCO2gap) in predicting postoperative complications. Conclusion During liver transplantation, the RER can reliably predict postoperative complications. Implementing this measure intraoperatively may provide a warning for physicians of impending complications and justify more aggressive optimization of oxygen delivery. Further studies are required to determine whether correcting the RER is feasible and could reduce the incidence of complications

Reconstructing ancient worlds: reception studies, archaeological representation and the interpretation of ancient Egypt

Archaeological studies of the reception and representation of the past have proliferated in recent years, but theoretical and methodological work on this area is limited. The wider cultural engagement with prehistoric and ancient cultures is a long-established practice that has continued from antiquity to the present. During this time, there has been an exchange of ideas between those who have investigated ancient material remains and others who have represented aspects of the past in more creative contexts. Such representations of prehistoric and ancient worlds play an important part in generating interpretations of the past, yet we still know little about how they relate to the archaeological process of creating knowledge. In the following discussion, concepts from the field of reception studies are considered in relation to establishing a sound basis for undertaking research on archaeological representation. A case study on the visual reception of ancient Egypt is presented as a means of suggesting how research on archaeologically inspired representations of the past might be structured