Association between Use of Enhanced Recovery after Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery after Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

Importance: The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. Objective: To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design, Setting, and Participants: This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Exposures: Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. Main Outcomes and Measures: The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. Results: During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P =.22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P =.02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P <.001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P <.001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P <.001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P <.001). Conclusions and Relevance: An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes

Controlled sign reversal of electroresistance in oxide tunnel junctions by electrochemical-ferroelectric coupling

The persistence of ferroelectricity in ultrathin layers relies critically on screening or compensation of polarization charges which otherwise destabilize the ferroelectric state. At surfaces, charged defects play a crucial role in the screening mechanism triggering novel mixed electrochemical-ferroelectric states. At interfaces, however, the coupling between ferroelectric and electrochemical states has remained unexplored. Here, we make use of the dynamic formation of the oxygen vacancy profile in the nanometerthick barrier of a ferroelectric tunnel junction to demonstrate the interplay between electrochemical and ferroelectric degrees of freedom at an oxide interface. We fabricate ferroelectric tunnel junctions with a La_0.7Sr_0.3MnO_3 bottom electrode and BaTiO_3 ferroelectric barrier. We use poling strategies to promote the generation and transport of oxygen vacancies at the metallic top electrode. Generated oxygen vacancies control the stability of the ferroelectric polarization and modify its coercive fields. The ferroelectric polarization, in turn, controls the ionization of oxygen vacancies well above the limits of thermodynamic equilibrium, triggering the build up of a Schottky barrier at the interface which can be turned on and off with ferroelectric switching. This interplay between electronic and electrochemical degrees of freedom yields very large values of the electroresistance (more than 10^6% at low temperatures) and enables a controlled switching between clockwise and counterclockwise switching modes in the same junction (and consequently, a change of the sign of the electroresistance). The strong coupling found between electrochemical and electronic degrees of freedom sheds light on the growing debate between resistive and ferroelectric switching in ferroelectric tunnel junctions, and moreover, can be the source of novel concepts in memory devices and neuromorphie computing

The OpenMolcas Web: A Community-Driven Approach to Advancing Computational Chemistry

The developments of the open-source OpenMolcas chemistry software environment since spring 2020 are described, with a focus on novel functionalities accessible in the stable branch of the package or via interfaces with other packages. These developments span a wide range of topics in computational chemistry and are presented in thematic sections: electronic structure theory, electronic spectroscopy simulations, analytic gradients and molecular structure optimizations, ab initio molecular dynamics, and other new features. This report offers an overview of the chemical phenomena and processes OpenMolcas can address, while showing that OpenMolcas is an attractive platform for state-of-the-art atomistic computer simulations

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Remifentanilo en neurocirugía: Influencia en la extubación precoz e implicaciones en la estancia postoperatoria inmediata

Objectives: To determine whether the use of a new opioid such as remifentanyl modifies the standard care provided to patients undergoing elective neurosurgery in our hospital. To assess the time of extubation and the length of stay in the Intensive Care Unit (ICU). Material and method: Retrospective study of a cohort of neurosurgical patients free from complications undergoing elective supratentorial tumor surgery through craniotomy. All consecutive patients between November 2003 and February 2004 were included in the study. Data were obtained from pre-anesthesia, anesthesia and intensive care medical records. Age, sex, ASA risk, anesthetic technique, length of the surgical procedure, intraoperative opiate use, time and place of extubation, as well as length of stay in the ICU, were recorded. In order to study the impact of intraoperative opiate use on the time of extubation and the postoperative stay, patients were divided in two groups: remifentanyl and fentanyl. The descriptive analysis of quantitative endpoints is shown with mean values, standard deviations and quartiles, and is graphically shown using box charts; for qualitative endpoints, contingency tables were used. Intergroup comparisons were performed using the chi-square test for qualitative endpoints and the Student´s t or Mann Whitney test for quantitative endpoints. Results: Thirty two elective craniotomies were performed for resection of supratentorial tumors in patients free from complications, and data were obtained from 31 patients. The statistical analysis did not show differences regarding sex, age or ASA classification between patients receiving remifentanyl (18) and patients receiving fentanyl (13) intraoperatively. When remifentanyl was used in 67% of patients, total intravenous anesthesia (TIVA) was provided for anesthetic maintenance, while sevoflurane was used in 77% of patients with fentanyl. Length of surgical-anesthetic procedure was greater in the fentanyl group, with a mean difference of almost one hour. Extubation was performed in the operating room in 67% of patients in the remifentanyl group and in the ICU in 100% of patients in the fentanyl group; however, this did not result in an earlier discharge from the Intensive Care Unit. Conclusion: Data suggest that remifentanyl facilitates the extubation. New pharmacological options allow variations of the clinical practice that can benefit our patients. However, these changes do not lead to a shorter stay in the ICU, since that does not only depends on clinical factors, but also on organizational factors.Objetivos: Determinar si el uso de un nuevo opioide como remifentanilo modifica la actuación habitual en el manejo de los pacientes neuroquirúrgicos programados en nuestro centro. Valorar el momento de la extubación y la duración de la estancia en la Unidad de Cuidados Intensivos (UCI). Material y método: Estudio retrospectivo de una cohorte de pacientes neuroquirúrgicos no complicados sometidos a cirugía tumoral supratentorial programada mediante craneotomía. La muestra consistió en todos los casos consecutivos entre noviembre de 2003 y febrero de 2004. Los datos se obtuvieron de las historias clínicas de preanestesia, anestesia y de cuidados intensivos. Se recogió edad, sexo, riesgo ASA, técnica anestésica, duración quirúrgica, opioide intraoperatorio empleado, momento y lugar de la extubación, así como la duración de la estancia en UCI. Para estudiar la influencia del opioide intraoperatorio empleado sobre los resultados de momento de la extubación y estancia postoperatoria se dividen los casos en dos grupos: remifentanilo y fentanilo. El análisis descriptivo de variables cuantitativas se presenta mediante media, desviación estándar y cuartiles y gráficamente con diagramas de cajas; cara las variables cualitativas mediante tablas de contingencia. Las comparaciones intergrupo se realizaron con test Chi cuadrado en el caso de variables cualitativas y con t de Student o Mann-Whitney en las cuantitativas. Resultados: Se realizaron 32 craneotomías para resección de tumores supratentoriales programadas no complicadas, obteniéndose los datos de 31 casos. Tras el análisis estadístico no se objetivan diferencias respecto al sexo, edad ni clasificación ASA entre los pacientes que recibieron remifentanilo (18) y aquellos a los que se les administró fentanilo (13) intraoperatorio. Cuando se utilizó remifentanilo, en el 67% de los casos, se optó por realizar anestesia total intravenosa (TIVA) para el mantenimiento anestésico, mientras que el sevoflurano fue utilizado en el 77% de los pacientes con fentanilo. La duración quirúrgico-anestésica fue superior en el grupo de fentanilo, con una diferencia media aproximada de una hora. La extubación se realizó en quirófano en el 67% de los casos en el grupo remifentanilo y en UCI en el 100% de los casos en el grupo fentanilo; sin embargo, esto no se reflejó en un alta más precoz de la Unidad de Cuidados Intensivos. Conclusión: Los datos señalan una facilitación de la extubación con remifentanilo. Las nuevas opciones farmacológicas permiten variaciones en la práctica clínica de las que se pueden beneficiar nuestros pacientes. Sin embargo, estos cambios no se traducen en una menor estancia en UCI, ya que esta no está sólo condicionada por razones clínicas sino también organizativas

Characterization of surface metallic states in SrTiO_(3) by means of aberration corrected electron microscopy

El texto completo de este trabajo no se encuentra disponible por no haber sido facilitado aún por su autor, por restricciones de copyright, o por no existir una versión digitalAn unusual conducting surface state can be produced in SrTiO3 substrates by irradiation with Argon ions from a plasma source, at low energy and high doses. The effects of irradiation are analyzed here by atomic force microscopy (AFM) and aberration corrected scanning transmission electron microscopy (STEM) combined with electron energy loss spectroscopy (EELS). Depth sensitive studies demonstrate the existence of a heavily damaged surface layer and an oxygen vacancy rich layer immediately underneath, both induced during the irradiation process. We find a clear dependence of the Ti oxidation state with the depth, with a very intense Ti3+ component near the surface. Oxygen vacancies act as n-type doping by releasing electrons into the lattice and producing an insulator-to-metal transition, which explains the unusual metallic behavior of these samples.Materials Sciences and Engineering Division of the US Department of Energy (DOE)ORNL’s Shared Research Equipment (ShaRE) User ProgramERC starting Investigator AwardDepto. de Física de MaterialesFac. de Ciencias FísicasTRUEpu