The Development of a Scoring Tool for the Measurement of Performance in Managing Hypotension and Intra-Operative Cardiac Arrest during Spinal Anaesthesia for Caesarean Section

Background: At level one hospitals in South Africa a high annual number of maternal deaths occur due to the unrecognised/ untreated complications of spinal anaesthesia. The authors developed a clinical scenario and scoring system to measure intern performance in managing hypotension and cardiac arrest during spinal anaesthesia for caesarean section on a human patient simulator. This system was then subjected to tests of validity and reliability.Methods: The simulator-based clinical scenario was developed by two specialist anaesthesiologists. A modified Delphi technique was used to achieve consensus among 10 anaesthetic specialists regarding a standardised scoring system. A total of 20 medical officers with a Diploma in Anaesthesiology and 20 interns completed the scenario and were scored by two senior anaesthesiologists.Results: Medical officers scored an average of 252 and 246 points, whereas interns scored an average of 216 and 215 points (p = 0.005 and p = 0.013, respectively). The scoring instrument demonstrated high inter-assessor reliability with an intra-class correlation coefficient of 0.983.Conclusions: The scoring tool was shown to be valid and reliable. It offers a standardised assessment process and may be used to refine institutional intern training programmes, with a view to improving anaesthesia skills in community service medical officers.Keywords: Anaesthesia Spinal, Caesarean Section, Internship, Residency, Simulation, Simulato

Seasonal development of iron limitation in the sub-Antarctic zone

The seasonal and sub-seasonal dynamics of iron availability within the sub-Antarctic zone (SAZ;  ∼ 40–45°&thinsp;S) play an important role in the distribution, biomass and productivity of the phytoplankton community. The variability in iron availability is due to an interplay between winter entrainment, diapycnal diffusion, storm-driven entrainment, atmospheric deposition, iron scavenging and iron recycling processes. Biological observations utilizing grow-out iron addition incubation experiments were performed at different stages of the seasonal cycle within the SAZ to determine whether iron availability at the time of sampling was sufficient to meet biological demands at different times of the growing season. Here we demonstrate that at the beginning of the growing season, there is sufficient iron to meet the demands of the phytoplankton community, but that as the growing season develops the mean iron concentrations in the mixed layer decrease and are insufficient to meet biological demand. Phytoplankton increase their photosynthetic efficiency and net growth rates following iron addition from midsummer to late summer, with no differences determined during early summer, suggestive of seasonal iron depletion and an insufficient resupply of iron to meet biological demand. The result of this is residual macronutrients at the end of the growing season and the prevalence of the high-nutrient low-chlorophyll (HNLC) condition. We conclude that despite the prolonged growing season characteristic of the SAZ, which can extend into late summer/early autumn, results nonetheless suggest that iron supply mechanisms are insufficient to maintain potential maximal growth and productivity throughout the season.</p

Seasonal Depletion of the Dissolved Iron Reservoirs in the Sub-Antarctic zone of the Southern Atlantic Ocean

Seasonal progression of dissolved iron (DFe) concentrations in the upper water column were examined during four occupations in the Atlantic sector of the Southern Ocean. DFe inventories from euphotic and aphotic reservoirs decreased progressively from July to February, while dissolved inorganic nitrogen (DIN) decreased from July to January with no significant change between January and February. Results suggest that between July and January, DFe loss from both euphotic and aphotic reservoirs were predominantly in support of phytoplankton growth (Iron to carbon (Fe:C) uptake ratio of 16±3 μmol mol‐1) highlighting the importance of the “winter DFe‐reservoir” for biological uptake. During January to February, excess loss of DFe relative to DIN (Fe:C uptake ratio of 44±8 μmol mol‐1 and aphotic DFe loss rate of 0.34±0.06 μmol m‐2 d‐1) suggests that scavenging is the dominant removal mechanism of DFe from the aphotic, while continued production is likely supported by recycled nutrients. Plain Language Summary Trace metal iron is one of the limiting nutrients for primary productivity in the Southern Ocean; however the relative importance of seasonal iron supply and sinks remains poorly understood, due to sparse data coverage across the seasonal cycle and lack of high‐resolution dissolved iron (DFe) measurements. Here, we present four “snap‐shots” of DFe measurements at a single station in the south‐east Southern Atlantic Ocean (one in winter and three in late spring‐summer), to address the seasonal evolution of DFe and dissolved inorganic nitrogen (DIN) concentrations within the biologically active sunlit and subsurface reservoirs. We observed a seasonal depletion of DFe inventories from July‐February, while DIN inventories decreases from July‐January with no concomitant changes between January‐February. This suggests that, in addition to biological uptake in the sunlit layer, the observed decrease in DFe inventories below this (relative to DIN) is driven by aggregation and incorporation of iron particles into larger "marine snow" sinking particles, while nutrient recycling is driving the observed continuation of primary productivity during late summer. Our results provide insight into seasonal change of DFe availability in different reservoirs where interplay between removal and supply processes are controlling its distributions and bioavailability to support upper surface primary production

Impact of social integration on metabolic functions: evidence from a nationally representative longitudinal study of US older adults

BACKGROUND: Metabolic functions may operate as important biophysiological mechanisms through which social relationships affect health. It is unclear how social embeddedness or the lack thereof is related to risk of metabolic dysregulation. To fill this gap we tested the effects of social integration on metabolic functions over time in a nationally representative sample of older adults in the United States and examined population heterogeneity in the effects. METHODS: Using longitudinal data from 4,323 adults aged over 50 years in the Health and Retirement Study and latent growth curve models, we estimated the trajectories of social integration spanning five waves, 1998–2006, in relation to biomarkers of energy metabolism in 2006. We assessed social integration using a summary index of the number of social ties across five domains. We examined six biomarkers, including total cholesterol, high-density lipoprotein cholesterol, glycosylated hemoglobin, waist circumference, and systolic and diastolic blood pressure, and the summary index of the overall burden of metabolic dysregulation. RESULTS: High social integration predicted significantly lower risks of both individual and overall metabolic dysregulation. Specifically, adjusting for age, sex, race, and body mass index, having four to five social ties reduced the risks of abdominal obesity by 61% (odds ratio [OR] [95% confidence interval {CI}] = 0.39 [0.23, 0.67], p = .007), hypertension by 41% (OR [95% CI] = 0.59 [0.42, 0.84], p = .021), and the overall metabolic dysregulation by 46% (OR [95% CI] = 0.54 [0.40, 0.72], p < .001). The OR for the overall burden remained significant when adjusting for social, behavioral, and illness factors. In addition, stably high social integration had more potent metabolic impacts over time than changes therein. Such effects were consistent across subpopulations and more salient for the younger old (those under age 65), males, whites, and the socioeconomically disadvantaged. CONCLUSIONS: This study addressed important challenges in previous research linking social integration to metabolic health by clarifying the nature and direction of the relationship as it applies to different objectively measured markers and population subgroups. It suggests additional psychosocial and biological pathways to consider in future research on the contributions of social deficits to disease etiology and old-age mortality

Stress analysis in a layered aortic arch model under pulsatile blood flow

BACKGROUND: Many cardiovascular diseases, such as aortic dissection, frequently occur on the aortic arch and fluid-structure interactions play an important role in the cardiovascular system. Mechanical stress is crucial in the functioning of the cardiovascular system; therefore, stress analysis is a useful tool for understanding vascular pathophysiology. The present study is concerned with the stress distribution in a layered aortic arch model with interaction between pulsatile flow and the wall of the blood vessel. METHODS: A three-dimensional (3D) layered aortic arch model was constructed based on the aortic wall structure and arch shape. The complex mechanical interaction between pulsatile blood flow and wall dynamics in the aortic arch model was simulated by means of computational loose coupling fluid-structure interaction analyses. RESULTS: The results showed the variations of mechanical stress along the outer wall of the arch during the cardiac cycle. Variations of circumferential stress are very similar to variations of pressure. Composite stress in the aortic wall plane is high at the ascending portion of the arch and along the top of the arch, and is higher in the media than in the intima and adventitia across the wall thickness. CONCLUSION: Our analysis indicates that circumferential stress in the aortic wall is directly associated with blood pressure, supporting the clinical importance of blood pressure control. High stress in the aortic wall could be a risk factor in aortic dissections. Our numerical layered aortic model may prove useful for biomechanical analyses and for studying the pathogeneses of aortic dissection

JET machine operations in T&D-T

JET, the world's largest operating tokamak with unique Be/W wall and tritium handling capability, completed a Deuterium-Tritium (D-T) campaign in 2021 (Maggi et al 29th Fusion Energy Conf.) following a decade of preparatory experiments, dedicated enhancements, technical rehearsals and training (Horton et al 2016 Fusion Eng. Des. 109-111 925). Operation with tritium raises significant technical, safety and scientific challenges not encountered in standard protium or deuterium operation. This contribution describes the tritium operational requirements, pulses and technical preparations, new operating procedures, lessons learned and details on the achieved operational availability and performance. The preparation and execution of the recent JET tritium experiments benefitted from the previous experience in 1991 (Preliminary Tritium Experiment), 1997 (DTE1 campaign) and 2003 (Trace Tritium Campaigns) and consisted of the following five phases: technical rehearsals and scenario preparation, tritium commissioning, 100% tritium campaign, D-T campaign (DTE2), tritium clean-up. Following the clean-up JET resumed normal operation and is currently undertaking a further D-T campaign (DTE3)