Nature of the magnetic coupling in infinite-layer nickelates versus cuprates

In contrast to the cuprates, where the proximity of antiferromagnetism (AFM) and superconductivity is well established, first indications for AFM interactions in superconducting infinite-layer nickelates were only recently obtained. Here, we explore, based on first-principles simulations, the nature of the magnetic coupling in NdNiO2 as a function of the on-site Coulomb and exchange interaction, varying the explicit hole doping and the treatment of the Nd $4f$ electrons. The $U$-$J$ phase diagrams for undoped nickelates and cuprates indicate $G$-type ordering, yet show different $U$ dependency. By either Sr hole doping or explicit treatment of the Nd $4f$ electrons, we find a transition to a Ni $C$-type AFM ground state. We trace the effect of Sr doping back to a distinct accommodation of the holes by the Ni versus Cu $e_g$ orbitals. The interaction between Nd $4f$ and Ni $3d$ states stabilizes $C$-type AFM order on both sublattices. Though spin-orbit interactions induce a band splitting near the Fermi energy, the bad-metal state is retained even under epitaxial strain. These results establish the distinct role of the magnetic interactions in the nickelates versus the cuprates and suggest the former as a unique platform to investigate the relation to unconventional superconductivity.Comment: 8 pages, 5 figure

Clinical pharmacokinetics and pharmacodynamics of propofol

Propofol is an intravenous hypnotic drug that is used for induction and maintenance of sedation and general anaesthesia. It exerts its effects through potentiation of the inhibitory neurotransmitter -aminobutyric acid (GABA) at the GABA(A) receptor, and has gained widespread use due to its favourable drug effect profile. The main adverse effects are disturbances in cardiopulmonary physiology. Due to its narrow therapeutic margin, propofol should only be administered by practitioners trained and experienced in providing general anaesthesia. Many pharmacokinetic (PK) and pharmacodynamic (PD) models for propofol exist. Some are used to inform drug dosing guidelines, and some are also implemented in so-called target-controlled infusion devices, to calculate the infusion rates required for user-defined target plasma or effect-site concentrations. Most of the models were designed for use in a specific and well-defined patient category. However, models applicable in a more general population have recently been developed and published. The most recent example is the general purpose propofol model developed by Eleveld and colleagues. Retrospective predictive performance evaluations show that this model performs as well as, or even better than, PK models developed for specific populations, such as adults, children or the obese; however, prospective evaluation of the model is still required. Propofol undergoes extensive PK and PD interactions with both other hypnotic drugs and opioids. PD interactions are the most clinically significant, and, with other hypnotics, tend to be additive, whereas interactions with opioids tend to be highly synergistic. Response surface modelling provides a tool to gain understanding and explore these complex interactions. Visual displays illustrating the effect of these interactions in real time can aid clinicians in optimal drug dosing while minimizing adverse effects. In this review, we provide an overview of the PK and PD of propofol in order to refresh readers' knowledge of its clinical applications, while discussing the main avenues of research where significant recent advances have been made

Intravenous drug dose optimization and drug effect monitoring in anaesthesia

Dit proefschrift onderstreept het belang van het optimaliseren van de dosering van anesthetica en geeft een beschrijving van de middelen die de anesthesiologen hebben om dit doel te bereiken. Twee belangrijke onderwerpen komen hierbij aan bod. Ten eerste hebben we onderzocht wat de invloed is van hersentumoren in de frontale hersenkwab op de pharmacokinetiek (de manier waarop het lichaam medicatie verwerkt) en pharmacodynamiek (de invloed van medicatie op het lichaam) van propofol bij patiënten die hieraan geopereerd werden. Op basis van ons onderzoek concluderen wij dat hersentumoren wel invloed hebben op de farmacokinetiek, maar niet op de farmacodynamiek van propofol. Ten tweede hebben we beoordeeld hoe effectief verschillende hypnose en analgesie monitors (BIS, CVI, CI, CS) zijn als hulpmiddel bij het optimaliseren van een anesthetische dosis in de algemene populatie. Uiteindelijk concluderen wij dat de huidige generatie hypnose en analgesie monitors anesthesiologen wel beter in staat stellen om de medicatie dosis te optimaliseren dan de huidige praktijk (standaard dosering schema’s en doseren op geleide van hemodynamische variabelen), maar dat ze nog steeds belangrijke tekortkomingen hebben

Journal of Clinical Monitoring and Computing 2019 end of year summary:monitoring tissue oxygenation and perfusion and its autoregulation

Tissue perfusion monitoring is increasingly being employed clinically in a non-invasive fashion. In this end-of-year summary of the Journal of Clinical Monitoring and Computing, we take a closer look at the papers published recently on this subject in the journal. Most of these papers focus on monitoring cerebral perfusion (and associated hemodynamics), using either transcranial doppler measurements or near-infrared spectroscopy. Given the importance of cerebral autoregulation in the analyses performed in most of the studies discussed here, this end-of-year summary also includes a short description of cerebral hemodynamic physiology and its autoregulation. Finally, we review articles on somatic tissue oxygenation and its possible association with outcome

Intraoperative monitoring of the central and peripheral nervous systems:a narrative review

The central and peripheral nervous systems are the primary target organs during anaesthesia. At the time of the inception of the British Journal of Anaesthesia, monitoring of the central nervous system comprised clinical observation, which provided only limited information. During the 100 yr since then, and particularly in the past few decades, significant progress has been made, providing anaesthetists with tools to obtain real-time assessments of cerebral neurophysiology during surgical procedures. In this narrative review article, we discuss the rationale and uses of electroencephalography, evoked potentials, near-infrared spectroscopy, and transcranial Doppler ultrasonography for intraoperative monitoring of the central and peripheral nervous systems.</p

Surviving the storm:manual vs. mechanical chest compressions onboard a lifeboat during bad weather conditions

Objective: It is challenging for rescuers to perform cardiopulmonary resuscitation (CPR) onboard lifeboats, particularly during rough weather. A mechanical chest compression device (MCD) may provide better quality chest compressions. The aim of this study was to compare the quality of chest compressions performed by lifeboat-crewmembers with those of a MCD during rough-sea conditions.Methods: Lifeboat-crewmembers were scheduled to provide compression-onlyCPR on a resuscitation-mannequin during two sets of five 6-min epochs on alifeboat at sea in two different weather-conditions. Simultaneously a MCD wasused for compression-only CPR on another mannequin onboard the lifeboat. Ona third occasion compressions by MCD only were measured due to COVID-19restrictions. The primary outcome variable was the quality of chest compression,evaluated using published variables and standards (mean compression depthand compression frequency, percentage correct compression depth, percentageof not leaning on the thorax, percentage of correct hand placement on thethorax, hands-off-time).Results: Six male lifeboat-crewmembers (mean age 35 years) performed CPRduring two different weather conditions. In weather-conditions one (wind∼6–7 Beaufort/wave-height: 100–150 cm) quality of manual compressions wassignificantly worse than mechanical compressions for mean compression depth(p &lt; 0.05) and compression frequency (p &lt; 0.05), percentage correct compression depth (p &lt; 0.05), percentage of not leaning on the thorax (p &lt; 0.05), and hands off time (p &lt; 0.05). Crewmembers could only perform CPR for a limited time-period (sea-conditions/seasickness) and after one set of five epochs measurements were halted. In weather-condition two (wind ∼9 Beaufort/wave-height ∼200 cm) similar results were found during two epochs, after which measurements were halted (sea-conditions/seasickness). In weather-condition three (wind ∼7 Beaufort/wave-height ∼300–400 cm) MCD compressions were according to resuscitation-guidelines except for three epochs during which the MCD was displaced.Conclusion: Crewmembers were only able to perform chest-compressions for alimited time because of the weather-conditions. The MCD was able to providegood quality chest compressions during all but three epochs during the studyperiod. More research is needed to determine whether MCD-use in real-lifecircumstances improves outcome. Inclusion of data on use of a MCD on lifeboatsshould be considered in future revisions of the USFD and resuscitation guidelines

Anesthesia and intraoperative neurophysiological spinal cord monitoring

Purpose of review We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery. Recent findings In recent years, the use of IONM has increased significantly. It has developed into a mature discipline, enabling neurosurgical procedures of ever-increasing complexity. It is thus of growing importance for the anesthesiologist to appreciate the interplay between IONM and anesthesia and to build up experience working in a team with the neurosurgeon and the neurophysiologist. Safety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM

Vaccine safety in the next decade: why we need new modes of trust building.

Among the realm of highly varied vaccine perceptions and concerns expressed by publics around the world, vaccine safety is the most frequently cited. While many of the safety questions raised have substantial evidence to address the concerns, vaccines do have small risks, and need vigilant and responsive systems to address them. With more and more new vaccines, combinations of vaccines and new technologies to develop and deliver them, new safety concerns will arise that need attention. Adding to this landscape is the dramatic impact which digital communication has had on how fast rumours and vaccine concerns can spread, making the task of the public health and scientific community even more pressing. One of the more recently characterised vaccine safety issues, now named 'immunisation stress-related-response,' has gained particularly high visibility given these highly globally connected social media networks. To better anticipate and address these rapidly shared vaccine safety concerns, a number of global efforts and local responses are being made. Co-created social media campaigns engaging parents and adolescents have been effective, while the WHO's Vaccine Safety Net (VSN) initiative has grown its global network to increase awareness about vaccines and contribute to building confidence in vaccines. The VSN reviews websites around the world to assess their quality and accuracy to ensure and promote access to trustworthy and science-based information on vaccine safety for internet users. These and the efforts of the multiple network partners are more crucial than ever to sustain public confidence in this evolving vaccine safety landscape