What Is the Best Pain Control After Major Hepatopancreatobiliary Surgery?

In the modern era, hepato-pancreato-biliary (HPB) surgery has become safe with significant reductions in morbidity and mortality at high volume centers for both liver and pancreas surgery. While laparoscopic surgery has provided a safe approach with superior pain control laparotomy is still needed for the majority of HPB operations. Inadequate pain control is not only associated with poor patient experience but contributes to inferior outcomes. Specifically, inadequate pain control affects the neuroendocrine stress response, increases complication rates, and prolongs length of stay. Furthermore, there is an ongoing opioid epidemic and all fields of medicine should strive to reduce narcotic use to limit transformation into chronic opiate dependence. As such, successful pain control after HPB surgery continues to be a challenge and rigorous studies evaluating postoperative results are needed. The following article reviews the modalities debated to be the best strategies for pain control after major HPB surgery, as well as a discussion of other important considerations when executing these plans

The Brain at High Altitude: From Molecular Signaling to Cognitive Performance

The brain requires over one-fifth of the total body oxygen demand for normal functioning. At high altitude (HA), the lower atmospheric oxygen pressure inevitably challenges the brain, affecting voluntary spatial attention, cognitive processing, and attention speed after short-term, long-term, or lifespan exposure. Molecular responses to HA are controlled mainly by hypoxia-inducible factors. This review aims to summarize the cellular, metabolic, and functional alterations in the brain at HA with a focus on the role of hypoxia-inducible factors in controlling the hypoxic ventilatory response, neuronal survival, metabolism, neurogenesis, synaptogenesis, and plasticity

Community participatory action to build a canopy bridge for wild black and gold howler monkeys (Alouatta caraya) in northern Argentina

The combination of urbanization and destruction of native forests commonly has forced wild animals to search for food and shelter in urban areas. Groups of black and gold howler monkeys (Alouatta caraya) are moving into urban areas in Northern Argentina as a consequence of rapid alteration and degradation of their habitats. In general, local people in the area are unaware of and disconnected from conservation actions, such as the protection of local biodiversity. We aimed to address this issue by organizing a group of high school students from both the city of Corrientes and outlying rural areas with the objective of transforming their perceptions on local non-human primates and to build the inaugural canopy bridge to instill biodiversity appreciation. With the students, we identified a location to install a bridge to facilitate the movement of Alouatta caraya across areas of discontinuous canopy. The students worked to build awareness within their community, obtained the necessary permission, and designed the bridge. From the beginning of the awareness campaign to the bridge installation, the process took four years. Afterwards, we installed two more bridges in the same region. From this single case study, we learned that participatory actions are a very important tool for residents of local communities to act collectively to promote biodiversity conservation.Fil: Raño, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Palazzo, Mariana. Instituto Pio Xi - Club de Ciencias Arquímedes; ArgentinaFil: Soliz, Alicia. Colegio Secundario San Cayetano; ArgentinaFil: Holzer, Juan C.. Dirección de Parques y Reservas de la Provincia de Corrientes; ArgentinaFil: Perez, Dario A.. Colegio Secundario San Cayetano; ArgentinaFil: Sánchez, Emilio M.. Dirección de Parques y Reservas de la Provincia de Corrientes; ArgentinaFil: Romero, Verónica Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Sanchez Gavier, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Kowalewski, Miguel Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; Argentin

Communicative Predictors of a Shared Family Identity: Comparison of Grandchildren’s Perceptions of Family-of-Origin Grandparents and Stepgrandparents

From an intergroup perspective on family relationships, the current study investigates family-of-origin grandparents and stepgrandparents to determine similarities and differences in communication and relational dimensions. Participants (N = 88) completed questionnaires on family-of-origin grandparents and stepgrandparent relationships. From the perspective of young adult grandchildren, the research explores the role of supportive communication, reciprocal self-disclosure, nonaccommodative communication, and parental encouragement in predicting a sense of shared family identity with each grandparent type. Results are discussed in terms of implications for intergroup research, grandparent-grandchild communication, and stepfamily relationships

Emotional Support and Mental Health Among Somali Men in a Rural Midwestern Town

Perceived social support has been correlated with refugees’ positive mental health outcomes; yet, little is known about the perceived sources of support after secondary migration to new-destination rural towns. Somali refugee men (n _ 49) residing in a rural Midwest United States community were recruited using respondent-driven sampling to complete a self-administered structured survey in English or Somali using audio computer-assisted self-interview software. Questions assessed perceived sources of support, psychological distress, and happiness. Somali participants reported low utilization of both informal (30.4%) and formal (24.4%) supports when sad, stressed, or worried. Two thirds of participants reported low levels of distress and 98% reported being happy or very happy. This exploratory research contributes to understandings of Somali men’s perceived support in a postsecondary migration setting. We discuss implications for social support interventions and culturally tailored assessment, diagnoses, and treatment to enhance Somalis’ support and psychological well-being

“It's my language, my culture and it's personal!” Migrant mothers' experience of language use and identity change in their relationship with their children: an interpretative phenomenological analysis

The question of how migrants’ language use impacts their ethnic identity has received considerable attention in the literature. There is, however, little understanding of how this relationship manifests or is negotiated in interethnic families. This paper presents an in-depth exploration of Spanish mothers’ experiences of Spanish- and English-language interactions with their English-born children. Semi-structured interviews were conducted with Spanish mothers living in Britain in interethnic partnerships and transcripts were subjected to interpretative phenomenological analysis. Analysis reveals a process of identity change where participants’ shifting ethnic identifications with host and heritage culture is intimately related to their language use with their children. Pivotal to this process is the participants’ need to maintain their ‘Spanish mother’ identity, a desire that can only be fulfilled by transferring their heritage language to their children and speaking it with them. Findings reveal how this dynamic impacts perception of family roles, relationship quality and psychological well-being

Fabrication and arc erosion behavior of Ag-SnO2-ZnO electrical contact materials

This study investigated the synthesis of Ag-SnO2-ZnO by powder metallurgy methods and their subsequent electrical contact behavior. The pieces of Lambda g-SnO2-ZnO were prepared by ball milling and hot pressing. The arc erosion behavior of the material was evaluated using homemade equipment. The microstructure and phase evolution of the materials were investigated through X-ray diffraction, energy-dispersive spectroscopy and scanning electron microscopy. The results showed that, although the mass loss of the Ag-SnO2-ZnO composite (9.08 mg) during the electrical contact test was higher than that of the commercial Ag-CdO (1.42 mg), its electrical conductivity remained constant (26.9 +/- 1.5% IACS). This fact would be related to the reaction of Zn2SnO4's formation on the material's surface via electric arc. This reaction would play an important role in controlling the surface segregation and subsequent loss of electrical conductivity of this type of composite, thus enabling the development of a new electrical contact material to replace the non-environmentally friendly Ag-CdO composite