The use of intraoperative nitrous oxide leads to postoperative increases in plasma homocysteine

Hyperhomocysteinemia is an independent risk factor for coronary artery and cerebrovascular disease, but its significance in the perioperative period is unknown. Nitrous oxide inhibits methionine synthase, which aids in the conversion of homocysteine to methionine. In this prospective, controlled, randomized study, we determined the effect of intraoperative nitrous oxide exposure on postoperative plasma homocysteine concentrations. Twenty ASA physical status I-III patients, aged \u3e18 yr, presenting for elective craniotomy, were randomized to receive general anesthesia with or without nitrous oxide (inspired nitrous oxide \u3e50%). Plasma was sampled before the induction of anesthesia, on arrival in the postanesthesia care unit (PACU) after discontinuation of nitrous oxide, and 24 h after induction. There was a significant increase (22.6 ± 11.4 vs 13.0 ± 4.7 μmol/L; P = 0.0038 for postoperative versus preinduction values) in plasma homocysteine concentrations in the nitrous oxide group on arrival in the PACU and for 24 h. In the nonnitrous oxide group, mean plasma homocysteine concentrations did not change (9.5 ± 1.9 vs 9.8 ± 1.6 μmol/L; P = 0.86 for postoperative versus preinduction values). The change in plasma homocysteine concentrations in the nitrous oxide group was significantly different from that in the nonnitrous group (P = 0.0031). We conclude that the use of intraoperative nitrous oxide leads to significant increases in perioperative plasma homocysteine concentrations. Implications: Short-term exposure to nitrous oxide led to significant increases in plasma homocysteine. Further investigations are required to determine the clinical significance of this change

We haven't got a seat on the bus for you or All the seats are mine: Narratives and career transitions in professional golf

In this article we explore how the stories an athlete tells throughout life in sport affect her career transition experiences. We base our enquiry on a social constructionist conception of narrative theory which holds that storytelling is integral to the creation and maintenance of identity and sense of self. Life stories were gathered through interviews with two professional women golfers (Christiana and Kandy) over a six‐year period. Through a narrative analysis of structure and form we explored each participant’s stories of living in and withdrawing from professional golf. We suggest Christiana told monological performance‐oriented stories which, while aligning with the culture of elite sport, resulted in an exclusive athletic identity and foreclosure of alternative selves and roles. On withdrawal, Christiana experienced narrative wreckage, identity collapse, mental health difficulties and considerable psychological trauma. In contrast, Kandy told dialogical discovery‐oriented stories which, while being in tension with the dominant performance narrative, created and sustained a multidimensional identity and self. Her stories and identity remained intact, authentic and continuous on withdrawal from tournament golf and she experienced few psychological problems

Mediators of improved child diet quality following a health promotion intervention: the Melbourne InFANT program

BACKGROUND: Young children’s diets are currently suboptimal. Given that mothers have a critical influence on children’ diets, they are typically a target of interventions to improve early childhood nutrition. Understanding the maternal factors which mediate an intervention’s effect on young children’s diets is important, but has not been well investigated. This research aimed to test whether maternal feeding knowledge, maternal feeding practices, maternal self-efficacy, and maternal dietary intakes acted as mediators of the effect of an intervention to improve child diet quality. METHODS: The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster-randomized controlled trial, conducted from 2008–2010. This novel, low-dose, health promotion intervention was delivered quarterly over 15 months and involved educational activities, promotion of peer discussion, a DVD and written materials. Post-intervention, when children were approximately 18 months of age, child diets were assessed using multiple 24-hour recalls and a purpose-developed index of diet quality, the Obesity Protective Dietary Index. Maternal mediators were assessed using a combination of previously validated and purpose-deigned tools. Mediation analysis was conducted using the test of joint significance and difference of coefficients methods. RESULTS: Across 62 parents’ groups in Melbourne, Australia, 542 parents were recruited. Post- intervention, higher maternal feeding knowledge and lower use of foods as rewards was found to mediate the direct intervention effect on child diet quality. While other aspects of maternal feeding practices, self-efficacy and dietary intakes did not act as mediators, they were associated with child diet quality. CONCLUSIONS: Mediation analysis of this novel health promotion intervention showed the importance of maternal feeding knowledge and use of foods as rewards in impacting child diet quality. The other maternal factors assessed were appropriate targets but further research on how to impact these in an intervention is important. This evidence of intervention efficacy and mediation provides important insights for planning future interventions. TRIAL REGISTRATION: Current Controlled Trials ISRCTN81847050, registered 23 November 2007. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12966-014-0137-5) contains supplementary material, which is available to authorized users

Stories of success: Cultural narratives and personal stories of elite and professional athletes

Using a narrative methodology to explore the stories Olympic and elite athletes tell about success, we identified three alternatives to the dominant conception of success as the achievement of performance outcomes. In these alternatives, success is storied as: (1) ‘I did the best that I could’ – a controllable and sustainable story of effort and application; (2) ‘It’s the closest thing you can get to flying’ – a story where success relates to embodied experience and discovery; (3) ‘People I made the journey with’ – which prioritises relationships and connection between people. We reflect on three key insights: (1) success is a multidimensional concept, broader than the singular conception encapsulated within the dominant performance narrative; (2) through various narrative strategies, experienced athletes resist cultural pressures towards a singular conception of success; (3) for long-term performance and well-being, it is necessary to work towards multiple forms of success over time and across contexts

Nonrigid registration of three-dimensional ultrasound and magnetic resonance images of the carotid arteries

Atherosclerosis at the carotid bifurcation can result in cerebral emboli, which in turn can block the blood supply to the brain causing ischemic strokes. Noninvasive imaging tools that better characterize arterial wall, and atherosclerotic plaque structure and composition may help to determine the factors which lead to the development of unstable lesions, and identify patients at risk of plaque disruption and stroke. Carotid magnetic resonance (MR) imaging allows for the characterization of carotid vessel wall and plaque composition, the characterization of normal and pathological arterial wall, the quantification of plaque size, and the detection of plaque integrity. On the other hand, various ultrasound (US) measurements have also been used to quantify atherosclerosis, carotid stenosis, intima-media thickness, total plaque volume, total plaque area, and vessel wall volume. Combining the complementary information provided by 3D MR and US carotid images may lead to a better understanding of the underlying compositional and textural factors that define plaque and wall vulnerability, which may lead to better and more effective stroke prevention strategies and patient management. Combining these images requires nonrigid registration to correct the nonlinear misalignments caused by relative twisting and bending in the neck due to different head positions during the two image acquisition sessions. The high degree of freedom and large number of parameters associated with existing nonrigid image registration methods causes several problems including unnatural plaque morphology alteration, high computational complexity, and low reliability. Thus, a twisting and bending model was used with only six parameters to model the normal movement of the neck for nonrigid registration. The registration technique was evaluated using 3D US and MR carotid images at two field strengths, 1.5 and 3.0 T, of the same subject acquired on the same day. The mean registration error between the segmented carotid artery wall boundaries in the target US image and the registered MR images was calculated using a distance-based error metric after applying a twisting and bending model based nonrigid registration algorithm. An average registration error of 1.4 +/- 0.3 mm was obtained for 1.5 T MR and 1.5 +/- 0.4 mm for 3.0 T MR, when registered with 3D US images using the nonrigid registration technique presented in this paper. Visual inspection of segmented vessel surfaces also showed a substantial improvement of alignment with this nonrigid registration technique compared to rigid registration

Prosthetic thigh arteriovenous access: outcome with SVS/AAVS reporting standards

AbstractPurposeDifferences in the reporting methods of results for arteriovenous (AV) access can dramatically affect apparent outcome. To enable meaningful comparisons in the literature, the Society for Vascular Surgery and the American Association for Vascular Surgery (SVS/AAVS) recently published reporting standards for dialysis access. The purpose of the present study was to determine infection rates, patency rates, and possible predictive factors for prosthetic thigh AV access outcomes with the reporting standards of the SVS/AAVS.MethodsA retrospective analysis was performed of all patients who underwent placement of thigh AV access by the Surgical Teaching Service at Greenville Memorial Hospital between 1989 and 2001. Outcomes were determined based on SVS/AAVS Standards for Reports Dealing with AV Accesses. The rate of revision per year of access patency was also determined; this end point more accurately reflects the true cost and morbidity associated with AV access than do patency or infection rates alone.ResultsOne hundred twenty-five polytetrafluoroethylene thigh AV accesses were placed in 100 patients. Nine accesses were excluded from the study, six because there was no patient follow-up and 3 as a result of deaths unrelated to the access procedure and which occurred less than 30 days after access placement. There were six (4%) late access-related deaths. There were 18 (15%) early access failures, related to infection in 14 cases (12%), thrombosis in three cases (2%), and steal in one case (1%). Early failure was more common in patients with diabetes mellitus (P = .036). The primary and secondary functional patency rates were 19% and 54%, respectively, at 2 years. Infection occurred in 48 (41%) accesses. The patency and infection rates were not influenced by patient age, gender, body mass index, or diabetes mellitus. The median number of interventions per year of access patency was 1.68, and this outcome was positively correlated with body mass index (P < .001).ConclusionsProsthetic AV access in the thigh is associated with higher morbidity compared with that reported for the upper extremity, and should be considered only if no upper extremity AV access option is available. Early access failure and the requirement for an increased number of interventions to reestablish and maintain access patency are more common in patients with diabetes mellitus and obesity. The number of interventions per year of access patency is a valuable end point when assessing the outcome of AV access procedures