Sedation for Esophagogastroduodenal Endoscopy

Different anesthetic techniques and drugs can be used for esophagogastroduedonal endoscopy. However, the scientists are still searching for appropriate drugs and protocols for sedation during esophagogastroduedonal endoscopy. The aim of this review is to discuss the topics related with sedation and esophagogastroduedonal endoscopy in the light of literature. Today standard procedure for diagnostic esophagogastroduedonal endoscopy usually consists of topical pharyngeal anesthesia, minimal sedation or anxiolysis, which may be complemented with analgesia when needed. When a prolonged, complex, or particularly troublesome or painful examination is foreseen, deeper sedation with multiple drugs and in closed observation of a staff may be required

Wafer Level Vacuum Packaging of MEMS-Based Uncooled Infrared Sensors

This paper introduces a cost-effective, high-performance approach to achieving wafer level vacuum packaging (WLVP) for MEMS-based uncooled infrared sensors. Reliable and hermetic packages for MEMS devices are achieved using a cap wafer that is formed using two silicon wafers, where one wafer has precise grating/moth-eye structures on both sides of a double-sided polished wafer for improved transmission of over 80% in the long-wave infrared (LWIR) wavelength region without the need for an AR coating, while the other wafer is used to form a cavity. The two wafers are bonded using Au-In transient liquid phase (TLP) bonding at low temperature to form the cap wafer, which is then bondelectrical and Electronics d to the sensor wafer using glass frit bonding at high temperature to activate the getter inside the cavity region. The bond quality is assessed using three methods, including He-leak tests, cap deflection, and Pirani vacuum gauges. Hermeticity is confirmed through He-leak tests according to MIL-STD 883, yielding values as low as 0.1 × 10−9 atm·cc/s. The average shear strength is measured as 23.38 MPa. The package pressure varies from 133–533 Pa without the getter usage to as low as 0.13 Pa with the getter usage

Desflurane anaesthesia in a patient with multiple sclerosis in total hip replacement

Multiple sclerosis (MS) is a progressive demyelinating disease presenting with a relapsing-remitting course and affects large areas of the brain and the spinal cord. Surgical stress often induces exacerbation of MS symptoms. It is mandatory to prepare the MS patient very carefully for the surgery and anaesthesia with an effective premedication and an effective postoperative analgesia following a safe and minimal-risk anaesthesia management. In recent reports, results of general and regional anaesthesia in MS patients have been discussed. To our knowledge this is the first case report of the use of desflurane anaesthesia in a patient with MS. In conclusion, desflurane anaesthesia is a safe and useful method for MS patients

Social media analysis in the context of social responsibility approach of football fan groups

As one of sectors that address social problems, sports can pioneer very useful social responsibility efforts with its wide area of influence. Participation in social responsibility projects, especially through popularity of football, reaches much wider audience. It is seen that unofficial fan groups, which are already part of society, can direct very different sports stakeholders with their leadership positions that will affect large masses. Although it is important for this leadership to be done with active participation, it is also fact that it can be much more effective with creative and innovative projects. By examining initiatives in which in general football fans are involved within framework of social responsibility as stakeholders of football, it can be understood which problems in social area are more important from perspective of football fans. Thus, in future, much higher level of benefit can be provided for social problems by using such resources much more effectively and efficiently. In this context, this study was conducted with aim of examining social responsibility-focused Instagram posts of fan groups of three most important sports clubs operating in sports in Turkey in context of participation, leadership, innovation and creativity. In line with purpose of the study, Instagram pages, which run by fan groups, examined belong to Beşiktaş club’s Çarşı and UNIBJK fan groups, Fenerbahçe club’s Genç Fenerbahçeliler and UNIGFB fan groups, and Galatasaray club’s ultrAslan and UAUNI fan groups. 150 Instagram posts from each fan group, dating back to April 12, 2021, and total of 900 posts, were examined through content analysis. In content analysis, social responsibility-focused posts were coded and evaluated. In general, it was observed that the posts were made on axis of Agenda-Setting Approach. It is seen that social responsibility is increasingly becoming strategic necessity among sports stakeholders and is also used as means of strengthening legitimacy. In addition to leadership provided in terms of participation, it has been determined that there are areas that need to be improved in terms of creativity and innovation

Heterozygous BTNL8 variants in individuals with multisystem inflammatory syndrome in children (MIS-C).

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition following SARS-CoV-2 infection associated with intestinal manifestations. Genetic predisposition, including inborn errors of the OAS-RNAseL pathway, has been reported. We sequenced 154 MIS-C patients and utilized a novel statistical framework of gene burden analysis, burdenMC, which identified an enrichment for rare predicted-deleterious variants in BTNL8 (OR = 4.2, 95% CI: 3.5-5.3, P < 10-6). BTNL8 encodes an intestinal epithelial regulator of Vγ4+γδ T cells implicated in regulating gut homeostasis. Enrichment was exclusive to MIS-C, being absent in patients with COVID-19 or bacterial disease. Using an available functional test for BTNL8, rare variants from a larger cohort of MIS-C patients (n = 835) were tested which identified eight variants in 18 patients (2.2%) with impaired engagement of Vγ4+γδ T cells. Most of these variants were in the B30.2 domain of BTNL8 implicated in sensing epithelial cell status. These findings were associated with altered intestinal permeability, suggesting a possible link between disrupted gut homeostasis and MIS-C-associated enteropathy triggered by SARS-CoV-2

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Controlling the Near-wake of a Circular Cylinder with a Single, Large-scale Tripwire

Control of the flow past a circular cylinder using a single tripwire on its surface has been studied experimentally as a function of the wire angular location for different wire-to-cylinder diameter ratios (0.029Ph.D