A case study of two adolescent–parent pairs describing the association between vagal tone and social-emotional adjustment during a Positive Cognitive Behaviour Therapy Programme

OBJECTIVE : A case study describing the association between vagal tone and social-emotional adaptation in two distressed adolescent–parent (A–P) pairs during a Positive Cognitive Behaviour Therapy Programme (P-CBTP). METHODS : Two A–P pairs completed a P-CBTP with pre- and post-intervention biosocial-emotional assessments; weekly training sessions over 7 weeks to develop individual strengths, new adaptive cognitions, positive discipline skills, optimism and knowledge on age-appropriate developmental expressions; augmented by moderate physical activity. Resting vagal tone and vagal reactivity were assessed by time-domain measures of vagal activity (RMSSD). RESULTS : Social-emotional adjustment improved in all A–P pairs. Resting vagal tone increased over the intervention period, from low-to-low-normal towards average-for-normal in three subjects. The fourth individual had excessive pre-intervention resting vagal tone that declined in the direction of normal over the intervention period. Vagal reactivity in response to orthostatic stress remained the same pre- to post-intervention. CONCLUSIONS : Changes in resting vagal tone demonstrated improvements in psychological functioning in all four subjects over the period of intervention. Results supported the view of the association between vagal tone and mental health not being an absolute positive relationship, but that low, as well as excessive, vagal tone may be maladaptive. Indications are that the same may apply to vagal reactivity to psychological stress. More studies need to examine the association between resting vagal tone and emotion regulation in A–P relationships during P-CBTP, keeping in mind that a linear relationship cannot summarily be expected in population studies.http://www.tandfonline.com/loi/rcmh202019-09-21hj2018PsychiatrySchool of Health Systems and Public Health (SHSPH

The Effect of Electrolyte Composition on the Performance of a Single‐Cell Iron–Chromium Flow Battery

Flow batteries are promising for large‐scale energy storage in intermittent renewable energy technologies. While the iron–chromium redox flow battery (ICRFB) is a low‐cost flow battery, it has a lower storage capacity and a higher capacity decay rate than the all‐vanadium RFB. Herein, the effect of electrolyte composition (active species and supporting electrolyte concentrations), Fe/Cr molar ratio, and supporting electrolyte type (HCl and H2SO4) on the performance (current efficiency (CE), voltage efficiency (VE), energy efficiency, discharge capacity, and capacity decay) of an ICRFB is investigated. The storage capacity of the optimum electrolyte (1.3 m FeCl2, 1.4 m CrCl3, 5.0 mm Bi2O3 in 1.0 m HCl) is 40% higher (from 17.5 to 24.4 Ah L−1), while the capacity decay rate is tenfold lower (from 3.0 to 0.3% h−1) than the performance of the previously used 1.0 m FeCl2, 1.0 m CrCl3 in 3.0 m HCl. At the optimum Fe and Cr concentrations and ratio in 0.5 m HCl, a near constant CE (92.3%), VE (78.7%), and EE (72.6%) are obtained over 50 cycles. The significantly higher capacity decay when using 1.0 m H2SO4 (1.6% h−1) compared to 1.0 m HCl (0.3% h−1) confirms that HCl is the more suitable supporting electrolyte

Quality of recovery after total hip and knee arthroplasty in South Africa : a national prospective observational cohort study

BACKGROUND: Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives of this second phase of changing practice were to document quality of patient recovery, record patient characteristics and audit standard perioperative practice. METHODS: From May to December 2018, nine South African public hospitals conducted a 10-week prospective observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30 days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative patient characteristics and perioperative care were documented to audit practice. RESULTS: Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%) were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic, multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively. On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%). CONCLUSION: Quality of recovery measured by a median DAH30 of 26 days justifies performance of THA/TKA in South African public hospitals. That said, perioperative practice, including optimisation of modifiable risk factors, lacked standardisation suggesting that quality of patient care and postoperative recovery may improve with implementation of ERP principles. Notwithstanding the limited resources available, we anticipate that a change of practice for THA/TKA is feasible if ‘buy-in’ from the involved multidisciplinary units is obtained in the next phase of our nationwide ERP initiative.http://www.biomedcentral.com/bmcmusculoskeletdisordpm2021AnaesthesiologyOrthopaedic SurgeryPhysiotherap

Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study.

BACKGROUND: Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. METHODS: We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed in units of metabolic equivalents of tasks by the responsible anaesthesiologists in the preoperative assessment clinic, graded as poor (10). All participants also completed the DASI questionnaire, underwent CPET to measure peak oxygen consumption, and had blood tests for measurement of NT pro-BNP concentrations. After surgery, patients had daily electrocardiograms and blood tests to measure troponin and creatinine concentrations until the third postoperative day or hospital discharge. The primary outcome was death or myocardial infarction within 30 days after surgery, assessed in all participants who underwent both CPET and surgery. Prognostic accuracy was assessed using logistic regression, receiver-operating-characteristic curves, and net risk reclassification. FINDINGS: Between March 1, 2013, and March 25, 2016, we included 1401 patients in the study. 28 (2%) of 1401 patients died or had a myocardial infarction within 30 days of surgery. Subjective assessment had 19·2% sensitivity (95% CI 14·2-25) and 94·7% specificity (93·2-95·9) for identifying the inability to attain four metabolic equivalents during CPET. Only DASI scores were associated with predicting the primary outcome (adjusted odds ratio 0·96, 95% CI 0·83-0·99; p=0·03). INTERPRETATION: Subjectively assessed functional capacity should not be used for preoperative risk evaluation. Clinicians could instead consider a measure such as DASI for cardiac risk assessment. FUNDING: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University.This study was supported by grants from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University (Melbourne, VIC, Australia). DNW is supported by a New Investigator Award from the Canadian Institutes of Health Research. DNW and BHC are partly supported by Merit Awards from the Department of Anesthesia at the University of Toronto. RMP is a Career Development Fellow for the British Journal of Anaesthesia and Royal College of Anaesthetists, and a professor for the UK National Institute for Health Research. TEFA is a clinical research training fellow for the UK Medical Research Council and British Journal of Anaesthesia. MPWG holds the British Oxygen Company Chair of Anaesthesia of the Royal College of Anaesthetists, which is awarded by the UK National Institute of Academic Anaesthesia. We thank the Li Ka Shing Knowledge Institute of St Michael's Hospital (Toronto, ON, Canada) for generously supporting the costs of international trial insurance for this study, and all the participating patients and staff across the 25 study sites