Anaesthesia and subglottic airway obstruction

In this article, we describe the anaesthetic management and laser excision of a subglottic tumour that caused upper airway obstruction. Stridor was the presenting feature. A good history and careful assessment will reduce the likelihood of erroneous or delayed diagnosis and will improve patient outcome.This case report highlights the use of target-controlled infusions and jet ventilation (high-pressure source ventilation) in the surgical excision of a subglottic tumour.Keywords: shared airway; jet ventilation; TIVA/TCI; laser excision; monitorin

The ecology of religious beliefs

Although ecological forces are known to shape the expression of sociality across a broad range of biological taxa, their role in shaping human behavior is currently disputed. Both comparative and experimental evidence indicate that beliefs in moralizing high gods promote cooperation among humans, a behavioral attribute known to correlate with environmental harshness in nonhuman animals. Here we combine fine-grained bioclimatic data with the latest statistical tools from ecology and the social sciences to evaluate the potential effects of environmental forces, language history, and culture on the global distribution of belief in moralizing high gods (n = 583 societies). After simultaneously accounting for potential nonindependence among societies because of shared ancestry and cultural diffusion, we find that these beliefs are more prevalent among societies that inhabit poorer environments and are more prone to ecological duress. In addition, we find that these beliefs are more likely in politically complex societies that recognize rights to movable property. Overall, our multimodel inference approach predicts the global distribution of beliefs in moralizing high gods with an accuracy of 91%, and estimates the relative importance of different potential mechanisms by which this spatial pattern may have arisen. The emerging picture is neither one of pure cultural transmission nor of simple ecological determinism, but rather a complex mixture of social, cultural, and environmental influences. Our methods and findings provide a blueprint for how the increasing wealth of ecological, linguistic, and historical data can be leveraged to understand the forces that have shaped the behavior of our own species

Coevolution of religious and political authority in Austronesian societies

Authority, an institutionalized form of social power, is one of the defining features of the large-scale societies that evolved during the Holocene. Religious and political authority have deep histories in human societies and are clearly interdependent, but the nature of their relationship and its evolution over time is contested. We purpose-built an ethnographic dataset of 97 Austronesian societies and used phylogenetic methods to address two long-standing questions about the evolution of religious and political authority: first, how these two institutions have coevolved, and second, whether religious and political authority have tended to become more or less differentiated. We found evidence for mutual interdependence between religious and political authority but no evidence for or against a long-term pattern of differentiation or unification in systems of religious and political authority. Our results provide insight into how political and religious authority have worked synergistically over millennia during the evolution of large-scale societies

Church attendance and alloparenting: an analysis of fertility, social support and child development among English mothers

Many aspects of religious rituals suggest they provide adaptive benefits. Studies across societies consistently find that investments in ritual behaviour return high levels of cooperation. Another line of research finds that alloparental support to mothers increases maternal fertility and improves child outcomes. Although plausible, whether religious cooperation extends to alloparenting and/or affects child development remains unclear. Using 10 years of data collected from the Avon Longitudinal Study of Parents and Children (ALSPAC), we test the predictions that church attendance is positively associated with social support and fertility (n = 8207 to n = 8209), and that social support is positively associated with fertility and child development (n = 1766 to n = 6561). Results show that: (i) relative to not attending, church attendance is positively related to a woman's social network support and aid from co-religionists, (ii) aid from co-religionists is associated with increased family size, while (iii) fertility declines with extra-religious social network support. Moreover, while extra-religious social network support decreased over time, co-religionist aid remained constant. These findings suggest that religious and secular networks differ in their longevity and have divergent influences on a woman's fertility. We find some suggestive evidence that support to mothers and aid from co-religionists is positively associated with a child's cognitive ability at later stages of development. Findings provide mixed support for the premise that ritual, such as church attendance, is part of a strategy that returns high levels of support, fertility and improved child outcomes. Identifying the diversity and scope of cooperative breeding strategies across global religions presents an intriguing new horizon in the evolutionary study of religious systems. This article is part of the theme issue ‘Ritual renaissance: new insights into the most human of behaviours'.1. Introduction (a) Cooperative support to mothers: from foragers to modern nation states 2. Methods (a) Sample and participants (b) Variables and data processing 3. Results (a) Is frequency of maternal church attendance positively associated with a mother's social network support, and/or aid from co-religionists? (b) Is the frequency of maternal church attendance positively associated with fertility? (c) Is a mother's social network support, and/or aid from co-religionists positively related to her fertility? (d) Is a mother's social network support and/or aid from co-religionists positively associated with child physiological and cognitive development? 4. Discussion (a) Limitations of the present study 5. Conclusio

LOGIKA FUZZY UNTUK MENENTUKAN ASUPAN KALORI PADA TERAPI DIET TERHADAP PENDERITA OBESITAS

It takes time for a while to determine calory intake for diabetics. Computer technology has been growing rapidly, that can help human life even outside the field of computer science. One of the ways to fulfill those needs is by using fuzzy methode. Fuzzy methode has been applicated in many fields, especially in health. In diet theraphy, obesity can be prevented by restriction in food intake, called diet. Calory intake is determined manually by counting ideal weight combined with other weight. In this research, researcher use fuzzy logic to determine calory intake for patients with obesity when nutrition section still use counting ideal weight, basal needs and activity manually. Therefore, it is a need a methode that can determine calory intake in diet therapy for the sake of a new knowledge and more competitive like for Puskesmas Ambacang.Keywords : Fuzzy Logic, Mamdani Method, Calory Inta

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

BACKGROUND: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. METHODS: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. FINDINGS: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). INTERPRETATION: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. FUNDING: UK Medical Research Council and Health Technology Assessment Programme

Coding culture: challenges and recommendations for comparative cultural databases

Considerable progress in explaining cultural evolutionary dynamics has been made by applying rigorous models from the natural sciences to historical and ethnographic information collected and accessed using novel digital platforms. Initial results have clarified several long-standing debates in cultural evolutionary studies, such as population origins, the role of religion in the evolution of complex societies and the factors that shape global patterns of language diversity. However, future progress requires recognition of the unique challenges posed by cultural data. To address these challenges, standards for data collection, organisation and analysis must be improved and widely adopted. Here, we describe some major challenges to progress in the construction of large comparative databases of cultural history, including recognising the critical role of theory, selecting appropriate units of analysis, data gathering and sampling strategies, winning expert buy-in, achieving reliability and reproducibility in coding, and ensuring interoperability and sustainability of the resulting databases. We conclude by proposing a set of practical guidelines to meet these challenges

Recruitment and retention of participants in UK surgical trials : survey of key issues reported by trial staff

Source of Funding This research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) (NIHR-BRC-1215-20008) and by the Medical Research Council (MRC) Network of Hubs for Trials Methodology Research (MR/L004933/1-N66), as part of the wider PIRRIST project. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The Health Services Research Unit, University of Aberdeen, receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. The funders had no input into the study design, data collection, analysis, interpretation or manuscript writing. ACKNOWLEDGEMENTS We are grateful to all survey respondents and to PIRRIST study collaborators and advisers who helped to promote survey. We thank Caroline Jordan and Liz Woolliams for providing administrative support; Rebecca Harmston for providing valuable advice from a patient perspective; Murat Akkulak at the Royal College of Surgeons for providing the RCS portfolio of surgical trials; Amadea Turk for helping to identify potential participants; and colleagues who kindly piloted and helped to improve the survey including Kerry Avery, Karen Barnett, Helen Bulbeck, Marloes Franssen, Nicola Higgins, Jennifer Hirst, Lynne Maddocks, Peter McCulloch, James Shepperd, Jean Simmonds and Sharon Tonner. Anonymised survey data can be made available on request. Please contact the corresponding author. This study was not preregistered. The authors declare no potential competing interests.Peer reviewedPublisher PD