Evaluating the Likelihood of Use of Bispectral Index Guided Anesthesia as a Strategy to Reduce Postoperative Delirium in Surgical Patients 65 Years of Age or Older

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two parts to this project. The goal of part 1 was to evaluate recent trends in BIS monitor use for patients 65 years of age or older through retrospective chart review. The goal of part 2 was to conduct a voluntary survey to assess anesthesia provider’s knowledge of current recommendations, opinions, barriers to use, and if there are plans for practice change related to BIS monitor use. Data collected during part 1 demonstrated the odds ratio of BIS use in this sample overall 0.078, indicating that the likelihood of BIS being used in this sample was 12.8 times lower than BIS not being used (n=281, p

Optimisation of surface measurement for metal additive manufacturing using coherence scanning interferometry

Surface topography measurement for metal additive manufacturing (AM) is a challenging task for contact and non-contact methods. In this paper, we present an experimental investigation of the use of coherence scanning interferometry (CSI) for measurement of AM surfaces. Our approach takes advantage of recent technical enhancements in CSI, including high dynamic range for light level and adjustable data acquisition rates for noise reduction. The investigation covers several typical metal AM surfaces made from different materials and AM processes. Recommendations for measurement optimisation balance three aspects: data coverage, measurement area and measurement time. This study also presents insight into areas of interest for future rigorous examination, such as measurement noise and further development of guidelines for the measurement of metal AM surfaces

New discrete and polymeric supramolecular architectures derived from dinuclear Co(II), Ni(II) and Cu(II) complexes of aryl-linked bis-beta-diketonato ligands and nitrogen bases: synthetic, structural and high pressure studies

New examples of nitrogen base adducts of dinuclear Co(II), Ni(II) and Cu(II) complexes of the doubly deprotonated forms of 1,3-aryl linked bis-β-diketones of type [RC([double bond, length as m-dash]O)CH2C([double bond, length as m-dash]O)C6H4C([double bond, length as m-dash]O)CH2C([double bond, length as m-dash]O)R] (L1H2) incorporating the mono- and difunctional amine bases pyridine (Py), 4-ethylpyridine (EtPy), piperidine (pipi), 1,4-piperazine (pip), N-methylmorpholine (mmorph), 1,4-dimethylpiperazine (dmpip) and N,N,N′,N′-tetramethylethylenediamine (tmen) have been synthesised by reaction of the previously reported [Cu2(L1)2]·2.5THF (R = Me), [Cu2(L1)2(THF)2] (R = t-Bu), [Ni2(L1)2(Py)4] (R = t-Bu) and [Co2(L1)2(Py)4] (R = t-Bu) complexes with individual bases of the above type. Comparative X-ray structural studies involving all ten base adduct derivatives have been obtained and reveal a range of interesting discrete and polymeric molecular architectures. The respective products have the following stoichiometries: [Cu2(L1)2(Py)2]·Py (R = Me), [Cu2(L1)2(EtPy)2]·2EtPy (R = t-Bu), [Cu2(L1)2(pipi)2]·2pipi (R = t-Bu), [Cu2(L1)2(mmorph)2] (R = t-Bu), [Cu2(L1)2(tmen)2] (R = t-Bu) and {[Cu2(L1)2(pip)]·pip·2THF}n, [Co2(L1)2(tmen)2] (R = t-Bu), [Ni2(L1)2(Py)4]·dmpip (R = t-Bu), [Ni2(L1)2(pipi)4]·pipi (R = t-Bu) and [Ni2(L1)2(tmen)2] (R = t-Bu). The effect of pressure on the X-ray structure of [Cu2(L1)2(mmorph)2] has been investigated. An increase in pressure from ambient to 9.1 kbar resulted in modest changes to the unit cell parameters as well as a corresponding decrease of 6.7 percent in the unit cell volume. While a small ‘shearing’ motion occurs between adjacent molecular units throughout the lattice, no existing bonds are broken or new bonds formed

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. // Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed

The UK Biobank imaging enhancement of 100,000 participants: rationale, data collection, management and future directions

UK Biobank is a population-based cohort of half a million participants aged 40–69 years recruited between 2006 and 2010. In 2014, UK Biobank started the world’s largest multi-modal imaging study, with the aim of re-inviting 100,000 participants to undergo brain, cardiac and abdominal magnetic resonance imaging, dual-energy X-ray absorptiometry and carotid ultrasound. The combination of large-scale multi-modal imaging with extensive phenotypic and genetic data offers an unprecedented resource for scientists to conduct health-related research. This article provides an in-depth overview of the imaging enhancement, including the data collected, how it is managed and processed, and future direction

Great expectations or small country living? Enabling small rural creative businesses with ICT.

Small businesses are prototypical rural business, but limited by distance. However, creative businesses are less constrained by space and hold great promise for rural development. Indeed, the rural is an attractive creative aesthetic milieu. Moreover, new broadband technologies seem to offer a solution to address connectivity; the social and spatial problem of being rural. Consequently, we ask how does broadband enable small rural creative firms. We sought out the practices and experiences of creative business owners, finding that broadband offered useful technical, creative, and business linking. However many were frustrated by poor technical performance. Furthermore, the accelerating pace of ICT worried respondents, who feared being left behind. Nonetheless for most-without broadband their rural location would have been impossible. We found that broadband has fostered creative rural businesses, but as new ways of making a small country living rather than stimulating a rural creative milieu. The digital promise of a creative transformation of the rural has not been realised in Scotland

Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences

Non peer reviewe

A communal catalogue reveals Earth's multiscale microbial diversity

Our growing awareness of the microbial world's importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth's microbial diversity.Peer reviewe