SciCombinator

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The Gas Man simulation software provides an opportunity to teach, understand and examine the pharmacokinetics of volatile anesthetics. The primary aim of this study was to investigate the accuracy of a cardiac output and alveolar ventilation matched Gas Man model and to compare its predictive performance with the standard pharmacokinetic model using patient data.Therefore, patient data from volatile anesthesia were successively compared to simulated administration of desflurane and sevoflurane for the standard and a parameter-matched simulation model with modified alveolar ventilation and cardiac output. We calculated the root-mean-square deviation (RMSD) between measured and calculated induction, maintenance and elimination and the expiratory decrement times during emergence and recovery for the standard and the parameter-matched model.During induction, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [induction (desflurane), standard: 1.8 (0.4) % Atm, parameter-matched: 0.9 (0.5) % Atm., P = .001; induction (sevoflurane), standard: 1.2 (0.9) % Atm, parameter-matched: 0.4 (0.4) % Atm, P = .029]. During elimination, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [elimination (desflurane), standard: 0.7 (0.6) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .001; elimination (sevoflurane), standard: 0.7 (0.5) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .008]. The RMSDs during the maintenance of anesthesia and the expiratory decrement times during emergence and recovery showed no significant differences between the patient and simulated data for both simulation models.Gas Man simulation software predicts expiratory concentrations of desflurane and sevoflurane in humans with good accuracy, especially when compared to models for intravenous anesthetics. Enhancing the standard model by ventilation and hemodynamic input variables increases the predictive performance of the simulation model. In most patients and clinical scenarios, the predictive performance of the standard Gas Man simulation model will be high enough to estimate pharmacokinetics of desflurane and sevoflurane with appropriate accuracy.

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We aimed to examine the feasibility of our newly-developed, integrated, and high-intensity individual cognitive behavioral therapy (CBT) protocol for treatment-resistant chronic pain.

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A performance-based financing (PBF) pilot project was implemented in 2011 in Burkina Faso. After more than five years of implementation (data collection in 2016), the project’s sustainability was not guaranteed. This study’s objective is to assess this project’s sustainability in 2016 by identifying the presence/absence of different determinants of sustainability according to the conceptual framework of Seppey et al. (2017).

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Older women are vulnerable to the risks associated with some forms of gambling. While research has examined how individuals functionally interact with gambling products, very limited research has investigated how individuals conceptualise and interpret the risks associated with these products. Theorists suggest that risk-taking is not based on a lack of knowledge but on the different ways people make sense of their lives. As such, this study aimed to understand the factors that may influence how older women who gamble on electronic gambling machines (EGMs) perceive the risks associated with gambling on these products. It examined how risk perceptions interacted with a range of complex social factors in women’s everyday lives to influence their risk behaviours. Semi-structured interviews were conducted with 20 Australian women aged 55 and over who had been negatively impacted by EGM gambling. This study found that older women’s risk perceptions of gambling were shaped by their early recreational experiences with gambling, rather than their current regular and harmful gambling behaviours. Risk perceptions of EGMs were often downplayed or ignored as women sought to maintain valued social identities within the venues. Women went through a process of risk negotiation whereby the benefits of this social interaction outweighed the potential harms associated with the machines. This also led them to deflect or ignore risk minimisation messaging which was completely focused on individual behaviours. This study signals the importance of moving away from individualised responsible gambling messages towards risk information about gambling products. This research also provides evidence of the need for regulation addressing the design features of EGMs that ultimately may make products safer and protect the most vulnerable from gambling harm.

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To describe the radiological features, diagnostic accuracy and features of imaging studies and their relation with clinical course of coronavirus disease 2019 (COVID-19) pneumonia in pregnant women.

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RARS is a challenging clinical problem that impacts many patients. This article seeks to systematically review the literature on RARS management.

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Palliative care (PC) clinicians treat seriously ill patients who are at increased risk for compromised decision-making capacity (DMC). These patients face profound and complex questions about which treatments to accept and which to decline. PC clinicians, therefore, have the especially difficult task of performing thorough, fair, and accurate DMC assessments in the face of the complex effects of terminal illness, which may be complicated by fluctuating acute medical conditions, mental illness, or cognitive dysfunction. This study, written by a team of clinicians with expertise in PC, ethics, psychiatry, pediatrics, and geriatrics, aims to provide expert guidance to PC clinicians on best practice for complex DMC assessment.

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Light-powered micromotors have drawn enormous attention because of their potential applications in cargo delivery, environmental monitoring, and noninvasive surgery. However, the existing micromotors still suffer from some challenges, including slow speed, poor controllability, single locomotion mode, and no deformation during movement. Herein, we employ a combined electrospinning with brushing of Chinese ink to simply fabricate a light-responsive gradient-structured poly(vinyl alcohol)/carbon (PVA/carbon) composite motor. Because of the surface deposition and ultrahigh loading amount of carbon nanoparticles (ca. 43%), the motor exhibits rapid (39 mm/s), direction-controlled, and multimodal locomotion (vertical movement, horizontal motion, rotation) under light irradiation. Simultaneously, gradient alignment structure of the PVA nanofibrous matrix endows the motor with controllable and reversible deformation during locomotion. We finally demonstrate the potential applications of the motors in leakage monitoring, object salvage, smart access, and intelligent assembly. The present work will inspire the design of novel photosensitive motors for applications in various fields, such as microrobots, environmental monitoring, and biomedicine.

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Laparoscopic surgery is regarded as the gold standard for the surgical management of cholelithiasis. To improve post-operative pain, low-pressure laparoscopic cholecystectomies (LPLC) have been trialed. A recent systematic review found that LPLC reduced pain; however, many of the randomised control trials were at a high risk of bias and the overall quality of evidence was low.

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Many biotic and abiotic processes contribute to nitrous oxide (N2 O) production in the biosphere, but N2 O consumption in the environment has heretofore been attributed primarily to canonical denitrifying microorganisms. The nosZ genes encoding the N2 O reductase enzyme, NosZ, responsible for N2 O reduction to dinitrogen are now known to include two distinct groups: the well-studied Clade I which denitrifiers typically possess, and the novel Clade II possessed by diverse groups of microorganisms, most of which are non-denitrifiers. Clade II N2 O reducers could play an important, previously unrecognized role in controlling N2 O emissions for several reasons, including: (1) the consumption of N2 O produced by processes other than denitrification, (2) hypothesized non-respiratory functions of NosZ as an electron sink or for N2 O detoxification, (3) possible differing enzyme kinetics of Clade II NosZ compared to Clade I NosZ, and (4) greater nosZ gene abundance for Clade II compared to Clade I in soils of many ecosystems.