Electrodermal and central measures of the tonic orienting reflex (OR).

Sokolov described both phasic and tonic aspects of the Orienting Reflex (OR), but subsequent research and theory development has focussed primarily on the phasic OR at the expense of the tonic OR. The present study used prestimulus skin conductance level (SCL) during a dishabituation paradigm to model the tonic OR, examining its amplitude patterning over repeated standard stimulus presentations and a change stimulus. We expected sensitisation (increased amplitude) following the initial and change trials, and habituation (decrement) over the intervening trials. Prestimulus EEG alpha level was explored as a potential central measure of the tonic OR (as an inverse correlate), examining its pattern over stimulus repetition and change in relation to the SCL model. We presented a habituation series of innocuous auditory stimuli to two groups (each N = 20) at different ISIs (Long 13-15 s and Short 5-7 s) and recorded electrodermal and EEG data during two counterbalanced conditions; Indifferent: no task requirements; Significant: silent counting. Across groups and conditions, prestimulus SCLs and alpha amplitudes generally showed the expected trials patterns, confirming our main hypotheses. Findings have important implications for including the assessment of Sokolov's tonic OR in modelling central and autonomic nervous system interactions of fundamental attention and learning processes.

An audit of postoperative haemodynamic stability after intraoperative labetalol administration in non-cardiac surgery patients.

Anaesthesiologists commonly use intravenous labetalol to adjust patient haemodynamics during surgical procedures. Cases of profound hypotension after continuous labetalol infusions have been reported; however, there is limited evidence regarding the safety of intraoperative labetalol boluses. This audit examined the frequency of postoperative hypotension and bradycardia in 292 adult non-cardiac surgery patients treated with intraoperative labetalol boluses. Blood pressure and heart rate data were collected from the post-anaesthesia care unit and on the floor units for 24 hours after surgery. The median total intraoperative labetalol dose was 10mg. A total of 30/292 patients had all-cause postoperative hypotension within 24 hours of surgery, 26 of which had other medical or surgical precipitants. Fifteen patients developed bradycardia. There were no deaths or intensive care unit admissions attributed to labetalol. This audit demonstrates a low risk of all-cause postoperative hypotension (10%) and bradycardia (5%) after the use of small IV doses of intraoperative labetalol.

Guidelines to the Practice of Anesthesia-Revised Edition 2024.

OVERVIEW: The Guidelines to the Practice of Anesthesia-Revised Edition 2024 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia-Revised Edition 2024 supersede all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome. Anesthesiologists should exercise their own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.

RéSUMé: Le Guide d'exercice de l'anesthésie, version révisée 2024 (le Guide), a été préparé par la Société canadienne des anesthésiologistes (SCA), qui se réserve le droit de décider des termes de sa publication et de sa diffusion. Le Guide est soumis à révision et des versions mises à jour sont publiées chaque année. Le Guide d'exercice de l'anesthésie, version révisée 2024, remplace toutes les versions précédemment publiées de ce document. Bien que la SCA incite les anesthésiologistes du Canada à se conformer à son guide d'exercice pour assurer une grande qualité des soins dispensés aux patient·es, elle ne peut garantir les résultats d'une intervention spécifique. Les anesthésiologistes doivent exercer leur jugement professionnel pour déterminer la méthode d'intervention la mieux adaptée à l'état de leur patient·e. La SCA n'accepte aucune responsabilité ou imputabilité de quelque nature que ce soit découlant d'erreurs ou d'omissions ou de l'utilisation des renseignements contenus dans son Guide d'exercice de l'anesthésie.

The effects of rhythmic structure on tapping accuracy.

Prior investigations of simple rhythms in familiar time signatures have shown the importance of several mechanisms; notably, those related to metricization and grouping. But there has been limited study of complex rhythms, including those in unfamiliar time signatures, such as are found outside mainstream Western music. Here, we investigate how the structures of 91 rhythms with nonisochronous onsets (mostly complex, several in unfamiliar time signatures) influence the accuracy, velocity, and timing of taps made by participants attempting to synchronize with these onsets. The onsets were piano-tone cues sounded at a well-formed subset of isochronous cymbal pulses; the latter occurring every 234 ms. We modelled tapping at both the rhythm level and the pulse level; the latter provides insight into how rhythmic structure makes some cues easier to tap and why incorrect (uncued) taps may occur. In our models, we use a wide variety of quantifications of rhythmic features, several of which are novel and many of which are indicative of underlying mechanisms, strategies, or heuristics. The results show that, for these tricky rhythms, taps are disrupted by unfamiliar period lengths and are guided by crude encodings of each rhythm: the density of rhythmic cues, their circular mean and variance, and recognizing common small patterns and the approximate positions of groups of cues. These lossy encodings are often counterproductive for discriminating between cued and uncued pulses and are quite different to mechanisms-such as metricization and emphasizing group boundaries-thought to guide tapping behaviours in learned and familiar rhythms.

Evidence for a universal association of auditory roughness with musical stability.

We provide evidence that the roughness of chords-a psychoacoustic property resulting from unresolved frequency components-is associated with perceived musical stability (operationalized as finishedness) in participants with differing levels and types of exposure to Western or Western-like music. Three groups of participants were tested in a remote cloud forest region of Papua New Guinea (PNG), and two groups in Sydney, Australia (musicians and non-musicians). Unlike prominent prior studies of consonance/dissonance across cultures, we framed the concept of consonance as stability rather than as pleasantness. We find a negative relationship between roughness and musical stability in every group including the PNG community with minimal experience of musical harmony. The effect of roughness is stronger for the Sydney participants, particularly musicians. We find an effect of harmonicity-a psychoacoustic property resulting from chords having a spectral structure resembling a single pitched tone (such as produced by human vowel sounds)-only in the Sydney musician group, which indicates this feature's effect is mediated via a culture-dependent mechanism. In sum, these results underline the importance of both universal and cultural mechanisms in music cognition, and they suggest powerful implications for understanding the origin of pitch structures in Western tonal music as well as on possibilities for new musical forms that align with humans' perceptual and cognitive biases. They also highlight the importance of how consonance/dissonance is operationalized and explained to participants-particularly those with minimal prior exposure to musical harmony.

Prehabilitation in the lung cancer pathway: a scoping review.

BACKGROUND: Lung cancer is the third most common type of cancer in the UK. Treatment outcomes are poor and UK deaths from lung cancer are higher than any other cancer. Prehabilitation has shown to be an important means of preparing patients both physically and psychologically for cancer treatment. However, little is understood about the context and mechanisms of prehabilitation that can impact physiological and psychological wellbeing. Our aim was to review and summarise primary research on prehabilitation in the lung cancer pathway using a realist approach. METHODS: A scoping review of empirical primary research was conducted. Five online medical databases from 2016 - February 2023 were searched. All articles reporting on prehabilitation in lung cancer were included in the review. For this review, prehabilitation was defined as either a uni-modal or multi-modal intervention including exercise, nutrition and/or psychosocial support within a home, community or hospital based setting. A realist framework of context, mechanism and outcome was used to assist with the interpretation of findings. RESULTS: In total, 31 studies were included in the review, of which, three were published study protocols. Over 95% of studies featured an exercise component as part of a prehabilitation programme. Twenty-six of the studies had a surgical focus. Only two studies reported using theory to underpin the design of this complex intervention. There was large heterogeneity across all studies as well as a lack of clinical trials to provide definitive evidence on the programme design, setting, type of intervention, patient criteria, delivery, duration and outcome measures used. CONCLUSION: A standardised prehabilitation programme for lung cancer patients does not yet exist. Future lung cancer prehabilitation programmes should take into account patient led values, needs, goals, support structures and beliefs, as these factors can affect the delivery and engagement of interventions. Future research should consider using a conceptual framework to conceptualise the living with and beyond cancer experience to help shape and inform personalised prehabilitation services.

Training Anesthesiology Residents to Care for the Traumatically Injured in the United States.

Training and education for trauma anesthesiology have been predicated on 2 primary pathways: learning through peripheral "complex, massive transfusion cases"-an assumption that is flawed due to the unique demands, skills, and knowledge of trauma anesthesiology-or learning through experiential education, which is also incomplete due to its unpredictable and variable exposure. Residents may receive training from senior physicians who may not maintain a trauma-focused continuing medical education. Further compounding the issue is the lack of fellowship-trained clinicians and standardized curricula. The American Board of Anesthesiology (ABA) provides a section for trauma education in its Initial Certification in Anesthesiology Content Outline. However, many trauma-related topics also fall under other subspecialties, and the outline excludes "nontechnical" skills. This article focuses on the training of anesthesiology residents and proposes a tier-based approach to teaching the ABA outline by including lectures, simulation, problem-based learning discussions, and case-based discussions that are proctored in conducive environments by knowledgeable facilitators.

What is the Optimal Dipole Moment for Nonpolarizable Models of Liquids?

In classical nonpolarizable models, electrostatic interactions are usually described by assigning fixed partial charges to interaction sites. Despite the multitude of methods and theories proposed over the years for partial charge assignment, a fundamental question remains─what is the correct degree of polarization that a fixed-charge model should possess to provide the best balance of interactions (including induction effects) and yield the best description of the potential energy surface of a liquid phase? We address this question by approaching it from two separate and independent viewpoints: the QUantum mechanical BEspoke (QUBE) approach, which assigns bespoke force field parameters for individual molecules from ab initio calculations with minimal empirical fitting, and the Polarization-Consistent Approach (PolCA) force field, based on empirical fitting of force field parameters with an emphasis on transferability by rigorously accounting for polarization effects in the parameterization process. We show that the two approaches yield consistent answers to the above question, namely, that the dipole moment of the model should be approximately halfway between those of the gas and the liquid phase. Crucially, however, the reference liquid-phase dipole needs to be estimated using methods that explicitly consider both mean-field and local contributions to polarization. In particular, continuum dielectric models are inadequate for this purpose because they cannot account for local effects and therefore significantly underestimate the degree of polarization of the molecule. These observations have profound consequences for the development, validation, and testing of nonpolarizable models.

Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility.

PURPOSE OF REVIEW: With advances in resuscitative techniques, trauma patients are surviving increasingly severe injuries and physiological insult. Timely recognition of futility remains important in terms of patient dignity and resource preservation yet is increasingly challenging in the face of these advances. The understanding of biochemical derangement from pathophysiological processes of trauma and iatrogenic effects of resuscitation has expanded recently. RECENT FINDINGS: Acidosis and hypocalcaemia have been recognized as important contributors to mortality among trauma patients. Although less well recognized and studied, critical injury and high blood product volume resuscitation render patients vulnerable to life-threatening hyperkalaemia. The methods of correcting disruptions to acid-base and electrolyte homeostasis during damage control resuscitation have changed little recently and often rely on evidence from undifferentiated populations. Biochemical disturbances have value as ancillary predictors of futility in trauma resuscitation. SUMMARY: These findings will contribute to a greater understanding among anaesthesiologists of the causative mechanisms and effects of biochemical derangement after severe injury and aid them in the delivery of well tolerated and effective damage control resuscitation. Gaps in the evidence base are highlighted to encourage future work.

Guidelines to the Practice of Anesthesia: Revised Edition 2023.

OVERVIEW: The Guidelines to the Practice of Anesthesia Revised Edition 2023 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2023 supersede all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome. Anesthesiologists should exercise their own professional judgment in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.

RéSUMé: Le Guide d'exercice de l'anesthésie, version révisée 2023 (le Guide), a été préparé par la Société canadienne des anesthésiologistes (SCA), qui se réserve le droit de décider des termes de sa publication et de sa diffusion. Le Guide est soumis à révision et des versions mises à jour sont publiées chaque année. Le Guide d'exercice de l'anesthésie, version révisée 2023, remplace toutes les versions précédemment publiées de ce document. Bien que la SCA incite les anesthésiologistes du Canada à se conformer à son guide d'exercice pour assurer une grande qualité des soins dispensés aux patients, elle ne peut garantir les résultats d'une intervention spécifique. Les anesthésiologistes doivent exercer leur jugement professionnel pour déterminer la méthode d'intervention la mieux adaptée à l'état de leur patient. La SCA n'accepte aucune responsabilité ou imputabilité de quelque nature que ce soit découlant d'erreurs ou d'omissions ou de l'utilisation des renseignements contenus dans son Guide d'exercice de l'anesthésie.

New musical interfaces for older adults in residential care: assessing a user-centred design approach.

Purpose:For older adults in aged-care, group music-making can bring numerous physical and psychological benefits, ultimately improving their quality of life. However, personalising music-making to optimise these benefits is often difficult given their diverse ages, experiences, abilities, cognitive and motor skills, and their experience with music technology.Materialsandmethods:In this study, we conducted a 10-week group music-making intervention with twenty participants in an aged-care home, using a prototype digital musical instrument that we iteratively refined by following a user-centred design approach from direct resident feedback. The prototype instrument adopted a novel method for errorless learning in music-making settings, which we also refined, by increasing the difficulty level of the instrument's operation. We also assessed the residents' engagement with the sessions by obtaining feedback from caregivers and facilitators.Results:Results show that residents' enjoyment decreased as the complexity (difficulty) of our errorless learning implementation increased. We also found that resident engagement increased when changes to the prototype digital musical instrument were provided, but not when residents were giving feedback. Results also found that participation over the course of the intervention, and the number of songs played during each session also enhanced engagement.Conclusions: Overall, our results show the intervention was beneficial to residents, although we note some areas of enhancement for further interventions in designing prototype musical instruments for group music-making in aged-care settings. IMPLICATIONS FOR REHABILITATIONOlder adults positively engage with novel music technology, and do so increasingly over subsequent sessions. Repeated sessions may have the potential to enhance longer-term adoption of technologies as well as any rehabilitative effects of the group music-making activity.There is significant potential for residents with different abilities to all make music together, although to maximise the sustainability of the devices, the sessions, and the subsequent rehabilitative benefits, residents must be given the right adaptation for individual interfaces that balances ambition and ability.Rapid DMI prototyping positively enhances engagement among older adults, suggesting that in the case of a custom DMI, an upgrade schedule should be aligned with key rehabilitative milestones. Similarly, in the case of pre-developed digital music systems, resident exposure to new features or functionality should be strategically introduced, so as to maximise engagement for key phases of resident rehabilitation.

The incidence of awake tracheal intubation in anesthetic practice is decreasing: a historical cohort study of the years 2014-2020 at a single tertiary care institution.

PURPOSE: Awake tracheal intubation (ATI) is recommended in airway management guidelines when significant difficulty is predicted with airway management. Use of the technique may be declining, which may have implications for patient safety or for skills acquisition and maintenance. This historical cohort database study sought to determine if the use of ATI was decreasing in our adult tertiary care center. METHODS: With institutional research ethics board approval, we queried our anesthesia information management system for cases with ATI descriptors for each year from 2014 to 2020. Records of the retrieved cases were independently reviewed by all three authors to verify they met inclusion criteria for the ATI cohort prior to analysis for the primary outcome. Secondary outcome measures included airway device and route used for ATI, first attempt and ultimate success rates, and reported adverse issues recorded in cases of failed ATI or those requiring more than one attempt. RESULTS: A total of 692 cases of ATI were identified between 2014 and 2020. There was a statistically significant decrease in yearly ATIs over the seven-year study period (Chi square goodness of fit, P < 0.001), with ATI use decreasing by about 50%. First attempt success was significantly greater with use of flexible bronchoscopy vs video laryngoscopy to facilitate ATI (84% vs 60%; P < 0.001), while there was no difference in first attempt success with the oral vs nasal route (82% vs 82%; P = 1.0). CONCLUSION: In this single-center historical cohort study, the use of ATI decreased significantly from 2014 to 2020. Whether this decrease will result in morbidity or mortality related to airway management is currently unclear. Regardless, it has implications for training opportunities and maintenance of competence in performing the procedure.

RéSUMé: OBJECTIF: L'intubation trachéale éveillée (ITE) est recommandée dans les lignes directrices de prise en charge des voies aériennes lorsque des difficultés significatives sont anticipées dans la prise en charge des voies aériennes. L'utilisation de cette technique pourrait être en déclin, ce qui pourrait avoir des répercussions sur la sécurité des patients ou sur l'acquisition et le maintien des compétences. Cette étude de cohorte historique visait à déterminer si l'utilisation de l'ITE était en diminution dans notre centre de soins tertiaires pour adultes. MéTHODE: Après avoir obtenu l'approbation du comité d'éthique de la recherche de notre institution, nous avons extrait les données des patients ayant des descripteurs d'ITE de 2014 à 2020 à partir de notre système de gestion de l'information en anesthésie. Les données des dossiers de ces patients ont été examinées de manière indépendante par les trois auteurs afin de vérifier s'ils répondaient aux critères d'inclusion de la cohorte ITE avant l'analyse du critère d'évaluation principal. Les critères d'évaluation secondaires comprenaient le dispositif d'intubation et la voie d'accès utilisés pour l'ITE, les taux de réussite de la première tentative et de la réussite finale, et les problèmes indésirables signalés enregistrés dans les cas d'échec de l'ITE ou ceux nécessitant plus d'une tentative. RéSULTATS: Au total, 692 cas d'ITE ont été identifiés entre 2014 et 2020. Il y a eu une diminution annuelle statistiquement significative des ITE au cours de la période d'étude de sept ans (test d'adéquation du Chi carré, P < 0,001), l'utilisation de l'ITE diminuant d'environ 50 %. Le succès de l'intubation à la première tentative a été significativement plus important avec l'utilisation de la bronchoscopie flexible en comparaison à la vidéolaryngoscopie pour faciliter l'ITE (84 % vs 60 %; P < 0,001), bien qu'aucune différence n'ait été observée dans le succès de la première tentative par voie orale en comparaison à nasale (82 % versus 82 %; P = 1,0). CONCLUSION: Dans cette étude de cohorte historique monocentrique, l'utilisation de l'intubation trachéale éveillée a diminué de manière significative de 2014 à 2020. Il n'est pas clair si cette diminution entraînera une morbidité ou une mortalité liée à la prise en charge des voies aériennes. Quoi qu'il en soit, cela a des implications pour la formation et le maintien des compétences dans l'exécution de la procédure.

Exploring older adult needs and preferences for technology-assisted group music-making. A qualitative analysis of data collected during the participatory user-centred design process.

PURPOSE: Engagement with arts, recreation and leisure is highly valued by older adults, with positive links to their continued wellbeing. Despite an availability of new music technology, these devices are rarely designed with older adults in mind. This project explores the needs and preferences of older adults in residential care as they interact with digital music interfaces in a group music-making context. MATERIALS AND METHODS: Twenty participants at an Australian residential aged-care facility were involved in a user-centred design process (20 sessions across six months) to develop digital music interfaces suitable for group music-making. Participants' verbal comments were audio-recorded and transcribed, supported by further written observation notes made by the activity facilitators. RESULTS: A hybrid inductive and deductive approach to thematic analysis revealed three main themes: individual music-making, ensemble music-making and social engagement. Our results suggest that when interfaces are designed with older adults in mind, technology-assisted group music-making can facilitate bringing together residents with different experiences and abilities. CONCLUSIONS: These findings suggest implications for rehabilitation in developing a range of musical devices for older adults to account for required flexibility, whilst maintaining an appropriate and satisfyingly "rich" musical outcome.Implications for rehabilitationOlder adults positively engage with music technology, showing distinct personal preferences for aspects of physical interaction, balance and quality of sound. Rehabilitation and/or wellbeing-based musical activities for older adults in residential care may benefit from considering tools that allow for personal adaptations such as these to be made.Preferences for musical interaction can be influenced by previous musical experiences, as well as physical and/or cognitive abilities. However, on any given day musical preferences can also be subject to change.Within a group music-making context, there is a significant capacity for older adults to feel agency in contributing to the overall sound; rehabilitation activities and/or technologies could be designed where this individual contribution to the group can be enhanced.Group music-making using new digital music interfaces has the potential to encourage interpersonal social connections that are most likely made over repeated sessions.