Photonically active bowtie nanoassemblies with chirality continuum.

Chirality is a geometrical property described by continuous mathematical functions1-5. However, in chemical disciplines, chirality is often treated as a binary left or right characteristic of molecules rather than a continuity of chiral shapes. Although they are theoretically possible, a family of stable chemical structures with similar shapes and progressively tuneable chirality is yet unknown. Here we show that nanostructured microparticles with an anisotropic bowtie shape display chirality continuum and can be made with widely tuneable twist angle, pitch, width, thickness and length. The self-limited assembly of the bowties enables high synthetic reproducibility, size monodispersity and computational predictability of their geometries for different assembly conditions6. The bowtie nanoassemblies show several strong circular dichroism peaks originating from absorptive and scattering phenomena. Unlike classical chiral molecules, these particles show a continuum of chirality measures2 that correlate exponentially with the spectral positions of the circular dichroism peaks. Bowtie particles with variable polarization rotation were used to print photonically active metasurfaces with spectrally tuneable positive or negative polarization signatures for light detection and ranging (LIDAR) devices.

Policy recommendations to ensure that research software is openly accessible and reusable.

Research data is optimized when it can be freely accessed and reused. To maximize research equity, transparency, and reproducibility, policymakers should take concrete steps to ensure that research software is openly accessible and reusable.

FAIR-USE4OS: Guidelines for creating impactful open-source software.

This paper extends the FAIR (Findable, Accessible, Interoperable, Reusable) guidelines to provide criteria for assessing if software conforms to best practices in open source. By adding "USE" (User-Centered, Sustainable, Equitable), software development can adhere to open source best practice by incorporating user-input early on, ensuring front-end designs are accessible to all possible stakeholders, and planning long-term sustainability alongside software design. The FAIR-USE4OS guidelines will allow funders and researchers to more effectively evaluate and plan open-source software projects. There is good evidence of funders increasingly mandating that all funded research software is open source; however, even under the FAIR guidelines, this could simply mean software released on public repositories with a Zenodo DOI. By creating FAIR-USE software, best practice can be demonstrated from the very beginning of the design process and the software has the greatest chance of success by being impactful.

The association between inflammatory markers in blood and cerebrospinal fluid: a systematic review and meta-analysis.

BACKGROUND: Neuroinflammatory processes have been hypothesized to play a role in the pathogenesis of psychiatric and neurological diseases. Studies on this topic often rely on analysis of inflammatory biomarkers in peripheral blood. Unfortunately, the extent to which these peripheral markers reflect inflammatory processes in the central nervous system (CNS) is unclear. METHODS: We performed a systematic review and found 29 studies examining the association between inflammatory marker levels in blood and cerebrospinal (CSF) samples. We performed a random effects meta-analysis of 21 studies (pooled n = 1679 paired samples) that reported the correlation of inflammatory markers in paired blood-CSF samples. RESULTS: A qualitative review revealed moderate to high quality of included studies with the majority of studies reporting no significant correlation of inflammatory markers between paired blood-CSF. Meta-analyses revealed a significant low pooled correlation between peripheral and CSF biomarkers (r = 0.21). Meta-analyses of individual cytokines revealed a significant pooled correlation for IL-6 (r = 0.26) and TNFα (r = 0.3) after excluding outlier studies, but not for other cytokines. Sensitivity analyses showed that correlations were highest among participants with a median age above 50 (r = 0.46) and among autoimmune disorder patients (r = 0.35). CONCLUSION: This systematic review and meta-analysis revealed poor correlation between peripheral and central inflammatory markers in paired blood-CSF samples, with increased correlations in certain study populations. Based on the current findings, peripheral inflammatory markers are a poor reflection of the neuroinflammatory profile.

The role of viscoelastic hemostatic assays for postpartum hemorrhage management and bedside intrapartum care.

Viscoelastic hemostatic assays are point-of-care devices that assess coagulation and fibrinolysis in whole blood samples. These technologies provide numeric and visual information of clot initiation, clot strength, and clot lysis under low-shear conditions, and have been used in a variety of clinical settings and subpopulations, including trauma, cardiac surgery, and obstetrics. Emerging data indicate that these devices are useful for detecting important coagulation defects during major postpartum hemorrhage (especially low plasma fibrinogen concentration [hypofibrinogenemia]) and informing clinical decision-making for blood product use. Data from observational studies suggest that, compared with traditional formulaic approaches to transfusion management, targeted or goal-directed transfusion approaches using data from viscoelastic hemostatic assays are associated with reduced hemorrhage-related morbidity and lower blood product requirement. Viscoelastic hemostatic assays can also be used to identify and treat coagulation defects in patients with inherited or acquired coagulation disorders, such as factor XI deficiency or immune-mediated thrombocytopenia, and to assess hemostatic profiles of patients prescribed anticoagulant medications to mitigate the risk of epidural hematoma after neuraxial anesthesia and postpartum hemorrhage after delivery.

Legal hypergraphs.

Complexity science provides a powerful framework for understanding physical, biological and social systems, and network analysis is one of its principal tools. Since many complex systems exhibit multilateral interactions that change over time, in recent years, network scientists have become increasingly interested in modelling and measuring dynamic networks featuring higher-order relations. At the same time, while network analysis has been more widely adopted to investigate the structure and evolution of law as a complex system, the utility of dynamic higher-order networks in the legal domain has remained largely unexplored. Setting out to change this, we introduce temporal hypergraphs as a powerful tool for studying legal network data. Temporal hypergraphs generalize static graphs by (i) allowing any number of nodes to participate in an edge and (ii) permitting nodes or edges to be added, modified or deleted. We describe models and methods to explore legal hypergraphs that evolve over time and elucidate their benefits through case studies on legal citation and collaboration networks that change over a period of more than 70 years. Our work demonstrates the potential of dynamic higher-order networks for studying complex legal systems, and it facilitates further advances in legal network analysis. This article is part of the theme issue 'A complexity science approach to law and governance'.

GPT-4 passes the bar exam.

In this paper, we experimentally evaluate the zero-shot performance of GPT-4 against prior generations of GPT on the entire uniform bar examination (UBE), including not only the multiple-choice multistate bar examination (MBE), but also the open-ended multistate essay exam (MEE) and multistate performance test (MPT) components. On the MBE, GPT-4 significantly outperforms both human test-takers and prior models, demonstrating a 26% increase over ChatGPT and beating humans in five of seven subject areas. On the MEE and MPT, which have not previously been evaluated by scholars, GPT-4 scores an average of 4.2/6.0 when compared with much lower scores for ChatGPT. Graded across the UBE components, in the manner in which a human test-taker would be, GPT-4 scores approximately 297 points, significantly in excess of the passing threshold for all UBE jurisdictions. These findings document not just the rapid and remarkable advance of large language model performance generally, but also the potential for such models to support the delivery of legal services in society. This article is part of the theme issue 'A complexity science approach to law and governance'.

Pollen and viruses contribute to spatio-temporal variation in asthma-related emergency department visits.

BACKGROUND: Asthma exacerbations are an important cause of emergency department visits but much remains unknown about the role of environmental triggers including viruses and allergenic pollen. A better understanding of spatio-temporal variation in exposure and risk posed by viruses and pollen types could help prioritize public health interventions. OBJECTIVE: Here we quantify the effects of regionally important Cupressaceae pollen, tree pollen, other pollen types, rhinovirus, seasonal coronavirus, respiratory syncytial virus, and influenza on asthma-related emergency department visits for people living near eight pollen monitoring stations in Texas. METHODS: We used age stratified Poisson regression analyses to quantify the effects of allergenic pollen and viruses on asthma-related emergency department visits. RESULTS: Young children (<5 years of age) had high asthma-related emergency department rates (24.1 visits/1,000,000 person-days), which were mainly attributed to viruses (51.2%). School-aged children also had high rates (20.7 visits/1,000,000 person-days), which were attributed to viruses (57.0%), Cupressaceae pollen (0.7%), and tree pollen (2.8%). Adults had lower rates (8.1 visits/1,000,000 person-days) which were attributed to viruses (25.4%), Cupressaceae pollen (0.8%), and tree pollen (2.3%). This risk was spread unevenly across space and time; for example, during peak Cuppressaceae season, this pollen accounted for 8.2% of adult emergency department visits near Austin where these plants are abundant, but 0.4% in cities like Houston where they are not; results for other age groups were similar. CONCLUSIONS: Although viruses are a major contributor to asthma-related emergency department visits, airborne pollen can explain a meaningful portion of visits during peak pollen season and this risk varies over both time and space because of differences in plant composition.

Impact of cell salvage on hematocrit and post-partum anemia in low hemorrhage risk elective cesarean delivery.

BACKGROUND: Postpartum anemia is a significant contributor to peripartum morbidity. The utilization of cell salvage in low risk cases and its impact on postpartum anemia has not been investigated. We therefore aimed to examine the impact of autologous blood transfusion/cell salvage in routine cesarean delivery on postoperative hematocrit and anemia. STUDY DESIGN AND METHODS: Retrospective cohort study from a perfusion database from a large academic center where cell salvage is performed at the discretion of the obstetrical team. Data from 99 patients was obtained. All patients were scheduled elective cesarean deliveries that took place on the labor and delivery floor. Thirty patients in the cohort had access to cell salvage where autologous blood was transfused after surgery. Pre-procedural hemoglobin/hematocrit measurements were obtained along will postpartum samples that were collected on post-partum day one. RESULTS: The median amount of blood returned to cell salvage patients was 250 mL [206-250]. Hematocrit changes in cell salvage patients was significantly smaller than controls (-1.85 [-3.87, -0.925] vs -6.4 [-8.3, -4.75]; p < 0.001). The odds of developing new anemia following surgery were cut by 74% for the cell salvage treatment group, compared to the odds for the control group (OR = 0.26 (0.07-0.78); p = 0.028) DISCUSSION: Despite losing more blood on average, patients with access to cell salvage had higher postoperative HCT, less postpartum anemia, and no difference in complications related to transfusion. The utilization of cell salvage for routine cesarean delivery warrants further research.

Remote Monitoring and Artificial Intelligence: Outlook for 2050.

Remote monitoring and artificial intelligence will become common and intertwined in anesthesiology by 2050. In the intraoperative period, technology will lead to the development of integrated monitoring systems that will integrate multiple data streams and allow anesthesiologists to track patients more effectively. This will free up anesthesiologists to focus on more complex tasks, such as managing risk and making value-based decisions. This will also enable the continued integration of remote monitoring and control towers having profound effects on coverage and practice models. In the PACU and ICU, the technology will lead to the development of early warning systems that can identify patients who are at risk of complications, enabling early interventions and more proactive care. The integration of augmented reality will allow for better integration of diverse types of data and better decision-making. Postoperatively, the proliferation of wearable devices that can monitor patient vital signs and track their progress will allow patients to be discharged from the hospital sooner and receive care at home. This will require increased use of telemedicine, which will allow patients to consult with doctors remotely. All of these advances will require changes to legal and regulatory frameworks that will enable new workflows that are different from those familiar to today's providers.

Survey Validation for Measuring Perceptions of Work-Related Factors That Influence Career Paths of Men and Women in Academic Anesthesiology.

BACKGROUND: Women's underrepresentation in positions of leadership in medicine has been attributed to environmental, structural, motivational, and situational factors. The purpose of this study was to design and validate a survey instrument based on these constructs, using a sample of men and women anesthesiologists from 3 urban academic medical centers. METHODS: Following institutional review board review, survey domains were defined based on a literature review. Items were developed, and content validation was performed by external experts. Anesthesiologists at 3 academic institutions were invited to complete the anonymous survey. Validation measures were performed on the collected responses, including reliability, convergent, and discriminant validity. In addition, differences between men and women respondents were evaluated. RESULTS: Content validation by external experts yielded 38 items with 5-point Likert scales, defining 3 constructs: environmental (14 items), structural (13 items), and motivational (11 items) factors, with single-item measures on situational factors. Content validity indices used Cohen's Kappa coefficients, with 0.85 as the acceptance cutoff. Two hundred seventy-four anesthesiologists in 3 academic institutions received the online survey. One hundred fifteen responses were received (42% response rate), yielding 103 complete survey responses, of which 86 cases included gender. Cronbach's α reliability estimates for the environmental, structural, and motivational scale scores were .88, .84, and .64, respectively, after scale revision. Evidence of convergent (Pearson's r = 0.68; P < .001) and discriminant validity (Pearson's r = 0.017; P = .84) confirmed theoretical expectations. Gender group differences showed statistically significant differences in perceptions toward environmental but not toward structural and motivational factors. CONCLUSIONS: The iterative design and validation processes yielded a 3-scale survey instrument with parsimonious item sets. The preliminary evidence of construct validity and reliability fills a gap in the instrumentation literature for assessing gender issues in medicine. Findings were consistent with theoretical expectations. Women are more likely than men to experience challenges in the work environment for career advancement. No differences were found between men and women on perceived resources and overall motivation factors. Investigations should continue with larger and more diverse samples and medical specialties.

Impact of Care Fragmentation after Major Lower Extremity Amputation.

BACKGROUND: Care fragmentation (CF) is a known risk factor for unplanned readmission, morbidity, and mortality after surgery. The goal of this study was to evaluate the impact of CF on outcomes of major lower extremity amputation for peripheral vascular disease. METHODS: Health-care Cost and Utilization Project Database for NY (2016) and MD/FL (2016-2017) were queried using International Classification of Diseases 10thedition to identify patients who underwent above the knee-, through the knee-, and below the knee-amputation for peripheral vascular disease. Patients with CF were identified as those with admissions to ≥2 hospitals during the study period. We compared the postamputation outcomes of mortality, readmission rate, length of stay (LOS) and hospital charges. RESULTS: We identified a total of 13,749 encounters of 2,742 patients who underwent major lower extremity amputations. There were 1,624 (59.2%) patients with CF. Patients with CF were younger (68.4 years old vs. 69.7 years old, P = 0.005), with higher Charlson Comorbidity Indices (4.4 vs. 4.1, P < 0.001), and required more hospital resources on index admission ($113,699 vs. $91,854, P < 0.001). These patients were prevalent for higher 30-, and 90-day readmission rates (34.7% vs. 24.5%, P < 0.001 and 54.7% vs. 42.0%, P < 0.001, respectively). On their first postamputation readmission, LOS (16.3 days vs. 14.7 days, P = 0.004) and hospital charge ($48,964 vs. $44,388, P = 0.002) were significantly higher. Multivariate regression analysis demonstrated that the CF was an independent predictor for 30-day (hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.39-1.96, P < 0.001) and 90-day (HR 1.66, 95% CI 1.42-1.95, P < 0.001) readmission after the major lower extremity amputation, but not for mortality (HR 0.83, 95% CI 0.56-1.23, P = 0.36). CONCLUSIONS: CF after major lower extremity amputation is associated with higher readmission rate, LOS, and hospital charge. Collaboration of care providers to maintain continuity of care for peripheral vascular disease patients may enhance quality of care and reduce health care cost.

Motivations and demographic differences in pregnant individuals in the decision to participate in research.

PURPOSE: Although many patients agree to participate in research studies, many decline. The decision of whether or not to participate is especially complex in pregnant individuals as they may be concerned about both themselves and the fetus. We sought to understand patient reasoning for and demographic associations with participation in a trial surrounding the utility of epidural preservative-free morphine after successful vaginal delivery. METHODS: We conducted a survey-based study in which parturients were approached within 36 hr after delivery to complete a survey assessing reasons for why they participated or not in the original trial. The survey also included self-reported demographics. Survey responses were categorized as follows: active participation, passive participation, ambivalence, aversion, miscommunication, clinical difficulty, unwilling to receive placebo, and screening failures. RESULTS: The survey response rate was 47%. Having a bachelor's degree or higher was associated with participating in the study (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.07 to 3.64; P = 0.03). Race and ethnicity were not predictive of participation. Participants who self-identified as Black were more likely to select reasons of aversion for why they did not participate in the trial (OR, 2.6; 95% CI, 1.00 to 6.75; P = 0.05). Seventy-three percent of participants who self-identified as Black and declined to participate selected aversion, compared with 31% of those who self-identified as non-Black. Additionally, 71% of participants who self-identified as Hispanic and declined to participate selected aversion, compared with 32% of those who self-identified as non-Hispanic. CONCLUSIONS: These findings can help identify areas for improvement of participation of pregnant individuals in research studies. Demographic associations may influence participation and reasons for participation.

RéSUMé: OBJECTIF: Bien que bon nombre de patient·es acceptent de participer à des études de recherche, beaucoup déclinent. La décision de participer ou non est particulièrement complexe chez les personnes enceintes, car elles peuvent être inquiètes pour elles-mêmes et pour le fœtus. Nous avons cherché à comprendre le raisonnement des patient·es et les associations démographiques concernant la participation à une étude portant sur l'utilité de la morphine péridurale sans agent de conservation après un accouchement vaginal réussi. MéTHODE: Nous avons mené une étude basée sur des questionnaires dans laquelle les personnes parturientes ont été approchées dans les 36 heures suivant l'accouchement afin de compléter un questionnaire évaluant les raisons pour lesquelles elles avaient participé ou non à l'étude initiale. Le questionnaire comprenait également des données démographiques autodéclarées. Les réponses au questionnaire ont été classées comme suit : participation active, participation passive, ambivalence, aversion, mauvaise communication, difficulté clinique, refus de recevoir un placebo et échecs au dépistage. RéSULTATS: Le taux de réponse était de 47 %. Le fait d'avoir un baccalauréat ou plus était associé à la participation à l'étude (rapport de cotes [RC], 1,97; intervalle de confiance [IC] à 95 %, 1,07 à 3,64; P = 0,03). La race et l'origine ethnique n'étaient pas prédictives de la participation. Les participant·es qui se sont identifié·es comme Noir·es étaient plus susceptibles de choisir des raisons d'aversion pour expliquer leur non-participation à l'étude (RC, 2,6; IC 95 %, 1,00 à 6,75; P = 0,05). Soixante-treize pour cent des participant·es qui se sont identifié·es comme Noir·es et ont refusé de participer ont choisi l'aversion, comparativement à 31 % des personnes qui se sont identifié·es comme non Noir·es. De plus, 71 % des participant·es qui se sont identifié·es comme d'origine hispanique et ont refusé de participer ont choisi l'aversion, comparativement à 32 % des personnes qui se sont identifié·es comme non Hispaniques. CONCLUSION: Ces résultats peuvent aider à identifier les domaines dans lesquels la participation des personnes enceintes aux études de recherche peut être améliorée. Les associations démographiques peuvent influencer la participation et les raisons de la participation.

Relationship between demographic and social variables and performance in virtual reality among healthcare personnel: an observational study.

BACKGROUND: Virtual reality is emerging as an important component of medical education. Although the benefits of virtual reality are apparent, the optimal strategy to orient to or differentiate learners in the virtual space have not been delineated. The purpose of this study was to investigate the relationships between demographic variables, social variables, and self-perceived comfort with technology to performance on a standardized non-medical virtual reality experience. METHODS: This observational study was performed at the International Meeting on Simulation in Healthcare in 2022. This conference includes medical and non-medical attendees. Participants provided demographic information and participated in a scored non-medical VR experience due to the heterogeneity of the sample. Participants then completed a System Usability Index and NASA Task Load Index form. Participants were dividedintolow scoring, medium scoring, and high scoring groups according to their final game score for further analysis. RESULTS: 95 participants were included in final analysis. 55 (57.9%) of participants had prior virtual reality experience. Higher scores were associated with younger age (11.09, p < 0.001), identifying as male (11.09, p < 0.001), and a higher frequency of playing video games in the past (18.96, p < 0.001). The high score group was more likely to report comfort with virtual reality (6.29, p = 0.003) as well as comfort with new technology (4.61, p = 0.012). NASA Task Load Index scores trended down and System Usability Index scores trended up with increasing score. Being a nurse was a positive predictor of a higher score when compared to physicians in the multivariate analysis. CONCLUSION: Performance during an immersive virtual reality experience was most closely related to age, gender, and frequency of playing video games. Self-perceived comfort with virtual reality was more predictive of score than prior virtual reality experience.

Do upper respiratory viruses contribute to racial and ethnic disparities in emergency department visits for asthma?

BACKGROUND: There are marked disparities in asthma-related emergency department (ED) visit rates among children by race and ethnicity. Following the implementation of coronavirus disease 2019 (COVID-19) prevention measures, asthma-related ED visits rates declined substantially. The decline has been attributed to the reduced circulation of upper respiratory viruses, a common trigger of asthma exacerbations in children. OBJECTIVES: To better understand the contribution of respiratory viruses to racial and ethnic disparities in ED visit rates, we investigated whether the reduction in ED visit rates affected Black, Latinx, and White children with asthma equally. METHODS: Asthma-related ED visits were extracted from electronic medical records at Dell Children's Medical Center in Travis County, Texas. ED visit rates among children with asthma were derived by race/ethnicity. Incidence rate ratios (IRRs) and 95% CIs were estimated by year (2019-2021) and season. RESULTS: In spring 2019, the ED visit IRRs comparing Black children with White children and Latinx children with White children were 6.67 (95% CI = 4.92-9.05) and 2.10 (95% CI = 1.57-2.80), respectively. In spring 2020, when infection prevention measures were implemented, the corresponding IRRs decreased to 1.73 (95% CI = 0.90-3.32) and 0.68 (95% CI = 0.38-1.23), respectively. CONCLUSIONS: The striking reduction of disparities in ED visits suggests that during nonpandemic periods, respiratory viruses contribute to the excess burden of asthma-related ED visits among Black and Latinx children with asthma. Although further investigation is needed to test this hypothesis, our findings raise the question of whether Black and Latinx children with asthma are more vulnerable to upper respiratory viral infections.

Omics-driven investigation of the biology underlying intrinsic submaximal working capacity and its trainability.

Submaximal exercise capacity is an indicator of cardiorespiratory fitness with clinical and public health implications. Submaximal exercise capacity and its response to exercise programs are characterized by heritability levels of about 40%. Using physical working capacity (power output) at a heart rate of 150 beats/min (PWC150) as an indicator of submaximal exercise capacity in subjects of the HERITAGE Family Study, we have undertaken multi-omics and in silico explorations of the underlying biology of PWC150 and its response to 20 wk of endurance training. Our goal was to illuminate the biological processes and identify panels of genes associated with human variability in intrinsic PWC150 (iPWC150) and its trainability (dPWC150). Our bioinformatics approach was based on a combination of genome-wide association, skeletal muscle gene expression, and plasma proteomics and metabolomics experiments. Genes, proteins, and metabolites showing significant associations with iPWC150 or dPWC150 were further queried for the enrichment of biological pathways. We compared genotype-phenotype associations of emerging candidate genes with reported functional consequences of gene knockouts in mouse models. We investigated the associations between DNA variants and multiple muscle and cardiovascular phenotypes measured in HERITAGE subjects. Two panels of prioritized genes of biological relevance to iPWC150 (13 genes) and dPWC150 (6 genes) were identified, supporting the hypothesis that genes and pathways associated with iPWC150 are different from those underlying dPWC150. Finally, the functions of these genes and pathways suggested that human variation in submaximal exercise capacity is mainly driven by skeletal muscle morphology and metabolism and red blood cell oxygen-carrying capacity.NEW & NOTEWORTHY Multi-omics and in silico explorations of the genes and underlying biology of submaximal exercise capacity and its response to 20 wk of endurance training were undertaken. Prioritized genes were identified: 13 genes for variation in submaximal exercise capacity in the sedentary state and 5 genes for the response level to endurance training, with no overlap between them. Genes and pathways associated with submaximal exercise capacity in the sedentary state are different from those underlying trainability.

Whole Genome Sequence Analysis of the Plasma Proteome in Black Adults Provides Novel Insights Into Cardiovascular Disease.

BACKGROUND: Plasma proteins are critical mediators of cardiovascular processes and are the targets of many drugs. Previous efforts to characterize the genetic architecture of the plasma proteome have been limited by a focus on individuals of European descent and leveraged genotyping arrays and imputation. Here we describe whole genome sequence analysis of the plasma proteome in individuals with greater African ancestry, increasing our power to identify novel genetic determinants. METHODS: Proteomic profiling of 1301 proteins was performed in 1852 Black adults from the Jackson Heart Study using aptamer-based proteomics (SomaScan). Whole genome sequencing association analysis was ascertained for all variants with minor allele count ≥5. Results were validated using an alternative, antibody-based, proteomic platform (Olink) as well as replicated in the Multi-Ethnic Study of Atherosclerosis and the HERITAGE Family Study (Health, Risk Factors, Exercise Training and Genetics). RESULTS: We identify 569 genetic associations between 479 proteins and 438 unique genetic regions at a Bonferroni-adjusted significance level of 3.8×10-11. These associations include 114 novel locus-protein relationships and an additional 217 novel sentinel variant-protein relationships. Novel cardiovascular findings include new protein associations at the APOE gene locus including ZAP70 (sentinel single nucleotide polymorphism [SNP] rs7412-T, ß=0.61±0.05, P=3.27×10-30) and MMP-3 (ß=-0.60±0.05, P=1.67×10-32), as well as a completely novel pleiotropic locus at the HPX gene, associated with 9 proteins. Further, the associations suggest new mechanisms of genetically mediated cardiovascular disease linked to African ancestry; we identify a novel association between variants linked to APOL1-associated chronic kidney and heart disease and the protein CKAP2 (rs73885319-G, ß=0.34±0.04, P=1.34×10-17) as well as an association between ATTR amyloidosis and RBP4 levels in community-dwelling individuals without heart failure. CONCLUSIONS: Taken together, these results provide evidence for the functional importance of variants in non-European populations, and suggest new biological mechanisms for ancestry-specific determinants of lipids, coagulation, and myocardial function.

The use of simulation in liver transplantation anesthesiology fellowship training: A survey of fellowship program directors in the United States.

INTRODUCTION: Liver transplantation surgeries are challenging cases for anesthesiologists. While intra-operative teaching is paramount, simulation has emerged as an educational tool to augment clinical training. A variety of simulation modalities have been described in the literature, but no study has aimed to assess the use of simulation in liver transplantation fellowship training. METHODS: A 20-question survey detailing the use of simulation, including simulation modalities used and barriers to simulation use, was developed and distributed to 22 program directors for liver transplantation anesthesiology fellowships. An exploratory analysis was performed on multiple-choice and free-text responses. RESULTS: Thirteen program directors completed the survey and were included in our analysis. Most programs (61.5%) did not report the use of simulation for liver transplantation fellow training. Of the programs that did use simulation, four required it as a mandatory component of their curriculum. Task trainers and screen-based simulators were more commonly used by these programs. Faculty availability and interest, as well as a lack of an established curriculum, were cited as major limitations to simulation use. CONCLUSIONS: Simulation is an important component of anesthesiology trainee education, as evidenced by the requirement for simulation during residency by the American Council for Graduate Medical Education. Our findings suggest that simulation is an underutilized educational tool that we believe could greatly augment the training of liver transplantation anesthesiology fellows by providing exposure to a wide range of clinical challenges.

Influence of semaglutide use on the presence of residual gastric solids on gastric ultrasound: a prospective observational study in volunteers without obesity recently started on semaglutide.

PURPOSE: Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) have become increasingly popular as both diabetic and weight loss therapies. One effect of this class of medication is delayed gastric emptying, which may impact the risk of aspiration during anesthesia delivery. METHODS: In this prospective study, we used gastric ultrasound to evaluate the presence of solid gastric contents in both supine and lateral positions after an eight-hour fast in those taking GLP-1RA compared with controls. Participants underwent a second ultrasound evaluation two hours later after drinking 12 fluid ounces of water (approximately 350 mL). RESULTS: Twenty adults voluntarily enrolled, giving a total of ten participants in each group. In the supine position, 70% of semaglutide participants and 10% of control participants had solids present on gastric ultrasound (risk ratio [RR], 3.50; 95% confidence interval [CI], 1.26 to 9.65; P = 0.02.) In the lateral position, 90% of semaglutide participants and 20% of control participants had solids identified on gastric ultrasound (RR, 7.36; 95% CI, 1.13 to 47.7; P = 0.005). Two hours after drinking clear liquids, the two groups did not differ in the lateral position, but in the supine position, 90% of control group participants were rated as empty compared with only 30% of semaglutide group participants (P = 0.02). CONCLUSIONS: This study provides preliminary evidence that GLP-1RAs may affect gastric emptying and residual gastric contents following an overnight fast and two hours after clear liquids, which may have implications for aspiration risk during anesthetic care.

RéSUMé: OBJECTIF: Les agonistes des récepteurs du peptide-1 de type glucagon (GLP-1) (AR-GLP-1) sont de plus en plus populaires comme traitements du diabète et pour la perte de poids. L'un des effets de cette classe de médicaments est le retard de la vidange gastrique, ce qui peut avoir un impact sur le risque d'aspiration pendant l'administration de l'anesthésie. MéTHODE: Dans cette étude prospective, nous avons utilisé l'échographie gastrique pour évaluer la présence de contenu gastrique solide en décubitus dorsal et latéral après un jeûne de huit heures chez les personnes prenant des AR-GLP-1 par rapport à un groupe témoin. Les participant·es ont passé une deuxième échographie deux heures plus tard, après avoir bu 12 onces liquides d'eau (environ 350 mL). RéSULTATS: Vingt personnes adultes se sont inscrites volontairement, soit un total de dix participant·es dans chaque groupe. En décubitus dorsal, 70 % des personnes du groupe sémaglutide et 10 % des personnes du groupe témoin présentaient des solides à l'échographie gastrique (risque relatif [RR], 3,50; intervalle de confiance [IC] à 95 %, 1,26 à 9,65; P = 0,02). En décubitus latéral, 90 % des personnes du groupe sémaglutide et 20 % des personnes du groupe témoin présentaient des solides à l'échographie gastrique (RR, 7,36; IC 95 %, 1,13 à 47,7; P = 0,005). Deux heures après avoir bu des liquides clairs, le contenu gastrique évalué ne différait pas entre les deux groupes en position latérale, mais en décubitus dorsal, l'estomac de 90 % des participant·es du groupe témoin a été jugé vide, comparativement à seulement 30 % chez les participant·es du groupe sémaglutide (P = 0,02). CONCLUSION: Cette étude procure des données préliminaires selon lesquelles les AR-GLP-1 pourraient affecter la vidange gastrique et le contenu gastrique résiduel après un jeûne d'une nuit et deux heures après l'ingestion de liquides clairs, ce qui pourrait avoir des implications quant au risque d'aspiration pendant les soins anesthésiques.

Is There an Association between Platelet Count and Blood Loss in the Parturient? A Retrospective Study.

OBJECTIVE: The influence of thrombocytopenia on blood loss and postpartum hemorrhage (PPH) has been conflicting. Our aim was to determine if there is an association between predelivery platelet count and quantitative blood loss (QBL) and PPH in both vaginal (VD) and cesarean deliveries (CD). STUDY DESIGN: We conducted a retrospective database study at a single institution from April 1, 2017 to September 9, 2020. The platelet count closest to time of delivery and the QBL was assessed separately for VD and CD. RESULTS: A total of 22,479 records were reviewed, of which 16,822 (75%) were VD and 5,657 (25%) were CD. A total of 2,600 (12%) patients had thrombocytopenia, defined as a platelet count <150,000/mm3. Of these, 1,980 (76%) had a VD and 620 (24%) had CD. We found a statistically significant difference in QBL between parturients with thrombocytopenia compared with those without, with a median estimated difference in QBL of 25 (95% confidence interval [CI]: 16-32) and 57 mL (95% CI: 31-87) in VD and CD patients, respectively. We also found a statistically significant difference in QBL when comparing patients among all the platelet count ranges except in the lowest platelet count range of 50,000 to 69,999/mm3 with a mean difference of 52 (95% CI: 25-81) and 107 mL (95% CI: 39-180) in the VD and CD patients, respectively in the platelet count range of 70,000 to 99,999/mm3 . We also found the incidence of PPH was greater in those with thrombocytopenia, p < 0.001, but the median difference in QBL in all platelet groups was small. CONCLUSION: We found a statistically significant association between lower predelivery platelet counts and QBL and PPH. The clinical significance of these results is debatable, because at all platelet count ranges, differences in blood loss were small. KEY POINTS: · Hemorrhage is etiology of morbidity and mortality in obstetric parturients.. · We found a small increase in blood loss in those with thrombocytopenia.. · The clinical relevance of these findings is debatable since the increased blood loss was small..