Recommendations for standards of monitoring during anaesthesia and recovery 2021: Guideline from the Association of Anaesthetists.

This guideline updates and replaces the 5th edition of the Standards of Monitoring published in 2015. The aim of this document is to provide guidance on the minimum standards for monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the UK and Ireland, but it is recognised that these guidelines may also be of use in other areas of the world. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and during transfer. There are new sections specifically discussing capnography, sedation and regional anaesthesia. In addition, the indications for processed electroencephalogram and neuromuscular monitoring have been updated.

Laboratory evaluation of a low-cost, real-time, aerosol multi-sensor.

Exposure to occupational aerosols are a known hazard in many industry sectors and can be a risk factor for several respiratory diseases. In this study, a laboratory evaluation of low-cost aerosol sensors, the Dylos DC1700 and a modified Dylos known as the Utah Modified Dylos Sensor (UMDS), was performed to assess the sensors' efficiency in sampling respirable and inhalable dust at high concentrations, which are most common in occupational settings. Dust concentrations were measured in a low-speed wind tunnel with 3 UMDSs, collocated with an aerosol spectrometer (Grimm 1.109) and gravimetric respirable and inhalable samplers. A total of 10 tests consisting of 5 different concentrations and 2 test aerosols, Arizona road dust and aluminum oxide, were conducted. For the Arizona road dust, total particle count was strongly related between the spectrometer and the UMDS with a coefficient of determination (R2) between 0.86-0.92. Particle count concentrations measured with the UMDS were converted to mass and also were related with gravimetrically collected inhalable and respirable dust. The UMDS small bin (i.e., all particles) compared to the inhalable sampler yielded an R2 of 0.86-0.92, and the large bin subtracted from the small bin (i.e., only the smallest particles) compared to the respirable sampler yielded an R2 of 0.93-0.997. Tests with the aluminum oxide demonstrated a substantially lower relationship across all comparisons. Furthermore, assessment of intra-instrument variability was consistent for all instruments, but inter-instrument variability indicated that each instrument requires its own calibration equation to yield accurate exposure estimates. Overall, it appears that the UMDS can be used as a low-cost tool to estimate respirable and inhalable concentrations found in many workplaces. Future studies will focus on deployment of a UMDS network in an occupational setting.

Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland.

This guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end-tidal carbon dioxide monitoring have been updated.

Stereoscopic advantages for vection induced by radial, circular, and spiral optic flows.

Although observer motions project different patterns of optic flow to our left and right eyes, there has been surprisingly little research into potential stereoscopic contributions to self-motion perception. This study investigated whether visually induced illusory self-motion (i.e., vection) is influenced by the addition of consistent stereoscopic information to radial, circular, and spiral (i.e., combined radial + circular) patterns of optic flow. Stereoscopic vection advantages were found for radial and spiral (but not circular) flows when monocular motion signals were strong. Under these conditions, stereoscopic benefits were greater for spiral flow than for radial flow. These effects can be explained by differences in the motion aftereffects generated by these displays, which suggest that the circular motion component in spiral flow selectively reduced adaptation to stereoscopic motion-in-depth. Stereoscopic vection advantages were not observed for circular flow when monocular motion signals were strong, but emerged when monocular motion signals were weakened. These findings show that stereoscopic information can contribute to visual self-motion perception in multiple ways.

North American Invasion of the Tawny Crazy Ant (Nylanderia fulva) Is Enabled by Pheromonal Synergism from Two Separate Glands.

A new invader, the "tawny crazy ant", Nylanderia fulva (Hymenoptera: Formicidae; Formicinae), is displacing the red imported fire ant, Solenopsis invicta (Formicidae: Myrmicinae), in the southern U.S., likely through its superior chemical arsenal and communication. Alone, formic acid is unattractive, but this venom (= poison) acid powerfully synergizes attraction of tawny crazy ants to volatiles from the Dufour's gland secretion of N. fulva workers, including the two major components, undecane and 2-tridecanone. The unexpected pheromonal synergism between the Dufour's gland and the venom gland appears to be another key factor, in addition to previously known defensive and detoxification semiochemical features, for the successful invasion and domination of N. fulva in the southern U.S. This synergism is an efficient mechanism enabling N. fulva workers to outcompete Solenopsis and other ant species for food and territory. From a practical standpoint, judicious point-source release formulation of tawny crazy ant volatiles may be pivotal for enhanced attract-and-kill management of this pest.

Glacial Acetic Acid Adverse Events: Case Reports and Review of the Literature.

Glacial acetic acid is a dangerous chemical that has been associated with several adverse drug events involving patients over recent years. When diluted to the proper concentration, acetic acid solutions have a variety of medicinal uses. Unfortunately, despite warnings, the improper dilution of concentrated glacial acetic acid has resulted in severe burns and other related morbidities. We report on 2 additional case reports of adverse drug events involving glacial acetic acid as well as a review of the literature. A summary of published case reports is provided, including the intended and actual concentration of glacial acetic acid involved, the indication for use, degree of exposure, and resultant outcome. Strategies that have been recommended to improve patient safety are summarized within the context of the key elements of the medication use process.

Evidence of localized resource depletion following a natural colonization event by a large marine predator.

For central place foragers, forming colonies can lead to extensive competition for prey around breeding areas and a zone of local prey depletion. As populations grow, this area of reduced prey can expand impacting foraging success and forcing animals to alter foraging behaviour. Here, we examine a population of marine predators, the northern fur seal (Callorhinus ursinus), which colonized a recently formed volcanic island, and assess changes in foraging behaviour associated with increasing population density. Specifically, we measured pup production and adult foraging behaviour over a 15-year period, during which the population increased 4-fold. Using measures of at-sea movements and dive behaviour, we found clear evidence that as the population expanded, animals were required to allot increasing effort to obtain resources. These changes in behaviour included longer duration foraging trips, farther distances travelled, a larger foraging range surrounding the island and deeper maximum dives. Our results suggest that as the northern fur seal population increased, local prey resources were depleted as a result of increased intraspecific competition. In addition, the recent slowing of population growth indicates that this population may be approaching carrying capacity just 31 years after a natural colonization event. Our study offers insight into the dynamics of population growth and impacts of increasing population density on a large marine predator. Such data could be vital for understanding future population fluctuations that occur in response to the dynamic environment, as natural and anthropogenic factors continue to modify marine habitats.

Rhabdomyolysis and acute renal failure in a sickle cell trait athlete: a case study.

This case study reports the clinical details and pathologic mechanisms of a nonfatal case of rhabdomyolysis secondary to heat exhaustion and sickle cell trait (SCT) resulting in acute renal failure. A 19-year-old African American male college football player collapsed after running 5 intervals of 300 m during a preseason conditioning test. After 17 days of treatment, the athlete was released from the hospital to a short-term noncritical care facility for further treatment and dialysis. Scientific literature reports that at least 15 college football players with SCT have died as a result of a sickling crisis after intense physical exertion. This case study presents the clinical importance of prompt medical treatment and sustained low-efficiency dialysis in treating rhabdomyolysis and its sequelae after collapse in an SCT athlete.

Aerosol Measurement Degradation in Low-Cost Particle Sensors Using Laboratory Calibration and Field Validation.

Increasing concern over air pollution has led to the development of low-cost sensors suitable for wide-scale deployment and use by citizen scientists. This project investigated the AirU low-cost particle sensor using two methods: (1) a comparison of pre- and post-deployment calibration equations for 24 devices following use in a field study, and (2) an in-home comparison between 3 AirUs and a reference instrument, the GRIMM 1.109. While differences (and therefore some sensor degradation) were found in the pre- and post-calibration equation comparison, absolute value changes were small and unlikely to affect the quality of results. Comparison tests found that while the AirU did tend to underestimate minimum and overestimate maximum concentrations of particulate matter, ~88% of results fell within ±1 µg/m3 of the GRIMM. While these tests confirm that low-cost sensors such as the AirU do experience some sensor degradation over multiple months of use, they remain a valuable tool for exposure assessment studies. Further work is needed to examine AirU performance in different environments for a comprehensive survey of capability, as well as to determine the source of sensor degradation.

B cell and antibody targeting of transplant alloantigen epitopes is supported by both self and allo-recognition.

Donor-specific antibody (DSA) responses against human leukocyte antigen (HLA) proteins mismatched between kidney transplant donors and recipients cause allograft loss. Using single-cell, molecular, structural, and proteomic techniques, we profiled the HLA-specific (alloreactive) B cell response in kidney and blood of a transplant recipient with antibody-mediated rejection (AMR). We identified 14 distinct alloreactive B cell lineages, which spanned the rejected organ and blood and expressed high-affinity anti-donor HLA-specific B cell receptors, many of which were clonally linked to circulating DSA. The alloreactive B cell response was focused on exposed, solvent-accessible mismatched HLA residues, while also demonstrating extensive contacts with self-HLA residues. Consistent with structural evidence of self-recognition, measurable self-reactivity by donor-specific B cells was common and positively correlated with anti-donor affinity maturation. Thus, allo- and self-reactive signatures appeared to converge, suggesting that during AMR, the recognition of non-self and breaches of tolerance conspire to produce a pathogenic donor-specific adaptive response.

The effects of fish oil supplementation on markers of inflammation in chronic kidney disease patients.

OBJECTIVE: One prevalent characteristic of all stages of chronic kidney disease (CKD) is excessive production of proinflammatory cytokines. Fish oil (FO) supplementation has been reported to lower levels of proinflammatory cytokines. The benefits of FO for an extensive range of populations and a variety of health concerns are apparent, yet the anti-inflammatory benefits for nondialysis CKD patients are not as well documented. Therefore, the purpose of this study was to investigate the effects of the daily consumption of FO (1,400 mg eicosapentaenoic acid + 1,000 mg docosahexaenoic acid) on interleukin 1ß (IL-1ß), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) for 8 weeks in nondialysis CKD patients. DESIGN, SETTING, AND SUBJECTS: In this double-blind, randomized, placebo-controlled intervention, the effect of 8 weeks of FO administration on IL-1ß, IL-6, and TNF-α levels in nondialysis CKD patients were evaluated. INTERVENTION: Thirty-one nondialysis CKD patients (17 = FO; 14 = placebo) randomly received either FO dietary supplementation 2.4 g/day (1,400 mg eicosapentaenoic acid + 1,000 mg docosahexaenoic acid) or placebo (safflower oil) for 8 weeks. MAIN OUTCOME MEASURES: IL-1ß, IL-6, and TNF-α were all measured as markers of inflammation. RESULTS: One-way analysis of variance revealed no significant differences in IL-6 (P = .06), IL-1ß (P = .18), and TNF-α (P = .20) between groups in pretest values. Additionally, no pretest differences existed between groups for age (P = .549), weight (P = .324), waist circumference (P = .086), gender (P = .591), and ethnicity (P = .875). Covariance was calculated using compliance, age, gender, ethnicity, body weight, and waist circumference as covariates. No significant differences were discovered between groups after FO supplementation for IL-6 (P = .453) and TNF-α (P = .242). A significant difference was discovered for IL-1ß (P = .050) with lower levels in the FO group. CONCLUSIONS: The results of this study are in agreement with some previous studies that suggest that FO supplementation has no effect on plasma proinflammatory cytokines TNF-α or IL-6, but does have an effect on IL-1ß in nondialysis CKD patients.

Relationships among self-esteem, stress, and physical activity in college students.

The purpose of this study was to identify population and sex-specific relationships between perceived stress, self-esteem, and physical activity in college students. 90 students, ages 18 and older and enrolled in five sections of a health and human behavior class during the spring 2010 semester, were contacted for this study with 74 consenting to serve as study participants. Each participant completed three surveys: the Rosenberg Self-Esteem Scale, the Perceived Stress Scale, and the International Physical Activity Questionnaire. Significant correlations were observed between perceived stress and self-esteem in men, and in women. Physical activity was not significantly correlated with perceived stress or self-esteem.