The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial.

BACKGROUND AND AIMS: Virtual reality has been shown to be an effective non-pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention. METHODS: Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale. RESULTS: The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0-10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: -4.2 [-5.2-4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention. CONCLUSION: To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.

Four Years of CHEER: Cost and QALY Savings of a Free Nurse-run Walk-in Clinic Serving an Uninsured, Predominantly Spanish-speaking Immigrant Population in Providence.

Non-emergent visits to emergency departments by uninsured patients impose unnecessary costs on both patients and safety-net institutions. We evaluated the health and economic impacts of providing free, walk-in care to low-income, uninsured adults-most of them Hispanic-at a free clinic between January 2013 and December 2016. Providing access to health care services for uninsured patients at Clínica Esperanza/Hope Clinic reduced emergency department expenditures in Rhode Island by approximately $448,876 (range: $410,377-$487,375) annually and may have also reduced future healthcare costs for this population by more than $48 million ($12,034,469 annually) over the four-year evaluation period. For every $1 in funding for walk-in clinic operation, delivering free care provided a return on investment of $71.18 (range: $70.95-71.40) in healthcare value. Providing access to non-emergent walk-in care at the more than 12,000 free healthcare clinics nationwide may save billions in ED costs while improving the health of uninsured individuals.

Heated intravenous fluids alone fail to prevent hypothermia in cats under general anaesthesia.

Objectives The objective was to evaluate the clinical efficiacy of a constant rate infusion of heated fluid as the sole means of preventing intraoperative hypothermia in cats. Methods This randomised, prospective, clinical study was conducted at a university teaching veterinary hospital. Female cats (American Society of Anesthesiologists [ASA] grade I) undergoing elective surgery by laparotomy under general anaesthesia (acepromazine 0.05 mg/kg SC; morphine 0.2 mg/kg IV; propofol IV titrated, isoflurane 2% in 100% oxygen) were randomised in two groups. Both groups were infused with fluid (NaCl 0.9%, 5 ml/kg/h) either at room temperature (control group) or prewarmed at 43°C (warmed group) using an Astoflo Plus eco (Stihler Electronic) fluid heating device. No other heating device was used. Temperature, heart rate, respiratory rate and SpO2 were evaluated after induction (T0) and every 15 mins for 1 h (T15, T30, T45, T60). Mean arterial blood pressure was recorded every 30 mins (T0, T30 and T60). Results Thirty-four female cats (ASA grade I) were enrolled in the study. There was no difference in age, weight, propofol dose or room temperature (22.4 ± 1.1°C vs 22.0 ± 1.5°C; P = 0.363) between control and warmed groups, respectively. In both groups, oesophageal temperature significantly decreased during anaesthesia ( P <0.0001). The temperature decrease after 1 h was -3.6 ± 0.7°C in the warmed group and was not significantly different from the control group (-3.4 ± 0.7°C; P = 0.307). The slopes of the temperature decrease did not significantly differ between the two groups (-0.058 ± 0.013°C/min vs -0.060 ± 0.010°C/min for the control and warmed groups, respectively; P = 0.624). Conclusions and relevance This study provides clinical evidence that a constant rate infusion of heated fluid alone fails to prevent intraoperative hypothermia in cats. The low infusion rate (5 ml/kg/h) could partly explain the ineffectiveness of this active warming device in minimising or delaying the onset of intraoperative hypothermia.

A novel linker methodology for the synthesis of tailored conjugate vaccines composed of complex carbohydrate antigens and specific TH-cell peptide epitopes.

Pathogenic organisms or oncogenically transformed cells often express complex carbohydrate structures at their cell surface, which are viable targets for active immunotherapy. We describe here a novel, immunologically neutral, linker methodology for the efficient preparation of highly defined vaccine conjugates that combine complex saccharide antigens with specific TH-cell peptide epitopes. This novel heterobifunctional approach was employed for the conjugation of a (1-->2)-beta-mannan trisaccharide from the pathogenic fungus Candida albicans as well as the carbohydrate portion of tumor-associated ganglioside GM2 to a TH-cell peptide epitope derived from the murine 60 kDa self heat-shock protein (hsp60). Moreover, the linkage chemistry has proven well suited for the synthesis of more complex target structures such as a biotinylated glycopeptide, a three component vaccine containing an immunostimulatory peptide epitope from interleukin-1 beta (IL-1 beta), and for the conjugation of complex carbohydrates to carrier proteins such as bovine serum albumin.

Chemoenzymatic synthesis of GM3 and GM2 gangliosides containing a truncated ceramide functionalized for glycoconjugate synthesis and solid phase applications.

Analogues of GM3 and GM2 gangliosides were chemoenzymatically synthesized on a multifunctional ceramide-type tether designed to facilitate diverse strategies for glycoconjugate synthesis. The truncated ceramide aglycon maintains the stereogenic centres of natural ceramide while avoiding extensive hydrophobicity that can hamper synthesis and purification of the glycolipids. Tetanus toxoid and BSA glycoconjugates of these two gangliosides were prepared for immunization of mice, and for solid phase assays to screen for ganglioside-specific antibodies. Inhibition experiments showed that antibodies generated by tetanus toxoid conjugates of GM3 and GM2 exhibited specificity for the carbohydrate epitope and the stereogenic centres of the ceramide.