Goal-directed fluid therapy guided by plethysmographic variability index versus conventional liberal fluid therapy in neonates undergoing abdominal surgery: A prospective randomized controlled trial.

BACKGROUND: Intraoperative fluid therapy maintains normovolemia, normal tissue perfusion, normal metabolic function, normal electrolytes, and acid-base status. Plethysmographic variability index has been shown to predict fluid responsiveness but its role in guiding intraoperative fluid therapy is still elusive. AIMS: The aim of the present study was to compare intraoperative goal-directed fluid therapy based on plethysmographic variability index with liberal fluid therapy in term neonates undergoing abdominal surgeries. METHODS: A prospective randomized controlled study was conducted in a tertiary care centre, over a period of 18 months. A total of 30 neonates completed the study out of 132 neonates screened. Neonates with tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease, respiratory disorders, creatinine clearance <90 mL/min and who were hemodynamically unstable were excluded. Neonates were randomized to goal-directed fluid therapy group where the plethysmographic variability index was targeted at <18 or liberal fluid therapy group. Primary outcome was comparison of total amount of fluid infused intraoperatively in both the groups. Secondary outcomes included intraoperative and postoperative arterial blood gas parameters, biochemical parameters, use of vasopressors, number of fluid boluses, complications and duration of hospital stay. RESULTS: There was no significant difference in total intraoperative fluid infused [90 (84-117.5 mL) in goal-directed fluid therapy and 105 (85.5-144.5 mL) in liberal fluid therapy group (p = .406)], median difference (95% CI) -15 (-49.1 to 19.1). There was a decrease in serum lactate levels in both groups from preoperative to postoperative 24 h. The amount of fluid infused before dopamine administration was significantly higher in liberal fluid therapy group (58 [50.25-65 mL]) compared to goal-directed fluid therapy group (36 [22-44 mL], p = .008), median difference (95% CI) -22 (-46 to 2). In postoperative period, the total amount of fluid intake over 24 h was comparable in two groups (222 [204-253 mL] in goal-directed fluid therapy group and 224 [179.5-289.5 mL] in liberal fluid therapy group, p = .917) median difference (95% CI) cutoff -2 (-65.3 to 61.2). CONCLUSION: Intraoperative plethysmographic variability index-guided goal-directed fluid therapy was comparable to liberal fluid therapy in terms of total volume of fluid infused in neonates during perioperative period. More randomized controlled trials with higher sample size are required. TRIAL REGISTRATION: Central Trial Registry of India (CTRI/2020/02/023561).

Students respond positively to an instructor collecting and sharing aggregated class demographic data from a survey in a high-enrollment physiology course.

The impersonal nature of high-enrollment science courses makes it difficult to build student-instructor relationships, which can negatively impact student learning and engagement, especially for members of marginalized groups. In this study, we explored whether an instructor collecting and sharing aggregated student demographics could positively impact student-instructor relationships. We surveyed students in a high-enrollment physiology course about their perceptions of their instructor a) distributing a demographic survey, and b) sharing aggregated survey results in class. We found that 72% of students appreciated the demographic survey, and 91% thought it helped their instructor get to know them. Further, 73% of students expressed that the instructor sharing aggregated demographic data in class positively impacted their overall course experience, and over 90% thought both the collection and sharing of demographic data was appropriate. Most students felt both parts of the intervention increased their sense of belonging in class, increased how connected they felt to their instructor, and made their instructor seem more approachable and inclusive, but also made some students feel more different from their peers. Women and non-binary students felt the demographic survey increased instructor approachability more than men, and liberal students felt the survey increased instructor approachability more than non-liberal students. Compared to men, women and non-binary students were more likely to report that taking the survey increased instructor inclusivity and made them feel less different from their peers. Based on these results, collecting student demographic information and sharing it in aggregate may be a practical, effective way to enhance student-instructor relationships.

Flourishing, Mental Health Professionals and the Role of Normative Dialogue.

This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare providers and patients, proposing that 'liberal' approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust.

Comparison of different preoperative fasting times for pediatric elective surgical procedures: A randomized controlled trial.

Objective: To compare the mean residual gastric volume and gastric pH with standard and liberal fasting in children undergoing general anesthesia for elective procedures. Methods: A randomized controlled trial (NCT05922072) was conducted at Department of Pediatric Surgery, Mayo Hospital Lahore from June 2021 to December 2021 and 120 patients undergoing elective daycare surgical procedures under general anesthesia were enrolled. Patients were divided into Group-A (Standard fasting) and Group-B (Liberal fasting). Group-A with 6-, 4- and 2-hours Nil per oral (NPO) for solids/ formula milk, breast milk and clear fluid, while Group-B with six, four and one hour NPO for solids/ formula milk, breast milk and clear fluid respectively. Residual gastric volume and pH were measured after anesthetizing the patient. Effect modifiers like age, gender, duration of anesthesia and procedure were controlled through stratification. Post-stratification, t-test was applied and p-value less than 0.05 was taken as statistically significant. Results: In Group-A, mean age was 6.1±4.5 years and 6.4±4.6 years in Group-B. Mean residual gastric volume with standard fasting was 0.67±0.48 ml and liberal fasting 0.80±0.44 ml (p value 0.13). Mean gastric fluid pH with standard fasting was 1.72±0.78 as compared to liberal fasting 1.63±0.70 (p value 0.53). Conclusion: Free fluid fasting allows for significantly shorter fasting times, though statistically insignificant higher residual gastric volume was recorded in liberal fasting group with a lower pH.

Thinking critically, acting flexibly: Global forms of religiosity among millennial Muslim women in the UAE.

This article analyzes how liberal, American-curriculum universities and neoliberal entrepreneurship centers play a role in shaping the religious subjectivities of millennial Muslim women in the United Arab Emirates (UAE). It is grounded in 2 years of fieldwork and interviews conducted with middle-class, migrant Muslim women living in the UAE, a highly cosmopolitan urban setting shaped deeply by processes of globalization. Examining how 'global forms' materialize in local contexts, the article scrutinizes how the 'assemblages' emerging in educational and entrepreneurial contexts play a vital role in shaping women's practices and sensibilities, conceptualizations of God, and relationships to others. Tracing one woman's intellectual and religious trajectory through her self-narrative, the article intervenes in debates on the global reach and resonance of American educational 'imperialism'; the entanglement of religious and entrepreneurial subjectivity; and the contemporary forms of Islamic religiosity in the Middle East.

Cet article analyse comment les universités libérales à programme américain et les centres d'entrepreneuriat néolibéraux jouent un rôle dans la formation des subjectivités religieuses des femmes musulmanes de la génération Y des Émirats arabes unis (EAU). L'étude s'appuie sur deux années de travail de terrain et et sur des entretiens avec des femmes musulmanes migrantes de classe moyenne vivant aux Émirats arabes unis, un environnement très urbain et cosmopolite profondément marqué par les processus de mondialisation. En examinant comment les « formes globales ¼ se matérialisent dans les contextes locaux, l'article étudie comment les « assemblages ¼ émergeant dans les contextes éducatifs et entrepreneuriaux jouent un rôle essentiel dans la formation des pratiques et des sensibilités des femmes, dans leur conceptualisation de Dieu et dans leurs relations avec les autres. En retraçant la trajectoire intellectuelle et religieuse d'une femme à travers son récit personnel, l'article intervient dans les débats sur la portée et la résonance mondiales de l'« impérialisme ¼ éducatif américain, sur l'enchevêtrement de la subjectivité religieuse et entrepreneuriale et sur les formes contemporaines de la religiosité islamique au Moyen-Orient.

Comparative efficacy and safety of restrictive versus liberal transfusion thresholds in anemic preterm infants: a meta-analysis of 12 randomized controlled trials.

The comparative efficacy and safety of restrictive with liberal transfusion thresholds remain controversial in anemic preterm infants. This meta-analysis aimed to compare the efficacy and safety of these two transfusion thresholds for anemic preterm infants. We searched PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) for relevant randomized controlled trials (RCTs) comparing restrictive with liberal transfusion thresholds in anemic preterm infants through April 30, 2022. Two independent investigators screened literature, extracted data, and appraised the methodological quality of eligible studies. Meta-analysis was conducted using RevMan version 5.3.5. Twelve RCTs with 4380 preterm infants were included. Liberal transfusion threshold significantly increased the level of hemoglobin after transfusion (mean difference (MD): -10.03; 95% confidence interval (CI): -15.98 to -4.08; p=0.001; I2=94%) and hematocrit (MD: -3.62; 95%CI: -6.78 to -0.46; p=0.02; I2=80%) compared with restrictive transfusion. Infants' age at first transfusion in restrictive transfusion group was higher than that of infants in liberal transfusion group (MD: 5.08; 95%CI: 2.27 to7.89; p=0.004; I2=54%); however, restrictive transfusion was associated with more time on supplemental oxygen (MD: 3.56; 95%CI: 1.93 to 5.18; p<0.001; I2=62%) and ventilator or CPAP (MD: 3.31; 95%CI: 1.42 to 5.20; p=0.006; I2=75%). For the remaining outcomes, two transfusion strategies were comparable. Furthermore, a series of sensitivity analyses confirmed the robustness of the level of hemoglobin after transfusion, age at first transfusion, time on ventilator or CPAP, and safety outcomes. Evidence with substantial heterogeneity indicates that liberal and restrictive transfusion thresholds are effective and safe blood cell transfusion strategies in anemic preterm infants, but the liberal strategy may be more effective in shortening the length of necessary respiratory support.

Religious pluralism and the ethics of healthcare.

Democratic societies that separate church and state face major challenges in accommodating religious convictions. This applies especially to determining healthcare policies. Building on our prior work on the demands and limits of religious accommodation in democratic societies, we propose a set of ethical standards that can guide societies in meeting this challenge. In applying and defending these standards, we explore three topics: vaccine resistance, abortion, and concerns about rights to healthcare. We clarify these and other issues of religious accommodation and propose ethical standards for approaching these and other problems.

Liberal-democratic values and philosophers' beliefs about moral expertise.

In recent decades, the discipline of bioethics has grown rapidly, as has the practice of ethical consultation. Interestingly, this new recognition of the relevance of moral philosophy to our daily life has been accompanied by skepticism among philosophers regarding the existence of moral expertise or the benefits of philosophical training. In his recent article in Bioethics, William R. Smith suggested that this skepticism is rooted in philosophers' belief that moral expertise is inconsistent with liberal-democratic values, when in fact they are compatible. In this paper, we provide a unique opportunity to empirically examine Smith's observation by utilizing and extending global data on philosophers' beliefs about moral expertise, involving 4087 philosophers from 96 countries. Our findings support Smith's theoretical observation and show that societal levels of support for liberal-democratic values are associated with greater skepticism about moral expertise. We suggest that these findings might be explained by the cognitive process of motivated reasoning and an invalid inference of "is" from "ought." Consequently, the potential tension between moral expertise and liberal-democratic values is invalidly used for rejecting the existence of moral expertise, while its main and valid implication is for how moral expertise should be applied in liberal-democratic settings.

Bioethics, Ukraine, and the Peril of Silence.

By considering the history of bioethics and international humanitarian law, Joseph J. Fins contends that bioethics as an academic and moral community should stand in solidarity with Ukraine as it defends freedom and civility.

A very British state capitalism: Variegation, political connections and bailouts during the COVID-19 crisis.

The COVID-19 pandemic has resulted in governments playing increasingly prominent roles as active economic agents. However, state capitalism does not necessarily serve broad developmental purposes, and rather can be directed to supporting sectional and private interests. As the literature on variegated capitalism alerts us, governments and other actors regularly devise fixes in response to a systemic crisis, but the focus, scale, and scope of the interventions vary considerably, according to the constellation of interests. Rapid progress with vaccines notwithstanding, the UK government's response to COVID-19 has been associated with much controversy, not only because of an extraordinarily high death rate, but also because of allegations of cronyism around the granting of government contracts and bailouts. We focus on the latter, investigating more closely who got bailed out. We find that badly affected sectors (e.g. hospitality, transportation) and larger employers were more likely to get bailouts. However, the latter also favored the politically influential and those who had run up debt profligately. Although, as with state capitalism, crony capitalism is most often associated with emerging markets, we conclude that the two have coalesced into a peculiarly British variety, but one that has some common features with other major liberal markets. This might suggest that the eco-systemic dominance of the latter is coming to an end, or, at the least, that this model is drifting towards one that assumes many of the features commonly associated with developing nations.