Estimation of pulse pressure variation and cardiac output in patients having major abdominal surgery: a comparison between a mobile application for snapshot pulse wave analysis and invasive pulse wave analysis

Pulse pressure variation (PPV) and cardiac output (CO) can guide perioperative fluid management. Capstesia (Galenic App, Vitoria-Gasteiz, Spain) is a mobile application for snapshot pulse wave analysis (PWAsnap) and estimates PPV and CO using pulse wave analysis of a snapshot of the arterial blood pressure waveform displayed on any patient monitor. We evaluated the PPV and CO measurement performance of PWAsnap in adults having major abdominal surgery. In a prospective study, we simultaneously measured PPV and CO using PWAsnap installed on a tablet computer (PPV_PWAsnap, CO_PWAsnap) and using invasive internally calibrated pulse wave analysis (ProAQT; Pulsion Medical Systems, Feldkirchen, Germany; PPV_ProAQT, CO_ProAQT). We determined the diagnostic accuracy of PPV_PWAsnap in comparison to PPV_ProAQT according to three predefined PPV categories and by computing Cohen’s kappa coefficient. We compared CO_ProAQT and CO_PWAsnap using Bland-Altman analysis, the percentage error, and four quadrant plot/concordance rate analysis to determine trending ability. We analyzed 190 paired PPV and CO measurements from 38 patients. The overall diagnostic agreement between PPV_PWAsnap and PPV_ProAQT across the three predefined PPV categories was 64.7% with a Cohen’s kappa coefficient of 0.45. The mean (±?standard deviation) of the differences between CO_PWAsnap and CO_ProAQT was 0.6?±?1.3 L min^??1 (95% limits of agreement 3.1 to ??1.9 L min^??1) with a percentage error of 48.7% and a concordance rate of 45.1%. In adults having major abdominal surgery, PPV_PWAsnap moderately agrees with PPV_ProAQT. The absolute and trending agreement between CO_PWAsnap with CO_ProAQT is poor. Technical improvements are needed before PWAsnap can be recommended for hemodynamic monitoring.

     

The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury

Objectives. The costs associated with traumatic injury are often exacerbated by the development of post-traumatic stress symptoms. However, it is unclear what decreases the development of post-traumatic symptoms over time. The aim of the present research was to examine the role of psychological symptoms and social group memberships in reducing the development of post-traumatic stress symptoms after orthopaedic injuries (OIs) and acquired brain injuries (ABIs). Design and Methods. A longitudinal prospective study assessed self-reported general health symptoms, social group memberships, and post-traumatic stress symptoms among participants with mild or moderate ABI (n= 62) or upper limb OI (n= 31) at 2 weeks (T1) and 3 months (T2) after injury. Results. Hierarchical regressions revealed that having fewer T1 general health symptoms predicted lower levels of T2 post-traumatic stress symptoms after OI but forming more new group memberships at T1 predicted lower levels of T2 post-traumatic stress symptoms after ABI. Conclusion. A focus on acquiring group memberships may be particularly important in reducing the development of post-traumatic stress symptoms after injuries, such as ABI, which result in long-term life changes. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT?: ? Post-traumatic stress symptoms are a common outcome after accidental traumatic injury. ? Persistent post-traumatic stress symptoms can be a risk factor for the development of PTSD. WHAT DOES THIS STUDY ADD?: ? New insight into the contributions of general health symptoms and social group memberships in the development of post-traumatic stress symptoms after accidental injury. ? The development of post-traumatic stress symptoms over time is associated with higher levels of general health symptoms among individuals with orthopaedic injuries; They are associated with lower levels of social group memberships among individuals with acquired brain injuries.     

Distribution and sequestration of palytoxin in coral reef animals.

In the reefs off the Colombian coast (Caribbean Sea) and around Lizard Island, Australia (Pacific), palytoxin (PTX), which has been detected in zoanthid species of the genus Palythoa, also occurred in various other marine organisms living in close association with zoanthid colonies, e.g. sponges (Porifera), soft corals (Alcyonaria), gorgonians (Gorgonaria), mussels, and crustaceans. Predators, e.g. polychaete worms (Hermodice carunculata), a starfish (Acanthaster planci) and fish (Chaetodon species) feeding on Palythoa colonies, accumulate high toxin concentrations in their organs, where PTX is stored in its active form. The high level of toxin tolerance observed in marine animals may enable the wide distribution of PTX in marine biota and its transport and sequestration in food chains.     

No country for old men? The role of a ‘Gentlemen's Club’ in promoting social engagement and psychological well-being in residential care

Objective: Social isolation is a common problem in older people who move into care that has negative consequences for well-being. This is of particular concern for men, who are marginalised in long-term care settings as a result of their reduced numbers and greater difficulty in accessing effective social support, relative to women. However, researchers in the social identity tradition argue that developing social group memberships can counteract the effects of isolation. We test this account in this study by examining whether increased socialisation with others of the same gender enhances social identification, well-being (e.g. life satisfaction, mood), and cognitive ability.

Method: Care home residents were invited to join gender-based groups (i.e. Ladies and Gentlemen's Clubs). Nine groups were examined (five male groups, four female groups) comprising 26 participants (12 male, 14 female), who took part in fortnightly social activities. Social identification, personal identity strength, cognitive ability and well-being were measured at the commencement of the intervention and 12 weeks later.

Results: A clear gender effect was found. For women, there was evidence of maintained well-being and identification over time. For men, there was a significant reduction in depression and anxiety, and an increased sense of social identification with others.

Conclusion: While decreasing well-being tends to be the norm in long-term residential care, building new social group memberships in the form of gender clubs can counteract this decline, particularly among men.