Choice Of Agent Research Articles

Dexmedetomidine Administration does not Affect Electrocorticography Reading during Epilepsy Focal Removal Surgery

Epilepsy prevalent across all ages and genders, making it one of the most widespread neurologic disorder. Worldwide, 20-40% of epilepsy patients are refractory or resistant to oral anti-epileptic drugs, requiring surgery to treat their seizures. The use of electrocorticography (ECoG) can help determine the focus of epilepsy and requires anaesthetic drugs that do not affect the electroencephalography (EEG) readings during surgery. The aim of this case was to study the effect of using dexmedetomidine (DEX) as additional to maintenance anesthesia in epileptic craniotomy surgery with ECoG. A 28-year-old man came to the hospital with complaints of recurrent seizures, generalized tonic-clonic type seizures that lasted 2-3 minutes, was unconscious during the seizure, fell asleep afterwards, and recurred 2-3 times a day. The patient had suffered from epilepsy since 4 years ago. Physical and supporting examinations were within normal limits. Head MSCT examination with contrast suspected oligodendroglioma. The patient was administered dexmetomidine while underwent epilepsy craniotomy surgery with ECoG to remove the tumor which was suspected to be the epileptic focus. The choice of anesthetic agent in epilepsy craniotomy, especially when involving ECoG modalities, requires special consideration to improve intraoperative quality and postoperative outcomes. Propofol is the most widely used induction agent. However, these agents have anticonvulsant effects and activate non-specific spike waves in large areas of the brain. This has the potential to interfere with spike wave monitoring with ECoG. The use of dexmedetomidine has been shown to produce a stable hemodynamic effect and does not affect the ECoG readings. The use of DEX as an adjuvant in anesthesia maintenance does not inhibit spike waves during surgery, so ECoG can be used effectively for anesthesia in craniotomy operations with ECoG.

A novel biological antibacterial polyvinyl alcohol/polyionic liquid hydrogel for wound dressing.

The release of antibiotics or anions by traditional bacteriostatic agents led to the development of bacterial drug resistance and environmental pollution. Ionic liquids (ILs) have become important choices for antibacterial agents because of their excellent physical, chemical and biological properties. In this paper, the bioactivities of 1-vinyl-3-butylimidazolium chloride ([VBIM]Cl, IL) and poly (1-vinyl-3-butylimidazolium chloride) (P[VBIM]Cl, PIL) were evaluated, and the potential antibacterial material was used to synthesize hydrogels. Using the colony formation assay and the Oxford cup method, antibacterial effect of IL and PIL were tested. Cell-Counting-Kit-8 (CCK-8) experiments were used to study the IC50 (half maximal inhibitory concentration) values of IL and showed 1.47mg/mL, 0.35mg/mL and 0.33mg/mL at 24 h, 48 h and 72 h, respectively. The IC50 value of PIL were 12.15μg/mL, 12.06μg/mL and 11.76μg/mL at 24 h, 48 h and 72 h, respectively. The PIL is further crosslinked with polyvinyl alcohol (PVA) to form a novel hydrogel through freeze-thaw cycles. The newly fabricated hydrogel exhibited a high water content, excellent water absorption properties and outstanding mechanical performance. Using the colony formation assay and the inhibition zone assay, the hydrogels exhibited favorable antibacterial effects (against E.coli and S.aureus) such that nearly 100% of the bacteria were killed in liquid medium while cultivating with H4 (synthesized by 0.5g PIL and 1g PVA). In addition, the cytotoxicity of PIL was significantly reduced through hydrogen bond crosslinking. H4 showed the highest antibacterial activity and a good biocompatibility. The results indicated that the PVA&PIL hydrogels had great potential for wound dressing.

Myocardial protection in cardiac surgery: a comprehensive review of current therapies and future cardioprotective strategies.

Cardiac surgery with cardiopulmonary bypass results in global myocardial ischemia-reperfusion injury, leading to significant postoperative morbidity and mortality. Although cardioplegia is the cornerstone of intraoperative cardioprotection, a number of additional strategies have been identified. The concept of preconditioning and postconditioning, despite its limited direct clinical application, provided an essential contribution to the understanding of myocardial injury and organ protection. Therefore, physicians can use different tools to limit perioperative myocardial injury. These include the choice of anesthetic agents, remote ischemic preconditioning, tight glycemic control, optimization of respiratory parameters during the aortic unclamping phase to limit reperfusion injury, appropriate choice of monitoring to optimize hemodynamic parameters and limit perioperative use of catecholamines, and early reintroduction of cardioprotective agents in the postoperative period. Appropriate management before, during, and after cardiopulmonary bypass will help to decrease myocardial damage. This review aimed to highlight the current advancements in cardioprotection and their potential applications during cardiac surgery.

Quality of antibiotic prescribing for outpatient cystitis in adult females

Background: Urinary tract infections (UTI) are responsible for a significant portion of female, outpatient antibiotic prescriptions. Especially true in uncomplicated cases, where symptoms remain the cornerstone of diagnosis, ensuring the optimal choice of agent, dose, and duration may mitigate future bacterial resistance and lower the likelihood of adverse events and/or recurrence. This study is the first in Canada to examine the quality of antibiotic prescribing to females in the outpatient setting, for uncomplicated UTI–by agent, dose, and duration. Methods: All adult female residents of British Columbia with a physician record for cystitis from January 1, 2014, to December 31, 2018, were identified. Patients with a history of urologic abnormalities, spinal cord injury, catheter use, kidney transplant, as well as pregnant females, were excluded. Primary outcomes included the proportion of total episodes prescribed and the proportion of appropriate antibiotic use, examined using Poisson regression. Results: A total of 182,162 episodes of cystitis were examined, with 70% receiving an antibiotic prescription. The rate of cystitis-associated prescribing was 697 prescriptions per 1,000 population. Overall, 35% of prescriptions were appropriate by guideline adherence or clinical justification. Nitrofurantoin and trimethoprim-sulfamethoxazole, accounted for 71% of total antibiotic use. Seven days was the most commonly dispensed duration of therapy, followed by 5, then 10. Conclusions: Shortening length of therapy in line with clinical guidelines and encouraging the use of first line agents present clear, actionable targets for provincial stewardship efforts.

Factors Involved in Anti-VEGF Treatment Decisions for Neovascular Age-Related Macular Degeneration: Insights from Real-World Clinical Practice.

Anti-vascular endothelial growth factor (anti-VEGF) agents are widely prescribed for the treatment of neovascular age-related macular degeneration (nAMD). Although studies have investigated patient choice of anti-VEGF agent, little is known regarding factors that influence physician preference of anti-VEGF agent for their patients. To describe physician rationale and challenges in prescribing anti-VEGF treatments for patients with nAMD. Data were drawn from the Adelphi Real World nAMD Disease Specific Programme™, a cross-sectional survey with retrospective data capture of physicians and their patients with nAMD in the United States between October 2021 and May 2022. Physicians (n = 56) reported data for up to 13 consecutively consulting patients (n = 451), including current anti-VEGF treatments used, factors affecting physicians' choice of anti-VEGF agent and treatment strategy, and restrictions on specific agents. Most physicians prefer employing a "treat-and-extend" treatment strategy, over "fixed interval" or "pro re nata" strategies. However, in routine clinical practice, "treat-and-extend" was reported for less than half of nAMD-diagnosed eyes. Top factors influencing physician choice of anti-VEGF agent and treatment strategy included maximizing clinical benefit (eg visual acuity gains and fluid control), patient convenience, and reducing out-of-pocket costs. However, physicians also reported facing substantial roadblocks in prescribing their choice of anti-VEGF agent, including restrictions on approved agents and gaps in insurance coverage. Persistent fluid was the most common physician-selected reason for switching a patient away from an anti-VEGF agent. Physicians face barriers to prescribing their preferred anti-VEGF agents in real-world healthcare settings. Overcoming these challenges may improve treatment outcomes for patients with nAMD.

A narrative review and update on drain-related outbreaks

Outbreaks linked to hospital drainage systems are well reported, and continue to present challenges to incident management teams. Such outbreaks can be protracted and complex, with multi-modal strategies being required for remediation. To summarize recent drain-related outbreaks, investigate whether multi-modal control measures are being implemented, and determine any antecedent factors. Databases were searched for drain-related outbreaks over a 5-year period. Search terms employed included 'healthcare drainage outbreaks', 'drain outbreaks', 'drainage system outbreaks', 'sink outbreaks' and 'shower outbreaks'. Information was collected on country of origin, pathogens involved, unit affected, drain types, patient numbers, drainage system interventions, type of drain disinfectant, infection control interventions, typing method, outcomes and any antecedent factors. Nineteen drain-related outbreak studies were reviewed. The majority of incidents were due to carbapenemase-producing Enterobacterales, and were from critical care settings. Most (16/19) studies recognized the need for a multi-modal approach. Information on the success of interventions was not documented for all incidents, but 13/19 studies reported no further cases after control measures. Variation in the choice of agent and frequency of application exists with regards to drain disinfection. Seven studies discussed antecedent factors. Despite drain-related outbreaks being reported for the last 24 years and review articles on the subject, outbreaks continue to pose significant challenges. There is currently no UK guidance on the management of drain-related outbreaks or the design of new buildings to mitigate the risk. Addressing the challenges from hospital drainage systems should be considered a priority by agencies and guidance developers.

In Situ Photodeposition of Gold Nanoparticles with Exposed High-Activity Crystal Facets under Different Sacrificial Agents.

In situ photodeposition presents a powerful approach for integrating noble metal co-catalysts onto semiconductor surfaces. However, achieving precise control over the microstructure of the deposited co-catalyst remains a major challenge. Au nanoparticles (NPs) are deposited onto H-KCNO using HAuCl4 in the presence of various sacrificial agents in this study. Notably, the choice of sacrificial agent decisively influences the exposed crystal facets, loaded content, and particle size of the deposited Au NPs. Importantly, in situ photodeposition under an ethanol solution facilitates the exposure of the highly active (111) and (220) crystal facets of Au. The introduction of Au NPs significantly enhances photocatalytic hydrogen evolution, achieving rates of 4.93, 57.88, and 15.44 μmol/h for H-KCNO/Au-(water, ethanol, and lactic acid), respectively. The observed photocatalytic activity for hydrogen evolution indicates that the exposure of the highly active planes emerges as critical for significant performance enhancement. Photoelectrochemical and photoluminescence measurements suggest that the highly active (111) and (220) crystal facets effectively segregate sites for redox reactions, thereby impeding the recombination of photogenerated electron-hole pairs.

Survey of Thai Physicians' Practice in Pediatric Septic Shock.

(1) Background: Sepsis management in children is crucial, especially in emergency services. This study aims to evaluate Thai physicians' knowledge gaps in the emergency management of sepsis in children and to evaluate their adherence to the current sepsis clinical practice guidelines. (2) Methods: This is a cross-sectional survey of Thai physicians' management of septic shock in children. The survey was conducted through online questionnaires from March 2019-April 2019. (3) Results: Of the 366 responders, 362 (98.9%) were completed. Most of the responders were general practitioners (89.2%) and pediatricians (10.8%). The time from positive sepsis screening to being evaluated by physicians within 15 min was reported by 83.9%. The most common choice of fluid resuscitation was normal saline solution (77.3%). The practice of a fluid loading dose (20 mL/kg) consistent with the guidelines was 56.3%. The selection of the first vasoactive agent in warm shock (norepinephrine) and cold shock (epinephrine) according to recommendations in the guidelines was 74.3% and 36.2%, respectively. There was a significant difference between general practitioners and pediatricians in terms of knowledge about initial fluid resuscitation and the optimal vasoactive agent in cold shock (p-value < 0.001). In the multivariate model, factors associated with the guideline-based decision-making of vasoactive agent choice for cold shock were specialist training (pediatrician) and the completion of sepsis management training certification, with adjusted odds ratios (AORs) of 7.81 and 2.96, but working experience greater than ten years was inconsistent with the guideline-based decision-making (AOR 0.14). (4) Conclusions: Thai clinicians were unfamiliar with pediatric sepsis therapy standards, specifically the quantity of early fluid resuscitation and the appropriate vasoactive medications for cold shock. To encourage adherence to the guidelines, we propose a regularly required training course on pediatric sepsis management.

Which Actions Are Always Necessary in Fully-Observable Non-Deterministic Planning?

Explaining the sequential action choices of an autonomous agent is essential for understanding the agent and learning from the agent. Given a goal-reaching action sequence in a non-deterministic environment, one important aspect of explaining action choices is deciding if the action choice is always necessary for the action sequence, or if it may be omitted under certain circumstances. Most works in explainable planning (XAIP) have been focused on explanation of action choices in deterministic environments as assumed by classical planning, and one widely used notion is causal link. In this work, we will apply the notion of causal link to justifying actions choices of a trace in fully-observable non-determinisitic (FOND) settings. We will also introduce a new notion -- the always-necessary actions of a trace -- and propose an approach that derives the always-necessary actions of a trace from the causal link justifications of action choices.

Midazolam as mean sedative agent in out-of-hospital cardiac arrest shock: is it associated to increased mortality?

Abstract Funding Acknowledgements None. Background The choice of a sedative agent for patients undergoing invasive ventilation has been widely studied. However, data regarding the optimal sedation strategy after Out-of-Hospital Cardiac Arrest (OHCA) when the patients are suffering from post-OHCA shock is sparse. Aim To explore whether the use of midazolam in patients admitted for OHCA that are additionally haemodynamically unstable increases in-hospital mortality, cardiovascular (CV) mortality, cerebral performance status (CPC) at discharge, and days of intubation or admission, when used selectively during the acute phase of deteriorating post-OHCA shock patients. Methods We report a prospective, observational, single-centre cohort that included all-comers admitted due to OHCA of presumed cardiac cause between May-2019 and July-2023, that remained comatose at admission. Midazolam was only administrated as the mean sedation agent when the patient was in a hemodynamically deteriorating situation (SCAI D-E). Baseline characteristics, OHCA features, blood samples measurements, in-hospital treatments and neurological condition at discharge were registered. Primary outcome was in-hospital death from any cause. Secondary outcomes included CPC at discharge (1-2 VS 3-5), CV mortality, days of admission, days of intubation, need of tracheostomy, myopathy, enolase at 48h and heart transplant during admission. Patients were stratified according to whether they had received midazolam as mean sedation agent at some stage of admission or not. Results 103 patients of the 109 admitted were included (6 refused consent), 45 of them (43%) received midazolam at some stage of admission. No differences in baseline characteristics were found. Mean age was 60.6 years, 79.6% were male, most frequent comorbidities were hypertension (53.4%) and dyslipidaemia (46.6%), and 20,4% had had a previous myocardial infarction. OHCA characteristics, shock parameters and administered treatments did not significantly differ between the two groups (Table 1). In-hospital mortality was numerically higher in the midazolam group but did not reach statistical significance (56% vs. 38%, p=0.075) (Figure 1). There were no differences neither in secondary outcomes (CV mortality 4% vs. 5%, p=0.865; CPC 1-2 70% vs. 83%, p=0.244; days of intubation 6 vs. 4, p=0.203; tracheostomy 18% vs. 10%, p=0.275; days of admission 14 vs. 15, p=0.851; 48h enolase 38 vs. 29, p=0.919; heart transplant during admission 0% vs. 1,7%, p=0.376; myopathy 30% vs. 21% p=0.282). Conclusion In patients admitted due to OHCA, even though the administration of midazolam is given in unstable patients, it is not related to a higher in-hospital mortality nor poorer outcomes.Table 1.OHCA and shock characteristicsFigure 1.Cumulative Survival

Variations in Perioperative Thromboprophylaxis Practices: Do the Guidelines Need a Closer Look?

BackgroundIn 2022, the American Association for Thoracic Surgery (AATS) and the European Society of Thoracic Surgeons (ESTS) published joint guidelines regarding the timing, duration, and choice of agent for perioperative venous thromboembolism prophylaxis for thoracic cancer patients. Now, 1 year after their release, we looked to assess practices and general adherence to these recommendations. MethodsWe conducted a survey among board-certified/board-eligible thoracic surgeons in the United States, between July and October 2023. ResultsA total of 103 board-certified thoracic surgeons responded to the survey. Over half of the surgeons reported using preoperative chemical thromboprophylaxis routinely for lobectomy/sublobar resections (56.3%), pneumonectomy/extended lung resections (64.1%), and esophagectomy (67%). Over two thirds of thoracic surgeons limited the duration of postoperative chemical thromboprophylaxis to the patient’s length of hospital stay and never administered chemoprophylaxis post-discharge. Among surgeons who always continued chemical thromboprophylaxis post-discharge, low-molecular-weight heparin (LMWH) was the most commonly used agent (>70%), followed by direct oral anticoagulants (13.8%-16.7%). Only 33.3% of surgeons prescribing post-discharge chemical thromboprophylaxis after lobectomy/sublobar resections continued prophylaxis up to 4 weeks postoperatively. ConclusionsContrary to the 2022 joint AATS/ESTS guidelines, the majority of surveyed thoracic surgeons in the United States do not routinely prescribe postoperative thromboprophylaxis after lung and esophageal cancer resections. The dogma of routine extended thromboprophylaxis must be reevaluated as modern minimally invasive thoracic surgery allows for very earlier ambulation and enhanced recovery. There is a need for randomized controlled trials exploring the utility of extended thromboprophylaxis and newer agents such as direct oral anticoagulants.

Comparative Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists, Sodium-Glucose Cotransporter 2 Inhibitors, Dipeptidyl Peptidase-4 Inhibitors, and Sulfonylureas for Sight-Threatening Diabetic Retinopathy

To investigate whether the choice of glucose-lowering agent for type 2 diabetes (T2D) impacts a patient's risk of developing sight-threatening diabetic retinopathy complications. Retrospective observational database study emulating an idealized target trial. Adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014, to December 31, 2021, with T2D and moderate cardiovascular disease (CVD) risk who had no baseline history of advanced diabetic retinal complications, initiating treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sulfonylureas. We used inverse propensity scoring weights in time-to-event Cox proportional hazards models. Treatment for either diabetic macular edema or proliferative diabetic retinopathy. The final study population included 371 698 patients, of whom 42 265 initiated GLP-1 RA, 53 476 initiated SGLT2i, 78 444 initiated DPP-4i, and 197 513 initiated sulfonylurea agents. The probability of treatment for sight-threatening retinopathy within 2 and 5 years was 0.3% and 0.7% for patients initiating SGLT2i (median follow-up 830 [interquartile range (IQR), 343-1401] days), 0.4% and 1.0% for GLP-1 RA (669 [IQR, 256-1167] days), 0.4% and 0.9% for DPP-4i (1263 [IQR, 688-1938] days), and 0.5% and 1.2% for sulfonylurea (1223 [IQR, 662-1879] days). Sodium-glucose cotransporter 2 inhibitors use was associated with a lower risk of treatment for sight-threatening retinopathy compared with all other medication classes, including GLP-1 RA (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55-0.97), DPP-4i (HR, 0.79; 95% CI, 0.64-0.97), and sulfonylurea (HR, 0.61; 95% CI, 0.50-0.74). Glucagon-like peptide-1 receptor agonists use was associated with a similar risk of sight-threatening retinopathy as DPP-4i (HR, 1.07; 95% CI, 0.85-1.35) and sulfonylurea (HR, 0.83; 95% CI, 0.67-1.03). Sodium-glucose cotransporter 2 inhibitors use was associated with a lower risk of sight-threatening diabetic retinopathy among adults with T2D and moderate CVD risk compared with other glucose-lowering therapies. Glucagon-like peptide-1 receptor agonists do not confer increased retinal risk, relative to DPP-4i and sulfonylurea medications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Chronic dacryocystitis: An insight into bacteriology and antimicrobial sensitivity pattern.

Adequate management of chronic dacryocystitis is an essential prerequisite before any intraocular surgery owing to a grave risk of endophthalmitis. The knowledge of bacteriology of chronic dacryocystitis would accentuate the choice of effective antimicrobial agents and thus help in reducing the irrational use of antimicrobial agents and subsequent development of drug resistance. We aimed to identify the causative bacterial flora and study the antimicrobial sensitivity and resistance pattern in cases of chronic dacryocystitis. This was a cross-sectional observational study. Conjunctival swabs were obtained from both eyes from 102 patients with clinical evidence of chronic dacryocystitis. Specimens for microbiological analysis were obtained, either from the conjunctival cul-de-sac and everted puncta by applying pressure over the lacrimal sac area or from the refluxing material after irrigating the lacrimal sac with sterile saline. The specimens were sent for culture and sensitivity in the department of microbiology. Ethical approvals were duly obtained. Percentage assessment was used for statistical analysis. The cultures showed the presence of Staphylococcus aureus in 50% of bacterial isolates obtained from the involved eyes, followed by coagulase-negative Staphylococcus in 11.53% of isolates and Enterococcus also in 11.53% of isolates. It was observed that cefoxitin was the most sensitive antibiotic against Gram-positive organisms, followed by vancomycin and clindamycin, whereas maximum resistance was seen for penicillin and ofloxacin. For Gram-negative organisms, imipenem was found to be most sensitive, followed by gentamicin and co-amoxiclav, whereas maximum resistance was seen for ciprofloxacin. It was concluded that Gram-positive bacteria predominantly S. aureus was the most commonly isolated bacteria in cases of chronic dacryocystitis as compared to Gram-negative bacteria and cefoxitin was found to be the overall most effective antibiotic for Gram-positive bacteria.

Maximizing filler content and manufacturing highly thermal conductive composite materials through eutectic liquefaction of epoxy resin

We report novel research results demonstrating the production of polymer nanocomposites with high thermal conductivity. The use of diluents, a conventionally used method to reduce viscosity and increase processability, had clear limitations that could not be used for solid epoxy, but in this study, the melting point of the epoxy itself was reduced through the introduction of the eutectic system, allowing the solid epoxy to be converted into a liquid phase. By utilizing eutectic liquid (EL) derived from ketone-containing epoxy resin (DBPE) and diphenylamine (DPA), we achieved maximal filler content. Unlike DBPE’s solid form at 135 °C, EL displayed liquidity with a viscosity of 50 Pa·s at 50 °C, enabling curing with isophorone diamine (IPDA) below DBPE’s melting point. While DBPE/IPDA yielded a tensile strength of 7.2 MPa due to uneven mixing, EL/IPDA reached 44.3 MPa, marking a 520 % improvement. EL’s viscosity dropped dramatically, reaching 0.06 Pa·s at 98 °C. The EL/IPDA mixture’s viscosity at 98 °C was 150 Pa·s, allowing up to 80 wt% hexagonal boron nitride (h-BN) filler. This led to a thermal conductivity of 16 W/m·K, 20 wt% higher than DGEBA’s 60 wt% filling rate. Notably, EL/h-BN composites achieved 16 times the thermal conductivity of DGEBA/h-BN composites, which is 1 W/m·K. Lowering the melting point and viscosity expanded curing agent choices, enhanced tensile strength, increased filler content, and heightened thermal conductivity, showcasing EL’s remarkable potential.

What Is the Impact of Multimodal Treatment in Patients with Leiomyosarcoma of Bone? A Multicenter Study of 35 Patients with an Ultra-Rare Tumor Entity.

Primary leiomyosarcoma of bone (LMSoB) is extremely rare, comprising only <0.7% of primary malignant bone tumors, and is therefore considered an ultra-rare tumor entity. There is currently no consensus as to whether therapeutic strategies should be based on the biological characteristics of soft tissue leiomyosarcoma or on primary tumor localization in the bone. The use of perioperative chemotherapy and its effectiveness in this rare tumor entity remains unclear. We aimed to evaluate the impact of different treatment approaches in a multicenter setting with a total of 35 patients included. The 5-year overall survival (OS) was 74%. Patients with localized disease undergoing surgery had a significantly higher 5-year OS compared to patients who did not undergo surgical treatment (82% vs. 0%, p = 0.0015). Axial tumor localization was associated with worse event-free survival (EFS) probability (p < 0.001) and OS (p = 0.0082). A high proportion of our patients developed secondary metastases. Furthermore, the perioperative chemotherapy protocols applied to our patients were not associated with an improved EFS or OS. Therefore, the benefit of perioperative chemotherapy in LMSoB needs to be further investigated, and the choice of agents still needs to be clarified.

Perioperative management of a double valve replacement and coronary artery bypass graft in a patient with carcinoid syndrome; a case report and literature review

Introduction Carcinoid tumors are rare neuroendocrine tumors; about 5% of patients develop the carcinoid syndrome. We present the case of a patient with carcinoid syndrome undergoing cardiac surgery. Case report A 74-year-old patient with carcinoid heart disease and hepatic metastases underwent double valve replacement and CABG. The patient was on octreotide therapy and antihypertensive medication. An octreotide infusion was commenced perioperatively. Pharmaceutical agents that could potentially precipitate histamine release or exacerbate catecholamine secretion and carcinoid crises were avoided. Postoperatively, recovery was complicated by atrial fibrillation, chest infection, pleural effusions, acute kidney injury and delirium. Discussion Hepatic metastases cause systemic hormones’ secretion, which cause a carcinoid crisis. Perioperative administration of octreotide is used, while vigilance is required to differentiate between hemodynamic effects related to the operation or disease specific factors. Conclusion No carcinoid crisis was evident perioperatively. High vigilance with appropriate monitoring, aggressive management combined with meticulous choice of pharmaceutical agents led to this outcome.

Technology-Enabled Agent Choice and Uptake of Social Assistance Programs: Evidence from India’s Food Security Program

Problem definition: Beneficiaries of social assistance programs with transfers of undifferentiated commodities often have a designated agent to collect their entitlements from. This gives monopoly power to agents over beneficiaries. When coupled with weak government monitoring, agents do not have incentives to adhere to stipulated operating guidelines, leading to reduced uptake by beneficiaries. Some governments are attempting to break the monopoly by allowing beneficiaries to choose agents. However, the impact of choice on uptake may be limited by lack of alternate agents in beneficiaries’ vicinities, restricted ability of agents to compete with undifferentiated commodities, and collusion among agents. Methodology/results: Using a reverse difference-in-differences framework on data from a food security program in two neighboring states in India, Andhra Pradesh and Telangana, we find that providing agent choice results in a 6.6% increase in the quantity of entitlements collected by the beneficiary households. We also find that increase in uptake is about four times higher in regions with high agent density compared with those with low agent density. This emphasizes the importance of having an alternate agent in the vicinity for choice to be effective. Nearly all of the increase in uptake is attributable to new beneficiaries collecting entitlements from their preassigned agent. This is suggestive of agents improving adherence to operating guidelines in response to choice. We find associative evidence for this response in the number of days agents keep their shops open. Managerial implications: Governments executing in-kind transfers of undifferentiated commodities are piloting interventions to provide choice to their beneficiaries. Replacement of in-kind transfers with cash, an increasingly popular intervention, may be challenging in volatile markets, as the magnitude of the transfer needs to be periodically adjusted. Our results indicate that alternate designs of providing choice even in a limited form, that is, the place where the beneficiaries can collect their entitlements with products and prices fixed, can present a viable alternative. Funding: This research was partially supported by a grant from the Omidyar Network to the Digital Identity Research Initiative at the Indian School of Business. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0528 .

Harnessing Bacillus cereus from Surabaya Seawater for Enhanced Diesel Fuel Bioremediation in Tropical Ocean

Hydrocarbon is one of the primary organic pollutants that contaminate seawater. Most hydrocarbons which pollute the sea waters of Indonesia are the constituents of diesel fuel. This condition emphasizes the need to develop a bioremediation strategy for diesel fuel pollution in the country. A successful plan for bioremediation is primarily determined by the choice of the bacterial agent, which can be isolated from the polluted seawater. Furthermore, the setup must consider the characteristics and capability of the bacterial isolates to degrade diesel fuel. This study thus aimed to analyze the potential of Bacillus cereus isolated from the polluted seawater of Surabaya, East Java, Indonesia, as a bioremediation agent. The results of bacterial density, pH measurements, TPH and GC-MS assays indicated that the locally isolated Bacillus cereus could significantly reduce the hydrocarbon concentrations. More importantly, after 14 days of bioremediation, the polluting diesel fuel was categorized as biodegradable based on the BOD:COD ratio. This study shows that Bacillus cereus has excellent potential for bioremediating hydrocarbon contaminants in tropical seawater. HIGHLIGHTS Bacillus cereus from Surabaya's polluted waters fights diesel pollutants effectively. Bacillus cereus degrades hydrocarbons efficiently over two weeks, proving its bioremediation potential. Rise in BOD:COD ratio indicates Bacillus cereus' effective reduction of complex organics. GC-MS shows Bacillus cereus transforms hydrocarbons into shorter chains systematically. Bacillus cereus offers an eco-friendly solution for diesel pollution in tropical climates, urging further exploration. GRAPHICAL ABSTRACT

Reintroducing Time, Money and Constraints: Viability to Bridge the Economic and Monetary Theories

Why use a viabilistic approach to model economy? Because it is urgent to re-assess the modeling of the business cycle that integrates dynamic money creation and that has at its core the notion of constraints. The purpose of this paper is thus to propose an evolutionary economic model using a mathematical framework derived from set-valued analysis, differential inclusions and viability theory. As this approach is dynamical, the model will not use two concepts on which neo-classical economics are built i.e., (1) the existence of static repeated equilibria, (2) the optimization by an economic agent of a utility function. Furthermore, we will not use any self-organization process or “invisible hand”, as in our viabilist framework the economic viability will be maintained by explicit choices of the economic agents and of the lender of last resort over the budgetary and monetary rules to apply. Indeed, even simple constraints on the second-derivative of the means of payments already induce four-phased business cycles. Coupling these constraints over the creation of means of payment with economic evolutions of prices and commodities through a budgetary constraint allows for a single formalism, tackling jointly the question of the viability of economic and monetary evolutions.

Prospects for pharmacological screening of oral detoxification drugs with differentiation of targeted pathologies in animal husbandry

In the modern livestock sector, the domestic industry of the North-West region, cases of poisoning of animals on farms and large complexes are increasingly occurring. This is primarily due to the intensive use of various synthetic modulators, growth stimulants, fertilizers in the agronomic industry and the excessive use of antibiotics, hormones and other veterinary drugs in animal husbandry.Pharmacological screening of oral detoxification agents with differentiation of target pathologies is a promising direction in the development of domestic animal husbandry. A reasonable choice of sorbents in each individual case of poisoning allows you to quickly achieve a therapeutic effect, reduce the toxic load on the animal’s body, which further ensures sustainable productivity and high quality products. This work highlights the results of some studies on the functional activity of the most common enterosorbents in relation to toxins of various natures.Based on the results of the study, it was noted that with an increase in pH from 2.0 (rennet model) to 7.5 (analogue of the distal small intestine), a release of part of the indicator substance from the pores of the sorbent (desorption) is observed, which reduces its absolute sorption effect [5] . The lowest desorption value was shown by atoxyl (8.5%) and phytopos (9.0%). That is why these drugs are the most effective oral detoxification agents for toxins with a molecular weight close to methylene blue.The maximum adsorption effect for various poisonings in animals can be achieved by using sorbing agents that are highly selective for a particular toxin. Research on the choice of oral detoxification agents with differentiation of target pathologies significantly expands the database on existing sorbents, makes it possible to prevent and treat poisonings of various types more effectively, and provides opportunities for the combined use of various adsorbent substances.