Important Reminders Research Articles

Long-term communication of aftershock forecasts: The Canterbury earthquake sequence in New Zealand

On 14 February 2016, a magnitude (M)5.7 earthquake struck in Christchurch New Zealand (Aotearoa in the Maori language). The shaking caused damage to historic facades, power outages, cliff collapses, rock falls, and liquefaction but no reported injuries or fatalities. This Valentine’s Day earthquake was an aftershock in the Canterbury earthquake sequence (CES), which began on 4 September 2010 with the M7.1 Darfield Earthquake and included the destructive and fatal M6.2 Christchurch aftershock on 22 February 2011. This study, eight months after the Valentine’s Day earthquake and six years after the initiation of the CES, is the first to explore long-term aftershock forecast information and communication needs. The exploratory study also aimed to gather feedback on aftershock scenarios, an alternative form for communicating the forecast.The qualitative study involved workshops with emergency managers, public health officials, and members of the public in Christchurch. Key findings for long-term communication throughout an earthquake sequence include: 1. divergent earthquake experiences affect aftershock communication response and information needs; 2. understanding aftershock sequence behavior is foundational to sense-making when large aftershocks occur; 3. strategic earthquake sequence updates from the trusted science agency and local agencies could serve as important reminders for earthquake preparedness; 4. communication of aftershock forecast uncertainty could aid with both the credibility of the information and living with uncertainty, and 5. inclusion of impact information and preparedness advice into aftershock forecast scenarios could provide links to actionable information. The paper derives implications for research and practice of long-term communications during an aftershock sequence.

How can we reduce maternal mortality due to preeclampsia? The 4P rule.

In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention - Vigilant Prenatal Care - Timely Delivery (Parturition) - Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.

School-Based Agricultural Education Industry Certifications: Part 3—Resources and Regulations

"Resources and Regulations" discusses where to find test prep and study materials to better prepare students for industry certification testing. This article also discusses a few important rules and reminders to follow while preparing for and distributing industry certification tests.

Learning to Collaborate in a Project-based Graduate Course: A Multilevel Study of Student Outcomes

The context of this study is an interdisciplinary project-based course at a large public university in Scandinavia. The course is taught annually to 3,300 graduate students from all fields of study, and learning to collaborate is a specified learning objective. Similar courses are widespread in higher education institutions worldwide, and empirical evidence of their impacts on students’ skill development is needed. This study examined students’ collaboration skill outcomes; whether outcomes vary by gender, academic achievement, field of study, course format (accelerated and semester based); and variations in outcomes across student groups and course classes. We used a pretest-posttest design in which 89% of students answered a self-report questionnaire about collaboration skills. The results indicate that the participating students’ interdisciplinary, interpersonal, and conflict management skills improved significantly from the beginning to the end of the course (p < .001, d > 0.4). We also found that the accelerated course format positively influenced the students’ conflict management skill outcomes and that the variability in the students’ overall collaboration outcomes was related to their student group (not their course classes). Another important takeaway from our study is that the students’ gender, academic achievement, and field of study showed little impact on their collaboration skills. The non-significance of the measured individual characteristics and the significance of the student group for students’ collaboration outcomes are important reminders for teachers in higher education to guide and support both their students’ learning and group processes in project-based courses.

Technology Focus: Well Testing (February 2023)

The energy transition is in a continuous pursuit of innovative technology applications from all corners of the oil and gas industry. With the exponential growth of carbon capture and sequestration (CCS) projects, similar subsurface appraisal objectives remain. Derisking dynamic reservoir performance and characterizing storage pore space are key enablers for prospective CCS projects. The mention of well testing often takes readers to a visualization of hydrocarbon disposition by a flare. Once a bright and vibrant spectacle of our industry’s exploration updates, the days of flaunting a chairman’s flow or banker’s burn are past. Waning application of well testing during our energy transition is a specious assumption, and it’s the optics that are transforming as the well testing discipline proves its value to long-term carbon storage projects. Injecting CO2 into the subsurface is hardly a new concept; operators have been doing this for decades as part of enhanced oil recovery. However, the application of injecting CO2 is changing in response to operators’ environmental, social, and governance ambitions. While carbon storage concepts exist in many forms, anchoring a storage project requires pore space of adequate quantity and quality in proximity to a fixed source of emissions. Carbon storage projects also must manage additional risks such as sustained injectivity performance, geologic seal integrity, and plume migration, to name a few. Enter well testing. Quantifying injection performance of supercritical fluids is crucial for optimizing wells to meet project needs while minimizing the number of required penetrations through a structural seal. Whether for a saline aquifer or a previously depleted field, pressure transient analysis enhances understanding of the pore space intended for storage and the potential heterogeneities within. Furthermore, integrating well testing with other reservoir-description tools may be used to monitor migration of stored fluids within the reservoir. With corporate and regulatory targets driving the unprecedented pace and scale of CCS opportunities, well testing is quickly reaffirming itself as a powerful tool in characterizing pore space essential to our lower-carbon goals. This month’s papers highlight ongoing developments within the well testing discipline and important reminders about how to properly use dynamic data. The application of these well testing fundamentals to a nascent carbon storage market is still evolving. Recommended additional reading at OnePetro: www.onepetro.org. SPE 208967 Rate-Pseudopressure Deconvolution Enhances Rate-Time Models Production History-Matches and Forecasts of Shale Gas Wells by L.M. Ruiz Maraggi, The University of Texas at Austin, et al. URTeC 3705570 Analysis of Multiple Flow/Buildup Tests Including a 5-year Buildup: Case Study of an Australian Shale Gas Well by Christopher R. Clarkson, University of Calgary, et al. OTC 31691 Challenges and Mitigation Strategies for High-Rate Gas Well Testing in High-Pressure/High-Temperature DST Operation by Jakpakorn Hemaprasertsuk, PTTEP, et al.

S3237 Pneumocystis jirovecii Infection in Cirrhosis: A Case Report and Review of the Literature

Introduction: Pneumocystis jirovecii is a fungus that causes serious pneumonia in immunocompromised individuals most classically associated with AIDS or prolonged steroid use. Immune dysfunction is a well- nown complication of cirrhosis; however, Pneumocystis pneumonia (PCP) is not typically associated with cirrhosis as a common risk factor. We present a case of PCP in a patient with cirrhosis and review the existing cases in the literature. Case Description/Methods: A 59-year-old male with past medical history of alcoholic cirrhosis (MELD 30, Child Pugh Class C) presented with sepsis secondary to spontaneous bacterial peritonitis. He reported he was 6 months sober. He initially improved on ceftriaxone alone; he did not receive steroids. On hospital day five he developed dyspnea and hypoxia. CT-angiogram revealed extensive ground glass opacities. Despite broad spectrum antimicrobials, his condition deteriorated resulting in invasive ventilation. Bronchoalveolar lavage was significant for Pneumocystis jiroveci by polymerase chain reaction. HIV testing was negative. Due to renal impairment, therapy was initiated with clindamycin and primaquine before he expired (Figure). Discussion: This case was unique in that cirrhosis was the only identified risk factor for immunosuppression which predisposed to PCP. PCP is rare outside of risk factors including AIDS, prolonged systemic steroids and other immunosuppressive therapies, organ transplantation, hematologic malignancy, and solid tumors. There were 14 similar cases in the literature. Of the 15 total cases, 66% were male; the median age was 54. Eleven were in the setting of alcoholic hepatitis, and 9 of these received steroids. However, none of the steroid exposures were significant enough to be a classic risk factor for PCP. Common comorbidities included COPD and lymphopenia. CMV pneumonia was seen in 33% of cases. Esophageal candidiasis and Histoplasma capsulatum pneumonia were also recorded. Fatality in 87% of cases suggests that PCP in cirrhosis is associated with a poor prognosis. There are multiple possible mechanisms why these patients developed PCP. Systemic inflammation related to cirrhosis may dysregulate key inflammatory mediators required for immune response to Pneumocystis. Also, Low CD4 counts related to portal hypertension and splenic sequestration may play a role, although an effective immune response also requires interplay of B cells and natural killer cells. This case and review are important reminders of the severity of immunocompromise in cirrhosis.Figure 1.: CT-Angiogram with diffuse ground glass opacities. Table 1. - Author Date Age/sex Prior steroid exposure (duration if applicable) Etiology of cirrhosis Additional conditions Treatment for PCP Death (y/n) Ikawa 2001 40M Y (10 days and 22 days with a 7 day interim in between) alcohol abuse cytomegalovirus pneumonia, esophageal candidiasis, lymphopenia none Y Faria 2007 44F present in 6 of 7 cases (median duration: 16 days)* alcohol abuse cytomegalovirus isolated in 3 of 7 cases* trimethoprim/ sulfamethoxazole (TMP/SMX) Y 49M alcohol abuse TMP/SMX Y 50M alcohol abuse TMP/SMX Y 53M alcohol abuse TMP/SMX Y 56F alcohol abuse TMP/SMX Y 58F alcohol abuse TMP/SMX Y 61M alcohol abuse TMP/SMX Y Dodi 2010 54F Y (9 days) alcohol abuse cytomegalovirus pneumonia, hepatorenal syndrome TMP/SMX Y Yee 2017 52M N hepatitis c hepatitis c, lymphopenia primaquine, clindamycin, corticosteroids, TMP/SMX N Hadfield 2019 63M N alcohol abuse COPD TMP/SMX Y Akhter 2020 67F N hepatitis c COPD steroids, antibiotics (unspecified) N Dugan 2020 64M N NASH COPD, lymphopenia, histoplasma capsulatum pneumonia TMP/SMX Y Chung 2020 43M Y (26 days) alcohol abuse n/a TMP/SMX Y Meyers 2022 59M N alcohol abuse COPD, lymphopenia clindamycin, primaquine Y *Not specified which cases had the exposures and/or conditions.

O9-2 Participants' and leaders' experiences of a family-based health promotion programme: A Healthy Generation

BackgroundFamily-based interventions may be a promising solution to increase children's physical activity, but there is a lack of knowledge on how to facilitate such interventions, specifically in socioeconomically disadvantaged areas. The aim of this study was to explore participants' and leader's experiences of the content and delivery of the family-based programme A Healthy Generation.MethodA Healthy Generation is a health-promoting programme, for families with children in grade 2 (8-9 years) including siblings. Intervention components are: activity sessions, parental support groups, healthy meals and health information. The programme is delivered twice a week for one school year in collaboration with local municipalities, health coordinators and a variation of invited sport organisations in socioeconomically disadvantaged areas. Data was collected through participant observations during activity sessions, interviews with leaders (n = 11), and four focus groups with parents (n = 27) who had participated in the programme. Data was transcribed verbatim and analysed using content analysis.ResultsLeaders' and participants' experienced the programme to have an appealing ?Family-concept for joy, activity and integration?. The variation of activities provided opportunities and challenges to new interests, and the family approach were perceived as valuable for parental engagement and integration. To be ?A suitable programme for all participants?, activities directed to whole families needed to be simple and fun to keep all participants engaged, but also provide a progression for learning. Free and locally situated activities, meals and equipment for whole families facilitated participation, whereas lack of time and socio-cultural differences were barriers. The programme delivery consisted of ?A fruitful leadership collaboration? where health coordinators played an important role as coordinators of a heterogeneous group, so the invited leaders could focus on the content of their sport. They also provided participants with continuity and important reminders for participation during and in-between activity sessions.ConclusionsParticipants' and leaders' experiences of a family-based health promoting programme give insight to the importance of local involvement, collaborative leadership and a well-adjusted family programme for health promotion. The study also draws attention to opportunities and barriers for increased integration through health promotion aimed at families in socioeconomically disadvantaged areas.

Camus, Roth, Covid-19: the dangers of forgetting

Pandemic literature (and there is a sprawling canon of it) tells us much about the past so that we can learn for our future, but we have been poor students. We should have been better prepared for Covid-19, and even merely scratching the surface of pandemic literature by examining Albert Camus’s The Plague and Phillip Roth’s Nemesis is very revealing. Despite the remarkable heterogeneity of our world, there are some things about disease that are shared globally, and many things that are recorded in literature are pertinent to the current pandemic situation. Remembering past pandemics is vital to dealing with future ones. This article argues that documentation of pandemics offers important reminders of epidemiology but also about how race, class, gender, and sexuality are involved both in the representation and in the movement of disease. Fiction gives us the chance to revise our thinking both about our relationship with microbes and about how we imagine a balance between individual liberties and social responsibility. These matters seemed to many of us entirely novel concerns brought out by the novel coronavirus. In reality, they are not novel and have long been the concerns of pandemic literature. There are great dangers in forgetting this.

Using clinical pathways to prospectively identify poor prognosis cancer patients: A preliminary analysis.

329 Background: Cancer patients in the last year of life may have different clinical needs and evolving goals of care. Helping clinicians consistently identify such patients in a systematic and prospective fashion, at a discrete moment in the care trajectory, is an important step towards optimizing the care of these patients. Methods: Physician medical directors for each clinical pathway at our institution were tasked with identifying nodes within their respective treatment pathways associated with poor prognosis, specifically a median overall survival of &lt; 12 months. This information was embedded into the underlying data model of the pathways platform, allowing us to determine how often clinicians navigated through poor prognosis nodes. Results: Pathways medical directors identified 44 nodes associated with poor prognosis. Some of these nodes encompassed a broader set of patients (metastatic pancreatic cancer, any line), whereas others were more specific (metastatic non-small cell lung cancer, squamous cell histology, second line or beyond). For the period 3/11/20 – 5/31/21, clinicians navigated in the platform for 11,057 unique patients. Of these, 1,234 (11.1%) unique patients were associated with poor prognosis nodes. Such navigations were much more common in patients with solid tumors (table). Conclusions: A well-maintained clinical pathways program can be a mechanism for defining clinical settings associated with poor prognosis and for routinely identifying patients in these settings. By embedding this into the pathways data model, we can provide physicians with important reminders and resources related to goals of care conversations, supportive care resources, and appropriate treatment options and clinical trials.[Table: see text]

EXPLORING THE IDEA OF EDUCATION FROM PHILOSOPHICAL STANDPOINT

This paper addresses the question of education by drawing from two significant philosophical texts – Plato’s cave allegory as book VII in his Republic and Kant’s What is Auflarung? (Enlightenment). They provide us with an important vantage point to problematize the question of education in the contemporary times. These classical texts have stood the challenges of times and today they provide us with important reminders as we struggle with the direction that education is taking. In the language of Giorgio Agamben, one can locate certain untimeliness to these texts, as their significance goes beyond any temporality. While providing the close reading of Plato’s cave allegory and Kant’s article, the paper explores three key ideas that emerge from these two texts – turning around, critique and Auflarung (enlightenment). By developing these ideas, the paper further explores their significance in the present times. The contemporary modern, utilitarian instrumental education has become bereft of the essence of education, which was always close to internal growth and development of an individual. In that light, it has become essential to draw from the work of scholars so that movement ahead can be charted.

The psychological and socio-political consequences of infectious diseases: Authoritarianism, governance, and nonzoonotic (human-to-human) infection transmission

What are the socio-political consequences of infectious diseases? Humans have evolved to avoid disease and infection, resulting in a set of psychological mechanisms that promote disease-avoidance, referred to as the behavioral immune system (BIS). One manifestation of the BIS is the cautious avoidance of unfamiliar, foreign, or potentially contaminating stimuli. Specifically, when disease infection risk is salient or prevalent, authoritarian attitudes can emerge that seek to avoid and reject foreign outgroups while favoring homogenous, familiar ingroups. In the largest study conducted on the topic to date (N &gt; 240,000), elevated regional levels of infectious pathogens were related to more authoritarian attitudes on three geographical levels: across U.S. metropolitan regions, U.S. states, and cross-culturally across 47 countries. The link between pathogen prevalence and authoritarian psychological dispositions predicted conservative voting behavior in the 2016 U.S. Presidential Election and more authoritarian governance and state laws, in which one group of people imposes asymmetrical laws on others in a hierarchical structure. Furthermore, cross-cultural analysis illustrated that the relationship between infectious diseases and authoritarianism was pronounced for infectious diseases that can be acquired from other humans (nonzoonotic), and does not generalize to other infectious diseases that can only be acquired from non-human species (zoonotic diseases). At a time of heightened awareness of infectious diseases, the current findings are important reminders that public health and ecology can have ramifications for socio-political attitudes by shaping how citizens vote and are governed.

Knowledge of Nonverbal Communication in Friday Sermons

This study identified the level of nonverbal communication knowledge (KNV) among Friday sermon orators. Friday sermons are observed to be an important medium at conveying important messages and reminders to the Muslim community, which is held every Friday. The technique of delivering a sermon will have a great impact on the congregation who listens to the sermon. This is becasue an impactful verbal delivery which is accompanied nonverbally, will provide an optimal impact to its audience. The combination of nonverbal and verbal communication will also increase the effectiveness of the sermon. This is because KNV is an important factor in attracting the audience’s interest and attention at continuing to listen to the sermon while receiving the conveyed message. Therefore, KNV is essentially needed by an effective sermon orator. This study is a quantitative research, which used a survey method involving 82 orators who responded to the questionnaire in order to find out the level of their on KNV. The findings show that the KNV among these Friday sermon orators who are based in Hulu Terengganu District achieve an overall mean which is at a moderately high level of 3.42, namely physical appearance 3.72, limb movement 3.28, facial expression 3.28, occultic 3.09, vocal 3.52 and chronological 3.60. Findings from this study is expected to encourage sermon orators to pay more attention on KNV during sermon delivery so that important messages can be effectively conveyed to the Muslim community and achieve the desired goals.

Knowledge of Nonverbal Communication in Friday Sermons

This study identified the level of nonverbal communication knowledge (KNV) among Friday sermon orators. Friday sermons are observed to be an important medium at conveying important messages and reminders to the Muslim community, which is held every Friday. The technique of delivering a sermon will have a great impact on the congregation who listens to the sermon. This is becasue an impactful verbal delivery which is accompanied nonverbally, will provide an optimal impact to its audience. The combination of nonverbal and verbal communication will also increase the effectiveness of the sermon. This is because KNV is an important factor in attracting the audience’s interest and attention at continuing to listen to the sermon while receiving the conveyed message. Therefore, KNV is essentially needed by an effective sermon orator. This study is a quantitative research, which used a survey method involving 82 orators who responded to the questionnaire in order to find out the level of their on KNV. The findings show that the KNV among these Friday sermon orators who are based in Hulu Terengganu District achieve an overall mean which is at a moderately high level of 3.42, namely physical appearance 3.72, limb movement 3.28, facial expression 3.28, occultic 3.09, vocal 3.52 and chronological 3.60. Findings from this study is expected to encourage sermon orators to pay more attention on KNV during sermon delivery so that important messages can be effectively conveyed to the Muslim community and achieve the desired goals.

Kierkegaard at the Intersections: The Single Individual and Identity Politics

Kierkegaard’s authorship is frequently charged with being so radically individualistic that his work is of little use to social theory. However, in this essay, I argue that Kierkegaard’s notion of “the single individual” actually offers important critical resources for some aspects of contemporary identity politics. Through a focused consideration of the two notes that form the little essay, “The Individual” (published with Point of View), I suggest that Kierkegaard does not ignore embodied historical existence, as is sometimes claimed, but instead simply rejects the idea that one’s moral dignity is determined by, or reducible to, such embodied differentiation. Instead, what we find in Kierkegaard is a rejection of the quantitative judgment of “the crowd” in favor of the qualitative neighbor-love of community. In light of Kierkegaard’s claim that it is the specifically religious category of the single individual that makes possible true human equality, I contend that we can develop a Kierkegaardian identity theory consistent with some aspects of the standpoint and intersectionality theory of Patricia Hill Collins and Kimberlé Crenshaw. Although Collins and Crenshaw operate at a structural level and Kierkegaard works at a theological level, they all offer important reminders to each other about the stakes of lives of meaning in light of the embodied task of social justice.

In praise of dystopias: a Hobbesian approach to collective action

ABSTRACT Long before Prospect Theory and Loss Aversion Theory, Thomas Hobbes’s account of self-interest and risk assessment formed the basis of a powerful argument for the benefits of negative appeals. Dismissing the pursuit of highest and final goods as inherently incapable of yielding collective action, Hobbes proposed a method focusing instead on the highest evil, something that individuals with different goals could agree on as a barrier to their respective pursuits. In his own theory, that evil was violent death in the dystopian setting of his notorious state of nature. The staying power of Hobbes’s memorable image itself validates Hobbes’s rationale and offers important reminders regarding the limits of utopian appeals to collective action.

Brothers in Arms: American Independence and the Men of France and Spain Who Saved It

Brothers in Arms: American Independence and the Men of France and Spain Who Saved It

Validation of the Insomnia Severity Index (ISI) for identifying insomnia in young adult cancer survivors: comparison with a structured clinical diagnostic interview of the DSM-5 (SCID-5)

ObjectivesInsomnia is a common problem affecting young adult cancer survivors (YACS) even years after treatment, yet it often goes unidentified and untreated. The Insomnia Severity Index is a widely-used insomnia measure, but has not been studied as an insomnia screener for YACS. The goal of this study was to validate the ISI in YACS by determining its utility in identifying YACS with insomnia disorder diagnosed with the Structured Clinical Interview for the DSM-5 (SCID-5). Methods250 YACS completed the ISI and SCID-5 Insomnia Module. Area under the curve (AUC) was calculated to reflect the ISI's discrimination between YACS with and without SCID-5 insomnia disorder. An ISI cut-off score with sensitivity ≥0.85 and specificity ≥0.75 was deemed acceptable. ResultsOf 250 participants, 52 met criteria for SCID-5 insomnia disorder diagnosis. The ISI had excellent discrimination, with an AUC = 0.91. A cut-off score ≥8 met study clinical screening criteria with sensitivity of 0.85 and specificity of 0.77. A cut-off score ≥7 with a higher sensitivity (0.96) but lower specificity (0.70) was noted as a potential alternative. Cut-off scores ≥12 and ≥ 14 were recommended for applications prioritizing overall accuracy. ConclusionsResults support validity of the ISI for identifying YACS with insomnia disorder. For clinical screening, data support the use of an ISI cut-off score ≥8 in YACS, and additional cut-off scores were found for research purposes or higher sensitivity. Results of this study and prior studies of the ISI offer important reminders that cut-off scores derived from different populations are not generalizable.

Importance of Metrics and Nurse-Sensitive Indicators.

We are constantly reminded of the importance of monitoring our patient outcome metrics and benchmarking our nurse-sensitive indicators to determine the quality and effectiveness of nursing care. Although the article by Connor et al is focused on developing tools to measure nurse-sensitive quality metrics in pediatric cardio-vascular care, there are some important reminders for the nursing community caring for adults. Nurse-sensitive indicators help us to benchmark and compare performance, share best practices for improving quality, and better inform nurse staffing models.So why is this important now? We are in various levels of contingency to crisis operations during a pandemic. Supplies may be limited—but really, doesn’t that happen even when we aren’t in pandemic mode? Intravenous tubings, medication shortages … the list goes on. Granted, we aren’t used to having shortages of personal protective equipment. Staffing models have been adapted—again, individual units and hospitals may have to deal with similar issues during a particularly aggressive influenza season (anyone remember 2009?). Patients may be staying longer in our units, leaving them susceptible to all of the negative outcomes of hospital-acquired conditions that we are dealing with on a routine basis. It is even more important to know how this current environment has affected patients’ outcomes and what we have learned.

Drinking Stories Among Climbers and Older Athletes in France and Australia

Despite stories about drinking being the focus of the research with young people, holiday makers, stag tour participants and college fraternities, stories of drinking among sportspeople have not featured significantly in the scholarship, even though alcohol consumption is a central feature in many aspects of sporting cultures and communities. Drawing on qualitative interviews with climbers in France and older athletes in Australia, the paper explores the ways in which drinking stories operate to confer accomplishment of a physical task (such as climbing) and to demarcate belonging to a membership group. In a departure from the literature on drinking stories in contemporary societies, these are not the themes of drinking to excess, transgression or vulgarity that are found in drinking stories by other social groups. When analysed together, however, they offer insights into the meanings ascribed to the social exchanges in drinking and offer important reminders of the consequences for drinking behaviours in sport. That similar themes of drinking stories were found in different sporting and geographical settings alerts us to the importance of drinking talk in sport; its absence in the scholarship highlighting the need to better understand the diversity of drinking in contemporary social life.

Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period

BackgroundAwareness with recall under general anesthesia remains a rare but important issue that warrants further study.MethodsWe present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics.ResultsThe low number of identified cases suggests an under-reporting bias. Themes that emerge from this small series can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identified anesthetic awareness cases include: obesity, use of total intravenous anesthesia, use of neuromuscular blockade, and either a lack of processed electroencephalogram (EEG) monitoring or documented high depth of consciousness index values. An interesting phenomenon was observed in one case, where adequately-dosed anesthesia was delivered without technical issue, processed EEG monitoring was employed, and the index value suggested an adequate depth of consciousness throughout the case.ConclusionsProvider-reported adverse event data in the immediate post-operative period are likely insensitive for detecting cases of intraoperative awareness. Though causation cannot firmly be established from our data, themes identified in this series of cases of awareness with recall under general anesthesia provide important reminders for anesthesia providers to maintain vigilance in monitoring depth and dose of anesthesia, particularly with total intravenous anesthesia.