Open Access Funding Research Articles

Unrestricted drinking before surgery: a structured patient interview.

Our recent study [1] showed that unrestricted drinking before surgery, and its implementation using fasting cards, shortened the median pre-operative liquid fasting time to 2.1 h. Although adherence to the guidelines was significantly improved, critics questioned whether patients drink too much liquid immediately before induction of anaesthesia. Therefore, we evaluated our study data regarding patients' drinking behaviour. In the third PDSA cycle [1], 25 weeks after the implementation of fasting cards, 143 patients underwent a structured interview. The results are summarised in Table 1. On the day of surgery, 130 (91%) patients had drunk at least 100 ml of liquid or at least 2 ml.kg−1 if they were children. The minimum time interval between drinking clear liquids and induction of anaesthesia was 25 min (Fig. 1). The median (IQR [range]) volume of the last liquid intake before induction of anaesthesia was 200 (150–250 [50–500]) ml. Patients were asked about the total amount drunk on the day of surgery. Of 108 patients, six had not drunk anything at all, two patients had only taken a few sips with their morning medication and two infants had drunk 50 ml each. Of the remaining 98 patients, the median (IQR [range]) pre-operative cumulative drinking volume was 400 (200–500 [100–1500]) ml, and was higher when anaesthesia was induced later in the day. Patients with induction of anaesthesia before 11.00 (n = 44) had drunk a median (IQR [range]) of 250 (200–363 [100–500]) ml, while patients with induction of anaesthesia after 11.00 (n = 54) had drunk a median (IQR [range]) of 500 (400–750 [100–1500]) ml; p < 0.0001. Regarding drinking quantities, patients drank small amounts repeatedly, hence the pre-operative total liquid intake increased as the day went on. Patients who usually drink little and may still be worried about urinary urgency also drink little pre-operatively. For them, small sips are enough to reduce thirst and dry mouth [2]. Thus, the lowest pre-operative cumulative drinking volume at anaesthetic induction, both before and after 11.00, was 100 ml. Other patients liked to drink more during the day; the largest cumulative total when anaesthetic induction was after 11.00 was 1500 ml, which was three times the largest cumulative total when anaesthetic induction was before 11.00 (500 ml). For elderly patients in particular, it is important to drink in the morning; these patients consume about 60% of their daily liquid intake between 05.00 and 13.00 and another 30% until 19.00. They might intentionally avoid drinking in the evening because they are concerned regarding night-time incontinence [3]. Therefore, the risk of peri-operative dehydration in this group is relatively high. Prolonged deprivation of fluids harms patients [4], but forcing them to drink more than they want to, for example in the context of studies with rigid drinking instructions, makes them uncomfortable. Patients who drank an amount they were used to had less anxiety [2], and anxiety regarding their operation is the most troublesome aspect for many patients [5]. Unrestricted drinking before surgery allows patients to drink on the day of surgery in the manner they are used to and find comfortable. Therefore, only 3.5% of our study patients reported severe thirst, even though thirst appears to be the most frequent feature of peri-operative discomfort [5]. Unrestricted intake of clear liquids before induction of anaesthesia has been shown to reduce the incidence of postoperative nausea and vomiting [6, 7], a predictor of patient dissatisfaction with anaesthesia [7, 8]. Only 2.8% of our patients required an anti-emetic in the recovery room. Our study has some limitations. In the interviews, the patients were able to state the time of the last liquid intake very precisely. However, the amount of liquid last drunk sometimes referred to a time-period rather than a time-point. Thus, the last amount of liquid consumed may have been overestimated. Data on the total amount drunk on the day of surgery were not available for 35 patients as this question was only added to the interview on the second day of the survey. In summary, patients were allowed unrestricted drinking before surgery, drank wisely and according to their needs. The amount and type of liquid desired were highly individual. This liberal liquid regime may prevent peri-operative anxiety, stress, postoperative nausea and vomiting, postoperative delirium and other complications. No competing interests declared. Open Access funding enabled and organized by Projekt DEAL.

Erratum: Life-history traits drive spatial genetic structuring in Dinaric cave spiders

An omission to the funding section of the original article was made in error. The following sentence has been added: "Open access funding was provided by the University Of Geneva".The original version of this article has been updated.

Don't sugar coat it: The independent and synergistic impacts of obesity and gestational diabetes on placental parameters.

Don't sugar coat it: The independent and synergistic impacts of obesity and gestational diabetes on placental parameters.

Erratum: Enhancing biomass utilization by combined pulp and fuel production

An erratum on: Granacher J, Nguyen T-V, Castro-Amoedo R, McDonald EC and Maréchal F (2022) Enhancing biomass utilization by combined pulp and fuel production. Front. Energy Res. 10:979502. doi: 10.3389/fenrg.2022.979502An omission to the funding section of the original article was made in error. The following sentence has been added: "Open access funding was provided by the École Polytechnique Fédérale de Lausanne".The original version of this article has been updated.

Author preferences for open access in Portugal: survey findings

PurposeSurveying authors at doctoral-granting institutions of higher education in Portugal, the authors in this paper aim to seek to determine the extent to which Portuguese researchers prefer that their work appears in open access journals or open access repositories resulting in improved access to quality, peer-reviewed scientific information and faster scientific and technological advances. The authors also seek to gauge Portuguese author's familiarity with open access, the importance they attach to open access when choosing a publication outlet, and to determine their preferences for achieving open access.Design/methodology/approachThe methodology adopted in this research is the case study. The case study intends to understand a complex social phenomenon through an in-depth study holistically. In May 2020, the authors distributed a survey to faculty in all academic ranks at 14 Portuguese higher education institutions to learn the extent to which Portuguese authors currently make their research openly available, ascertain their awareness of open access, their support of the European Union (EU) open access goal and their preferences for achieving open access.FindingsResearchers at Portuguese universities overwhelmingly are aware of arguments in favor of open access and believe that open access benefits researchers in their fields. Portuguese researchers regularly publish in open access journals and deposit their papers in institutional or disciplinary repositories.Research limitations/implications16.7% of 740 potential respondents completed the survey. The relatively low response rate prevents extrapolations from being made to the universe. The study was implemented during the COVID-19 pandemic, which, due to the disruption created in all sectors, made data collection complex and delayed its subsequent treatment.Originality/valueSimilar studies have been conducted at individual universities and in particular disciplines to determine the degree to which their faculty authors are aware of open access, its benefits, and preferences for achieving it. A similar study of Bulgarian university authors was conducted in 2018. No previous study of Portuguese authors at institutions of higher education has been conducted. The results will be useful to Portuguese institutions of higher education and academic libraries to establish and revise open access outreach and implementation services that may be helpful to their faculty in meeting EU open access and funder open access requirements.

How do the skin barrier and microbiome adapt to the extra-uterine environment after birth? Implications for the clinical practice.

The multiple protective functions of the skin derive from the interactions between epithelial skin and immune cells as well as the commensal microbiota. Developed in the last trimester of intra-uterine life, the skin barrier adapts dynamically after birth. Specific differences in the structure and physiology have been disclosed between infant and adult skin. The stratum corneum of infants is thinner and structured by thicker corneocytes with a more anisotropic surface in comparison to adult skin. Lower levels of the natural moisturizing factor and its constituents, together with the increased protease activity in the epidermis result in dry baby skin and ongoing adaptation of the desquamation to the extra-uterine environment. Infant epidermis is characterized by an accelerated proliferation rate and clinically competent permeability barrier in term neonates, despite the higher baseline values of transepidermal water loss in infants. The skin surface of newborns is less acidic, which could increase susceptibility to diaper and atopic dermatitis. Immediately after birth, skin is colonized by commensal bacteria-a process dependent on the mode of delivery and of major importance for the maturation of the immune system. Skin bacterial diversity and dysbiosis have been related to different pathology such as atopic and seborrheic dermatitis. This paper focuses on the ongoing structural, functional and biochemical adaptation of the human skin barrier after birth. We discuss the interactions on the 'skin barrier/ microbiota/ immune system' axis and their role in the development of competent functional integrity of the epidermal barrier.

The leaf sheath promotes prolonged flooding protection by giving rise to specialized adventitious roots.

This article is a Commentary on Lin et al. (2023), 238: 1403–1419.

Two Cases of TMEM151A-Associated Paroxysmal Dyskinesia in a Single-Center Series of PRRT2-Negative Patients.

Two Cases of TMEM151A-Associated Paroxysmal Dyskinesia in a Single-Center Series of PRRT2-Negative Patients.

Erratum: Measuring democracy among ordinary citizens—Challenges to studying democratic ideals

An erratum on: Refle J-E (2022) Measuring democracy among ordinary citizens—Challenges to studying democratic ideals. Front. Polit. Sci. 4:934996. doi: 10.3389/fpos.2022.934996An omission to the funding section of the original article was made in error. The following sentence has been added: "Open access funding was provided by the University of Lausanne".The original version of this article has been updated.

Erratum: Patterns of (de)politicization in times of crisis: Swiss residents' political engagement, 1999-2020

An erratum on: Marquis L, Kuhn U and Monsch G-A (2022) Patterns of (de)politicization in times of crisis: Swiss residents' political engagement, 1999–2020. Front. Polit. Sci. 4:981919. doi: 10.3389/fpos.2022.981919 An omission to the funding section of the original article was made in error. The following sentence has been added: "Open access funding was provided by the University of Lausanne".The original version of this article has been updated.

Erratum: New findings on compositionally distinct maar volcanoes: A case study from Acıgöl (Nevşehir) caldera (Central Anatolia, Turkey)

An erratum on: Uslular G, Gençalioğlu Kuşcu G, Bégué F, Ruch J, Lupi M, Higgins O and Caricchi L (2022) New findings on compositionally distinct maar volcanoes: A case study from Acıgöl (Nevşehir) caldera (Central Anatolia, Turkey). Front. Earth Sci. 10:909951. doi: 10.3389/feart.2022.909951An omission to the funding section of the original article was made in error. The following sentence has been added: "Open access funding was provided by the University of Geneva".The original version of this article has been updated.

Erratum: Kinematics and geomorphological changes of a destabilising rock glacier captured from close-range sensing techniques (Tsarmine rock glacier, Western Swiss Alps)

An erratum on: Vivero S, Hendrickx H, Frankl A, Delaloye R and Lambiel C (2022) Kinematics and geomorphological changes of a destabilising rock glacier captured from close-range sensing techniques (Tsarmine rock glacier, Western Swiss Alps). Front. Earth Sci. 10:1017949. doi: 10.3389/feart.2022.1017949An omission to the funding section of the original article was made in error. The following sentence has been added: "Open access funding was provided by the University of Lausanne".The original version of this article has been updated.

You are what you eat? Rodent study suggests defended body weight mainly dictated by fatcontent of diet.

Preclinical and clinical data suggest that body weight (i.e., body fat) is physiologically regulated, and the high heritability seen from monozygotic twin studies suggests a genetic basis to one's defended body weight. Genome-wide association studies have found that a high proportion of variants that correlate with elevated body mass index are expressed in the central nervous system, signifying that the molecular predicates that likely encode for defended body weight will be found in the brain [(1)]. In this context, an individual integrates peripheral signals (e.g., adipokines, myokines, hepatokines) relaying the metabolic state of various tissues to the brain and reacts to maintain relatively stable weight. However, the recent increased prevalence of obesity/overweight reveals that environmental factors must be influencing this system, and why some people are more susceptible to weight gain in a given environment is not fully understood [(2)]. In this issue, Fang et al. [(3)] present an interesting and thorough set of experiments that demonstrate how fat content in diet affects defended body weight in C57BL/6N mice. By changing the macronutrient composition (fat and carbohydrate) of diets and undertaking switches in diet at different ages (young and adult) and for different durations (4, 8, or 24 weeks), as well as putting mice through rounds of weight gain and weight loss (yo-yo dieting), they provide strong evidence that the major driver of defended body weight in these animals is the amount of fat within the diet. The key takeaway message is that higher-fat diets (HFDs, i.e., diets with 45% fat or more) cause defense of an elevated body weight plateau, whereas lower-fat diets (LFDs, i.e., diets with 10% or 25% fat) cause defense of a lower body weight plateau irrespective of the age at which the diets start or their duration. Furthermore, HFD- and LFD-fed animals showed similar physiology to a 16-hour fast, and switching mice back to LFDs after HFD feeding caused rapid and sustained weight loss, with most groups returning to the LFD-fed weight. They suggest that HFDs do not impede normal physiological defense of body weight but rather cause an increase to a new defended body weight. This paradigm shift is subtle but important. Although understanding the mechanisms behind these findings is beyond the scope of the paper, increases in circulating lipids from diets have been causally linked to inflammation of the hypothalamus and may, in part, explain the present findings [(4)]. Of course, humans are exposed to many different variables that are hard to replicate in rodent models. For example, workers are much more sedentary than in the past, numerous excess calories are consumed through simple sugars found in soft drinks, and we undertake numerous activities and hobbies that directly affect our daily metabolic rate. All of these parameters likely contribute to our defended body weight; however, the diet likely remains one of the major modifiable inputs. The search for the molecular underpinnings of defense of body weight will continue to evolve with each new study adding to our overall understanding of this important physiological regulation; however, this study [(3)] clearly demonstrates that fat content seems directly implicated in body weight regulation. The type of food we eat likely influences the system of how our body weight is regulated, and understanding these interactions is crucial. This study suggests that eating diets high in fat may result in the overconsumption of calories leading to elevated body weight. Would you like meringue and gruyère double cream just after having eaten a large fondue? Of course you would. Open access funding provided by Universite de Fribourg. The author declared no conflict of interest.

Teaching resilience in fragile times

Teaching resilience in fragile times

“Ideology and simultaneously more than mere ideology”: On Habermas’ reflections and hypotheses on a further structural transformation of the political public sphere

“Ideology and simultaneously more than mere ideology”: On Habermas’ reflections and hypotheses on a further structural transformation of the political public sphere

For my friend Richard J. Bernstein

For my friend Richard J. Bernstein

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Ganz entspannt im hier und jetzt: Fostering social presence in communicative language instruction—Before, during, and after the pandemic

Ganz entspannt im hier und jetzt: Fostering social presence in communicative language instruction—Before, during, and after the pandemic

The strange route of an umbilical venous catheter

Journal of Paediatrics and Child HealthVolume 59, Issue 3 p. 593-594 Case ImagesOpen Access The strange route of an umbilical venous catheter First published: 28 March 2023 https://doi.org/10.1111/jpc.1_16038AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Answer The pattern was confirmed by echographic evaluation showing the catheter reaching the heart through the whole inferior vena cava (Fig. 2) without evidence of ductus venosus patency. The umbilical venous catheter passed through the right internal iliac vein (IIV) and then arrived to the heart passing through the inferior vena cava bypassing the liver. The patient had no other cardiovascular abnormalities on clinical and imaging evaluations. Fig. 2Open in figure viewerPowerPoint Ultrasound showing the catheter reaching the heart passing through the whole inferior vena cava. This is a rare case of extrahepatic insertion of the umbilical vein in the right IIV, different to the previously reported cases of insertion in the left IIV1-4 or umbilical vein bifurcation, with a suggested origin consequent to a resorption in early fetal life of both umbilical veins rather than only the right one.1 This anomaly has possible prenatal diagnosis3 and syndromic associations.1 A consent for image publication was obtained from the child's parents. Acknowledgement Open Access Funding provided by Universita degli Studi di Padova within the CRUI-CARE Agreement. References 1Currarino G, Stannard MW, Kolni H. Umbilical vein draining into the inferior vena cava via the internal iliac vein, bypassing the liver. Pediatr. Radiol. 1991; 21: 265– 6. 2Fliegel CP, Nars PW. Aberrant umbilical vein. Pediatr. Radiol. 1984; 14: 55– 6. 3Gorincour G, Droullé P, Guibaud L. Prenatal diagnosis of umbilicoportosystemic shunts: Report of 11 cases and review of the literature. AJR Am. J. Roentgenol. 2005; 184: 163– 8. 4Leonidas JC, Fellows RA. Congenital absence of the ductus venosus: With direct connection between the umbilical vein and the distal inferior vena cava. AJR Am. J. Roentgenol. 1976; 126: 892– 5. Volume59, Issue3March 2023Pages 593-594 FiguresReferencesRelatedInformation

Democratic faith. A philosophical profile of Richard J. Bernstein

Democratic faith. A philosophical profile of Richard J. Bernstein