The Use of Aprepitant versus Ondansetron in the Prevention of Postoperative Nausea and Vomiting (PONV) in Adult Patients Undergoing General Anesthesia

Background: The incidence of postoperative nausea and vomiting (PONV) following general anesthesia remains high despite the increasing number of healthcare advances. Aprepitant has demonstrated promising effectiveness in the prevention of PONV and can add value to current healthcare practices. Further investigation is needed to determine aprepitant’s effectiveness and best use to create practice recommendations. Objectives: (1) To evaluate the effectiveness of aprepitant versus ondansetron in the prevention of PONV utilizing three databases: PubMed, CINAHL, and EMBASE. This systematic review will serve as the basis for objective two. (2) To demonstrate an increase in knowledge of anesthesia providers pertaining to the use of aprepitant in the prevention of PONV. Methodology: Ten articles, including eight randomized controlled trials (RCTs) and two systematic reviews, were deemed eligible for use in this systematic review. Based on the evidence from these ten articles, aprepitant was found to have superior protection against PONV in comparison to ondansetron; aprepitant in combination with ondansetron was shown to have more effectiveness than ondansetron alone against PONV; and aprepitant demonstrated improved effectiveness in the prevention of postoperative vomiting and time to first vomiting episode. With this information, a pre-test, educational module, and post-test were created for anesthesia providers to evaluate baseline knowledge and knowledge growth. Results: The statistical analysis between the pre-test and post-test demonstrated an increase in provider knowledge on PONV and use of aprepitant. Conclusions: Aprepitant administered alone along with aprepitant administered with ondansetron is more effective than ondansetron alone in reducing PONV rates. Implementation of an educational based intervention increased providers knowledge on information pertaining to aprepitant and its use in the prevention of PONV. Continual implementation of this quality improvement project has the potential to lead to decreased PONV rates, improved patient outcomes, and increased patient satisfaction. Keywords: Aprepitant, Antiemetic, Ondansetron, Nausea, Vomiting, Postoperative nausea and vomiting (PONV

What Stays in Mind? - Retention Rates in Programming MOOCs

This work presents insights about the long-term effects and retention rates of knowledge acquired within MOOCs. In 2015 and 2017, we conducted two introductory MOOCs on object-oriented programming in Java with each over 10,000 registered participants. In this paper, we analyze course scores, quiz results and self-stated skill levels of our participants. The aim of our analysis is to uncover factors influencing the retention of acquired knowledge, such as time passed or knowledge application, in order to improve long-term success. While we know that some participants learned the programming basics within our course, we lack information on whether this knowledge was applied and fortified after the course's end. To fill this knowledge gap, we conducted a survey in 2018 among all participants of our 2015 and 2017 programming MOOCs. The first part of the survey elicits responses on whether and how MOOC knowledge was applied and gives participants opportunity to voice individual feedback. The second part of the survey contains several questions of increasing difficulty and complexity regarding course content in order to learn about the consolidation of the acquired knowledge. We distinguish three programming knowledge areas in the survey: First, understanding of concepts, such as loops and boolean algebra. Second, syntax knowledge, such as specific keywords. Third, practical skills including debugging and coding. We further analyzed the long-term effects separately per participant skill group. While answer rates were low, the collected data shows a decrease of knowledge over time, relatively unaffected by skill level. Application of the acquired knowledge improves the memory retention rates of MOOC participants across all skill levels

Continuous intraoperative recurrent laryngeal nerve monitoring : techniques, applications, and controversies

Purpose of Review Purpose of the present review is to illustrate the current state of the art concerning continuous intraoperative recurrent laryngeal nerve monitoring (cIONM) for thyroid surgery. Recent Findings cIONM potentially leads to an improved postoperative vocal cord palsy rate, compared to the intermittent technique. There are currently two main approaches for cIONM: either conventional cIONM based on vagal nerve stimulation or experimental methods, which do not require the positioning of a vagal nerve electrode. One of these methods is the recently described technique “LAR-cIONM,” which utilizes the laryngeal adductor reflex. Summary cIONM represents an advancement of intermittent nerve monitoring, which allows for an immediate reaction to signal changes. Threshold values and guidelines to prevent recurrent laryngeal nerve palsy were validated for the direct stimulation of the vagal nerve and require verification for alterative cIONM methods, including LAR-cIONM

Distribution and Source of Barium in Ground Water at Cattaraugus Indian Reservation, Southwestern New York

High concentrations of dissolved barium have been found in ground water from bedrock wells on the Seneca Nation of Indians Reservation on Cattaraugus Creek in southwestern New York. Concentrations in 1982 were as high as 23.0 milligrams per liter , the highest found reported from any natural ground-water system in the world. The highest concentrations are in a bedrock aquifer and in small lenses of saturated gravel between bedrock and the overlying till. The bedrock aquifer is partly confined by silt, clay, and till. The high barium concentrations are attributed to dissolution of the mineral barite (BaSO4), which is present in the bedrock and possibly in overlying silt, clay, or till. The dissolution of barite seems to be controlled by action of sulfate-reducing bacteria, which alter the BaSO4 equilibrium by removing sulfate ions and permitting additional barite to dissolve. Ground water from the surficial, unconsolidated deposits and surface water in streams contain little or no barium. Because barium is chemically similar to calcium, it probably could be removed by cation exchange or treatments similar to those used for water softening. (USGS

Epigenetic chromatin modification by amber suppression technology

The genetic incorporation of unnatural amino acids (UAAs) into proteins by amber suppression technology provides unique avenues to study protein structure, function and interactions both in vitro and in living cells and organisms. This approach has been particularly useful for studying mechanisms of epigenetic chromatin regulation, since these extensively involve dynamic changes in structure, complex formation and posttranslational modifications that are difficult to access by traditional approaches. Here, we review recent achievements in this field, emphasizing UAAs that help to unravel protein-protein interactions in cells by photo-crosslinking or that allow the biosynthesis of proteins with defined posttranslational modifications for studying their function and turnover in vitro and in cells

Nanoporous Au/Ag Catalyzed Benzylic sp3C−H Oxidation of 9H-Fluorene Derivatives and Similar Molecules with TBHP

Nanoporous gold (npAu) was tested as a catalyst for oxidations of various benzylic sp3-carbon positions in 9H-fluorene derivatives and similar hydrocarbons using tertbutyl hydroperoxide (TBHP) as an oxidant. The silver content in the npAu catalyst had a major influence on the overall conversion: Lower silver amounts (0.53 mol%) led to higher conversions, whereas higher amounts of silver increasingly resulted in the disproportionation of TBHP as a competing reaction. Because residual silver from the bulk alloy was oxidized by TBHP and leached into the solution during the reaction, the Ag content diminished over time. Therefore, the recycling of the catalyst had a positive effect on the conversion after each use. Using electron paramagnetic resonance (EPR) spectroscopy, the formation of radicals from TBHP by npAu was evidenced indicating a radical-based reaction mechanism which was further elucidated by NMR spectroscopic and GC-MS (trace) product analysis. Subsequent oxidations of benzylic sp3-carbon positions gave good to excellent conversions and chemoselectivities featuring npAu as a suitable catalyst for such reactions

Characterization of a Temperature-Sensitive Vertebrate Clathrin Heavy Chain Mutant as a Tool to Study Clathrin-Dependent Events In Vivo

Clathrin and clathrin-dependent events are evolutionary conserved although it is believed that there are differences in the requirement for clathrin in yeast and higher vertebrates. Clathrin is a long-lived protein and thus, with clathrin knockdowns only long-term consequences of clathrin depletion can be studied. Here, we characterize the first vertebrate temperature-sensitive clathrin heavy chain mutant as a tool to investigate responses to rapid clathrin inactivation in higher eukaryotes. Although we created this mutant using a clathrin cryo-electron microscopy model and a yeast temperature-sensitive mutant as a guide, the resulting temperature-sensitive clathrin showed an altered phenotype compared to the corresponding yeast temperature-sensitive clathrin. First, it seemed to form stable triskelions at the non-permissive temperature although endocytosis was impaired under these conditions. Secondly, as a likely consequence of the stable triskelions at the non-permissive temperature, clathrin also localized correctly to its target membranes. Thirdly, we did not observe missorting of the lysosomal enzyme beta-glucuronidase which could indicate that the temperature-sensitive clathrin is still operating at the non-permissive temperature at the Golgi or, that, like in yeast, more than one TGN trafficking pathway exists. Fourthly, in contrast to yeast, actin does not appear to actively compensate in general endocytosis. Thus, there seem to be differences between vertebrates and yeast which can be studied in further detail with this newly created tool