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The evidence supporting intraoperative use of processed electroencephalography monitoring to guide anesthetic delivery is rapidly maturing. This article reviews key features of electroencephalography waveforms and their clinical implications in selected patient populations and anesthetic techniques. The first patient topic reviewed is the vulnerable brain. This phrase has emerged as a description of patients who may exhibit increased sensitivity to anesthetics and/or may develop adverse neurocognitive effects following an anesthetic. Processed electroencephalography monitoring of patients with a known or suspected vulnerable brain with focused attention on the suppression ratio, alpha band power, and processed electroencephalography indices may prove useful. Second, processed electroencephalography monitoring along with vigilant attention to anesthetic delivery may minimize the risk of intraoperative awareness when providing a total intravenous anesthetic in combination with neuromuscular blockade. Third, we suggest that processed electroencephalography monitoring has a role in anesthetic and resuscitative management when faced with adverse changes in blood pressure. Fourth, processed electroencephalography monitoring can better identify anesthetic requirements and guide anesthetic titration in patients with known or suspected substance use.

Supplemental material, sj-docx-1-tct-10.1177_15330338221127169 for A Multimodal Approach to Discover Biomarkers for Taxane-Induced Peripheral Neuropathy (TIPN): A Study Protocol by Anukriti Sharma, PhD, Ken B. Johnson, MD, Bihua Bie, MD, PhD, Emily E. Rhoades, PhD, Alper Sen, MD, Yuri Kida, MS, Jennifer Hockings, PharmD, PhD, Alycia Gatta, BS, Jacqueline Davenport, MS, Connie Arcangelini, BS, Jennifer Ritzu, BS, Jennifer DeVecchio, BS, Ron Hughen, BS, Mei Wei, MD, G. Thomas Budd, MD, N. Lynn Henry, MD, Charis Eng, MD, PhD, Joseph Foss, MD, and Daniel M. Rotroff, PhD in Technology in Cancer Research & Treatment

Supplemental material, sj-docx-1-tct-10.1177_15330338221127169 for A Multimodal Approach to Discover Biomarkers for Taxane-Induced Peripheral Neuropathy (TIPN): A Study Protocol by Anukriti Sharma, PhD, Ken B. Johnson, MD, Bihua Bie, MD, PhD, Emily E. Rhoades, PhD, Alper Sen, MD, Yuri Kida, MS, Jennifer Hockings, PharmD, PhD, Alycia Gatta, BS, Jacqueline Davenport, MS, Connie Arcangelini, BS, Jennifer Ritzu, BS, Jennifer DeVecchio, BS, Ron Hughen, BS, Mei Wei, MD, G. Thomas Budd, MD, N. Lynn Henry, MD, Charis Eng, MD, PhD, Joseph Foss, MD, and Daniel M. Rotroff, PhD in Technology in Cancer Research & Treatment

This article is the winner of the Real Estate and the Internet manuscript prize (sponsored by PricewaterhouseCoopers) presented at the American Real Estate Society Annual Meeting.Brokers have long ...

Recently, the use of artificial stucco (formally known as Exterior Insulation and Finish Systems, or EIFS) on residential real estate properties has been a topic of much debate. This article discusses the issues surrounding EIFS use. Hypotheses are developed and tested regarding the impact of EIFS on property value and marketing time. The results indicate that the market is not discounting EIFS clad homes, but that the presence of EIFS significantly extends a property's marketing time. These findings are consistent with the theoretical framework and are compatible with inefficient local real estate markets.

A rapid emergence from anesthesia combined with an extended duration of adequate analgesia is desired. Difficulties arise when trying to achieve a rapid emergence and provide adequate analgesia for procedures associated with moderate post operative pain. We propose to use pharmacokinetic (PK) and pharmacodynamic (PD) models with optimization techniques to determine anesthetic drugs ratios to improve post-anesthetic outcomes of emergence and analgesia. We hypothesize that optimized propofol, remifentanil, and fentanyl administrations will shorten emergence time and extend the period of adequate analgesia during patient recovery. Anesthesiologists administered a general anesthetic to 21 patients for laparoscopic procedures with propofol, remifentanil, and fentanyl according to their standard practice. The theoretical improvement provided by the optimization was measured by comparing the time differences between the control predictions and the optimized prediction of the TROR time and TRON time. In the control group the TROR was 10.2+-5.8 minutes (mean +- SD) and TRON was 3.5+-5.0 minutes after emergence. In the optimized group the TROR was 7.5+-2.2 minutes or 26% faster (p < .001, paired t-test) and the TRON was 7.4 +-2.4 minutes or 88% longer (p < .00001, t-test). Optimized administrations of propofol, remifentanil, and fentanyl resulted in a theoretically shorter emergence time and a longer period of adequate postoperative analgesia. The optimization algorithm shows potential for real-time clinical guidance in drug management.

Intro-Differences in anesthetic technique when using propofol, remifentanil and fentanyl can result in different emergence and nociception outcomes. After surgery, a brief emergence period combined with an extended duration of analgesia is desired. We propose to use pharmacokinetic (PK)1-4 and pharmacodynamic (PD)5,6 models to find optimized ratios of propofol and remifentanil to shorten emergence time and extend the time until inadequate analgesia is experienced during patient recovery. Modeling has been used to find the optimum effect site concentrations (CeS) for rapid wake up7; however, an optimization technique which also accounts for analgesic effect is desirable. Method-Anesthesiologists gave general anesthesia to 21 patients for laproscopic procedures using propofol, remifentanil, and fentanyl using a standard of care anesthetic technique. Baseline model predictions for CeS were calculated for remifentanil, fentanyl, and propofol. PD response surface models were used to calculate the probabilities of unconsciousness and response to noxious stimulus (30 PSI tibial pressure algometry, a surrogate of postoperative pain) during and after the anesthetic. Post-hoc optimized PK and PD model predictions were made for both sedation and analgesia by varying the ratio of propofol and remifentanil CeS, constrained to the same or higher PD model predicted probabilities, and leaving fentanyl CeS unchanged from baseline. For each patient, optimized changes to the recorded propofol and remifentanil infusions were made every 5 minutes during the general anesthetic. The theoretical improvement provided by the optimization was measured by comparing the time differences between the baseline model predications and the optimized prediction of the emergence time and time to inadequate analgesia. Results-The baseline model predictions found an average emergence time of 8.2 +/- 5.6 minutes after end of surgery and a duration of analgesia of 9.9 +/- 13.6 minutes after patient emergence. The optimized remifentanil and propofol CeS theoretically reduced the emergence time to 3.9 +/- 1.6 (p

Modern anesthesia practice uses a combination of drugs to manage pain and sedation. There are often adverse or negative side effects that arise due to the same combination. A control system will be designed that optimizes the delivery of intravenous sedatives and analgesics to allow esophageal instrumentation while minimizing respiratory compromise and loss of responsiveness in spontaneously breathing patients. A cost functional will be developed to combine the multiple optimization goals into a single objective optimization problem. It is not possible to simultaneously optimize all criteria. A compromise solution must be selected. After selecting weighting coefficients, simulations were run and evaluated by the optimization function. The top five were plotted. The peaks for the five selected doses look reasonable. The maintenance infusions are probably too low for someone to tolerate a placed probe. Additional work is needed to investigate this. These results show promise for the development of a multiobjective optimization approach to patient-specific selection of dosing schemes.

An increasing number of procedures using propofol and remifentanil are performed by clinicians with no formal in anesthesiology. The rapid kinetics of these drugs can rapidly lead to adverse effects the clinician is not trained to manage. We therefore propose to investigate through simulations drug ratios and dosing regimens that allow esophageal instrumentation while minimizing the probability of adverse events. Our simulation criteria were to reach and minimize the time above the esophageal instrumentation C95 isobol, as well as minimize the time above the loss or responsiveness C99 and respiratory compromise C95 isobols. A cost functional would be developed to score each simulation. This score could be used to identify preferred solutions. Simulations were first sorted manually and then different cost functionals were developed to achieve similar results. A relatively simple equation selected 80% of the runs identified manually. Further work is needed in developing the cost functional to increase this percentage and to add meaning to the score.

The following article is taken as an excerpt from the proceedings of the annual Acquisition Research Program. This annual event showcases the research projects funded through the Acquisition Research Program at the Graduate School of Business and Public Policy at the Naval Postgraduate School. Featuring keynote speakers, plenary panels, multiple panel sessions, a student research poster show and social events, the Annual Acquisition Research Symposium offers a candid environment where high-ranking Department of Defense (DoD) officials, industry officials, accomplished faculty and military students are encouraged to collaborate on finding applicable solutions to the challenges facing acquisition policies and processes within the DoD today. By jointly and publicly questioning the norms of industry and academia, the resulting research benefits from myriad perspectives and collaborations which can identify better solutions and practices in acquisition, contract, financial, logistics and program management. For further information regarding the Acquisition Research Program, electronic copies of additional research, or to learn more about becoming a sponsor, please visit our program website at: www.acquisitionresearch.org. For further information on or to register for the next Acquisition Research Symposium during the third week of May, please visit our conference website at: www.researchsymposium.org. Second Annual Acquisition Research Symposium Approved for public release; distribution is unlimited.

Closed-loop control of mechanical ventilators could have a positive impact on pre-hospital patient care. Several methods to achieve this goal have been researched. A current method entitled "Adaptive Volume ventilation" is being studied in the Department of Anesthesiology at the University of Utah Health Science Center. Preliminary clinical trials using the work of breathing model have shown that optimal settings for respiratory rate are significantly higher and optimal settings for tidal volume are significantly lower than those set by clinicians. Measured respiratory rate and tidal volumes were 9.7+/-1.4 bpm and 8.9+/-1.9 ml/kg, respectively. Optimal ventilator settings were calculated to be 19.3+/-3.5 bpm for respiratory rate and 5.3+/-1.3 ml/kg for tidal volume. Using these settings would decrease the work of breathing from 6.9+/-1.4 Joules/min of work to 4.6+/-2.1 Joules/min of work. clinical trials to investigate the effects these settings have on patients' blood gas concentration are currently underway. This type of controller has several applications in both civilian and military health systems, including use in the space program.

OneArgo is a major expansion of the Argo program, which has provided two decades of transformative physical data for the upper 2 km of the global ocean. The present Argo array will be expanded in three ways: (1) Global Core: the existing upper ocean measurements will be extended to high latitudes and marginal seas and with enhanced coverage in the tropics and western boundaries of the major ocean basins; (2) Deep: deep ocean measurements will be obtained for the 50% of the global oceans that are below 2,000-m depth; and (3) Biogeochemical: dissolved oxygen, pH, nitrate, chlorophyll, optical backscatter, and irradiance data will be collected to investigate biogeochemical variability of the upper ocean and the processes by which these cycles respond to a changing climate. The technology and infrastructure necessary for this expansion is now being developed through large-scale regional pilots to further refine the floats and sensors and to demonstrate the utility of these measurements. Further innovation is expected to improve the performance of the floats and sensors and to develop the analyses necessary to provide research-quality data. A fully global OneArgo should be operational within 5‐10 years.

Recommendation for Oxygen Measurements from Argo Floats: Implementation of In-Air-Measurement Routine to Assure Highest Long-term Accuracy As Argo has entered its second decade and chemical/biological sensor technology is improving constantly, the marine biogeochemistry community is starting to embrace the successful Argo float program. An augmentation of the global float observatory, however, has to follow rather stringent constraints regarding sensor characteristics as well as data processing and quality control routines. Owing to the fairly advanced state of oxygen sensor technology and the high scientific value of oceanic oxygen measurements (Gruber et al., 2010), an expansion of the Argo core mission to routine oxygen measurements is perhaps the most mature and promising candidate (Freeland et al., 2010). In this context, SCOR Working Group 142 “Quality Control Procedures for Oxygen and Other Biogeochemical Sensors on Floats and Gliders” (www.scor-int.org/SCOR_WGs_WG142.htm) set out in 2014 to assess the current status of biogeochemical sensor technology with particular emphasis on float-readiness, develop pre- and post-deployment quality control metrics and procedures for oxygen sensors, and to disseminate procedures widely to ensure rapid adoption in the community.