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We propose and implement an interpretable machine learning classification model for Explainable AI (XAI) based on expressive Boolean formulas. Potential applications include credit scoring and diagnosis of medical conditions. The Boolean formula defines a rule with tunable complexity (or interpretability) according to which input data are classified. Such a formula can include any operator that can be applied to one or more Boolean variables, thus providing higher expressivity compared to more rigid rule- and tree-based approaches. The classifier is trained using native local optimization techniques, efficiently searching the space of feasible formulas. Shallow rules can be determined by fast Integer Linear Programming (ILP) or Quadratic Unconstrained Binary Optimization (QUBO) solvers, potentially powered by special-purpose hardware or quantum devices. We combine the expressivity and efficiency of the native local optimizer with the fast operation of these devices by executing non-local moves that optimize over the subtrees of the full Boolean formula. We provide extensive numerical benchmarking results featuring several baselines on well-known public datasets. Based on the results, we find that the native local rule classifier is generally competitive with the other classifiers. The addition of non-local moves achieves similar results with fewer iterations. Therefore, using specialized or quantum hardware could lead to a significant speedup through the rapid proposal of non-local moves.

Background There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry. Aims To explore variables associated with involuntary care in the largest database of involuntary admissions published. Method We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression. Results A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61–5.38), and psychosis (odds ratio 4.48, 95% CI 4.31–4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85–5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56–2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99–2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57–1.74); unmarried status (odds ratio 1.62, 95% CI 1.49–1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35–1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24–1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62–0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87–0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86–0.93). Conclusions This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.

Introduction This paper will describe the research protocol for the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Project, which will determine the feasibility and acceptability of a cultural mentoring programme designed for Aboriginal and Torres Strait Islander nurses and midwives across five diverse local health districts in New South Wales, Australia. Government and health agencies highlight the importance of culturally appropriate and safe environments for Aboriginal people. Specifically, New South Wales Health prioritises workforce strategies that support Aboriginal people to enter and stay in the health workforce. However, retaining Aboriginal nurses and midwives remains challenging. The DANMM Project aligns with these local and state-wide health plans and strategies, addressing critical issues of workforce cultural safety and retention.Methods and analysis A mixed-methods study design will be employed to assess feasibility, acceptability and preliminary efficacy of the DANMM Programme across five publicly funded local health districts in New South Wales, Australia. Adhering to cultural safety, a project cultural governance group will be formed. Quantitative outcome measures include the use of questionnaires (Nursing Workplace Satisfaction Questionnaire, Ganngaleh nga Yagaleh Cultural Safety assessment tool). Resource implications will be measured using the Organisational Commitment and Health Professional Program Readiness Assessment Compass. These will be triangulated with individual and group yarning circles to provide a holistic evaluation of the programme.Ethics and dissemination The study has ethics approval: Aboriginal Health and Medical Research Council (#2054/23); New South Wales Health Human Research Committees (Greater Western Human Research Committee #2022/ETH01971, Murrumbidgee—site-specific approval, Sydney Local Health District—site-specific approval, Western Sydney Local Health District—site-specific approval and Mid North Coast—site-specific approval); and Charles Sturt University Human Research Committee (#2054/23). Findings will be disseminated through peer-reviewed articles, conferences and through roundtable discussions with key stakeholders.

Abstract Background The distribution of the duration that clinical cases of COVID-19 occupy hospital beds (the ‘length of stay’) is a key factor in determining how incident caseloads translate into health system burden. Robust estimation of length of stay in real-time requires the use of survival methods that can account for right-censoring induced by yet unobserved events in patient progression (e.g. discharge, death). In this study, we estimate in real-time the length of stay distributions of hospitalised COVID-19 cases in New South Wales, Australia, comparing estimates between a period where Delta was the dominant variant and a subsequent period where Omicron was dominant. Methods Using data on the hospital stays of 19,574 individuals who tested positive to COVID-19 prior to admission, we performed a competing-risk survival analysis of COVID-19 clinical progression. Results During the mixed Omicron-Delta epidemic, we found that the mean length of stay for individuals who were discharged directly from ward without an ICU stay was, for age groups 0–39, 40–69 and 70 +, respectively, 2.16 (95% CI: 2.12–2.21), 3.93 (95% CI: 3.78–4.07) and 7.61 days (95% CI: 7.31–8.01), compared to 3.60 (95% CI: 3.48–3.81), 5.78 (95% CI: 5.59–5.99) and 12.31 days (95% CI: 11.75–12.95) across the preceding Delta epidemic (1 July 2021–15 December 2021). We also considered data on the stays of individuals within the Hunter New England Local Health District, where it was reported that Omicron was the only circulating variant, and found mean ward-to-discharge length of stays of 2.05 (95% CI: 1.80–2.30), 2.92 (95% CI: 2.50–3.67) and 6.02 days (95% CI: 4.91–7.01) for the same age groups. Conclusions Hospital length of stay was substantially reduced across all clinical pathways during a mixed Omicron-Delta epidemic compared to a prior Delta epidemic, contributing to a lessened health system burden despite a greatly increased infection burden. Our results demonstrate the utility of survival analysis in producing real-time estimates of hospital length of stay for assisting in situational assessment and planning of the COVID-19 response.

Rydberg atom arrays are among the leading contenders for the demonstration of quantum speedups. Motivated by recent experiments with up to 289 qubits [Ebadi et al., Science 376, 1209 (2022)0036-807510.1126/science.abo6587], we study the maximum-independent-set problem on unit-disk graphs with a broader range of classical solvers beyond the scope of the original paper. We carry out extensive numerical studies and assess problem hardness, using both exact and heuristic algorithms. We find that quasiplanar instances with Union-Jack-like connectivity can be solved to optimality for up to thousands of nodes within minutes, with both custom and generic commercial solvers on commodity hardware, without any instance-specific fine-tuning. We also perform a scaling analysis, showing that by relaxing the constraints on the classical simulated annealing algorithms considered in Ebadi et al., our implementation is competitive with the quantum algorithms. Conversely, instances with larger connectivity or less structure are shown to display a time-to-solution potentially orders of magnitudes larger. Based on these results, we propose protocols to systematically tune problem hardness, motivating experiments with Rydberg atom arrays on instances orders of magnitude harder (for established classical solvers) than previously studied.

We study quantum interior-point methods (QIPMs) for second-order cone programming (SOCP), guided by the example use case of portfolio optimization (PO). We provide a complete quantum circuit-level description of the algorithm from problem input to problem output, making several improvements to the implementation of the QIPM. We report the number of logical qubits and the quantity and/or depth of non-Clifford T gates needed to run the algorithm, including constant factors. The resource counts we find depend on instance-specific parameters, such as the condition number of certain linear systems within the problem. To determine the size of these parameters, we perform numerical simulations of small PO instances, which lead to concrete resource estimates for the PO use case. Our numerical results do not probe large enough instance sizes to make conclusive statements about the asymptotic scaling of the algorithm. However, already at small instance sizes, our analysis suggests that, due primarily to large constant prefactors, poorly conditioned linear systems, and a fundamental reliance on costly quantum state tomography, fundamental improvements to the QIPM are required for it to lead to practical quantum advantage.

We provide a modular circuit-level implementation and resource estimates for several methods of block-encoding a dense $N\times N$ matrix of classical data to precision $\epsilon$; the minimal-depth method achieves a $T$-depth of $\mathcal {O}(\log (N/\epsilon)),$ while the minimal-count method achieves a $T$-count of $\mathcal{O} (N \log(\log(N)/\epsilon))$. We examine resource tradeoffs between the different approaches, and we explore implementations of two separate models of quantum random access memory. As a part of this analysis, we provide a novel state preparation routine with $T$-depth $\mathcal {O}(\log (N/\epsilon))$, improving on previous constructions with scaling $\mathcal {O}(\log ^{2} (N/\epsilon))$. Our results go beyond simple query complexity and provide a clear picture into the resource costs when large amounts of classical data are assumed to be accessible to quantum algorithms.

BackgroundAn association exists between psychosis and criminal offending, which evidence suggests can be reduced by effective mental health care for this vulnerable population. However mental health services often lose contact with people after diagnosis. The association between the first episode of psychosis and criminal offending highlights the need for effective mental health care for this vulnerable population.AimsTo investigate the association between the first diagnosis of psychosis (FDP) in prison or hospital and subsequent mental health service contact following release from prison or discharge from hospital.Materials and methodsIndividuals with a FDP either in prison (n = 492) or hospital setting (n = 24,910) between July 2006 and December 2011 in NSW (Australia), were followed post-release or discharge until their first mental health service contact in the community, the occurrence of an offence, death, or completion of the study period at the end of December 2012. Cox regression models were used to examine the predictors for the mental health service contacts following release or discharge.ResultsOver 70% of those with a FDP in prison or hospital had a psychosis-related or any community-based mental health service contact following release or discharge between July 2006 and December 2012. Those with a FDP in prison were more likely to have no contact with mental health services than those in hospital with no prior offence record (hazard ratio, HR = 3.14, 95% CI: 2.66–3.72 and adjusted hazard ratio, aHR = 3.05, 95% CI: 2.56–3.63) within a median follow-up time of 25 days for the prison group and 26 days for hospital group. Males, individuals of Aboriginal heritage and individuals diagnosed with substance-related psychoses compared to those with schizophrenia and related psychoses were less likely to have a mental health service contact following release or discharge in both the univariable and multivariable analysis.ConclusionThis study suggests that prior offending or a previous prison episode represents a barrier to mental health service contact in the community for those with a FDP. Effective rehabilitation planning while exiting prison and discharge planning from hospital are essential to the successful reintegration of these individuals with a FDP.

Summary: Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.

COVID-19 has increased the need for mental health care but disrupted its delivery. We examined impacts of the first year of the COVID-19 pandemic on consumer experience of NSW hospital and community mental health services, compared to their pre-COVID baseline. We also examined whether increased telehealth use was associated with changes in the quantity or experience of community mental health care. Data were 73,488 Your Experience of Service (YES) surveys from state mental health services in New South Wales (NSW), Australia, grouped into three periods: pre-COVID (January 2018 to March 2020), early-COVID (April to June 2020) and stable-COVID (July to December 2020). Experience scores were compared using mixed effects ordinal logistic regression. Supplementary questions on telehealth and community care (n=621) were examined by multinomial logistic regression. Experience scores improved significantly during the early-COVID period for community consumers and during the stable-COVID period for hospital consumers. Of community clients, 78% received some or all care by telehealth. Positive experience was more likely when most or all care was by telehealth and the amount of care increased. A reduced quantity of care, regardless of care modality, was the strongest predictor of worse experience. Increased service provision and telehealth support were well received over the first year of the pandemic. When contact hours are reduced due to COVID-19 risk mitigation strategies, it is vital to provide alternative methods of care such as telephone, or internet support, rather than just reducing face to face contact hours. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

With the long-term goal of studying models of quantum gravity in the lab, we propose holographic teleportation protocols that can be readily executed in table-top experiments. These protocols exhibit similar behavior to that seen in the recent traversable-wormhole constructions of Gao et al. [J. High Energy Phys., 2017, 151 (2017)] and Maldacena et al. [Fortschr. Phys., 65, 1700034 (2017)]: information that is scrambled into one half of an entangled system will, following a weak coupling between the two halves, unscramble into the other half. We introduce the concept of teleportation by size to capture how the physics of operator-size growth naturally leads to information transmission. The transmission of a signal through a semiclassical holographic wormhole corresponds to a rather special property of the operator-size distribution that we call size winding. For more general systems (which may not have a clean emergent geometry), we argue that imperfect size winding is a generalization of the traversable-wormhole phenomenon. In addition, a form of signaling continues to function at high temperature and at large times for generic chaotic systems, even though it does not correspond to a signal going through a geometrical wormhole but, rather, to an interference effect involving macroscopically different emergent geometries. Finally, we outline implementations that are feasible with current technology in two experimental platforms: Rydberg-atom arrays and trapped ions.

In Brown et al. [PRX Quantum, 4, 010321 (2023)], we discuss how holographic quantum gravity may be simulated using quantum devices and we give a specific proposal—teleportation by size and the phenomenon of size winding. Here, we elaborate on what it means to do quantum gravity in the lab and how size winding connects to bulk gravitational physics and traversable wormholes. Perfect size winding is a remarkable fine-grained property of the size wave function of an operator; we show from a bulk calculation that this property must hold for quantum systems with a nearly AdS_{2} bulk. We then examine in detail teleportation by size in three systems—the Sachdev-Ye-Kitaev model, random matrices, and spin chains—and discuss prospects for realizing these phenomena in near-term quantum devices.

Background: Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks., Methods: We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement., Results: A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research., Conclusions: We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care., Competing Interests: Competing interests: EA: grants from Swiss Academy for Anesthesia Research, Bbraun, Swiss National Science Foundation. Honoraria from Bbraun and Sintetica. JG: consulting fees from Pacira Biosciences and Pajunk Medical. AP: honoraria from FuijiFilm Sonosite. MW: advisory Board for Sintetica, Honoraria from Wisonic and Medovate. SA: Advisory Panel for DATAR innovations. JA: moderator of the Working Group Regional Anaesthesia Switzerland, Honoraria from Medtronic and Sintetica. AMRA: honoraria form AllerganSébastien Bloc—Consulting fees from BBraun—GE Medical Systems—Pajunk—Pfizer SAS. JB: Consulting fees from Intelligent Ultrasound. BC: jonoraria from Bbraun and Rivanna, Consulting from Stryker and Flat Medical, Research funding from Pacira, Share Options from Flat Medical. AC: speaking honoraria from GE Healthcare, royalties from textbook Oxford University Press. SC: consulting fees from MSD, Bbraun Medical, Wisonic, research grants from BARA (Belgian association of Regional anesthesia), ESRA and BeSARP (Belgian anesthesia society) HE-Consulting/Advisory Board Neuronoff, SPR, GateScience, NeuronoffBenjamin Fox—Speaking fees from Medovate and Sintetica. SG: consulting and speaking fees from MSD Switzerland. PH: royalties from Bestek Products. NH: Honoraria from Butterfly Network. RMGH- Honoraria from GE Healthcare. MH: consulting fees from Pacira Biosciences, Honoraria from Parcira Biosciences and Pajunk Medical. BMI: research funding to institution from SPR Therapeutics, Infutronix, Epimed International. AM: Consultant fees from Intelligent Ultrasound. CM: consultant fees from Masimo Corporation. SGM: Owner SGM Consulting, Partner Parvizi Surgical Innovations, Patent for Multicatheter infusion system. AN: Research support from SPR Therapeutics. SLO: Royalties from book Wolters-Kluwer. APawa: Honoraria from GE Healthcare, Consulting fees from Pacira Biosciences. PP: equipment support from Sonosiite Fujifilm Canada. MPS: Medovate speaking but no honoraria paid. SKS- Cofounder of Gate Science (developing a catheter for performing nerve blocks) JS: consulting fees from Sintetica. RT: Consulting fees from Clarius Mobile Health. VU: Associate Editor of the Canadian Journal of Anesthesia and Regional Anesthesia & Pain Medicine journals. TV: honoraria from CSL Behring, Pajunk., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Hypotension following induction of general anaesthesia has been shown to result in increased complications and mortality postoperatively. Patients admitted to the hospital undergoing urgent surgery are often fasted from fluids for significant periods compared to elective patients subject to Enhanced Recovery After Surgery protocols despite guidelines stating that a two-hour fast is sufficient. The aim of this prospective, observational study was to compare fasting times and intravascular volume status between elective surgery patients subject to enhanced recovery protocols and inpatient, urgent surgery patients and to assess differences in the incidence of post-induction hypotension. Fasting data was obtained by questionnaire in the preoperative area in addition to inferior vena cava collapsibility index, a non-invasive measure of intravascular volume. Blood pressure readings and drug administration for the ten minutes following induction were obtained from patients' charts. Inpatients undergoing urgent surgery were fasted significantly longer than enhanced recovery patients and had lower intravascular volume. However, no difference was found in the incidence of post-induction hypotension.

Using a modified Delphi technique, an international group of regional anaesthetists generated a list of top research priorities in regional anaesthesia. The list of unanswered research questions was created from a questionnaire completed by >500 anaesthetists and distilled into 11 priorities grouped into four themes: clinical practice and efficacy, pain management, technology and equipment, and training and assessment., (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Objectives: Total knee arthroplasty (TKA) is an effective surgery for end-stage knee osteoarthritis, but chronic postoperative pain and reduced function affect up to 20% of patients who undergo such surgery. There are limited treatment options, but percutaneous peripheral nerve stimulation (PNS) is a promising nonopioid treatment option for chronic, persistent postoperative pain. The objective of the present study was to evaluate the effect of a 60-day percutaneous PNS treatment in a multicenter, randomized, double-blind, placebo-controlled trial for treating persistent postoperative pain after TKA., Materials and Methods: Patients with postoperative pain after knee replacement were screened for this postmarket, institutional review board-approved, prospectively registered (NCT04341948) trial. Subjects were randomized to receive either active PNS or placebo (sham) stimulation. Subjects and a designated evaluator were blinded to group assignments. Subjects in both groups underwent ultrasound-guided placement of percutaneous fine-wire coiled leads targeting the femoral and sciatic nerves on the leg with postoperative pain. Leads were indwelling for eight weeks, and the primary efficacy outcome compared the proportion of subjects in each group reporting ≥50% reduction in average pain relative to baseline during weeks five to eight. Functional outcomes (6-minute walk test; 6MWT and Western Ontario and McMaster Universities Osteoarthritis Index) and quality of life (Patient Global Impression of Change) also were evaluated at end of treatment (EOT)., Results: A greater proportion of subjects in the PNS groups (60%; 12/20) than in the placebo (sham) group (24%; 5/21) responded with ≥50% pain relief relative to baseline (p = 0.028) during the primary endpoint (weeks 5-8). Subjects in the PNS group also walked a significantly greater distance at EOT than did those in the placebo (sham) group (6MWT; +47% vs -9% change from baseline; p = 0.048, n = 18 vs n = 20 completed the test, respectively). Prospective follow-up to 12 months is ongoing., Conclusions: This study provides evidence that percutaneous PNS decreases persistent pain, which leads to improved functional outcomes after TKA at EOT., Competing Interests: Conflict of Interest Johnathan H. Goree serves as a consultant to Saluda Medical, Stratus Medical, and Abbott. David M. Dickerson serves as a consultant to Abbott, Vertos, Biotronik, and SPR Therapeutics, and has received honoraria for lectures from Nalu. Yashar Eshraghi serves as a consultant for Saluda Medical and SPR Therapeutics. Ali K. Valimahomed serves as a consultant for SPR Therapeutics, Nalu, Vertos, and Biotronik, and has received honoraria for lectures from the World Academy of Pain Medicine. Jarna R. Shah serves as a consultant for and has received honoraria from SPR Therapeutics. Maged N. Guirguis serves as a consultant for SPR Therapeutics, Nevro, Saluda, Boston Scientific, Abbott, Averitas Pharma, PainTeq, and Avanos. Maxim S. Eckmann serves as a consultant for Avanos and has participated on a data safety monitoring or advisory board for Abbott. Amorn Wongsarnpigoon is an inventor on >40 patents planned, issued, or pending related to peripheral nerve stimulation (PNS) and has stock/stock options with SPR Therapeutics. Joseph W. Boggs is an inventor on >100 patents planned, issued, or pending related to PNS and has stock/stock options with SPR Therapeutics. John E. Gilbert, Amorn Wongsarnpigoon, and Joseph W. Boggs are all employees of SPR Therapeutics as well in case that needs to be included. The remaining authors reported no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Three-dimensional printing provides more versatility in the fabrication of scaffold materials for hard and soft tissue replacement, but a critical component is the ink. The ink solution should be biocompatible, stable, and able to maintain scaffold shape, size, and function once printed. This paper describes the development of a collagen ink that remains in a liquid pre-fibrillized state prior to printing. The liquid stability occurs due to the incorporation of ethylenediaminetetraacetic acid (EDTA) during dialysis of the collagen. Collagen inks were 3D-printed using two different printers. The resulting scaffolds were further processed using two different chemical crosslinkers, 1-Ethyl-3-[3-dimethylaminopropyl]carbodiimide hydrochloride)/N-hydroxysuccinimide (EDC/NHS) and genipin; gold nanoparticles were conjugated to the scaffolds. The 3D-printed scaffolds were characterized to determine their extrudability, stability, amount of AuNP conjugated, and overall biocompatibility via cell culture studies using fibroblast cells and stroma cells. The results demonstrated that the liquid collagen ink was amendable to 3D printing and was able to maintain its 3D shape. The scaffolds could be conjugated with gold nanoparticles and demonstrated enhanced biocompatibility. It was concluded that the liquid collagen ink is a good candidate material for the 3D printing of tissue scaffolds.

Administration of succinylcholine to patients with a variant in the butyrylcholinesterase (BChE) gene increases the risk of anesthesia emergence prior to recovery from neuromuscular blockade (NMB). Application of quantitative neuromuscular monitoring (NMM) can identify residual NMB. We present two patients with abnormal BChE gene variants. In the first case, quantitative monitoring was applied too late to prevent awareness, but allowed diagnosis and prevented admission to the intensive care unit. In the second case, monitoring was applied prior to NMB, which enabled early diagnosis and prevented premature awakening from anesthesia. These cases illustrate the importance of quantitative NMM, even in short cases and with short-acting depolarizing agents such as succinylcholine. The clinical implications of this report include a more consistent use of NMM to identify and manage patients with undiagnosed abnormal BChE and to prevent premature anesthesia emergence., Competing Interests: Name: Erica M. Harris, MSN, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Emily M. Funk, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. She is the corresponding author for this article. Disclosures: None. Name: Daniel Plezia, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Judson Elliott, MSN, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Ryland Elliott, MSN, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Jessica Szydlowski Pitman, DNP, CRNA, CHSE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Stuart A. Grant, MB, ChB Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Objectives: Perioperative fluid administration impacts the rate of complications following surgery. VExUS grading system is a standardized point of care ultrasound (POCUS)-based, comprehensive method to assess volume status. VExUS could serve as a tool to guide fluid management, if validated perioperatively. The primary aim was to assess the success rate of obtaining required windows for VExUS grading , as well as the feasibility within a perioperative setting among noncardiac surgery. Further, this study describes the incidence of perioperative venous congestion and associations with 30-day postoperative complications. Methods: This observational study was conducted in non-critically ill adults undergoing noncardiac surgery. Patients were scanned preoperatively, in the post anesthesia care unit (PACU), and 24 hours postoperatively for venous congestion. Researchers retrospectively captured 30-day complications for multivariate analyses. Results: The cohort included 69 participants. Ninety-one percent of scans over all timepoints were successfully completed. Pre-operatively, 57 (83%) scans were Grade 0, and 11 (16%) were Grade 1. Venous congestion was observed in 29 (44%) patients in the PACU (n=66). 22 (33%) patients were Grade 1, while 7 (11%) were Grade 2. At 24 hours (n=63), 31 patients (49%) had venous congestion: 20 (32%) Grade 1 and 11 (17%) Grade 2. Of the pre-operative Grade 0, 28 (50%) had at least one postoperative scan with venous congestion. No patients were Grade 3 at any timepoint. The 30-day complication rate was 32% (n=22). Eleven (16%) patients developed acute kidney injury (AKI). There was no statistically significant association between VExUS grading and all-cause complications or AKI. Conclusion: This study demonstrates that perioperative VExUS scoring is a feasible tool among a variety of noncardiac surgeries. We highlight that venous congestion is common and increases postoperatively within non-ICU populations. Larger studies are needed to assess the relationship between VExUS grading and postoperative complications., Competing Interests: The authors report no conflicts of interest related to this work., (Copyright (c) 2023 Justin Magin, Jacob Wrobel, Stuart Grant, Xinming An, Jacob Acton, Alexander Doyal, Shawn Jia, James Krakowski, Jay Schoenherr, Ricardo Serrano, Duncan McLean, David Flynn.)

Lower back pain is one of the leading causes of disability, affecting 11.9% of the population worldwide and studies have shown that intervertebral disc degeneration is a common cause for chronic lower back pain. We have explored the combination of three components, viscoelastic collagen, genipin, and gold nanoparticles to determine its potential to promote regeneration of the intervertebral disc, specifically for nucleus pulposus regeneration. The goal of this study was to develop, fabricate and characterize different formulations of viscoelastic collagen conjugated with gold nanoparticles and genipin to assess the feasibility as a tissue template. Results demonstrated the successful attachment of gold nanoparticles to the viscoelastic collagen utilizing the genipin crosslinker. For each of the viscoelastic collagen compositions examined, cell biocompatibility was achieved. The results also demonstrated an increase in stiffness of the material with different sizes and concentrations of AuNPs. Results from the TEM and STEM also demonstrated that the viscoelastic collagen that was developed did not display the characteristic D banding pattern of polymerized collagen. The findings from this study could lead to the development of a more efficient and cost-effective treatment for patients with chronic back pain caused by IVD degeneration.

Introduction: This cadaveric dye study assesses the effect of volume and number of injections on the spread of solution after ultrasound-guided rectus sheath injections. In addition, this study evaluates the impact of the arcuate line on solution spread., Materials and Methods: Ultrasound-guided rectus sheath injections were performed on seven cadavers on both sides of the abdomen, for a total of 14 injections. Three cadavers received one injection of 30 mL of a solution consisting of bupivacaine and methylene blue at the level of the umbilicus. Four cadavers received two injections of 15 mL of the same solution, one midway between the xiphoid process and umbilicus and one midway between the umbilicus and pubis., Results: Six cadavers were successfully dissected and analyzed for a total of 12 injections, while one cadaver was excluded due to poor tissue quality that was inadequate for dissection and analysis. There was a significant spread of solution with all injections caudally to the pubis without limitation by the arcuate line. However, a single 30 mL injection showed inconsistent spread to the subcostal margin in four of six injections, including in a cadaver with an ostomy. A double injection of 15 mL showed consistent spread from xiphoid to pubis in five of six injections, except in a cadaver with a hernia., Conclusions: Injections deep to the rectus abdominis muscle, using the same technique as an ultrasound-guided rectus sheath block, achieve spread along a large and continuous fascial plane without limitation by the arcuate line and may provide coverage of the entire anterior abdomen. A large volume is necessary for complete coverage and spread is improved with multiple injections. We suggest that two injections with a total volume of at least 30 mL per side may be needed to achieve adequate coverage in the absence of preexisting abdominal abnormalities., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2023, Rojas et al.)

These practice guidelines provide evidence-based recommendations on the management of neuromuscular monitoring and antagonism of neuromuscular blocking agents during and after general anesthesia. The guidance focuses primarily on the type and site of monitoring and the process of antagonizing neuromuscular blockade to reduce residual neuromuscular blockade., (Copyright © 2022, the American Society of Anesthesiologists. All Rights Reserved.)

Competing Interests: Competing interests: None declared.

Post-traumatic osteoarthritis (PTOA) is a progressive articular degenerative disease that degrades articular cartilage and stimulates apoptosis in chondrocyte cells. An injectable decellularized, extracellular matrix (ECM) scaffold, that might be able to combat the effects of PTOA, was developed where the ECM was conjugated with 20 nm gold nanoparticles (AuNP) and supplemented with curcumin and hyaluronic acid (HA). Porcine diaphragm ECM was decellularized and homogenized; AuNPs were conjugated using chemical crosslinking followed by mixing with curcumin and/or HA. Injection force testing and scanning electron microscopy with energy-dispersive X-ray spectroscopy were utilized to characterize the ECM scaffolds. In vitro testing with L929 murine fibroblasts, equine synovial fibroblasts, and Human Chondrocytes were used to determine biocompatibility, reactive oxygen species (ROS) reduction, and chondroprotective ability. The results demonstrated that conjugation of 20 nm AuNPs to the ECM was successful without significantly altering the physical properties as noted in the low injection force. In vitro work provided evidence of biocompatibility with a propensity to reduce intracellular ROS and an ability to mitigate apoptosis of chondrocyte cells stimulated with IL-1β, a known apoptosis inducing cytokine. It was concluded that an injectable AuNP-ECM may have the ability to mitigate inflammation and apoptosis.

Surgical repair of the anterior cruciate ligament (ACL) can involve autograft or allograft materials. Allografts are typically chosen to avoid donor site morbidity associated with autografts harvest, but they can also result in a prolonged inflammatory period and delayed graft remodeling when compared to autografts. The aim of this study was to investigate the use of gold nanoparticles (AuNPs) conjugated to allografts to determine if AuNPs can reduce inflammation and enhance graft remodeling in an ovine model. Six sheep had their ACL surgically removed and replaced with a decellularized human gracilis tendon. Three of the sheep received grafts conjugated with 20 nm gold nanoparticles, while three of the sheep received grafts without the gold nanoparticles. The sheep were sacrificed 8 weeks after ACL reconstruction. Immediately following sacrifice, joint fluid was collected for cytology. Semi-quantitative histological scoring of the bone tunnel portion and the intra-articular portion of the grafts were performed independently along with descriptive analysis of histologic changes and quantitative analysis of revascularization. The results demonstrated that AuNP experimental grafts had an overall better histological scores than the non-AuNPs graft. The AuNPs grafts exhibited decreased inflammation in the bone tunnel portion of the graft, the intra-articular portion of the graft, and in the synovial fluid cell count. Overall, the results demonstrated that the grafts conjugated with nanoparticles have the potential to be influence inflammation and overall remodeling response.